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Sample records for acute cervical spine

  1. MR imaging of acute cervical spine injuries

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    Kim, Kyu Hwa; Lee, Jung Hyung; Joo, Yang Goo [School of Medicine, Keimyung University, Daegu (Korea, Republic of)

    1995-01-15

    To describe magnetic resonance (MR) findings of the patients with acute cervical spinal injury and to assess the usefulness of the MR imagings. We retrospectively reviewed the MR images of 32 patients with acute cervical spinal injury. MR images were obtained with a 2.0 T superconductive MR imaging units (Spectro-20000, Gold-Star, Seoul), using spin-echo and gradient-echo technique. Most of patients were in their 3rd-4th decades and motor vehicle accident was the most frequent cause of acute cervical trauma. We assessed the MR findings with respect to the spinal cord, ligaments, paravertebral soft tissues, intervertebral disk, and bony spine. Spinal cord injury was the most common (65%), where cord swelling, edema, and/or hematoma were demonstrated most frequently at C5-6 level. Traumatic intervertebral disk herniations were the second most common (62.5%) and frequently occurred at the lower cervical levels, mostly at C5-6. Paravertebral soft tissue injury, vertebral body fracture, bone marrow edema and displacement were also well shown on MR images. MR imaging appears to be essential for the evaluation of traumatic disk herniations, spinal cord abnormalities, and injury of paravertebral soft tissue in the acute injury of the cervical spine.

  2. MR imaging of acute cervical spine injuries

    International Nuclear Information System (INIS)

    Kim, Kyu Hwa; Lee, Jung Hyung; Joo, Yang Goo

    1995-01-01

    To describe magnetic resonance (MR) findings of the patients with acute cervical spinal injury and to assess the usefulness of the MR imagings. We retrospectively reviewed the MR images of 32 patients with acute cervical spinal injury. MR images were obtained with a 2.0 T superconductive MR imaging units (Spectro-20000, Gold-Star, Seoul), using spin-echo and gradient-echo technique. Most of patients were in their 3rd-4th decades and motor vehicle accident was the most frequent cause of acute cervical trauma. We assessed the MR findings with respect to the spinal cord, ligaments, paravertebral soft tissues, intervertebral disk, and bony spine. Spinal cord injury was the most common (65%), where cord swelling, edema, and/or hematoma were demonstrated most frequently at C5-6 level. Traumatic intervertebral disk herniations were the second most common (62.5%) and frequently occurred at the lower cervical levels, mostly at C5-6. Paravertebral soft tissue injury, vertebral body fracture, bone marrow edema and displacement were also well shown on MR images. MR imaging appears to be essential for the evaluation of traumatic disk herniations, spinal cord abnormalities, and injury of paravertebral soft tissue in the acute injury of the cervical spine

  3. Imaging of acute cervical spine injuries: review and outlook

    International Nuclear Information System (INIS)

    Tins, B.J.; Cassar-Pullicino, V.N.

    2004-01-01

    Advances in imaging technology have been successfully applied in the emergency trauma setting with great benefit providing early, accurate and efficient diagnoses. Gaps in the knowledge of imaging acute spinal injury remain, despite a vast wealth of useful research and publications on the role of CT and MRI. This article reviews in a balanced manner the main questions that still face the attending radiologist by embracing the current and evolving concepts to help define and provide answers to the following; Imaging techniques - strengths and weaknesses; what are the implications of a missed cervical spine injury?; who should be imaged?; how should they be imaged?; spinal immobilisation - help or hazard?; residual open questions; what does all this mean?; and what are the implications for the radiologist? Although there are many helpful guidelines, the residual gaps in the knowledge base result in incomplete answers to the questions posed. The identification of these gaps in knowledge however should act as the initiating stimulus for further research. All too often there is a danger that the performance and productivity of the imaging modalities is the main research focus and not enough attention is given to the two fundamental prerequisites to the assessment of any imaging technology - the clinical selection criteria for imaging and the level of expertise of the appropriate clinician interpreting the images

  4. Imaging of acute cervical spine injuries: review and outlook

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    Tins, B.J. [Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry (United Kingdom); Cassar-Pullicino, V.N. [Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry (United Kingdom)]. E-mail: Victor.Pullicino@rjah.nhs.uk

    2004-10-01

    Advances in imaging technology have been successfully applied in the emergency trauma setting with great benefit providing early, accurate and efficient diagnoses. Gaps in the knowledge of imaging acute spinal injury remain, despite a vast wealth of useful research and publications on the role of CT and MRI. This article reviews in a balanced manner the main questions that still face the attending radiologist by embracing the current and evolving concepts to help define and provide answers to the following; Imaging techniques - strengths and weaknesses; what are the implications of a missed cervical spine injury?; who should be imaged?; how should they be imaged?; spinal immobilisation - help or hazard?; residual open questions; what does all this mean?; and what are the implications for the radiologist? Although there are many helpful guidelines, the residual gaps in the knowledge base result in incomplete answers to the questions posed. The identification of these gaps in knowledge however should act as the initiating stimulus for further research. All too often there is a danger that the performance and productivity of the imaging modalities is the main research focus and not enough attention is given to the two fundamental prerequisites to the assessment of any imaging technology - the clinical selection criteria for imaging and the level of expertise of the appropriate clinician interpreting the images.

  5. Misdiagnosing absent pedicle of cervical spine in the acute trauma setting

    Directory of Open Access Journals (Sweden)

    Fahad H. Abduljabbar

    2015-09-01

    Full Text Available 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.

  6. Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center.

    Science.gov (United States)

    Katzberg, R W; Benedetti, P F; Drake, C M; Ivanovic, M; Levine, R A; Beatty, C S; Nemzek, W R; McFall, R A; Ontell, F K; Bishop, D M; Poirier, V C; Chong, B W

    1999-10-01

    To determine the weighted average sensitivity of magnetic resonance (MR) imaging in the prospective detection of acute neck injury and to compare these findings with those of a comprehensive conventional radiographic assessment. Conventional radiography and MR imaging were performed in 199 patients presenting to a level 1 trauma center with suspected cervical spine injury. Weighted sensitivities and specificities were calculated, and a weighted average across eight vertebral levels from C1 to T1 was formed. Fourteen parameters indicative of acute injury were tabulated. Fifty-eight patients had 172 acute cervical injuries. MR imaging depicted 136 (79%) acute abnormalities and conventional radiography depicted 39 (23%). For assessment of acute fractures, MR images (weighted average sensitivity, 43%; CI: 21%, 66%) were comparable to conventional radiographs (weighted average sensitivity, 48%; CI: 30%, 65%). MR imaging was superior to conventional radiography in the evaluation of pre- or paravertebral hemorrhage or edema, anterior or posterior longitudinal ligament injury, traumatic disk herniation, cord edema, and cord compression. Cord injuries were associated with cervical spine spondylosis (P < .05), acute fracture (P < .001), and canal stenosis (P < .001). MR imaging is more accurate than radiography in the detection of a wide spectrum of neck injuries, and further study is warranted of its potential effect on medical decision making, clinical outcome, and cost-effectiveness.

  7. Magnetic resonance imaging of acute trauma of the cervical spine: spectrum of findings

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    Forster, B.B.; Koopmans, R.A. [British Columbia Univ., Vancouver, BC (Canada). Faculty of Medicine

    1995-06-01

    The magnetic resonance imaging (MRI) spectrum of acute injury to the cervical spine was illustrated in this pictorial essay. The appearance of the traumatized cord was discussed, including intramedullary hemorrhage, and the causes of spinal cord compression, such as disk herniation, epidural hematoma, fracture, dislocation and underlying spinal stenosis. The ability of MRI to directly reveal the severity of cord injury and simultaneously indicate the cause of cord compression proved particularly useful in the management of incomplete injury, for which surgical intervention may prevent further deterioration. The protocol for MRI of cervical spinal trauma included sagittal T1-weighted and T2-weighted conventional spin-echo sequences. In addition, transverse T2-weighted gradient-echo images were obtained. MRI`s ability to directly reveal the extent of cord injury was said to be a powerful tool in the management of incomplete injuries where further deterioration could be prevented by timely surgical intervention. 7 refs., 12 figs.

  8. Efficacies of various diagnostic modalities in acute trauma of the cervical spine

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    Tani, Ichiro (St. Marianna Univ., Kawasaki (Japan). School of Medicine)

    1993-12-01

    The author reviewed 71 consecutive cases of acute trauma of the cervical spine to define efficacies of various modalities such as plain film, CT and MRI. Pathologies on CT and/or MRI additionally found to plain films were analyzed and correlated to three groups divided according to neurological deficit. The following conclusions were obtained. The usefulness of plain films as the first modality of choice was confirmed. Both CT and MRI are necessary in addition to abnormal plain films in this group if patients have neurological deficit. MRI may be a modality of choice following plain films if they are negative. In the group of brachial plexus palsy MRI should be performed before CT to demonstrate traumatic meningocele. CT myelography is also useful although it is invasive. It is warranted to say that in the asymptomatic group CT and MRI are not indicated, because additionally found abnormalities are clinically insignificant. (author).

  9. Facet joint injuries in acute cervical spine trauma : evaluation with CT and MRI

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    Ha, Jeon Ju; Kim, Dong Hyun; Lee, Jeong Hwa; Lee, Keon; Kwon, Hyeok Po; Kwon, Jung Hyeok; Yun, Seong Mun [Dongkang General Hospital, Seoul (Korea, Republic of)

    1999-05-01

    To evaluate injury patterns of facet joints and associated soft tissue injuries in patients with acute traumatic cervical facet joint injuries. From among patients with cervical spine trauma, 27 with facet joint injuries, as seen on CT and MRI, were chosen for this study. CT scans were analyzed with regard to the location of facet joint injury, the presence or absence of facet dislocation or fracture, and other associated fractures. MR images were analyzed with regard to ligament injury, intervertebral disc injury, intervertebral disc herniation, and spinal cord injury. The most common location of facet joint injury was C6-7 level(n=10), followed by C5-6(n=8). Among these 27 patients with facet joint injuries, 12(44%) had bilateral injuries and 15(56%) unilateral injuries. Facet fractures were present in 17 cases(63%) and the fracture of inferior facet was more frequent than superior. Patterns of fracture were vertical, transverse, or comminuted, but vertical fracture was the most common. Various degrees of dislocation were observed in patients with facet fractures. Fractures other than facet included pillar(n=11), lamina(n=6), transverse process(n=14), body(n=13), and spinous process(n=3). On MR images, anterior longitudinal ligament injury was found in 8 patients(30%), posterior longitudinal ligament injury in 4(15%), and interspinous ligament injury in 20(74%). Twelve patients(44%) had spinal cord injuries including edema(n=8) and hemorrhage(n=4). Among patients with disc abnormalities, 11(41%) had intervertebral disc injuries, and traumatic disc herniations were found in nine. Traumatic cervical facet joint injuries were manifested as various patterns and frequently associated with other fractures or soft tissue injuries. Analysis of CT and MR findings of these injury patterns helped formulate a therapeutic plan and determine of prognosis.

  10. [Cervical spine trauma].

    Science.gov (United States)

    Yilmaz, U; Hellen, P

    2016-08-01

    In the emergency department 65 % of spinal injuries and 2-5 % of blunt force injuries involve the cervical spine. Of these injuries approximately 50 % involve C5 and/or C6 and 30 % involve C2. Older patients tend to have higher spinal injuries and younger patients tend to have lower injuries. The anatomical and development-related characteristics of the pediatric spine as well as degenerative and comorbid pathological changes of the spine in the elderly can make the radiological evaluation of spinal injuries difficult with respect to possible trauma sequelae in young and old patients. Two different North American studies have investigated clinical criteria to rule out cervical spine injuries with sufficient certainty and without using imaging. Imaging of cervical trauma should be performed when injuries cannot be clinically excluded according to evidence-based criteria. Degenerative changes and anatomical differences have to be taken into account in the evaluation of imaging of elderly and pediatric patients.

  11. The Torg-Pavlov ratio for the prediction of acute spinal cord injury after a minor trauma to the cervical spine.

    Science.gov (United States)

    Aebli, Nikolaus; Wicki, Anina G; Rüegg, Tabea B; Petrou, Nassos; Eisenlohr, Heidrun; Krebs, Jörg

    2013-06-01

    Acute cervical spinal cord injury (SCI) has been observed in some patients after a minor trauma to the cervical spine. The discrepancy between the severity of the trauma and the clinical symptoms has been attributed to spinal canal stenosis. However, to date, there is no universally established radiological parameter for identifying critical spinal stenosis in these patients. The spinal canal-to-vertebral body ratio (Torg-Pavlov ratio) has been proposed for assessing developmental spinal canal stenosis. The relevance of the Torg-Pavlov ratio for predicting the occurrence and severity of acute cervical SCI after a minor trauma to the cervical spine has not yet been established. To investigate the Torg-Pavlov ratio values of the cervical spine in patients suffering from acute cervical SCI after a minor trauma to the cervical spine and the use of the Torg-Pavlov ratio for identifying patients at risk of cervical SCI and predicting the severity and course of symptoms. Retrospective radiological study of consecutive patients. Forty-five patients suffering from acute cervical SCI and 68 patients showing no neurologic symptoms after a minor trauma to the cervical spine. Midvertebral sagittal cervical spinal canal diameter and the sagittal vertebral body diameter. Calculation of the Torg-Pavlov ratio values. Conventional lateral radiographs of the cervical spine (C3-C7) were analyzed to determine the Torg-Pavlov ratio values. Receiver operating characteristic curves were calculated for evaluating the classification accuracy of the Torg-Pavlov ratio for predicting SCI. The Torg-Pavlov ratio values in the SCI group were significantly (pPavlov ratio cutoff value of 0.7 yielded the greatest positive likelihood ratio for predicting the occurrence of SCI. However, there were no significant differences in the Torg-Pavlov ratio values between the different American Spinal Injury Association Impairment Score groups and between patients with complete, partial, and no recovery of

  12. Incidence and Outcomes of Acute Implant Extrusion Following Anterior Cervical Spine Surgery.

    Science.gov (United States)

    Smith, Gabriel A; Pace, Jonathan; Corriveau, Mark; Lee, Sungho; Mroz, Thomas E; Nassr, Ahmad; Fehlings, Michael G; Hart, Robert A; Hilibrand, Alan S; Arnold, Paul M; Bumpass, David B; Gokaslan, Ziya; Bydon, Mohamad; Fogelson, Jeremy L; Massicotte, Eric M; Riew, K Daniel; Steinmetz, Michael P

    2017-04-01

    Multi-institutional retrospective case series of 8887 patients who underwent anterior cervical spine surgery. Anterior decompression from discectomy or corpectomy is not without risk. Surgical morbidity ranges from 9% to 20% and is likely underreported. Little is known of the incidence and effects of rare complications on functional outcomes following anterior spinal surgery. In this retrospective review, we examined implant extrusions (IEs) following anterior cervical fusion. A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were reviewed to identify occurrence of 21 predefined treatment complications. Following anterior cervical fusion, the incidence of IE ranged from 0.0% to 0.8% across 21 institutions with 11 cases reported. All surgeries involved multiple levels, and 7/11 (64%) involved either multilevel corpectomies or hybrid constructs with at least one adjacent discectomy to a corpectomy. In 7/11 (64%) patients, constructs ended with reconstruction or stabilization at C7. Nine patients required surgery for repair and stabilization following IE. Average length of hospital stay after IE was 5.2 days. Only 2 (18%) had residual deficits after reoperation. IE is a very rare complication after anterior cervical spine surgery often requiring revision. Constructs requiring multilevel reconstruction, especially at the cervicothoracic junction, have a higher risk for failure, and surgeons should proceed with caution in using an anterior-only approach in these demanding cases. Surgeons can expect most patients to regain function after reoperation.

  13. Tuberculosis of the cervical spine

    African Journals Online (AJOL)

    Tuberculosis of the cervical spine is rare, comprising 3 -. 5% of cases of tuberculosis of the spine. Eight patients with tuberculosis of the cervicaJ spine seen during 1989 -. 1992 were reviewed. They all presented with neck pain. The 4 children presented with a kyphotic deformity. In all the children the disease was extensive, ...

  14. Mandibular condylar fractures and acute atlanto-axial subluxation Part 2 A physiopathological factor for the cervical spine sprain.

    Science.gov (United States)

    Cutilli, T; Corbacelli, A

    2009-05-01

    The aim of this study was to analyze the physiopathology of the acute cervical injure in the event of mandibular condylar fractures. As in the Part 1, 25 non-consecutive cases of condylar mandibular fractures (16 males and 9 females, mean age: 22.96/range 14-36 years) observed and treated in the Maxillofacial Surgery Department of the University of L'Aquila, have been studied. Types of fractures examined included: unilateral: 19 cases (solitary: 12; associated with other mandibular fractures: 7, homolateral: 2); bilateral: 6 cases (equivalent: 2, not equivalent: 4). A control group was constituted of 10 patients, 5 males and 5 females, aged from 19 to 24 years (mean range: 21.6) suffering from acute isolated cervical distorsion (whiplash). The study has been performed by means of the analysis of X-ray and computed tomography (CT)-CT/3D of the mandibular condylar regions, the occipital-atlanto-axial structures and the cervical region. In all the patients the following constant alterations that link up with these fractures have been observed: the rotation of atlas, the atlanto-axial subluxation and the derangement of the occipital-atlanto-epistropheal joint, homolateral to the side of the mandibular condylar fracture. The cervical spine shows the constant loss of physiological lordosis with hinge between C3 and C4. In the whiplash, as the authors have been able to assess in the control group, there are no alterations of occipital-atlanto-axial joint and the kinetic vector is placed on the longitudinal plane. In the mandibular condylar fractures the kinetic mechanism is completely different regarding the whiplash. The point of entry is the chin and the kinetic vector is oriented down-up, sometimes oblique in the opposite side. Subsequently the kinetic force is transmitted throughout the mandibular structure and causes the condylar or bicondylar fracture. The kinetic vector is placed before on the vertical plane, then on the horizontal plane and later on the vertical

  15. Radiology of the cervical spine

    International Nuclear Information System (INIS)

    Wackenheim, A.

    1989-01-01

    The author describes some particularities seen in the abnormal or pathological image of the cervical spine: The osteolysis of the cortical bone in the spinous processes, the 'Y' shaped course of the corporeal veins, the notch in interspinous bursitis, and the main forms of constitutional stenosis of the cervical canal. (orig.) [de

  16. Imaging of cervical spine injuries of childhood

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    Khanna, Geetika; El-Khoury, Georges Y. [University of Iowa Hospitals and Clinics, Department of Radiology, 3951 JPP, Iowa, IA (United States)

    2007-06-15

    Cervical spine injuries of children, though rare, have a high morbidity and mortality. The pediatric cervical spine is anatomically and biomechanically different from that of adults. Hence, the type, level and outcome of cervical spine injuries in children are different from those seen in adults. Normal developmental variants seen in children can make evaluation of the pediatric cervical spine challenging. This article reviews the epidemiology of pediatric cervical spine trauma, normal variants seen in children and specific injuries that are more common in the pediatric population. We also propose an evidence-based imaging protocol to avoid unnecessary imaging studies and minimize radiation exposure in children. (orig.)

  17. Cervical spine motion: radiographic study

    International Nuclear Information System (INIS)

    Morgan, J.P.; Miyabayashi, T.; Choy, S.

    1986-01-01

    Knowledge of the acceptable range of motion of the cervical spine of the dog is used in the radiographic diagnosis of both developmental and degenerative diseases. A series of radiographs of mature Beagle dogs was used to identify motion within sagittal and transverse planes. Positioning of the dog's head and neck was standardized, using a restraining board, and mimicked those thought to be of value in diagnostic radiology. The range of motion was greatest between C2 and C5. Reports of severe disk degeneration in the cervical spine of the Beagle describe the most severely involved disks to be C4 through C7. Thus, a high range of motion between vertebral segments does not seem to be the cause for the severe degenerative disk disease. Dorsoventral slippage between vertebral segments was seen, but was not accurately measured. Wedging of disks was clearly identified. At the atlantoaxio-occipital region, there was a high degree of motion within the sagittal plane at the atlantoaxial and atlanto-occipital joints; the measurement can be a guideline in the radiographic diagnosis of instability due to developmental anomalies in this region. Lateral motion within the transverse plane was detected at the 2 joints; however, motion was minimal, and the measurements seemed to be less accurate because of rotation of the cervical spine. Height of the vertebral canal was consistently noted to be greater at the caudal orifice, giving some warning to the possibility of overdiagnosis in suspected instances of cervical spondylopathy

  18. Thyroid storm following anterior cervical spine surgery for tuberculosis of cervical spine

    Directory of Open Access Journals (Sweden)

    Sanjiv Huzurbazar

    2014-01-01

    Full Text Available Objective: The primary objective was to report this rare case and discuss the probable mechanism of thyroid storm following anterior cervical spine surgery for Kochs cervical spine.

  19. Paediatric cervical spine injury but NEXUS negative

    OpenAIRE

    Maxwell, Melanie J; Jardine, Andrew D

    2007-01-01

    Cervical spine injuries in paediatric patients following trauma are extremely rare. The National Emergency X‐Radiography Utilization Study (NEXUS) guidelines are a set of clinical criteria used to guide physicians in identifying trauma patients requiring cervical spine imaging. It is validated for use in children. A case of a child who did not fulfil the NEXUS criteria for imaging but was found to have a cervical spine fracture is reported.

  20. Sport injuries of the cervical spine

    International Nuclear Information System (INIS)

    Bargon, G.

    1981-01-01

    The article reports on injuries of the cervical spine occurring during sports activities. An attempt is made to reconstruct the movements which led to the cervical spine injuries in question. In two cases of accidents occuring during bathing, one football accident and a toboggan accident, the injuries concerned point to hyperextension of the cervical spine as cause of the injury. In another football accident and a riding accident, the changes observed allow us to conclude that the movement leading to the injury must have been a hyperflexion. One accident occurring while jumping on the trampolin resulted in an injury of the upper cervical spine pointing to the action of a compressive force on the cervical spine in addition to the force resulting in hyperflexion. (orig.) [de

  1. Sport injuries of the cervical spine

    Energy Technology Data Exchange (ETDEWEB)

    Bargon, G

    1981-03-01

    The article reports on injuries of the cervical spine occurring during sports activities. An attempt is made to reconstruct the movements which led to the cervical spine injuries in question. In two cases of accidents occuring during bathing, one football accident and a toboggan accident, the injuries concerned point to hyperextension of the cervical spine as cause of the injury. In another football accident and a riding accident, the changes observed allow us to conclude that the movement leading to the injury must have been a hyperflexion. One accident occurring while jumping on the trampolin resulted in an injury of the upper cervical spine pointing to the action of a compressive force on the cervical spine in addition to the force resulting in hyperflexion.

  2. MRI of cervical spine injuries complicating ankylosing spondylitis

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    Koivikko, Mika P.; Koskinen, Seppo K. [Helsinki Medical Imaging Center, Helsinki University Central Hospital, Toeoeloe Hospital, Department of Radiology, Helsinki (Finland)

    2008-09-15

    The objective was to study characteristic MRI findings in cervical spine fractures complicating ankylosing spondylitis (AS). Technical issues related to MRI are also addressed. A review of 6,774 consecutive cervical spine multidetector CT (MDCT) scans obtained during 6.2 years revealed 33 ankylosed spines studied for suspected acute cervical spine injury complicating AS. Of these, 20 patients also underwent MRI. On MRI, of these 20 patients, 19 had a total of 29 cervical and upper thoracic spine fractures. Of 20 transverse fractures traversing both anterior and posterior columns, 7 were transdiskal and exhibited less bone marrow edema than did those traversing vertebral bodies. One Jefferson's, 1 atlas posterior arch (Jefferson's on MDCT), 2 odontoid process, and 5 non-contiguous spinous process fractures were detectable. MRI showed 2 fractures that were undetected by MDCT, and conversely, MDCT detected 6 fractures not seen on MRI; 16 patients had spinal cord findings ranging from impingement and contusion to complete transection. Magnetic resonance imaging can visualize unstable fractures of the cervical and upper thoracic spine. Paravertebral hemorrhages and any ligamentous injuries should alert radiologists to seek transverse fractures. Multiple fractures are common and often complicated by spinal cord injuries. Diagnostic images can be obtained with a flexible multipurpose coil if the use of standard spine array coil is impossible due to a rigid collar or excessive kyphosis. (orig.)

  3. Anaesthetic and Intensive Care Management of Traumatic Cervical Spine Injury

    Directory of Open Access Journals (Sweden)

    G S Umamaheswara Rao

    2008-01-01

    Full Text Available Trauma to the cervical spine may have devastating consequences. Timely interventions are essential to prevent avoidable neurological deterioration. In the initial stabilization of patients with acute cervical spine injuries, physiological disturbances, especially those involving cardiac and respiratory function require careful attention. Early surgery, which facilitates rapid mobi-lization of the patient, is fraught with important management considerations in the intraopoerative period and the subsequent critical care. Airway management poses a crucial challenge at this stage. Those patients who survive the injury with quadriplegia or quadriparesis may present themselves for incidental surgical procedures. Chronic systemic manifestations in these patients require attention in providing anaesthesia and postoperative care at this stage. The current review provides an insight into the physiological disturbances and the management issues in both acute and chronic phases of traumatic cervical spine injury.

  4. Respiratory Disorders in Complicated Cervical Spine Injury

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    S. A. Pervukhin

    2016-01-01

    Full Text Available Objective. Evaluating the results of respiratory therapy in patients with complicated traumatic injury of the cervical spine.Materials and methods. A retrospective comparative analysis of the clinical course was carried out in 52 patients with complicated traumatic injury of the cervical spine: group A: complete spinal cord injury (ASIA A, 37 patients and group B: incomplete injury (ASIA B, 15 patients. The severity of patients' status on integral scales, parameters of the respiratory pattern and thoracopulmonary compliance, gas composition, and acidbase status of the blood were assessed. Data on patients who required prolonged mechanical ventilation, duration of mechanical ventilation, incidence of nosocomial pneumonia, duration of stay in the ICU, time of hospital treatment, and mortality were included in the analysis. Results. The average APACHE II and SOFA scores were higher in group A patients. The development of the acute respiratory failure required longterm mechanical ventilation (more than 48 hours in 91.4% of group A patients and in 53.3% of group B patients. Ventilatorassociated pneumonia complicated the disease in 81.3% of group A patients and 62.5% of group B patients and was accompanied by sepsis in 25% and 12.5% of cases, respectively. Statistically significant deterioration of biomechanical properties and gas exchange function of the lungs was observed in patients complicated with septic pneumonia.Conclusion. Patients with complicated ASIA A and ASIA B cervical spine injuries demonstrate the presence of respiratory failure of neurogenic origin. In addition, the infectious bronchopulmonary complications aggravated respiratory failure in patients with ASIA A injury in 70.3% versus 33.3% in patients with ASIA B. Developmentof pulmonogenic sepsis led to deterioration of the biomechanical and gas exchange functions of the lungs and increased the likelihood of unfavorable outcome of the disease in 77.8% of cases. The high

  5. Brachial Plexopathy After Cervical Spine Surgery

    OpenAIRE

    Than, Khoi D.; Mummaneni, Praveen V.; Smith, Zachary A.; Hsu, Wellington K.; Arnold, Paul M.; Fehlings, Michael G.; Mroz, Thomas E.; Riew, K. Daniel

    2017-01-01

    Study Design: Retrospective, multicenter case-series study and literature review. Objectives: To determine the prevalence of brachial plexopathy after cervical spine surgery and to review the literature to better understand the etiology and risk factors of brachial plexopathy after cervical spine surgery. Methods: A retrospective case-series study of 12?903 patients at 21 different sites was performed to analyze the prevalence of several different complications, including brachial plexopathy....

  6. Hypoglossal Nerve Palsy After Cervical Spine Surgery

    OpenAIRE

    Ames, Christopher P.; Clark, Aaron J.; Kanter, Adam S.; Arnold, Paul M.; Fehlings, Michael G.; Mroz, Thomas E.; Riew, K. Daniel

    2017-01-01

    Study Design: Multi-institutional retrospective study. Objective: The goal of the current study is to quantify the incidence of 2 extremely rare complications of cervical spine surgery; hypoglossal and glossopharyngeal nerve palsies. Methods: A total of 8887 patients who underwent cervical spine surgery from 2005 to 2011 were included in the study from 21 institutions. Results: No glossopharyngeal nerve injuries were reported. One hypoglossal nerve injury was reported after a C3-7 laminectomy...

  7. Tophaceous gout in the cervical spine

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    Cabot, Jonathan [Royal Adelaide Hospital, Department of Orthopaedic Surgery, Adelaide, South Australia (Australia); Mosel, Leigh; Kong, Andrew; Hayward, Mike [Flinders Medical Centre, Department of Medical Imaging, Bedford Park, South Australia (Australia)

    2005-12-01

    Gout is a common metabolic disorder typically affecting the distal joints of the appendicular skeleton. Involvement of the axial skeleton, particularly the facet joints and posterior column of the cervical spine, is rare. This case report highlights such a presentation in a 76-year old female who presented with cervical spine pain following a fall. Her radiological findings were suggestive of a destructive metastatic process. Histological diagnosis confirmed tophaceous gout. (orig.)

  8. Tophaceous gout in the cervical spine

    International Nuclear Information System (INIS)

    Cabot, Jonathan; Mosel, Leigh; Kong, Andrew; Hayward, Mike

    2005-01-01

    Gout is a common metabolic disorder typically affecting the distal joints of the appendicular skeleton. Involvement of the axial skeleton, particularly the facet joints and posterior column of the cervical spine, is rare. This case report highlights such a presentation in a 76-year old female who presented with cervical spine pain following a fall. Her radiological findings were suggestive of a destructive metastatic process. Histological diagnosis confirmed tophaceous gout. (orig.)

  9. X-Ray Exam: Cervical Spine

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español X-Ray Exam: Cervical Spine KidsHealth / For Parents / X-Ray ... MRI): Lumbar Spine Broken Bones Getting an X-ray (Video) X-Ray (Video) View more Partner Message About Us ...

  10. Analysis of the Functional Independence Measure Value of Cervical Spine Injury Patients with Conservative Management

    Directory of Open Access Journals (Sweden)

    M. Zafrullah Arifin

    2012-06-01

    Full Text Available Analysis of the Functional Independence Measure Value of Cervical Spine Injury Patients with Conservative Management. Cervical spine injury is one of the most common spinal cord injuries in trauma patients. From 100,000 spinal cord injury cases reported in the United States of America (2008, sixty seven percent involve cervical spine injury. American Spinal Cord Injury Association (ASIA impairment score is used as an initial assessment but not enough attention prognostic outcome of these patients was paid to. The objective of this study is to analyze the value of functional independence measure (FIM cervical spine injury patients with conservative management and its correlation with age, sex, type of trauma, onset of trauma, cervical abnormalities, type of cervical spine lesion and ASIA impairment score. A prospective cohort study was performed to all patients with cervical spine injury treated inNeurosurgery Department of Dr. Hasan Sadikin Hospital Bandung that fullfiled the inclusion criteria. The subjects were classified based on age, sex, single/multiple trauma, acute /chronic, cervical abnormalities, complete/incomplete lesion and ASIA impairment score. The FIM examination was performed in Outpatient clinic of Neurosurgery. T-test and chi-square test was done to analyze the data. There were 17 cervical spine injury patients treated in Neurosurgery Department of Dr. Hasan Sadikin Hospital during April 2009–April 2010. The average FIM value of cervical spine injury in those patients is 4+ 1.63 by cohort prospective study. There were no correlation between FIM value with age, sex, type of trauma, onset of trauma and cervical abnormalities. Significant correlations were found between FIM value with type of cervical spine lesion and ASIA impairment score in cervical spine patients. Type of cervical spine lesion and ASIA impairment score have significant correlation with FIM value of patients in 6 months after cervical injury.

  11. Hypoglossal Nerve Palsy After Cervical Spine Surgery.

    Science.gov (United States)

    Ames, Christopher P; Clark, Aaron J; Kanter, Adam S; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Multi-institutional retrospective study. The goal of the current study is to quantify the incidence of 2 extremely rare complications of cervical spine surgery; hypoglossal and glossopharyngeal nerve palsies. A total of 8887 patients who underwent cervical spine surgery from 2005 to 2011 were included in the study from 21 institutions. No glossopharyngeal nerve injuries were reported. One hypoglossal nerve injury was reported after a C3-7 laminectomy (0.01%). This deficit resolved with conservative management. The rate by institution ranged from 0% to 1.28%. Although not directly injured by the surgical procedure, the transient nerve injury might have been related to patient positioning as has been described previously in the literature. Hypoglossal nerve injury during cervical spine surgery is an extremely rare complication. Institutional rates may vary. Care should be taken during posterior cervical surgery to avoid hyperflexion of the neck and endotracheal tube malposition.

  12. Non-contiguous spinal injury in cervical spinal trauma: evaluation with cervical spine MRI

    International Nuclear Information System (INIS)

    Choi, Soo Jung; Shin, Myung Jin; Kim, Sung Moon; Bae, Sang Jin

    2004-01-01

    We wished to evaluate the incidence of non-contiguous spinal injury in the cervicothoracic junction (CTJ) or the upper thoracic spines on cervical spinal MR images in the patients with cervical spinal injuries. Seventy-five cervical spine MR imagings for acute cervical spinal injury were retrospectively reviewed (58 men and 17 women, mean age: 35.3, range: 18-81 years). They were divided into three groups based on the mechanism of injury; axial compression, hyperflexion or hyperextension injury, according to the findings on the MR and CT images. On cervical spine MR images, we evaluated the presence of non-contiguous spinal injury in the CTJ or upper thoracic spine with regard to the presence of marrow contusion or fracture, ligament injury, traumatic disc herniation and spinal cord injury. Twenty-one cases (28%) showed CTJ or upper thoracic spinal injuries (C7-T5) on cervical spinal MR images that were separated from the cervical spinal injuries. Seven of 21 cases revealed overt fractures in the CTJs or upper thoracic spines. Ligament injury in these regions was found in three cases. Traumatic disc herniation and spinal cord injury in these regions were shown in one and two cases, respectively. The incidence of the non-contiguous spinal injuries in CTJ or upper thoracic spines was higher in the axial compression injury group (35.5%) than in the hyperflexion injury group (26.9%) or the hyperextension (25%) injury group. However, there was no statistical significance (ρ > 0.05). Cervical spinal MR revealed non-contiguous CTJ or upper thoracic spinal injuries in 28% of the patients with cervical spinal injury. The mechanism of cervical spinal injury did not significantly affect the incidence of the non-contiguous CTJ or upper thoracic spinal injury

  13. Non-contiguous spinal injury in cervical spinal trauma: evaluation with cervical spine MRI

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Soo Jung; Shin, Myung Jin; Kim, Sung Moon [University of Ulsan College of Medicine, Seoul (Korea, Republic of); Bae, Sang Jin [Sanggyepaik Hospital, Inje University, Seoul (Korea, Republic of)

    2004-12-15

    We wished to evaluate the incidence of non-contiguous spinal injury in the cervicothoracic junction (CTJ) or the upper thoracic spines on cervical spinal MR images in the patients with cervical spinal injuries. Seventy-five cervical spine MR imagings for acute cervical spinal injury were retrospectively reviewed (58 men and 17 women, mean age: 35.3, range: 18-81 years). They were divided into three groups based on the mechanism of injury; axial compression, hyperflexion or hyperextension injury, according to the findings on the MR and CT images. On cervical spine MR images, we evaluated the presence of non-contiguous spinal injury in the CTJ or upper thoracic spine with regard to the presence of marrow contusion or fracture, ligament injury, traumatic disc herniation and spinal cord injury. Twenty-one cases (28%) showed CTJ or upper thoracic spinal injuries (C7-T5) on cervical spinal MR images that were separated from the cervical spinal injuries. Seven of 21 cases revealed overt fractures in the CTJs or upper thoracic spines. Ligament injury in these regions was found in three cases. Traumatic disc herniation and spinal cord injury in these regions were shown in one and two cases, respectively. The incidence of the non-contiguous spinal injuries in CTJ or upper thoracic spines was higher in the axial compression injury group (35.5%) than in the hyperflexion injury group (26.9%) or the hyperextension (25%) injury group. However, there was no statistical significance ({rho} > 0.05). Cervical spinal MR revealed non-contiguous CTJ or upper thoracic spinal injuries in 28% of the patients with cervical spinal injury. The mechanism of cervical spinal injury did not significantly affect the incidence of the non-contiguous CTJ or upper thoracic spinal injury.

  14. The Management of Unstable Cervical Spine Injuries

    Directory of Open Access Journals (Sweden)

    Venu M. Nemani

    2014-01-01

    Full Text Available Injuries to the cervical spine can cause potentially devastating morbidity and even mortality. In this review we discuss the anatomy and biomechanics of the cervical spine. The evaluation and treatment of cervical spine injuries begins with the prompt immobilization of suspected injuries in the field. Once an assessment of the patient's neurological status is made, imaging studies are obtained, which can include X-rays, CT, and MRI. Careful scrutiny of the imaging studies for bony and/or ligamentous injury allows the physician to determine the mechanism of injury, which guides treatment. The ultimate treatment plan can consist of non-operative or operative management, and depends on patient specific factors (medical condition and neurological status, the mechanism of injury, and the resultant degree of instability. With prompt diagnosis and appropriate management, the morbidity of these injuries can be minimized.

  15. Rugby and cervical spine injuries – has anything changed? A 5-year ...

    African Journals Online (AJOL)

    related cervical spine injuries treated at the acute spinal injury (ASCI) unit at Groote Schuur Hospital from April 2003 to June 2008, and followed up with telephone interviews. Patient profile, rugby profile, subsequent injury management from the ...

  16. Cervical spine injuries in American football.

    Science.gov (United States)

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

    2009-01-01

    American football is a high-energy contact sport that places players at risk for cervical spine injuries with potential neurological deficits. Advances in tackling and blocking techniques, rules of the game and medical care of the athlete have been made throughout the past few decades to minimize the risk of cervical injury and improve the management of injuries that do occur. Nonetheless, cervical spine injuries remain a serious concern in the game of American football. Injuries have a wide spectrum of severity. The relatively common 'stinger' is a neuropraxia of a cervical nerve root(s) or brachial plexus and represents a reversible peripheral nerve injury. Less common and more serious an injury, cervical cord neuropraxia is the clinical manifestation of neuropraxia of the cervical spinal cord due to hyperextension, hyperflexion or axial loading. Recent data on American football suggest that approximately 0.2 per 100,000 participants at the high school level and 2 per 100,000 participants at the collegiate level are diagnosed with cervical cord neuropraxia. Characterized by temporary pain, paraesthesias and/or motor weakness in more than one extremity, there is a rapid and complete resolution of symptoms and a normal physical examination within 10 minutes to 48 hours after the initial injury. Stenosis of the spinal canal, whether congenital or acquired, is thought to predispose the athlete to cervical cord neuropraxia. Although quite rare, catastrophic neurological injury is a devastating entity referring to permanent neurological injury or death. The mechanism is most often a forced hyperflexion injury, as occurs when 'spear tackling'. The mean incidence of catastrophic neurological injury over the past 30 years has been approximately 0.5 per 100,000 participants at high school level and 1.5 per 100,000 at the collegiate level. This incidence has decreased significantly when compared with the incidence in the early 1970s. This decrease in the incidence of

  17. Magnetic resonance tomography for trauma of the cervical spine

    International Nuclear Information System (INIS)

    Meydam, K.; Sehlen, S.; Schlenkhoff, D.; Kiricuta, J.C.; Beyer, H.K.

    1986-01-01

    Twenty patients who had suffered spinal trauma were examined by magnetic resonance tomography. Fifteen patients with first degree trauma in Erdmann's classification showed no abnormality. Magnetic resonance tomography of the cervical spine appears to be a suitable method for investigating patients with whiplash injuries. It is indicated following severe flexion injuries with subluxations and neurological symptoms, since it is the only method that can demonstrate the spinal cord directly and completely and show the extent of cord compression. For patients with thoracic trauma and rapidly developing neurological symptoms, magnetic resonance tomography is ideal for showing post-traumatic syringomyelia. Magnetic resonance tomography following whiplash injuries is recommended if plain films of the cervical spine show any abnormalities, as well as for the investigation of acute or sub-acute neurological abnormalities. The various findings are discussed. (orig.) [de

  18. Magnetic resonance tomography for trauma of the cervical spine

    Energy Technology Data Exchange (ETDEWEB)

    Meydam, K.; Sehlen, S.; Schlenkhoff, D.; Kiricuta, J.C.; Beyer, H.K.

    1986-12-01

    Twenty patients who had suffered spinal trauma were examined by magnetic resonance tomography. Fifteen patients with first degree trauma in Erdmann's classification showed no abnormality. Magnetic resonance tomography of the cervical spine appears to be a suitable method for investigating patients with whiplash injuries. It is indicated following severe flexion injuries with subluxations and neurological symptoms, since it is the only method that can demonstrate the spinal cord directly and completely and show the extent of cord compression. For patients with thoracic trauma and rapidly developing neurological symptoms, magnetic resonance tomography is ideal for showing post-traumatic syringomyelia. Magnetic resonance tomography following whiplash injuries is recommended if plain films of the cervical spine show any abnormalities, as well as for the investigation of acute or sub-acute neurological abnormalities. The various findings are discussed.

  19. Is the cervical spine clear? Undetected cervical fractures diagnosed only at autopsy.

    Science.gov (United States)

    Sweeney, J F; Rosemurgy, A S; Gill, S; Albrink, M H

    1992-10-01

    Undetected cervical-spine injuries are a nemesis to both trauma surgeons and emergency physicians. Radiographic protocols have been developed to avoid missing cervical-spine fractures but are not fail-safe. Three case reports of occult cervical fractures documented at autopsy in the face of normal cervical-spine radiographs and computerized tomography scans are presented.

  20. Cervical spine injury in child abuse: report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Rooks, V.J.; Sisler, C.; Burton, B. [Tripler Army Medical Center, Honolulu, HI (United States). Dept. of Radiology

    1998-03-01

    Pediatric cervical spine injuries have rarely been reported in the setting of child abuse. We report two cases of unsuspected lower cervical spine fracture-dislocation in twin infant girls who had no physical examination findings to suggest cervical spine injury. Classic radio-graphic findings of child abuse were noted at multiple other sites in the axial and appendicular skeleton. Magnetic resonance (MR) imaging proved to be valuable in both the initial evaluation of the extent of cervical spine injury and in following postoperative changes. The unexpected yet devastating findings in these two cases further substantiate the importance of routine evaluation of the cervical spine in cases of suspected child abuse. (orig.)

  1. Cervical spine injury in child abuse: report of two cases

    International Nuclear Information System (INIS)

    Rooks, V.J.; Sisler, C.; Burton, B.

    1998-01-01

    Pediatric cervical spine injuries have rarely been reported in the setting of child abuse. We report two cases of unsuspected lower cervical spine fracture-dislocation in twin infant girls who had no physical examination findings to suggest cervical spine injury. Classic radio-graphic findings of child abuse were noted at multiple other sites in the axial and appendicular skeleton. Magnetic resonance (MR) imaging proved to be valuable in both the initial evaluation of the extent of cervical spine injury and in following postoperative changes. The unexpected yet devastating findings in these two cases further substantiate the importance of routine evaluation of the cervical spine in cases of suspected child abuse. (orig.)

  2. Brachial Plexopathy After Cervical Spine Surgery.

    Science.gov (United States)

    Than, Khoi D; Mummaneni, Praveen V; Smith, Zachary A; Hsu, Wellington K; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Retrospective, multicenter case-series study and literature review. To determine the prevalence of brachial plexopathy after cervical spine surgery and to review the literature to better understand the etiology and risk factors of brachial plexopathy after cervical spine surgery. A retrospective case-series study of 12 903 patients at 21 different sites was performed to analyze the prevalence of several different complications, including brachial plexopathy. A literature review of the US National Library of Medicine and the National Institutes of Health (PubMed) database was conducted to identify articles pertaining to brachial plexopathy following cervical spine surgery. In our total population of 12 903 patients, only 1 suffered from postoperative brachial plexopathy. The overall prevalence rate was thus 0.01%, but the prevalence rate at the site where this complication occurred was 0.07%. Previously reported risk factors for postoperative brachial plexopathy include age, anterior surgical procedures, and a diagnosis of ossification of the posterior longitudinal ligament. The condition can also be due to patient positioning during surgery, which can generally be detected via the use of intraoperative neuromonitoring. Brachial plexopathy following cervical spine surgery is rare and merits further study.

  3. Cervical spine instability in rheumatoid arthritis

    African Journals Online (AJOL)

    1983-01-22

    Jan 22, 1983 ... In consultation with the joint replacement unit a total knee joint replacement was contem- plilted. Before surgery routine flex ion and extension radiographs were taken of the patient's cervical spine (Figs I and 2), and significant subluxation between the atlas and the axis was disco- vered. The knee operation ...

  4. Posterior arch defects of the cervical spine

    International Nuclear Information System (INIS)

    Schwartz, A.M.; Wechsler, R.J.; Landy, M.D.; Wetzner, S.M.; Goldstein, S.A.

    1982-01-01

    Spondylolysis and absence of the pedicle are congenital anomalies of the posterior cervical spine. Their roentgenographic changes may be confused with other more serious entities which may necessitate either emergent therapy or require extensive diagnostic testing and treatment. Four cases are present and the literature is reviewed. A hypothesis for the embryologic etiology of these entities is proposed. (orig.)

  5. Posterior arch defects of the cervical spine

    Energy Technology Data Exchange (ETDEWEB)

    Schwartz, A.M.; Wechsler, R.J.; Landy, M.D.; Wetzner, S.M.; Goldstein, S.A.

    1982-05-01

    Spondylolysis and absence of the pedicle are congenital anomalies of the posterior cervical spine. Their roentgenographic changes may be confused with other more serious entities which may necessitate either emergent therapy or require extensive diagnostic testing and treatment. Four cases are present and the literature is reviewed. A hypothesis for the embryologic etiology of these entities is proposed.

  6. AOSpine subaxial cervical spine injury classification system

    NARCIS (Netherlands)

    Vaccaro, Alexander R.; Koerner, John D.; Radcliff, Kris E.; Oner, F. Cumhur; Reinhold, Maximilian; Schnake, Klaus J.; Kandziora, Frank; Fehlings, Michael G.; Dvorak, Marcel F.; Aarabi, Bizhan; Rajasekaran, Shanmuganathan; Schroeder, Gregory D.; Kepler, Christopher K.; Vialle, Luiz R.

    2016-01-01

    Purpose: This project describes a morphology-based subaxial cervical spine traumatic injury classification system. Using the same approach as the thoracolumbar system, the goal was to develop a comprehensive yet simple classification system with high intra- and interobserver reliability to be used

  7. Cervical human spine loads during traumatomechanical investigations

    NARCIS (Netherlands)

    Kallieris, D.; Rizzetti, A.; Mattern. R.; Thunnissen, J.G.M.; Philippens, M.M.G.M.

    1996-01-01

    The last decade's improvements in automotive safety resulted into a significant decrease of fatal injuries. However, due to the use of belts and airbags it can be observed that cervical spine injuries, non-severe and severe, have become more important. It seems that inertial loading of the neck by

  8. Surgery for failed cervical spine reconstruction.

    Science.gov (United States)

    Helgeson, Melvin D; Albert, Todd J

    2012-03-01

    Review article. To review the indications, operative strategy, and complications of revision cervical spine reconstruction. With many surgeons expanding their indications for cervical spine surgery, the number of patients being treated operatively has increased. Unfortunately, the number of patients requiring revision procedures is also increasing, but very little literature exists reviewing changes in the indications or operative planning for revision reconstruction. Narrative and review of the literature. In addition to the well-accepted indications for primary cervical spine surgery (radiculopathy, myelopathy, instability, and tumor), we have used the following indications for revision surgery: pseudarthrosis, adjacent segment degeneration, inadequate decompression, iatrogenic instability, and deformity. Our surgical goal for pseudarthrosis is obviously to obtain a fusion, which can usually be performed with an approach not done previously. Our surgical goals for instability and deformity are more complex, with a focus on decompression of any neurologic compression, correction of deformity, and stability. Revision cervical spine reconstruction is safe and effective if performed for the appropriate indications and with proper planning.

  9. Does applying the Canadian Cervical Spine rule reduce cervical spine radiography rates in alert patients with blunt trauma to the neck? A retrospective analysis

    Directory of Open Access Journals (Sweden)

    Yesupalan Rajam

    2008-06-01

    Full Text Available Abstract Background A cautious outlook towards neck injuries has been the norm to avoid missing cervical spine injuries. Consequently there has been an increased use of cervical spine radiography. The Canadian Cervical Spine rule was proposed to reduce unnecessary use of cervical spine radiography in alert and stable patients. Our aim was to see whether applying the Canadian Cervical Spine rule reduced the need for cervical spine radiography without missing significant cervical spine injuries. Methods This was a retrospective study conducted in 2 hospitals. 114 alert and stable patients who had cervical spine radiographs for suspected neck injuries were included in the study. Data on patient demographics, high risk & low risk factors as per the Canadian Cervical Spine rule and cervical spine radiography results were collected and analysed. Results 28 patients were included in the high risk category according to the Canadian Cervical Spine rule. 86 patients fell into the low risk category. If the Canadian Cervical Spine rule was applied, there would have been a significant reduction in cervical spine radiographs as 86/114 patients (75.4% would not have needed cervical spine radiograph. 2/114 patients who had significant cervical spine injuries would have been identified when the Canadian Cervical Spine rule was applied. Conclusion Applying the Canadian Cervical Spine rule for neck injuries in alert and stable patients would have reduced the use of cervical spine radiographs without missing out significant cervical spine injuries. This relates to reduction in radiation exposure to patients and health care costs.

  10. Epidural Hematoma Following Cervical Spine Surgery.

    Science.gov (United States)

    Schroeder, Gregory D; Hilibrand, Alan S; Arnold, Paul M; Fish, David E; Wang, Jeffrey C; Gum, Jeffrey L; Smith, Zachary A; Hsu, Wellington K; Gokaslan, Ziya L; Isaacs, Robert E; Kanter, Adam S; Mroz, Thomas E; Nassr, Ahmad; Sasso, Rick C; Fehlings, Michael G; Buser, Zorica; Bydon, Mohamad; Cha, Peter I; Chatterjee, Dhananjay; Gee, Erica L; Lord, Elizabeth L; Mayer, Erik N; McBride, Owen J; Nguyen, Emily C; Roe, Allison K; Tortolani, P Justin; Stroh, D Alex; Yanez, Marisa Y; Riew, K Daniel

    2017-04-01

    A multicentered retrospective case series. To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine. Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified. A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment ( P = .53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation. This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements.

  11. Cervical spine and crystal-associated diseases: imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Feydy, Antoine; Chevrot, Alain; Drape, Jean-Luc [Hopital Cochin, Service de Radiologie B, Paris Cedex 14 (France); Liote, Frederic [Hopital Lariboisiere, Federation de Rhumatologie, Paris (France); Carlier, Robert [Hopital Raymond Poincare, Radiologie, Garches (France)

    2006-02-01

    The cervical spine may be specifically involved in crystal-associated arthropathies. In this article, we focus on the three common crystals and diseases: hydroxyapatite crystal deposition disease, calcium pyrophosphate dihydrate (CPPD) deposition disease, and monosodium urate crystals (gout). The cervical involvement in crystal-associated diseases may provoke a misleading clinical presentation with acute neck pain, fever, or neurological symptoms. Imaging allows an accurate diagnosis in typical cases with calcific deposits and destructive lesions of the discs and joints. Most of the cases are related to CPPD or hydroxyapatite crystal deposition; gout is much less common. (orig.)

  12. Cervical spine and crystal-associated diseases: imaging findings

    International Nuclear Information System (INIS)

    Feydy, Antoine; Chevrot, Alain; Drape, Jean-Luc; Liote, Frederic; Carlier, Robert

    2006-01-01

    The cervical spine may be specifically involved in crystal-associated arthropathies. In this article, we focus on the three common crystals and diseases: hydroxyapatite crystal deposition disease, calcium pyrophosphate dihydrate (CPPD) deposition disease, and monosodium urate crystals (gout). The cervical involvement in crystal-associated diseases may provoke a misleading clinical presentation with acute neck pain, fever, or neurological symptoms. Imaging allows an accurate diagnosis in typical cases with calcific deposits and destructive lesions of the discs and joints. Most of the cases are related to CPPD or hydroxyapatite crystal deposition; gout is much less common. (orig.)

  13. Fractures of the articular processes of the cervical spine

    Energy Technology Data Exchange (ETDEWEB)

    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.

  14. Fractures of the articular processes of the cervical spine

    International Nuclear Information System (INIS)

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

    1982-01-01

    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

  15. MRI in the assessment of the supportive soft tissues of the cervical spine in acute trauma in children

    Energy Technology Data Exchange (ETDEWEB)

    Keiper, M.D.; Zimmerman, R.A.; Bilaniuk, L.T. [Department of Radiology, Children`s Hospital of Philadelphia, PA (United States)

    1998-06-01

    We carried out a retrospective analysis of imaging and clinical findings in 52 children with a history of cervical spinal trauma. No patient had evidence of a fracture on plain films or CT. All had MRI at 1.5 T because of persistent or delayed symptoms, unexplained findings of injury or instability, or as further assessment of the extent of soft-tissue injury. Clinical follow-up ranged from 6 months to 3.5 years. MRI was evaluated for its influence on therapy and outcome. MRI was positive in 16 (31 %) of 52 patients. Posterior soft-tissue or ligamentous injury was the most common finding in the 10 patients with mild to moderate trauma, while acute disc bulges and longitudinal ligament disruption, each seen in one case, were uncommon. MRI was superior to CT for assessment of the extent of soft-tissue injury and for identification of spinal cord injuries and intracanalicular hemorrhage in the six patients with more severe trauma. MRI specifically influenced the management of all four patients requiring surgery by extending the level of posterior stabilization. No patients with normal MRI or any of the 10 with radiographically stable soft-tissue injury on MRI, developed delayed clinical or radiographic evidence of instability or deformity. (orig.) With 2 figs., 2 tabs., 24 refs.

  16. Rare combination of cervical spine tumours

    OpenAIRE

    Jerome, Terrencejose; Sankaran, Balu; Varghese, Mathew

    2009-01-01

    Osteoid osteoma, osteoblastoma, and haemangioma should be included in the differential diagnosis of any young patient with pain in the back or the neck, painful scoliosis, or radicular or referred-type pain into the lower limb or the shoulder. Osteoid osteoma and haemangioma may occur in the same cervical spine and both have a significant importance in the prognosis, management and possible complications. Early diagnosis with a bone scan and computed tomography scan, leading to prompt treatme...

  17. Halovest treatment in traumatic cervical spine injury.

    Science.gov (United States)

    Razak, M; Basir, T; Hyzan, Y; Johari, Z

    1998-09-01

    This is a cross-sectional study on the use of halovest appliance in the Orthopaedic and Traumatology Department, Kuala Lumpur Hospital from June 1993 to September 1996. Fifty-three patients with cervical spine injuries were treated by halovest stabilization. Majority of cases was caused by motor-vehicle accident; others were fall from height at construction sites, fall at home, hit by falling object and assault. The injuries were Jefferson fracture of C1, odontoid fractures, hangman fractures, open spinous process fracture and fracture body of C2, and fracture, and fracture-dislocation of the lower cervical spines. Majority of patients had hospital stay less than 30 days. The use of the halovest ranges from 4 to 16 weeks and the healing rate was 96%. Two patients of lower cervical spine injury had redislocation and one of them was operated. There was one case of non-union of type II odontoid fracture and treated by posterior fusion. Other complications encountered during halovest treatment were minor. They were pin-site infection, pin-loosening, clamp loosening and neck pain or neck stiffness. This method of treatment enables patient to ambulate early and reduces hospital stay. We found that halovest is easy to apply, safe and tolerable to most of the patients.

  18. Rare Complications of Cervical Spine Surgery: Pseudomeningocoele.

    Science.gov (United States)

    Ailon, Tamir; Smith, Justin S; Nassr, Ahmad; Smith, Zachary A; Hsu, Wellington K; Fehlings, Michael G; Fish, David E; Wang, Jeffrey C; Hilibrand, Alan S; Mummaneni, Praveen V; Chou, Dean; Sasso, Rick C; Traynelis, Vincent C; Arnold, Paul M; Mroz, Thomas E; Buser, Zorica; Lord, Elizabeth L; Massicotte, Eric M; Sebastian, Arjun S; Than, Khoi D; Steinmetz, Michael P; Smith, Gabriel A; Pace, Jonathan; Corriveau, Mark; Lee, Sungho; Riew, K Daniel; Shaffrey, Christopher

    2017-04-01

    This study was a retrospective, multicenter cohort study. Rare complications of cervical spine surgery are inherently difficult to investigate. Pseudomeningocoele (PMC), an abnormal collection of cerebrospinal fluid that communicates with the subarachnoid space, is one such complication. In order to evaluate and better understand the incidence, presentation, treatment, and outcome of PMC following cervical spine surgery, we conducted a multicenter study to pool our collective experience. This study was a retrospective, multicenter cohort study of patients who underwent cervical spine surgery at any level(s) from C2 to C7, inclusive; were over 18 years of age; and experienced a postoperative PMC. Thirteen patients (0.08%) developed a postoperative PMC, 6 (46.2%) of whom were female. They had an average age of 48.2 years and stayed in hospital a mean of 11.2 days. Three patients were current smokers, 3 previous smokers, 5 had never smoked, and 2 had unknown smoking status. The majority, 10 (76.9%), were associated with posterior surgery, whereas 3 (23.1%) occurred after an anterior procedure. Myelopathy was the most common indication for operations that were complicated by PMC (46%). Seven patients (53%) required a surgical procedure to address the PMC, whereas the remaining 6 were treated conservatively. All PMCs ultimately resolved or were successfully treated with no residual effects. PMC is a rare complication of cervical surgery with an incidence of less than 0.1%. They prolong hospital stay. PMCs occurred more frequently in association with posterior approaches. Approximately half of PMCs required surgery and all ultimately resolved without residual neurologic or other long-term effects.

  19. 78 FR 65451 - Agency Information Collection (Neck (Cervical Spine) Conditions Disability Benefits Questionnaire...

    Science.gov (United States)

    2013-10-31

    ... (Cervical Spine) Conditions Disability Benefits Questionnaire) Activity Under OMB Review AGENCY: Veterans... Control No. 2900-- NEW (Neck (Cervical Spine) Conditions Disability Benefits Questionnaire)'' in any...) Conditions Disability Benefits Questionnaire).'' SUPPLEMENTARY INFORMATION: Title: (Neck (Cervical Spine...

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

    Science.gov (United States)

    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.

  1. Candida albicans osteomyelitis of the cervical spine

    International Nuclear Information System (INIS)

    Cha, Jang-Gyu; Hong, Hyun-Sook; Koh, Yoon-Woo; Kim, Hee-Kyung; Park, Jung-Mi

    2008-01-01

    Fungal osteomyelitis is a rare infection that usually develops in immunocompromised patients. Additionally, involvement of the cervical spine by Candida albicans is extremely rare; only three previous cases of Candida vertebral osteomyelitis have been reported in the literature. The diagnosis may be delayed due to nonspecific radiologic findings and a slow progression. We report the CT, MRI, bone scan, and PET-CT findings in a patient who developed Candida osteomyelitis, which was initially misdiagnosed as metastasis, at the atlas and axis following treatment for nasopharyngeal cancer. (orig.)

  2. [Spondylarthrosis of the cervical spine. Therapy].

    Science.gov (United States)

    Radl, R; Leixner, G; Stihsen, C; Windhager, R

    2013-09-01

    Chronic neck pain is often associated with spondylarthrosis, whereby segments C4/C5 (C: cervical) are most frequently affected. Spondylarthrosis can be the sole complaint, but it is associated with a degenerative cascade of the spine. The umbrella term for neck pain is the so-called cervical syndrome, which can be differentiated into segmental dysfunction and/or morphological changes of the intervertebral discs and small joints of the vertebral column. Conservative therapy modalities include physical therapy, subcutaneous application of local anesthetics, muscle, nerve and facet joint injections in addition to adequate analgesic and muscle relaxant therapy. If surgery is required, various techniques via dorsal and ventral approaches, depending on the clinic and morphologic changes, can be applied.

  3. Dysphagia associated with cervical spine and postural disorders.

    Science.gov (United States)

    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.

  4. Cervical spine injury in the elderly: imaging features

    Energy Technology Data Exchange (ETDEWEB)

    Ehara, S. [Dept. of Radiology, Iwate Medical University School of Medicine, Morioka (Japan); Shimamura, Tadashi [Dept. of Orthopedic Surgery, Iwate Medical University School of Medicine, Morioka (Japan)

    2001-01-01

    An increase in the elderly population has resulted in an increased incidence of cervical spine injury in this group. No specific type of cervical spine trauma is seen in the elderly, although dens fractures are reported to be common. Hyperextension injuries due to falling and the resultant central cord syndrome in the mid and lower cervical segments due to decreased elasticity as a result of spondylosis may be also characteristic. The imaging features of cervical spine injury are often modified by associated spondylosis deformans, DISH and other systemic disorders. The value of MR imaging in such cases is emphasized. (orig.)

  5. Surgical Management of Subaxial Cervical Spine Trauma: A Case Report

    Directory of Open Access Journals (Sweden)

    Hasan Emre Aydın

    2015-04-01

    Full Text Available These days, as a consequence of the improvement in technology and increase in the use of motor vehicles, spine injuries have become common. Spine traumas, which often occur after motor vehicle accidents, are observed mostly in cervical regions, particularly in the subaxial cervical region, which is also known as the subcervical region, and neurological damage occurs in 70% of the patients. Despite still being controversial, the common ranging for neurological evaluation is the American Spinal Injury Association ranging, which includes the motor and sensory loss and accordingly, the impairment rate. In subaxial cervical traumas, acute neurological deterioration is an indication and therefore requires urgent surgical treatment. The choice of anterior or posterior approach substantially depends on the traumatization mechanism, affected tissues, and neurological deterioration occurring after. The state of patient and instability are the most two important factors affecting the treatment decision. Although the anterior approach is accepted as a routinely available and easily applicable surgical technique, it lacks in the burst fractures involving the three colons, which shows a stabilization disorder. The anterior plate screw technique and posterior lateral mass screw application applied in our clinic are reviewed in literature and are discussed in two cases. Although the best clinical results are achieved in cases where only anterior surgery is performed and in cases where instability is excessive, in unstable compression and blow-out fractures, even if neurological deficit and three colon involvement are not observed in the patient, the requirement of posterior fusion is observed.

  6. Acute death due to hyperextension injury of the cervical spine caused by falling and slipping onto the face.

    Science.gov (United States)

    Osawa, Motoki; Satoh, Fumiko; Hasegawa, Iwao

    2008-10-01

    This retrospective study presents findings of cases involving fatal injuries, in which the victim was found dead at the scene, resulting from cervical hyperextension force attributable to a fall from a low height. External postmortem examination of 14 victims revealed that abrasions and lacerations of the face or the forehead are typical indicators of a direct impact. Either a disruption at the disk space or a transverse fracture of the vertebral body was apparent in the spinal column. The most frequent disk disruption injury occurred at the inter-vertebral space between C4 and C5, and double disruptions were observed in four instances. The damaged cord demonstrated central hemorrhage; moreover, axonal fragmentation and neuronal chromatolysis in the white matter column were evident histopathologically. The elderly victims (mean age, 64.7 years), many of whom displayed elevated blood alcohol levels, experienced the injury consequent to a fall from a low height, a fall during bicycling or slipping on a slope under accidental circumstances.

  7. Imaging the cervical spine following rugby related injury

    International Nuclear Information System (INIS)

    Beck, J.J.W.

    2016-01-01

    Rugby Union and Rugby League are popular sports with high participation across the world. The high impact nature of the sport results in a high proportion of injuries. Rugby has an association with cervical spine injury which has potentially catastrophic consequences for the patient. Anecdotal evidence suggests that radiographers find it challenging to visualise the cervicothoracic junction on the lateral supine cervical spine projection in broad shouldered athletes. This paper intends to analyse the risk factors for cervical spine injuries in rugby and discuss the imaging strategy in respect to radiography and CT scanning in high risk patient groups such as rugby players who are suspected of suffering a cervical spine injury. - Highlights: • Rugby as a participation sport represents a risk of cervical spine injury. • Conventional radiography lacks sensitivity in identifying cervical spine injury. • The body habitus of rugby players makes the imaging of the cervicothoracic junction challenging. • CT scanning should replace radiography in the event of serious suspicion of cervical spine injury. • The notion of CT being a high dose modality should be questioned.

  8. Hemivertebra of the cervical spine: an uncommon background for neck pain, cervical scoliosis, and torticollis.

    Science.gov (United States)

    Kapetanakis, Stylianos; Gkasdaris, Grigorios; Nastoulis, Evangelos; Stavrev, Vladimir

    2017-10-01

    A 15-year-old female patient presented with neck pain accompanied by cervical scoliosis, on the existence of torticollis. Although rare, hemivertebra of the cervical spine is a congenital deformation associated with these three clinical features.

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

    Science.gov (United States)

    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 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 difficile infection after degenerative cervical spine surgery. C. difficile infection after cervical spine surgery results in extended length of stay (p costs (p difficile after cervical spine surgery is nearly 8% versus 0.19% otherwise (p difficile to be a significant predictor of inpatient mortality (OR = 3.99, p 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 after surgery. Accepted antibiotic guidelines in this population must be followed to decrease the risk of developing postoperative C. difficile colitis.

  10. Considerations to improve the safety of cervical spine manual therapy.

    Science.gov (United States)

    Hutting, Nathan; Kerry, Roger; Coppieters, Michel W; Scholten-Peeters, Gwendolijne G M

    2018-02-01

    Manipulation and mobilisation of the cervical spine are well established interventions in the management of patients with headache and/or neck pain. However, their benefits are accompanied by potential, yet rare risks in terms of serious adverse events, including neurovascular insult to the brain. A recent international framework for risk assessment and management offers directions in the mitigation of this risk by facilitating sound clinical reasoning. The aim of this article is to critically reflect on and summarize the current knowledge about cervical spine manual therapy and to provide guidance for clinical reasoning for cervical spine manual therapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Fatal Cervical Spine Injury Following a Bicycle Crash

    Directory of Open Access Journals (Sweden)

    Uhrenholt Lars

    2017-06-01

    Full Text Available Spinal injury following direct loading of the head and neck is a rare sequel of bicycle crashes. Fatal head injuries following bicycle crashes have been described in great detail and safety measures such as bicycle helmets have been developed accordingly. Less frequently, however, potentially severe cervical spine injuries have been described. We present the case of a middle-aged female who sustained an ultimately fatal cervical spine injury following a collision with a car whilst biking wearing a helmet. We discuss the literature regarding the protective effects of bicycle helmets, the relevance to cervical spine injury and legislation on mandatory use of helmets for injury prevention.

  12. Rheumatoid arthritis: Radiological changes in the cervical spine

    International Nuclear Information System (INIS)

    Al-Boukai, Ahmad A.; Al-Arfaj, Abdurahman S.

    2003-01-01

    Objective was to describe the radiographic cervical spine changes in rheumatoid arthritis patients.Forty-nine patients (37 females and 12 males ) diagnosed with rheumatoid arthritis at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between June 1998 and December 2000, were studied for their radiographic cervical spine changes . Their mean age at disease onset was 41.4 + 13.4 years (range of 18-73)and mean duration of disease was 9.1+-6.28 years (range of 2-34). Their demographic data including rheumatoid factor status was obtained. Standard conventional radiographs cervical spine were obtained to study the cervical spine changes. Cervical radiographic changes were found in 34 patients (27 females and 7 males) 10 had subluxation (7 with atlanto-axial subluxation,2 with sub-axial subluxation,and one with lateral subluxation ). No vertical impaction was seen. Erosion of odontoid process was seen in one patient .All were rheumatoid seropositive Cervical spine changes in patients with rheumatoid arthritis are common, in particular subluxation in the upper cervical spine. Our study showed somewhat lesser prevalence of these changes. These were clinically correlated with disease duration, female sex, and rheumatoid factor, but were not clinically significant. (author)

  13. Imaging the Traumatized Spine'Clearing The Cervical Spine'

    International Nuclear Information System (INIS)

    Monu, U.V.J.

    2015-01-01

    Failure to recognize and diagnose injury to the cervical spine on plain radiographs can lead to severe and devastating consequences to the patient in particular and to the radiologist financially and otherwise. CT examination of the cervical spine aids and significantly improves diagnoses in many instances. it is neither economically feasible nor desirable to obtain CT on all patients. Meticulous attention to detail and zero tolerance for deviations from the usual radiographic landmarks will help select cases that should obtain additional imaging in form of CT or MRI scans. Faced with a task of clearing a cervical spine, a number of options are available. The first discriminator is whether or not the patient can be cleared clinically. If that is not possible, radiographic evaluation is needed. Strict adherence to a minimum three view plain radiograph for C-spine series must be maintained. Deviation from established norms for cervical spine radiographs should trigger a CT for additional evaluation

  14. Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery

    OpenAIRE

    Daniels, Alan H.; Hart, Robert A.; Hilibrand, Alan S.; Fish, David E.; Wang, Jeffrey C.; Lord, Elizabeth L.; Buser, Zorica; Tortolani, P. Justin; Stroh, D. Alex; Nassr, Ahmad; Currier, Bradford L.; Sebastian, Arjun S.; Arnold, Paul M.; Fehlings, Michael G.; Mroz, Thomas E.

    2017-01-01

    Study Design: Retrospective cohort study of prospectively collected data. Objective: To examine the incidence of iatrogenic spinal cord injury following elective cervical spine surgery. Methods: A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was conducted. Medical records for 17?625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011,...

  15. Pediatric cervical spine trauma imaging: a practical approach

    Energy Technology Data Exchange (ETDEWEB)

    Egloff, Alexia M.; Kadom, Nadja; Vezina, Gilbert; Bulas, Dorothy [Children' s National Medical Center, Department of Imaging and Radiology, Washington, DC (United States)

    2009-05-15

    Cervical spine trauma in children is rare and the diagnosis can be challenging due to anatomical and biomechanical differences as compared to adults. A variety of algorithms have been used in adults to accurately diagnose injuries, but have not been fully studied in pediatric patients. In this article we review suggested imaging protocols and the general characteristics, types of injuries, and measurements used to diagnose cervical spine injuries in children. (orig.)

  16. Cervical bracing practices after degenerative cervical surgery: a survey of cervical spine research society members.

    Science.gov (United States)

    Lunardini, David J; Krag, Martin H; Mauser, Nathan S; Lee, Joon Y; Donaldson, William H; Kang, James D

    2018-05-21

    Context: Prior studies have shown common use of post-operative bracing, despite advances in modern day instrumentation rigidity and little evidence of brace effectiveness. To document current practice patterns of brace use after degenerative cervical spine surgeries among members of the Cervical Spine Research Society (CSRS), to evaluate trends, and to identify areas of further study. A questionnaire survey METHODS: A 10 question survey was sent to members of the Cervical Spine Research Society to document current routine bracing practices after various common degenerative cervical spine surgical scenarios, including fusion and non-fusion procedures. The overall bracing rate was 67%. This included 8.4% who used a hard collar in each scenario. Twenty-two percent of surgeons never used a hard collar, while 34% never used a soft collar, and 3.6% (3 respondents) did not use a brace in any surgical scenario. Bracing frequency for specific surgical scenarios varied from 39% after foraminotomy to 88% after multi-level corpectomy with anterior & posterior fixation. After one, two and three level anterior cervical discectomy & fusion (ACDF), bracing rates were 58%, 65% and 76% for an average of 3.3, 4.3 and 5.3 weeks, respectively. After single level corpectomy, 77% braced for an average of 6.2 weeks. After laminectomy and fusion, 72% braced for an average of 5.4 weeks. Significant variation persists among surgeons on the type and length of post-operative brace usage after cervical spine surgeries. Overall rates of bracing have not changed significantly with time. Given the lack evidence in the literature to support bracing, reconsidering use of a brace after certain surgeries may be warranted. Copyright © 2018. Published by Elsevier Inc.

  17. Acute hypotension in a patient undergoing posttraumatic cervical spine fusion with somatosensory and motor-evoked potential monitoring while under total intravenous anesthesia: a case report.

    Science.gov (United States)

    Cann, David F

    2009-02-01

    Hypotension should be vigilantly prevented in patients with spinal cord injury. Recent advances in neurological, intraoperative monitoring techniques have allowed Certified Registered Nurse Anesthetists to assess the effects of spinal cord ischemia and compression as they occur. This case report describes a young, healthy man who sustained a cervical spine fracture and was scheduled for anterior spinal fusion with somatosensory and motor-evoked potential (MEP) monitoring while under total intravenous anesthesia. This patient experienced a brief period of intraoperative hypotension with evidence of abnormal MEPs. A wake-up test was performed, which showed normal functioning, and the case resumed an uneventful course. Although this scenario resulted in no neurological sequelae, the effects of spinal cord ischemia due to hypotension can lead to permanent, devastating motor and sensory damage.

  18. Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report and Review of the Literature.

    Science.gov (United States)

    Hershman, Stuart H; Kunkle, William A; Kelly, Michael P; Buchowski, Jacob M; Ray, Wilson Z; Bumpass, David B; Gum, Jeffrey L; Peters, Colleen M; Singhatanadgige, Weerasak; Kim, Jin Young; Smith, Zachary A; Hsu, Wellington K; Nassr, Ahmad; Currier, Bradford L; Rahman, Ra'Kerry K; Isaacs, Robert E; Smith, Justin S; Shaffrey, Christopher; Thompson, Sara E; Wang, Jeffrey C; Lord, Elizabeth L; Buser, Zorica; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Multicenter retrospective case series and review of the literature. To determine the rate of esophageal perforations following anterior cervical spine surgery. As part of an AOSpine series on rare complications, a retrospective cohort study was conducted among 21 high-volume surgical centers to identify esophageal perforations following anterior cervical spine surgery. Staff at each center abstracted data from patients' charts and created case report forms for each event identified. Case report forms were then sent to the AOSpine North America Clinical Research Network Methodological Core for data processing and analysis. The records of 9591 patients who underwent anterior cervical spine surgery were reviewed. Two (0.02%) were found to have esophageal perforations following anterior cervical spine surgery. Both cases were detected and treated in the acute postoperative period. One patient was successfully treated with primary repair and debridement. One patient underwent multiple debridement attempts and expired. Esophageal perforation following anterior cervical spine surgery is a relatively rare occurrence. Prompt recognition and treatment of these injuries is critical to minimizing morbidity and mortality.

  19. Does rehabilitation of cervical lordosis influence sagittal cervical spine flexion extension kinematics in cervical spondylotic radiculopathy subjects?

    Science.gov (United States)

    Moustafa, Ibrahim Moustafa; Diab, Aliaa Attiah Mohamed; Hegazy, Fatma A; Harrison, Deed E

    2017-01-01

    To test the hypothesis that improvement of cervical lordosis in cervical spondylotic radiculopathy (CSR) will improve cervical spine flexion and extension end range of motion kinematics in a population suffering from CSR. Thirty chronic lower CSR patients with cervical lordosis lordosis (p lordosis in the study group was associated with significant improvement in the translational and rotational motions of the lower cervical spine. This finding provides objective evidence that cervical flexion/extension is partially dependent on the posture and sagittal curve orientation. These findings are in agreement with several other reports in the literature; whereas ours is the first post treatment analysis identifying this relationship.

  20. Gouty Arthropathy of the Cervical Spine in a Young Adult

    Directory of Open Access Journals (Sweden)

    Yi-Jie Kuo

    2007-04-01

    Full Text Available We report a young man with gouty discitis of the cervical spine. To our knowledge, our patient is the youngest patient with cervical gouty discitis reported in the literature. The clinical manifestation was similar to that of cervical spondylosis with radiculopathy. Gouty discitis was diagnosed only when tophi in the disc were found during surgery and proved by pathologic study. Surgical decompression followed by optimization of pharmacologic treatment enabled good recovery from neurologic complications.

  1. Computed tomography of the spinal canal for the cervical spine and spinal cord injury

    International Nuclear Information System (INIS)

    Kimura, Isao; Niimiya, Hikosuke; Nasu, Kichiro; Shioya, Akihide; Ohhama, Mitsuru

    1983-01-01

    The cervical spinal canal and cervical spinal cord were measured in normal cases and 34 cases of spinal or spinal cord injury. The anteroposterior diameter and area of the normal cervical spinal canal showed a high correlation. The area ratio of the normal cervical spinal canal to the cervical spinal cord showed that the proportion of the cervical spinal cord in the spinal canal was 1/3 - 1/5, Csub(4,5) showing a particularly large proportion. In acute and subacute spinal or spinal cord injury, CT visualized in more details of the spinal canal in cases that x-ray showed definite bone injuries. Computer assisted myelography visualized more clearly the condition of the spinal cord in cases without definite findings bone injuries on x-ray. Demonstrating the morphology of spinal injury in more details, CT is useful for selection of therapy for injured spines. (Chiba, N.)

  2. Experimental evaluation of the stability of goat's cervical spine after percutaneous cervical diskectomy

    International Nuclear Information System (INIS)

    Du Zhongli; Zhou Yicheng; Wang Chengyuan; Hong Cheng; Liu Hanqiao; Zhang Jiangfan; Ding Hui; Feng Dingyi

    1999-01-01

    Objective: To evaluate the stability of the goat's cervical spine after PCD (percutaneous cervical diskectomy). Methods: Ten adult goats were studied. Seven had PCD at C 3-4 , and three at C 4-5 . The cervical spine of the goat was studied with MR using axial, corona land sagittal images and with anteroposterior and lateral radiographs before and after PCD. The height of the disk, the disk space angle and dislocation were measured respectively before and after PCD. The data were examined by t-test. Results: The disk space (7 cases, 70%) became narrow obviously, and hyperostosis (5 cases, 50%) disk bulging (4 cases, 40%) appeared after PCD, but there was no obvious dislocation or angulation between the adjacent vertebral bodies. Conclusions: The stability of the goat's cervical spine is not affected after PCD. Indicating that this might also hold true for human cervical spine

  3. The rheumatoid cervical spine: Signs of instability on plain cervical radiographs

    International Nuclear Information System (INIS)

    Roche, Clare J.; Eyes, Brian E.; Whitehouse, Graham H.

    2002-01-01

    The cervical spine is a common focus of destruction from rheumatoid arthritis, second only to the metacarpophalangeal joints. Joint, bone and ligament damage in the cervical spine leads to subluxations which can cause cervical cord compression resulting in paralysis and even sudden death. Because many patients with significant subluxations are asymptomatic, the radiologist plays a key role in recognizing the clinically important clues to instability on plain radiographs of the cervical spine-often difficult in rheumatoid arthritis when the bony landmarks are osteoporotic or eroded. This review focuses on the signs of instability on plain radiographs of the cervical spine, using diagrams and clinical examples to illustrate methods of identifying significant subluxations in rheumatoid arthritis. Roche, C.J., Eyes, B.E. and Whitehouse, G.H. (2002)

  4. Functional diagnostics of the cervical spine by using computer tomography

    International Nuclear Information System (INIS)

    Dvorak, J.; Hayek, J.; Grob, D.

    1988-01-01

    35 healthy adults and 137 patients after cervical spine injury were examined by functional CT. The range of axial rotation at the level occiput/atlas, atlas/axis and the segment below were measured in all subjects. A rotation occiput/atlas of more than 7 0 , and C1/C2 more than 54 0 could refer to segmental hypermobility, a rotation at the segment C1/C2 less than 29 0 to hypomobility. According to the postulated normal values based upon a 98% confidence level, out of 137 patients examined after cervical spine injury and with therapy-resistant neck pain, 45 showed signs of segmental hypermobility of the upper cervical spine, 17 showed hyper- or hypomobility at different levels, 10 patients presented segmental hypomobility at C1/C2 level alone. In all patients, according to the clinical assessment, functional pathology was suspected in the upper cervical spine. Surgical correction of rotatory instability should be considered as a possible therapeutic procedure after successful diagnostic stabilisation of the cervical spine by minerva cast. (orig.)

  5. Functional diagnostics of the cervical spine by using computer tomography

    Energy Technology Data Exchange (ETDEWEB)

    Dvorak, J; Hayek, J; Grob, D; Penning, L; Panjabi, M M; Zehnder, R

    1988-04-01

    35 healthy adults and 137 patients after cervical spine injury were examined by functional CT. The range of axial rotation at the level occiput/atlas, atlas/axis and the segment below were measured in all subjects. A rotation occiput/atlas of more than 7/sup 0/, and C1/C2 more than 54/sup 0/ could refer to segmental hypermobility, a rotation at the segment C1/C2 less than 29/sup 0/ to hypomobility. According to the postulated normal values based upon a 98% confidence level, out of 137 patients examined after cervical spine injury and with therapy-resistant neck pain, 45 showed signs of segmental hypermobility of the upper cervical spine, 17 showed hyper- or hypomobility at different levels, 10 patients presented segmental hypomobility at C1/C2 level alone. In all patients, according to the clinical assessment, functional pathology was suspected in the upper cervical spine. Surgical correction of rotatory instability should be considered as a possible therapeutic procedure after successful diagnostic stabilisation of the cervical spine by minerva cast.

  6. Catastrophic Cervical Spine Injuries in Contact Sports

    Science.gov (United States)

    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

  7. Catastrophic Cervical Spine Injuries in Contact Sports.

    Science.gov (United States)

    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

    2016-11-01

    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.

  8. Esophageal perforation associated with cervical spine surgery: Report of two cases and review of the literature

    NARCIS (Netherlands)

    Vrouenraets, B. C.; Been, H. D.; Brouwer-Mladin, R.; Bruno, M.; van Lanschot, J. J. B.

    2004-01-01

    Background/Aims: Esophageal perforation after anterior cervical spine surgery is a rare complication with various clinical presentations and treatments. Methods: Two cases of esophageal perforation after anterior cervical spine surgery are described, one occurring in the immediate postoperative

  9. Analysis of cervical spine function in healthy persons

    International Nuclear Information System (INIS)

    Weh, L.; Roettker, H.

    1990-01-01

    Radiograms were taken of subjects with no symptoms of cervical spine problems; the cervical spine was evaluated in the spontaneous posture and at maximal flexion and extension. The position and movement of the vertebra, intervertebral height and gliding were calculated. The results showed that (1) lordosis in women occurred less pronouncedly than in men, and that there was an increase with age; (2) C 2-3 was the least flexible segment and mobility increased in the caudal direction; mobility decreased with age and the segments of the lower cervical spine with the highest mobility decreased the most; (3) all posterior and ventral intervertebral heights showed a decrease with age at C 5-6 and C 6-7; (4) vertebral gliding decreased with age. (orig.) [de

  10. MR manifestations of vertebral artery injuries in cervical spine trauma

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Jeong Sik; Chung, Tae Sub; Kim, Young Soo; Cho, Yong Eun; Kang, Byung Chul; Kim, Dong Ik [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-11-01

    To assess the diagnostic efficacy of magnetic resonance (MR) imaging in the detection of a vertebral artery injury occurring from major cervical spine trauma. Conventional MR findings of 63 patients and 63 control subjects were compared to detect a possible change in the vertebral arteries resulted from trauma. Plain films, CT and clinical records were also reviewed to correlate the degree of cervical spine injury with vascular change. Nine cases of absent flow signals in vessel lumen were observed in eight patients and one was observed in the control group. Patients more frequently demonstrated other abnormalities such as intraluminal linear signals (n=3) or focal luminal narrowing (n=9) but there was no statistical significance. There was a close relationship between degree of cord damage and occlusion of the vertebral artery. Conventional MR imaging is useful in the detection of vertebral artery occlusion resulting from cervical spine trauma.

  11. Multidetector CT of blunt cervical spine trauma in adults.

    Science.gov (United States)

    Dreizin, David; Letzing, Michael; Sliker, Clint W; Chokshi, Falgun H; Bodanapally, Uttam; Mirvis, Stuart E; Quencer, Robert M; Munera, Felipe

    2014-01-01

    A number of new developments in cervical spine imaging have transpired since the introduction of 64-section computed tomographic (CT) scanners in 2004. An increasing body of evidence favors the use of multidetector CT as a stand-alone screening test for excluding cervical injuries in polytrauma patients with obtundation. A new grading scale that is based on CT and magnetic resonance (MR) imaging findings, the cervical spine Subaxial Injury Classification and Scoring (SLIC) system, is gaining acceptance among spine surgeons. Radiographic measurements described for the evaluation of craniocervical distraction injuries are now being reevaluated with the use of multidetector CT. Although most patients with blunt trauma are now treated nonsurgically, evolution in the understanding of spinal stability, as well as the development of new surgical techniques and hardware, has driven management strategies that are increasingly favorable toward surgical intervention. It is therefore essential that radiologists recognize findings that distinguish injuries with ligamentous instability or a high likelihood of nonfusion that require surgical stabilization from those that are classically stable and can be treated with a collar or halo vest alone. The purpose of this article is to review the spectrum of cervical spine injuries, from the craniocervical junction through the subaxial spine, and present the most widely used grading systems for each injury type. ©RSNA, 2014.

  12. [Literature review of whiplash injuries of the cervical spine].

    Science.gov (United States)

    Pavić, Roman

    2011-01-01

    The paper presents the latest information in world literature on whiplash injury of the cervical spine. This injury has been noted through history, mentioned as early as Ancient Egypt, and prevalent in the 19 century, the time before using the car, until today. The mechanism of injury is described, as well as treatment, and news in view of the frequency of injuries in different parts of the world and the impact of socio-cultural, economic, ethnic and geographic factors. Impacts of traffic laws, automobile production and automobile seats that would indicate the possibility of prevention as a result of a whiplash injury of the cervical spine are also presented.

  13. Examination of Cervical Spine Histological Sections - A Technical Note

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Ullerup, Rita; Vesterby, Annie

    2006-01-01

    Detailed knowledge of the cervical spine facet joints morphology and anatomy is increasingly important since improved understanding of clinical syndromes, such as whiplash injuries, and therapeutic interventions is based on this knowledge. So far systematic examination of the age-related morphology...... of these joints has not yet been performed, nor has any generally accepted histological classification system for degenerative changes in the cervical spine facet joints been proposed. In the case of whiplash injuries the presented histological method has particular relevance since it allows detailed description...

  14. A radiological study on the cervical spine in rheumatoid arthritis

    International Nuclear Information System (INIS)

    Taketomi, Eiji; Sakoh, Takashi; Sunahara, Nobuhiko

    1995-01-01

    The cervical spine was examined with the magnetic resonance imaging (MRI) and the conventional roentgenograms in 95 patients with rheumatoid arthritis. The MRI findings of upper cervical disorders were compared with various values determined in roentgenograms: the atlanto-dental interval (ADI), the space available for the spinal cord (SAC), and the Ranawat and Redlund-Johnell values. In patients with vertical setting (VS), MRI showed medullary compression in all those with abnormal Redlund-Johnell values and Ranawat values of 7 mm or less. In patients with anterior atlanto-axial subluxation, compression of the upper cervical cord was observed in all patients with SAC of 13 mm or less. In subaxial lesion of the cervical spine, MRI was found to be as good as roentgenograms in evaluating plate erosion and disc space narrowing and MRI showed extradural pannus. (author)

  15. A radiological study on the cervical spine in rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Taketomi, Eiji; Sakoh, Takashi; Sunahara, Nobuhiko [Kagoshima Univ. (Japan). Faculty of Medicine

    1995-03-01

    The cervical spine was examined with the magnetic resonance imaging (MRI) and the conventional roentgenograms in 95 patients with rheumatoid arthritis. The MRI findings of upper cervical disorders were compared with various values determined in roentgenograms: the atlanto-dental interval (ADI), the space available for the spinal cord (SAC), and the Ranawat and Redlund-Johnell values. In patients with vertical setting (VS), MRI showed medullary compression in all those with abnormal Redlund-Johnell values and Ranawat values of 7 mm or less. In patients with anterior atlanto-axial subluxation, compression of the upper cervical cord was observed in all patients with SAC of 13 mm or less. In subaxial lesion of the cervical spine, MRI was found to be as good as roentgenograms in evaluating plate erosion and disc space narrowing and MRI showed extradural pannus. (author).

  16. Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery.

    Science.gov (United States)

    Daniels, Alan H; Hart, Robert A; Hilibrand, Alan S; Fish, David E; Wang, Jeffrey C; Lord, Elizabeth L; Buser, Zorica; Tortolani, P Justin; Stroh, D Alex; Nassr, Ahmad; Currier, Bradford L; Sebastian, Arjun S; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Retrospective cohort study of prospectively collected data. To examine the incidence of iatrogenic spinal cord injury following elective cervical spine surgery. A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was conducted. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were reviewed to identify occurrence of iatrogenic spinal cord injury. In total, 3 cases of iatrogenic spinal cord injury following cervical spine surgery were identified. Institutional incidence rates ranged from 0.0% to 0.24%. Of the 3 patients with quadriplegia, one underwent anterior-only surgery with 2-level cervical corpectomy, one underwent anterior surgery with corpectomy in addition to posterior surgery, and one underwent posterior decompression and fusion surgery alone. One patient had complete neurologic recovery, one partially recovered, and one did not recover motor function. Iatrogenic spinal cord injury following cervical spine surgery is a rare and devastating adverse event. No standard protocol exists that can guarantee prevention of this complication, and there is a lack of consensus regarding evaluation and treatment when it does occur. Emergent imaging with magnetic resonance imaging or computed tomography myelography to evaluate for compressive etiology or malpositioned instrumentation and avoidance of hypotension should be performed in cases of intraoperative and postoperative spinal cord injury.

  17. Professional responsibility in relation to cervical spine manipulation.

    Science.gov (United States)

    Refshauge, Kathryn M; Parry, Sharon; Shirley, Debra; Larsen, Dale; Rivett, Darren A; Boland, Rob

    2002-01-01

    Manipulation of the cervical spine is one of the few potentially life-threatening procedures performed by physiotherapists. Is it worth the risk? A comparison of risks versus benefits indicates that at present, the risks of cervical manipulation outweigh the benefits: manipulation has yet to be shown to be more effective for neck pain and headache than other interventions such as mobilisation, whereas the risks, although infrequent, are serious. This analysis is of particular concern because the conditions for which manipulation is indicated are benign and usually self-limiting. Because physiotherapists have legal and ethical obligations to the community to avoid foreseeable harm and provide optimum care, it may be prudent to determine who in our profession should perform cervical manipulation. That is, the profession could restrict the practice of cervical spine manipulation. Although all registered physiotherapists in Australia are entitled to perform cervical manipulation, few choose to use this intervention. Therefore, it might be feasible to encourage those practitioners who wish to use cervical manipulation to undertake formal education programs. Such a requirement could be embodied in a code of practice that discourages those without formal training from performing cervical manipulation. By taking such measures, we could ensure that our profession exercises wisdom in its monitoring and use of cervical manipulation.

  18. Rare Complications of Cervical Spine Surgery: Horner's Syndrome.

    Science.gov (United States)

    Traynelis, Vincent C; Malone, Hani R; Smith, Zachary A; Hsu, Wellington K; Kanter, Adam S; Qureshi, Sheeraz A; Cho, Samuel K; Baird, Evan O; Isaacs, Robert E; Rahman, Ra'Kerry K; Polevaya, Galina; Smith, Justin S; Shaffrey, Christopher; Tortolani, P Justin; Stroh, D Alex; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    A multicenter retrospective case series. Horner's syndrome is a known complication of anterior cervical spinal surgery, but it is rarely encountered in clinical practice. To better understand the incidence, risks, and neurologic outcomes associated with Horner's syndrome, a multicenter study was performed to review a large collective experience with this rare complication. We conducted a retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records for 17 625 patients who received subaxial cervical spine surgery from 2005 to 2011 were reviewed to identify occurrence of 21 predefined treatment complications. Descriptive statistics were provided for baseline patient characteristics. Paired t test was used to analyze changes in clinical outcomes at follow-up compared to preoperative status. In total, 8887 patients who underwent anterior cervical spine surgery at the participating institutions were screened. Postoperative Horner's syndrome was identified in 5 (0.06%) patients. All patients experienced the complication following anterior cervical discectomy and fusion. The sympathetic trunk appeared to be more vulnerable when operating on midcervical levels (C5, C6), and most patients experienced at least a partial recovery without further treatment. This collective experience suggests that Horner's syndrome is an exceedingly rare complication following anterior cervical spine surgery. Injury to the sympathetic trunk may be limited by maintaining a midline surgical trajectory when possible, and performing careful dissection and retraction of the longus colli muscle when lateral exposure is necessary, especially at caudal cervical levels.

  19. Significance of prevertebral soft tissue measurement in cervical spine injuries

    Energy Technology Data Exchange (ETDEWEB)

    Dai Liyang E-mail: lydai@etang.com

    2004-07-01

    Objective: The objective of this study was to evaluate the diagnostic value of prevertebral soft tissue swelling in cervical spine injuries. Materials and methods: A group of 107 consecutive patients with suspected injuries of the cervical vertebrae were reviewed retrospectively to identify the presence of prevertebral soft tissue swelling and to investigate the association of prevertebral soft tissue swelling with the types and degrees of cervical spine injuries. Results: Prevertebral soft tissue swelling occurred in 47 (43.9%) patients. Of the 47 patients, 38 were found with bony injury and nine were without. The statistic difference was significant (P<0.05). No correlation was demonstrated between soft tissue swelling and either the injured level of the cervical vertebrae or the degree of the spinal cord injury (P>0.05). Anterior element injuries in the cervical vertebrae had widening of the prevertebral soft tissue more than posterior element injuries (P<0.05). Conclusion: The diagnostic value of prevertebral soft tissue swelling for cervical spine injuries is significant, but the absence of this sign does not mean that further image evaluation can be spared.

  20. Comparison of Three Prehospital Cervical Spine Protocols for Missed Injuries

    Directory of Open Access Journals (Sweden)

    Rick Hong

    2014-07-01

    Full Text Available Introduction: We wanted to compare 3 existing emergency medical services (EMS immobilization protocols: the Prehospital Trauma Life Support (PHTLS, mechanism-based; the Domeier protocol (parallels the National Emergency X-Radiography Utilization Study [NEXUS] criteria; and the Hankins’ criteria (immobilization for patients 65 years, those with altered consciousness, focal neurologic deficit, distracting injury, or midline or paraspinal tenderness.To determine the proportion of patients who would require cervical immobilization per protocol and the number of missed cervical spine injuries, had each protocol been followed with 100% compliance. Methods: This was a cross-sectional study of patients ≥18 years transported by EMS post-traumatic mechanism to an inner city emergency department. Demographic and clinical/historical data obtained by physicians were recorded prior to radiologic imaging. Medical record review ascertained cervical spine injuries. Both physicians and EMS were blinded to the objective of the study. Results: Of 498 participants, 58% were male and mean age was 48 years. The following participants would have required cervical spine immobilization based on the respective protocol: PHTLS, 95.4% (95% CI: 93.1-96.9%; Domeier, 68.7% (95% CI: 64.5-72.6%; Hankins, 81.5% (95% CI: 77.9-84.7%. There were 18 cervical spine injuries: 12 vertebral fractures, 2 subluxations/dislocations and 4 spinal cord injuries. Compliance with each of the 3 protocols would have led to appropriate cervical spine immobilization of all injured patients. In practice, 2 injuries were missed when the PHTLS criteria were mis-applied. Conclusion: Although physician-determined presence of cervical spine immobilization criteria cannot be generalized to the findings obtained by EMS personnel, our findings suggest that the mechanism-based PHTLS criteria may result in unnecessary cervical spine immobilization without apparent benefit to injured patients. PHTLS

  1. MRI in degenerative diseases of the cervical spine

    International Nuclear Information System (INIS)

    Schubeus, P.; Sander, B.; Hosten, N.; Mayer, H.M.; Weber, U.; Felix, R.

    1994-01-01

    MRI has grown increasingly important in recent years in diagnosis of degenerative diseases of the cervical spine, due to improvements of method that have made it a valuable diagnostic tool. The following contribution gives a brief introduction to the pathophysiology of degenerative changes in the cervical vertebral column and to the indications for MRI, describing within the framework of imaging the present state of MR examination technique. The ranking of the various gradient echo sequences, of the 3D methods and of the administration of contrast media in cervical myelopathy and radiaculopathy is discussed. (orig.) [de

  2. MRI findings in the upper cervical spine of rheumatoid arthritis

    International Nuclear Information System (INIS)

    Kawaida, Hidefumi; Sakou, Takashi; Morizono, Yoshiyuki; Yoshikuni, Nagatoshi; Taketomi, Eiji; Hashiguchi, Masanao

    1989-01-01

    In 55 patients with rheumatoid arthritis associated with upper cervical spine abnormality, the presence or absence of medullary and upper cervical pressures was examined on sagittal MRI scans. Atlanto-dental anterior incomplete dislocation and horizontal dislocation were imaged concurrently with X-rays. For horizontal dislocation, an abnormal Redlund-Johnell value and a Ranawat value of 7 mm or less were always associated with medullary pressure as seen on MRI. For anterior incomplete dislocation, upper cervical pressure was always associated when a space available for the spinal cord was 13 mm or less or frequently associated when the atlanto-dental interval was 8 mm or more. Many of the patients with the upper cervical abnormalities complained of occipital or cervical pain. The pain was always encountered in patients with an abnormal Redlund-Johnell value. Roentgenography of the cervical spine confirmed MRI-proven medullary or upper cervical pressure, suggesting the potential of MRI in the treatment of rheumatoid arthritis. (Namekawa, K)

  3. MRI findings in the upper cervical spine of rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Kawaida, Hidefumi; Sakou, Takashi; Morizono, Yoshiyuki; Yoshikuni, Nagatoshi; Taketomi, Eiji; Hashiguchi, Masanao

    1989-04-01

    In 55 patients with rheumatoid arthritis associated with upper cervical spine abnormality, the presence or absence of medullary and upper cervical pressures was examined on sagittal MRI scans. Atlanto-dental anterior incomplete dislocation and horizontal dislocation were imaged concurrently with X-rays. For horizontal dislocation, an abnormal Redlund-Johnell value and a Ranawat value of 7 mm or less were always associated with medullary pressure as seen on MRI. For anterior incomplete dislocation, upper cervical pressure was always associated when a space available for the spinal cord was 13 mm or less or frequently associated when the atlanto-dental interval was 8 mm or more. Many of the patients with the upper cervical abnormalities complained of occipital or cervical pain. The pain was always encountered in patients with an abnormal Redlund-Johnell value. Roentgenography of the cervical spine confirmed MRI-proven medullary or upper cervical pressure, suggesting the potential of MRI in the treatment of rheumatoid arthritis. (Namekawa, K).

  4. Early MRI findings in stab wound of the cervical spine: two case reports

    Energy Technology Data Exchange (ETDEWEB)

    Alkan, A.; Baysal, T.; Sarac, K.; Sigirci, A.; Kutlu, R. [Inonu Universitesi Turgut Ozal Tip Merkezi, Radyoloji Anabilim Dali, Malatya (Turkey)

    2002-01-01

    MR imaging was found to be the most sensitive modality for the detection of spinal cord abnormalities in the acutely injured spine. Although it is reported that traumatic pneumomyelogram indicates a base-of-skull or middle cranial fossa fracture and is almost certainly associated with intracranial subarachnoid air, early MR imaging may demonstrate subarachnoid air in penetrating trauma of the spinal cord without head injury. We report two cervical-spine stab-wound cases, one of which had subarachnoid air on early MR findings. (orig.)

  5. Closed cervical spine trauma associated with bilateral vertebral artery injuries

    NARCIS (Netherlands)

    Kloen, P.; Patterson, J. D.; Wintman, B. I.; Ozuna, R. M.; Brick, G. W.

    1999-01-01

    Bilateral vertebral artery injuries in closed cervical spine injuries are uncommon, but early recognition and treatment are important to prevent neurological deterioration. A case of bilateral vertebral injuries in a 35-year-old motor vehicle accident victim is presented, and the current literature

  6. tuberculosis of the cervical spine mimicking a paraplegic tumour in ...

    African Journals Online (AJOL)

    2011-05-05

    May 5, 2011 ... Magnetic Resonence Imaging. (MRI)and x-rays revealed an infiltrative lesion of C6-C7 vertebrae. Our main diffential ... response to result in caseation and abscess formation. INTRODUCTION. Tuberculosis (TB) of the ... MRI cervical spine coronal view (T2 weighted image). Notice the absence of significant ...

  7. Positional device for cinematographic MR of the cervical spine

    International Nuclear Information System (INIS)

    Muhle, C.; Melchert, U.H.; Brossmann, J.; Schroeder, C.; Wiskirchen, J.; Heller, M.

    1995-01-01

    A novel positioning device is explained and the experience obtained so far with its application in cinematic MRI of the cervical spine, allowing an extended range of movement from 60 degrees ante- to 40 degrees retroflexion. The tests were done with volounteers. (orig./MG) [de

  8. Screening cervical spine CT in the emergency department, phase 3: increasing effectiveness of imaging.

    Science.gov (United States)

    Griffith, Brent; Vallee, Phyllis; Krupp, Seth; Jung, Melissa; Slezak, Michelle; Nagarwala, Jumana; Loeckner, C Patrick; Schultz, Lonni R; Jain, Rajan

    2014-02-01

    The aim of this study was to determine the effect of a clinical education initiative on the appropriate utilization of screening cervical spine CT in the emergency department. The purpose was to assess if clinical education can produce stricter adherence to the ACR Appropriateness Criteria and improve the utilization of screening CT examinations in the emergency department. Institutional review board approval was obtained for this HIPAA-compliant study. All adult patients presenting to a level 1 trauma center with blunt trauma prompting screening cervical spine CT were eligible. For each study, the requesting clinician completed a survey selecting all clinical indications. CT examinations were evaluated by a board-certified radiologist blinded to survey data. Results were compared with retrospective and prospective studies performed before the institution of the education initiative. Of the 388 cervical spine CT examinations performed, 12 (3.1%) were positive for acute cervical spine injury, compared to only 1.0% before the clinical education program (phase 2). Of the 376 examinations without injury, 13% met all 5 National Emergency X-Radiography Utilization Study criteria for nonimaging (down from 16.1% in phase 2), and 15 (4%) required no imaging when both National Emergency X-Radiography Utilization Study and abbreviated Canadian cervical spine rule criteria were applied. Implementation of a clinical education initiative resulted in improved adherence to ACR Appropriateness Criteria and improved clinical effectiveness of the studies by increasing fracture detection rate. Initiatives such as these could potentially influence imaging overutilization without burdening emergency department clinicians with excessive roadblocks to image ordering. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  9. [The biomechanics of hyperextension injuries of the subaxial cervical spine].

    Science.gov (United States)

    Stein, G; Meyer, C; Ingenhoff, L; Bredow, J; Müller, L P; Eysel, P; Schiffer, G

    2017-07-01

    Hyperextension injuries of the subaxial cervical spine are potentially hazardous due to relevant destabilization. Depending on the clinical condition, neurologic or vascular damage may occur. Therefore an exact knowledge of the factors leading to destabilization is essential. In a biomechanical investigation, 10 fresh human cadaver cervical spine specimens were tested in a spine simulator. The tested segments were C4 to 7. In the first step, physiologic motion was investigated. Afterwards, the three steps of injury were dissection of the anterior longitudinal ligament, removal of the intervertebral disc/posterior longitudinal ligament, and dissection of the interspinous ligaments/ligamentum flavum. After each step, the mobility was determined. Regarding flexion and extension, an increase in motion of 8.36 % after the first step, 90.45 % after the second step, and 121.67 % after the last step was observed. Testing of lateral bending showed an increase of mobility of 7.88 %/27.48 %/33.23 %; axial rotation increased by 2.87 %/31.16 %/45.80 %. Isolated dissection of the anterior longitudinal ligament led to minor destabilization, whereas the intervertebral disc has to be seen as a major stabilizer of the cervical spine. Few finite-element studies showed comparable results. If a transfer to clinical use is undertaken, an isolated rupture of the anterior longitudinal ligament can be treated without surgical stabilization.

  10. Percutaneous vertebroplasty for multiple myeloma of the cervical spine

    International Nuclear Information System (INIS)

    Mont'Alverne, Francisco; Vallee, Jean-Noel; Guillevin, Remy; Cormier, Evelyne; Jean, Betty; Rose, Michelle; Chiras, Jacques; Caldas, Jose Guilherme

    2009-01-01

    Spinal involvement is a common presentation of multiple myeloma (MM); however, the cervical spine is the least common site of myelomatous involvement. Few studies evaluate the results of percutaneous vertebroplasty (PV) in the treatment of MM of the spine. The purpose of this series is to report on the use of PV in the treatment of MM of the cervical spine and to review the literature. From January 1994 to October 2007, four patients (three men and one woman; mean age, 45 years) who underwent five PV for painful MM in the cervical spine were retrospectively reviewed. The pain was estimated by the patient on a verbal analogic scale. Clinical follow-up was available for all patients (mean, 27.5 months; range, 1-96 months). The mean volume of cement injected per vertebral body was 2.3 ± 0.8 mL (range, 1.0-4.0 mL) with a mean vertebral filling of 55.0 ± 12.0% (range, 40.0-75.0%). Analgesic efficacy was achieved in all patients. One patient had a spinal instability due to a progression of spinal deformity noted on follow-up radiographs, without clinical symptoms. Cement leakage was detected in three (60%) of the five treated vertebrae. There was no clinical complication. The present series suggests that PV for MM of the cervical spine is safe and effective for pain control; nonetheless, the detrimental impact of the disease on bone quality should prompt close radiological follow-up after PV owing to the risk of spinal instability. (orig.)

  11. Tracheostomy following anterior cervical spine fusion in trauma patients.

    Science.gov (United States)

    Binder, Harald; Lang, Nikolaus; Tiefenboeck, Thomas M; Bukaty, Adam; Hajdu, Stefan; Sarahrudi, Kambiz

    2016-06-01

    Traumatic injuries to the cervical spine are frequently accompanied by cervical spinal cord injuries-often necessitating tracheostomy. The purpose of this study was to evaluate patient characteristics and outcomes after undergoing anterior cervical spine fusion (ACSF) with tracheostomy. All patients with cervical spine injury (CSI) who underwent ACSF and tracheostomy between December 1992 and June 2014 were included in this retrospective data analysis. The study group consisted of 32 men (84 %) and six women (16 %), with an average age of 47 ± 20 years. Blunt trauma to the cervical spine was the cause of CSI in all 38 patients. The mean Injury Severity Score (ISS) was 30.50 ± 6.25. Eighteen patients sustained severe concomitant injuries related to the spinal injury. In 15 patients (39.5 %), traumatic brain injury (TBI) with fractures of the cranium and/or intracranial lesions were observed. The mean Glasgow Coma Scale (GCS) score was 11 ± 4.5 (range 3-15). Two tracheostomies (5.3 %) were performed simultaneously with ACSF. The remaining 36 were performed with an average "delay" of 15 ± ten days. We observed no difference in time to tracheostomy among patients initially presenting with an American Spinal Injury Association (ASIA) score of either A, B, C or D. Only two patients (5.3 %) were identified as having an infection at the site of ACSF after placement of a tracheostomy. There were no deaths directly related to airway difficulties in our cohort. Our data show that tracheostomy is safely performed after an average of 15 days post-ACSF, thereby being associated with a very low rate of complications. However, future prospective randomised studies are needed to identify the optimal timing of tracheostomy placement after ACSF. IV; retrospective case series.

  12. The treatment of pharyngoesophageal perforation following anterior cervical spine intervention.

    Science.gov (United States)

    Aslıer, Mustafa; Doğan, Ersoy; Ecevit, Mustafa Cenk; Erdağ, Taner Kemal; Ikiz, Ahmet Omer

    2016-06-01

    We aimed to investigate the diagnostic and therapeutic approaches in pharyngoesophageal perforation (PEP) following anterior cervical spine intervention (ACSI). We reviewed the records of four patients with PEP after ACSI. Symptoms, physical examination findings, imaging results, treatment, and follow-up characteristics were evaluated. All four patients had undergone ACSI for either cervical trauma or cervical disc herniation with cervical cage reconstruction. Symptoms developed within the first 10 days of the postoperative period in three patients, and in the eighth month in one patient. Mucosal defects were detected during neck exploration in three patients. Reconstruction with primary suture and a local muscle flap was utilized in two patients. Three patients were discharged 3-8 weeks after surgical treatment. In cases of PEP after ACSI, a good prognosis can be achieved when symptoms are detected in the early period and reconstruction with local muscle flap is applied. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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

    Science.gov (United States)

    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. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Rare Complications of Cervical Spine Surgery: Horner’s Syndrome

    Science.gov (United States)

    Malone, Hani R.; Smith, Zachary A.; Hsu, Wellington K.; Kanter, Adam S.; Qureshi, Sheeraz A.; Cho, Samuel K.; Baird, Evan O.; Isaacs, Robert E.; Rahman, Ra’Kerry K.; Polevaya, Galina; Smith, Justin S.; Shaffrey, Christopher; Tortolani, P. Justin; Stroh, D. Alex; Arnold, Paul M.; Fehlings, Michael G.; Mroz, Thomas E.; Riew, K. Daniel

    2017-01-01

    Study Design: A multicenter retrospective case series. Objective: Horner’s syndrome is a known complication of anterior cervical spinal surgery, but it is rarely encountered in clinical practice. To better understand the incidence, risks, and neurologic outcomes associated with Horner’s syndrome, a multicenter study was performed to review a large collective experience with this rare complication. Methods: We conducted a retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records for 17 625 patients who received subaxial cervical spine surgery from 2005 to 2011 were reviewed to identify occurrence of 21 predefined treatment complications. Descriptive statistics were provided for baseline patient characteristics. Paired t test was used to analyze changes in clinical outcomes at follow-up compared to preoperative status. Results: In total, 8887 patients who underwent anterior cervical spine surgery at the participating institutions were screened. Postoperative Horner’s syndrome was identified in 5 (0.06%) patients. All patients experienced the complication following anterior cervical discectomy and fusion. The sympathetic trunk appeared to be more vulnerable when operating on midcervical levels (C5, C6), and most patients experienced at least a partial recovery without further treatment. Conclusions: This collective experience suggests that Horner’s syndrome is an exceedingly rare complication following anterior cervical spine surgery. Injury to the sympathetic trunk may be limited by maintaining a midline surgical trajectory when possible, and performing careful dissection and retraction of the longus colli muscle when lateral exposure is necessary, especially at caudal cervical levels. PMID:28451480

  15. Examination of Cervical Spine Histological Sections - A Technical Note

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Ullerup, Rita; Vesterby, Annie

    2006-01-01

    Detailed knowledge of the cervical spine facet joints morphology and anatomy is increasingly important since improved understanding of clinical syndromes, such as whiplash injuries, and therapeutic interventions is based on this knowledge. So far systematic examination of the age-related morphology...... of these joints has not yet been performed, nor has any generally accepted histological classification system for degenerative changes in the cervical spine facet joints been proposed. In the case of whiplash injuries the presented histological method has particular relevance since it allows detailed description...... of the anatomy and pathoanatomical status of the osteo-cartilagenous structures, including the facet joints from where a major portion of chronic whiplash patients experience their pain symptoms....

  16. Loading effects of anterior cervical spine fusion on adjacent segments

    Directory of Open Access Journals (Sweden)

    Chien-Shiung Wang

    2012-11-01

    Full Text Available Adjacent segment degeneration typically follows anterior cervical spine fusion. However, the primary cause of adjacent segment degeneration remains unknown. Therefore, in order to identify the loading effects that cause adjacent segment degeneration, this study examined the loading effects to superior segments adjacent to fused bone following anterior cervical spine fusion. The C3–C6 cervical spine segments of 12 sheep were examined. Specimens were divided into the following groups: intact spine (group 1; and C5–C6 segments that were fused via cage-instrumented plate fixation (group 2. Specimens were cycled between 20° flexion and 15° extension with a displacement control of 1°/second. The tested parameters included the range of motion (ROM of each segment, torque and strain on both the body and inferior articular process at the superior segments (C3–C4 adjacent to the fused bone, and the position of the neutral axis of stress at under 20° flexion and 15° extension. Under flexion and Group 2, torque, ROM, and strain on both the bodies and facets of superior segments adjacent to the fused bone were higher than those of Group 1. Under extension and Group 2, ROM for the fused segment was less than that of Group 1; torque, ROM, and stress on both the bodies and facets of superior segments adjacent to the fused bone were higher than those of Group 1. These analytical results indicate that the muscles and ligaments require greater force to achieve cervical motion than the intact spine following anterior cervical spine fusion. In addition, ROM and stress on the bodies and facets of the joint segments adjacent to the fused bone were significantly increased. Under flexion, the neutral axis of the stress on the adjacent segment moved backward, and the stress on the bodies of the segments adjacent to the fused bone increased. These comparative results indicate that increased stress on the adjacent segments is caused by stress-shielding effects

  17. Dysphagia produced by cervical spine osteophyte. A case report

    Directory of Open Access Journals (Sweden)

    Claudio Silveri

    2014-01-01

    Full Text Available We present a case of a 73-year-old male patient with progressive dysphagia, and hoarseness (irritability in the throat. He was studied with the appropriate imaging techniques, and esophagoscopy led to a diagnosis of extrinsic esophageal dysphagia for osteophyte obstruction of the cervical spine due to the arthrosis. A surgical resection was performed, without complications. Some considerations are given on this theme.

  18. Multidetector Computed Tomography of Cervical Spine Fractures in Ankylosing Spondylitis

    Energy Technology Data Exchange (ETDEWEB)

    Koivikko, M.P.; Kiuru, M.J.; Koskinen, S.K. [Helsinki Univ. Central Hospital, Toeoeloe Trauma Center (Finland). Dept. of Radiology

    2004-11-01

    Purpose: To analyze multidetector computed tomography (MDCT) cervical spine findings in trauma patients with advanced ankylosing spondylitis (AS). Material and Methods: Using PACS, 2282 cervical spine MDCT examinations requested by emergency room physicians were found during a period of 3 years. Of these patients, 18 (16 M, aged 41-87, mean 57 years) had advanced AS. Primary imaging included radiography in 12 and MRI in 11 patients. Results: MDCT detected one facet joint subluxation and 31 fractures in 17 patients: 14 transverse fractures, 8 spinous process fractures, 2 Jefferson's fractures, 1 type I and 2 type II odontoid process fractures, and 1 each: atlanto-occipital joint fracture and C2 laminar fracture plus isolated transverse process and facet joint fractures. Radiographs detected 48% and MRI 60% of the fractures. MRI detected all transverse and odontoid fractures, demonstrating spinal cord abnormalities in 72%. Conclusion: MDCT is superior to plain radiographs or MRI, showing significantly more injuries and yielding more information on fracture morphology. MRI is valuable, however, in evaluating the spinal cord and soft-tissue injuries. Fractures in advanced AS often show an abnormal orientation and are frequently associated with spinal cord injuries. In these patients, for any suspected cervical spine injuries, MDCT is therefore the imaging modality of choice.

  19. Clearance of the cervical spine in clinically unevaluable trauma patients.

    Science.gov (United States)

    Halpern, Casey H; Milby, Andrew H; Guo, Wensheng; Schuster, James M; Gracias, Vicente H; Stein, Sherman C

    2010-08-15

    Meta-analytic costeffectiveness analysis. Our goal was to compare the results of different management strategies for trauma patients in whom the cervical spine was not clinically evaluable due to impaired consciousness, endotracheal intubation, or painful distracting injuries. We performed a structured literature review related to cervical spine trauma, radiographic clearance techniques (plain radiography, flexion/extension, CT, and MRI), and complications associated with semirigid collar use. Meta-analytic techniques were used to pool data from multiple sources to calculate pooled mean estimates of sensitivities and specificities of imaging techniques for cervical spinal clearance, rates of complications from various clearance strategies and from empirical use of semirigid collars. A decision analysis model was used to compare outcomes and costs among these strategies. Slightly more than 7.5% of patients who are clinically unevaluable have cervical spine injuries, and 42% of these injuries are associated with spinal instability. Sensitivity of plain radiography or fluoroscopy for spinal clearance was 57% (95% CI: 57%-60%). Sensitivities for CT and MRI alone were 83% (82%-84%) and 87% (84%-89%), respectively. Complications associated with collar use ranged from 1.3% (2 days) to 7.1% (10 days) but were usually minor and short-lived. Quadriplegia resulting from spinal instability missed by a clearance test had enormous impacts on longevity, quality of life, and costs. These impacts overshadowed the effects of prolonged collar application, even when the incidence of quadriplegia was extremely low. As currently used, neuroimaging studies for cervical spinal clearance in clinically unevaluable patients are not cost-effective compared with empirical immobilization in a semirigid collar.

  20. Fractured cervical spine and aortic transection.

    LENUS (Irish Health Repository)

    Griffin, M J

    2012-02-03

    A 17-year-old victim of a road traffic accident presented. Following investigation diagnoses of fractured first cervical vertebra, aortic transection, diffuse cerebral oedema, fractured right ribs 2-4 and pubic rami were made. Management of this case presented a number of anaesthetic dilemmas: management of the airway, use of cross-clamp vs. shunting or heparinization and bypass, cardiovascular and neurological monitoring, maintenance of cardiovascular stability during and post cross-clamp, minimizing the risk of post-operative renal and neurological dysfunction.

  1. Ligamentum flavum hematomas of the cervical and thoracic spine.

    Science.gov (United States)

    Wild, Florian; Tuettenberg, Jochen; Grau, Armin; Weis, Joachim; Krauss, Joachim K

    2014-01-01

    To report extremely rare cases of ligamentum flavum hematomas in the cervical and thoracic spine. Only six cases of thoracic ligamentum flavum hematomas and three cases of cervical ligamentum flavum hematomas have been reported so far. Two patients presented with tetraparesis and one patient presented with radicular pain and paresthesias in the T3 dermatome. MRI was performed in two patients, which showed a posterior intraspinal mass, continuous with the ligamentum flavum. The mass was moderately hypointense on T2-weighted images and hyperintense on T1-weighted images with no contrast enhancement. The third patient underwent cervical myelography because of a cardiac pacemaker. The myelography showed an intraspinal posterior mass with compression of the dural sac at C3/C4. All patients underwent a hemilaminectomy to resect the ligamentum flavum hematoma and recovered completely afterwords, and did not experience a recurrence during follow-up of at least 2 years. This case series shows rare cases of ligamentum flavum hematomas in the cervical and thoracic spine. Surgery achieved complete recovery of the preoperative symptoms in all patients within days. Copyright © 2013 Elsevier B.V. All rights reserved.

  2. Surgical management of cervical spine instability in Rheumatoid Arthritis patients

    Directory of Open Access Journals (Sweden)

    Pedro Miguel Marques

    2015-01-01

    Full Text Available Aim: Cross-sectional study that aims to evaluate the results of cervical spine surgeries due to rheumatoid arthritis (RA instability, between January of 2000 and of 2012 in a main Portuguese centre Methods: Patients followed on Rheumatology submitted to cervical spine fusion due to atlantoaxial (AAI, sub-axial (SAI or cranio-cervical (CCI instabilities between 2000-2012 were included. Information about the surgical procedure and associated complications was gathered and imagiologic and clinical indexes before and after surgery (as anterior and posterior atlanto-axial interval and Ranawat index were evaluated and compared using adequate statistics. Results: Forty-five patients with RA were included: 25 with AAI, 13 with CCI and 7 with SAI. Ten AAI and 4 CCI patients were submitted to wiring stabilization techniques; 15 AAI and 9 CCI patients to rigid ones; and in all patients with SAI an anterior cervical arthrodesis was chosen. There is a significant increase in PADI and a decrease in AADI in the postoperative evaluation (p

  3. The morphometric analysis of the intervertebral foramen and the spinal nerve root in the cervical spine

    International Nuclear Information System (INIS)

    Yoshida, Yasuo

    2008-01-01

    The purpose of this study was to clarify the onset of cervical myelopathy and cervical spondylotic radiculopathy as well as what influence the anatomy of the cervical spine and cervical nerves have on their onset and occurrence of various types of disease state. We conducted imaging and morphological measurements on specimens of cervical spine of Japanese people, focusing attention on the running of intervertebral foramen and dorsal nerve rootlets of the cervical spine. The subjects were cervical spine specimens from 12 cadavers (7 males and 5 females, age at the time of death ranged from 48 to 93 years with a mean of 71 years) obtained at Showa University School of Dentistry in 2005 and 2006. Specimens were prepared by removing the atlas through the 1st thoracic vertebra from the cadavers, then resecting the soft tissue such as muscles to expose the cervical spine in whole circumference. The removed cervical spine specimens, from 1st to 7th cervical spines, were imaged by volume scan of radiographic helical CT at 0.6 mm spatial resolution, and their images were stored as Digital Imaging and Communications in Medicine (DICOM) data. Image measurement on the vertebral body, vertebral foramen, and intervertebral foramen was conducted based on DICOM data. Furthermore, macroscopic observation and measurement were conducted on the dorsal nerve rootlets of cervical spine specimens. The image measurement of cervical spine specimens showed that the intervertebral foramen at C5/6 was the narrowest, followed by C3/4, C4/5, C6/7, and C2/3, respecting. With regard to angles in the frontal section and horizontal section of the groove for the spinal nerve, there was no significant difference in the angle between the right and the left. In the frontal section, the angle was about 63deg at C3, about 57deg at C4, about 52deg at C5, and about 55deg at C6, showing a significantly acute angle at C5, while in the horizontal section, it was about 54deg at C3, about 59deg at C4, about 63

  4. [Cervical myelopathy after low grade distortion of the cervical spine. Possible association with pre-existing spondylosis of the cervical spine].

    Science.gov (United States)

    Aurich, M; Hofmann, G O; Gras, F M

    2015-04-01

    A patient with spondylosis deformans of the cervical spine with no neurological deficits developed rapidly progressive tetraparesis 1 day after a whiplash injury due to a car accident (rear end collision), although initially there were no clinical symptoms. Surgical decompression and spondylodesis led to relief of the neurological deficits. This case demonstrates that even a low grade whiplash injury (grade 1) can cause severe neurological symptoms later and that a degenerative disease of the spine is a predisposing factor.

  5. Benign metastasizing leiomyoma of the cervical spine 31 years after uterine leiomyoma resection.

    Science.gov (United States)

    Berti, Aldo F; Santillan, Alejandro; Velasquez, Luis A

    2015-09-01

    We report a 74-year-old woman presenting with a leiomyoma of the cervical spine 31 years after uterine leiomyoma resection. Benign metastasizing leiomyoma to the cervical spine is very rare. To the best of our knowledge, this is the fourth reported patient with a leiomyoma metastasizing to the cervical spine and that with the longest latency period for this type of tumor, 31 years. The pathological features were typical of leiomyoma. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. The kinematic relationships of the upper cervical spine.

    Science.gov (United States)

    Morishita, Yuichiro; Falakassa, Jonathan; Naito, Masatoshi; Hymanson, Henry J; Taghavi, Cyrus; Wang, Jeffrey C

    2009-11-15

    A retrospective radiographic study. To elucidate the kinematic relationships of the upper cervical spine. To our knowledge, few reports have described the kinematic relationships of the upper cervical spine in patients with general age-related cervical spondylosis. We performed Kinetic magnetic resonance imaging for 295 consecutive patients experiencing neck pain without neurologic symptoms. Subjects with rheumatoid arthritis, traumatic history, and severe degenerative changes in the upper cervical spine were excluded. Anterior atlantodens interval (AADI) and the cervicomedullary angle in 3 different postures were measured, and the variations in each value between flexion and neutral (F-N), neutral and extension (N-E), and flexion and extension (F-E) were calculated. The subjects were classified into 3 groups according to the space available for the cord values (A: or=15 mm). AADI significantly increased from extension to flexion posture, however, no significant differences were observed in every posture among the groups. F-N variation in AADI showed no significant differences among the groups; however, N-E variation between Groups A and C and between Groups B and C and F-E variation between Groups A and C showed significant differences. The cervicomedullary angle significantly increased from flexion to extension posture, however, no significant differences were observed in every posture among the groups. Angle variations among the groups showed no significant differences, except for F-N angle variation between Groups B and C. None of the variations in AADI and the cervicomedullary angle were significantly correlated. Our results suggest that only the kinematics of the atlantoaxial movement, especially the posterior movement, was greatly affected by the narrowing of space available for the cord. The central atlantoaxial joint may be closely related to the mechanisms for protecting the spinal cord by restriction of the atlantoaxial movement.

  7. Pediatric cervical spine marrow T2 hyperintensity: a systematic analysis

    Energy Technology Data Exchange (ETDEWEB)

    Gefen, Ron [Cooper University Hospital, Department of Diagnostic Radiology, Candem, NJ (United States); Schweitzer, Mark E. [The Ottawa Hospital and University of Ottawa, Department of Diagnostic Imaging, Ottawa (Canada); Shabshin, Nogah [Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-HaShomer (Israel); Hospital of University of Pennsylvania, Department of Diagnostic Imaging, Philadelphia, PA (United States)

    2011-08-15

    Hyperintense areas of vertebral bone marrow on fluid-sensitive sequences are at times seen on pediatric MRI of the cervical spine in children without suspicious clinical conditions to explain marrow pathology. Although these likely have no clinical significance they may be mistaken for pathology. The purpose of this study is to systematically evaluate the locations and patterns of marrow T2 hyperintensity in the pediatric cervical spine, with respect to age. At 1.5 T, the C2 through T3 vertebrae of 82 children aged 0-17 years without clinically suspicious marrow abnormality were retrospectively reviewed by two musculoskeletal radiologists, who were blinded to patients' age. The frequency, intensity, and location of the foci of marrow T2 hyperintensity were recorded for each vertebra on a 12-point scoring system and were correlated with the patients' age. Foci of marrow hyperintensity were seen in 46/82 (56.1%) patients and in 241/734 (32.8%) vertebrae. Foci were most common in C4 (42% of patients), C5 (45.7%), and C6 (37.8%). The foci of T2 hyperintensity were more common inferiorly (188 foci) and adjacent to the anterior cortex (123). Analysis revealed no significant correlation between age and marrow score (Spearman = -0.147, P = 0.19), but did find a trend towards increased presence of marrow T2 hyperintensity in the ages of most rapid growth, 8-14 years (81.5% of patients). Vertebral body marrow T2 hyperintensity was most common endosteally and in the mid-cervical spine with a slight peak in adolescence. We therefore believe that these pediatric cervical marrow changes may be related to rapid bone growth at the point of maximal kyphotic stress. (orig.)

  8. Posterior longitudinal ligament status in cervical spine bilateral facet dislocations

    International Nuclear Information System (INIS)

    Carrino, John A.; Manton, Geoffrey L.; Morrison, William B.; Flanders, Adam E.; Vaccaro, Alex R.; Schweitzer, Mark E.

    2006-01-01

    It is generally accepted that cervical spine bilateral facet dislocation results in complete disruption of the posterior longitudinal ligament. The goal of this study was to evaluate the integrity of numerous spine-stabilizing structures by MRI, and to determine if any associations between injury patterns exist with respect to the posterior longitudinal ligament status. Retrospective case series. A retrospective review was performed of 30 cervical spine injury subjects with bilateral facet dislocation. Assessment of 1.5T MRI images was carried out for: intervertebral disc disruption, facet fracture, and ligamentous disruption. Statistical analyses were performed to evaluate for associations between various injury patterns and posterior longitudinal ligament status. The frequency of MRI abnormalities was: anterior longitudinal ligament disruption (26.7%), disc herniation or disruption (90%), posterior longitudinal ligament disruption (40%), facet fracture (63.3%) and disruption of the posterior column ligament complex (97%). There were no significant associations between injury to the posterior longitudinal ligament and other structures. Compared to surgical reports, MRI was accurate for determining the status for 24 of 26 ligaments (three of three anterior longitudinal ligament, seven of nine posterior longitudinal ligament, and 14 of 14 posterior column ligament complex) but generated false negatives in two instances (in both MRI showed an intact posterior longitudinal ligament that was torn at surgery). (orig.)

  9. Surgical management of metastatic tumors of the cervical spine.

    Science.gov (United States)

    Davarski, Atanas N; Kitov, Borislav D; Zhelyazkov, Christo B; Raykov, Stefan D; Kehayov, Ivo I; Koev, Ilyan G; Kalnev, Borislav M

    2013-01-01

    To present the results from the clinical presentation, the imaging diagnostics, surgery and postoperative status of 17 patients with cervical spine metastases, to analyse all data and make the respective conclusions and compare them with the available data in the literature. The study analysed data obtained by patients with metastatic cervical tumours treated in St George University Hospital over a period of seven years. All patients underwent diagnostic imaging tests which included, separately or in combination, cervical x-rays, computed tomography scan and magnetic-resonance imaging. Severity of neurological damage and its pre- and postoperative state was graded according to the Frankel Scale. For staging and operating performance we used the Tomita scale and Harrington classification. Seven patients had only one affected vertebra, 4 patients--two vertebrae, one patient--three vertebrae, 2 patients--four vertebrae, and in the other 3 patients more than one segment was affected. Surgery was performed in 12 patients. One level anterior corpectomy was performed in 6 patients, three patients had two-level surgery, and one patient--three-level corpectomy; in the remaining 2 cases we used posterior approach in surgery. Complete corpectomy was performed in 4 patients, subtotal corpectomy was used in 6 patients and partial--in 2 patients. Anterior stabilization system ADD plus (Ulrich GmbH & Co. KG, Ulm, Germany) was implanted in 2 patients; in 8 patients anterior titanium plate and bone graft were used, and in 1 patient--posterior cervical stabilization system. Because of the pronounced pain syndrome and frequent neurological lesions as a result of the cervical spine metastases use of surgery is justified. The main purpose is to maximize tumor resection, achieve optimal spinal cord and nerve root decompression and stabilize the affected segment.

  10. Helical CT in the primary trauma evaluation of the cervical spine: an evidence-based approach

    Energy Technology Data Exchange (ETDEWEB)

    Blackmore, C.C. [Washington Univ., Seattle, WA (United States). Dept. of Radiology; Center for Cost and Outcomes Research, Univ. of Washington, Seattle (United States); Dept. of Radiology, Harborview Medical Center, Seattle, WA (United States); Mann, F.A. [Washington Univ., Seattle, WA (United States). Dept. of Radiology; Harborview Injury Prevention and Research Center, University of Washington, Seattle (United States); Wilson, A.J. [Washington Univ., Seattle, WA (United States). Dept. of Radiology

    2000-11-01

    This review provides a summary of the cost-effectiveness, clinical utility, performance, and interpretation of screening helical cervical spine CT for trauma patients. Recent evidence supports the use of helical CT as a cost-effective method for screening the cervical spine in high-risk trauma patients. Screening cervical spine CT can be performed at the time of head CT to lower the cost of the evaluation, and when all short- and long-term costs are considered, CT may actually save money when compared with traditional radiographic screening. In addition to having higher sensitivity and specificity for cervical spine injury, CT screening also allows more rapid radiological clearance of the cervical spine than radiography. Patients who are involved in high-energy trauma, who sustain head injury, or who have neurological deficits are candidates for CT screening. Screening with CT may enhance detection of other potentially important injuries of the cervical region. (orig.)

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

    International Nuclear Information System (INIS)

    Kawasaki, Motohiro; Tani, Toshikazu; Ushida, Takahiro; Ishida, Kenji

    2007-01-01

    Degenerative spondylolisthesis of the cervical spine has received insufficient attention in contrast to that of the lumbar spine. The authors analyzed the functional significance of anterior and posterior degenerative spondylolisthesis (anterolisthesis and retrolisthesis) of the cervical spine to elucidate its role in the development of cervical spondylotic myelopathy (CSM) in the elderly. A total of 79 patients aged 65 or older who eventually had surgical treatment for CSM were evaluated radiographically. Altogether, 24 patients (30%) had displacement of 3.5 mm or more (severe spondylolisthesis group), 31 had displacement of 2.0-3.4 mm (moderate spondylolisthesis group), and 24 had less than 2.0 mm displacement (mild spondylolisthesis group). The severe spondylolisthesis group consisted of 14 patients with anterolisthesis (anterolisthesis group) and 10 patients with retrolisthesis (retrolisthesis group). Patients with severe spondylolisthesis had a high incidence (93%) of degenerative spondylolisthesis at C3/4 or C4/5 and significantly greater cervical mobility than those with mild spondylolisthesis. The anterolisthesis group, but not the retrolisthesis group, had a significantly wider spinal canal than the mild spondylolisthesis group, although the degree of horizontal displacement and cervical mobility did not differ significantly between the anterolisthesis and retrolisthesis groups. Severe cord compression seen on T1-weighted magnetic resonance imaging (MRI) scans and high-intensity spinal cord signals seen on T2-weighted MRI scans corresponded significantly to the levels of the spondylolisthesis. Degenerative spondylolisthesis is not a rare radiographic finding in elderly patients with CSM, which tends to cause intense cord compression that is seen on MRI scans. Greater mobility of the upper cervical segments may be a compensatory reaction for advanced disc degeneration of the lower cervical segments, leading to the development of degenerative

  12. Cervical spinal cord, root, and bony spine injuries: a closed claims analysis.

    Science.gov (United States)

    Hindman, Bradley J; Palecek, John P; Posner, Karen L; Traynelis, Vincent C; Lee, Lorri A; Sawin, Paul D; Tredway, Trent L; Todd, Michael M; Domino, Karen B

    2011-04-01

    The aim of this study was to characterize cervical cord, root, and bony spine claims in the American Society of Anesthesiologists Closed Claims database to formulate hypotheses regarding mechanisms of injury. All general anesthesia claims (1970-2007) in the Closed Claims database were searched to identify cervical injuries. Three independent teams, each consisting of an anesthesiologist and neurosurgeon, used a standardized review form to extract data from claim summaries and judge probable contributors to injury. Cervical injury claims (n = 48; mean ± SD age 47 ± 15 yr; 73% male) comprised less than 1% of all general anesthesia claims. When compared with other general anesthesia claims (19%), cervical injury claims were more often permanent and disabling (69%; P cervical stenosis) were often present, cord injuries usually occurred in the absence of traumatic injury (81%) or cervical spine instability (76%). Cord injury occurred with cervical spine (65%) and noncervical spine (35%) procedures. Twenty-four percent of cord injuries were associated with the sitting position. Probable contributors to cord injury included anatomic abnormalities (81%), direct surgical complications (24% [38%, cervical spine procedures]), preprocedural symptomatic cord injury (19%), intraoperative head/neck position (19%), and airway management (11%). Most cervical cord injuries occurred in the absence of traumatic injury, instability, and airway difficulties. Cervical spine procedures and/or sitting procedures appear to predominate. In the absence of instability, cervical spondylosis was the most common factor associated with cord injury.

  13. Hyperextension strain of ''whiplash'' injuries to the cervical spine

    International Nuclear Information System (INIS)

    Griffiths, H.J.; Olson, P.N.; Everson, L.I.; Winemiller, M.

    1995-01-01

    A full cervical spine radiographic series (including flexion and extension views) was reviewed in 40 patients with clinically proven ''whiplash'' injuries and compared to the radiographs in 105 normal controls. The level and degree of kinking or kyphosis, subluxation, and the difference in the amount of fanning between spinous processes on flexion and extension films were measured in each patient. Localized kinking greater than 10 and over 12 mm of fanning, often occurring at the level below the kinking or kyphosis, occurred mainly in the group of whiplash patients (sensitivity 81%, specificity 76%, accuracy 80%). (orig./VHE)

  14. Tomographic imaging of the cervical spine of horses

    International Nuclear Information System (INIS)

    Souza, L.P.; Machado, V.M.V.; Santos, R.V.; Evangelista, F.C.; Vulcano, L.C.

    2012-01-01

    The anatomy of the cervical spine of mature horses based on images obtained with a helical computed tomography examination performed on anatomic specimens was studied. Computed tomography was the diagnostic imaging method of choice and allowed three-dimensional reconstructions of images and other anatomical planes, such as coronal and sagittal. All images were acquired and evaluated in the filter and window to bone tissue. It was possible to demonstrate the anatomical differences and peculiarities of the normal vertebrae, particularly the occipito-atlantoaxial region, which has a higher incidence of changes to assist in the visualization of any change of the bone pattern on CT studies. (author)

  15. Spinal CT scan, 1. Cervical and thoracic spines

    Energy Technology Data Exchange (ETDEWEB)

    Nakagawa, Hiroshi (Aichi Medical Univ. (Japan))

    1982-01-01

    Methods of CT of the cervical and thoracic spines were explained, and normal CT pictures of them were described. Spinal CT was evaluated in comparison with other methods in various spinal diseases. Plain CT revealed stenosis due to spondylosis or ossification of posterior longitudinal ligament and hernia of intervertebral disc. CT took an important role in the diagnosis of spinal cord tumors with calcification and destruction of the bone. CT scan in combination with other methods was also useful for the diagnosis of spinal injuries, congenital anomalies and infections.

  16. Percutaneous aspiration biopsy in cervical spine lytic lesions

    International Nuclear Information System (INIS)

    Tampieri, D.; Weill, A.; Melanson, D.; Ethier, R.

    1991-01-01

    We describe the technique and the results of the percutaneous aspiration biopsy (PAB) in a series of 9 patients presenting with neck pain and different degrees of myelopathy, in whom the cervical spine X-ray demonstrated lytic lesions of unknown origin. PAB is a useful, relatively safe technique, and leads to histological diagnosis between metastatic and inflammatory processes. Furthermore, in inflammatory lesions with negative hemoculture, PAB may help in detecting the micro-organism responsible and therefore allow a better antibiotic treatment. (orig.)

  17. Hyperextension strain of ``whiplash`` injuries to the cervical spine

    Energy Technology Data Exchange (ETDEWEB)

    Griffiths, H.J. [Dept. of Radiology, Univ. of Minnesota Hospital and Clinic, Minneapolis, MN (United States); Olson, P.N. [Dept. of Radiology, Univ. of Minnesota Hospital and Clinic, Minneapolis, MN (United States); Everson, L.I. [Dept. of Radiology, Univ. of Minnesota Hospital and Clinic, Minneapolis, MN (United States); Winemiller, M. [Dept. of Radiology, Univ. of Minnesota Hospital and Clinic, Minneapolis, MN (United States)

    1995-05-01

    A full cervical spine radiographic series (including flexion and extension views) was reviewed in 40 patients with clinically proven ``whiplash`` injuries and compared to the radiographs in 105 normal controls. The level and degree of kinking or kyphosis, subluxation, and the difference in the amount of fanning between spinous processes on flexion and extension films were measured in each patient. Localized kinking greater than 10 and over 12 mm of fanning, often occurring at the level below the kinking or kyphosis, occurred mainly in the group of whiplash patients (sensitivity 81%, specificity 76%, accuracy 80%). (orig./VHE)

  18. Intraosseous hemangioblastoma of the cervical spine: case report.

    Science.gov (United States)

    Li, Zhenteng; Curtis, Brian; Layser, Robert; Selvarajan, Santosh Kumar; Harrop, James; Kenyon, Lawrence C; Parsons, Theodore; Rubin, Asa

    2017-09-01

    A 69-year-old woman presented with bilateral upper-extremity radiculopathy and neck pain after a mechanical fall. Admission CT and MRI of the cervical spine demonstrated a pathological C-4 fracture. Subsequent malignancy workup was negative. A CT-guided biopsy of the lesion showed intraosseous hemangioblastoma. Hemangioblastoma is a highly vascular, slow-growing tumor of the CNS; intraosseous location of this tumor is extremely rare. The authors review the diversity of its presentation and the treatment techniques of this rare tumor in an extremely rare location.

  19. A Comparison of Cervical Spine Motion After Immobilization With a Traditional Spine Board and Full-Body Vacuum-Mattress Splint

    OpenAIRE

    Etier, Brian E.; Norte, Grant E.; Gleason, Megan M.; Richter, Dustin L.; Pugh, Kelli F.; Thomson, Keith B.; Slater, Lindsay V.; Hart, Joe M.; Brockmeier, Stephen F.; Diduch, David R.

    2017-01-01

    Background: The National Athletic Trainers’ Association (NATA) advocates for cervical spine immobilization on a rigid board or vacuum splint and for removal of athletic equipment before transfer to an emergency medical facility. Purpose: To (1) compare triplanar cervical spine motion using motion capture between a traditional rigid spine board and a full-body vacuum splint in equipped and unequipped athletes, (2) assess cervical spine motion during the removal of a football helmet and shoulde...

  20. Percutaneous Vertebroplasty Relieves Pain in Cervical Spine Metastases

    Directory of Open Access Journals (Sweden)

    Li Bao

    2017-01-01

    Full Text Available Percutaneous vertebroplasty (PVP has been shown to release spinal pain and stabilize the vertebral body. PVP is suggested as an alternative treatment in spinal metastasis. Although cervical metastases is less prevalent than thoracic and lumbar spine, PVP procedure in cervical vertebrae remains technical challenging. We retrospectively analyzed the data from patients (n=9 who underwent PVP using anterolateral approach to treat severe neck pain and restricted cervical mobility from metastatic disease. Patients were rated using modified Tokuhashi score and Tomita score before the procedure. Visual analog scale (VAS, neck disability index (NDI, analgesic use, and imaging (X-ray or CT were evaluated before PVP and 3 days, 3 months, and 6 months after PVP. All patients were in late stage of cancer evaluated using modified Tokuhashi and Tomita score. The cement leakage rate was 63.6% (14 of the 22 vertebrae with no severe complications. VAS, NDI, and analgesic use were significantly decreased 3 days after the procedure and remained at low level until 6 months of follow-up. Our result suggested PVP effectively released the pain from patients with cervical metastasis. The results warrant further clinical investigation.

  1. Cervical spine instability in the course of rheumatoid arthritis – imaging methods

    Directory of Open Access Journals (Sweden)

    Małgorzata Mańczak

    2017-08-01

    Full Text Available Cervical spine is affected in more than a half of patients with rheumatoid arthritis (RA. Depending on the degree of damage to the individual joints and ligaments RA-related cervical spine instability takes the form of atlanto-axial subluxation, subaxial subluxation or cranial settling. In the advanced cases spinal stenosis can occur as well as spinal cord injuries with typical neurological symptoms. The identification of patients with cervical spine instability before the occurrence of neurological complications still constitutes a diagnostic challenge. The article presents the methods of cervical spine imaging with the use of plain radiographs, magnetic resonance imaging (MRI and computed tomography (CT. We discuss the advantages and disadvantages associated with each method and the possibility of its application in the diagnosis of cervical spine instability in RA. The knowledge of the above mentioned issues is indispensable to select an appropriate time for surgical intervention.

  2. Management of cervical spine injuries in young children: lessons learned.

    Science.gov (United States)

    Smith, Jodi L; Ackerman, Laurie L

    2009-07-01

    Previous studies have shown that the correct use of car safety seats can protect infants and children from vehicular injury. Although child passenger devices are increasingly used in the US, motor vehicle crashes continue to be the leading cause of death and acquired disability in infants and children younger than 14 years of age. These events are likely related, at least in part, to the high percentage of children who are unrestrained or improperly restrained. The authors present 2 cases of severe cervical spine trauma in young children restrained in car safety seats during a motor vehicle crash: 1) a previously healthy 14-month-old girl who was improperly restrained in a forward-facing booster seat secured to the vehicle by a lap belt, and 2) a previously healthy 30-month-old girl who was a rear seat passenger restrained in a car safety seat. This study points out the unique challenges encountered in treating cervical spine injuries in infants and young children, as well as the lessons learned, and emphasizes the significance of continuing efforts to increase family and public awareness regarding the importance of appropriate child safety seat selection and use.

  3. The deformation behavior of the cervical spine segment

    Science.gov (United States)

    Kolmakova, T. V.; Rikun, Yu. A.

    2017-09-01

    The paper describes the model of the cervical spine segment (C3-C4) and the calculation results of its deformation behavior at flexion. The segment model was built based on the experimental literature data taking into account the presence of the cortical and cancellous bone tissue of vertebral bodies. Degenerative changes of the intervertebral disk (IVD) were simulated through a reduction of the disc height and an increase of Young's modulus. The construction of the geometric model of the cervical spine segment and the calculations of the stress-strain state were carried out in the ANSYS software complex. The calculation results show that the biggest protrusion of the IVD in bending direction of segment is observed when IVD height is reduced. The disc protrusion is reduced with an increase of Young's modulus. The largest protrusion in the direction of flexion of the segment is the intervertebral disk with height of 4.3 mm and elastic modulus of 2.5 MPa. The results of the study can be useful to specialists in the field of biomechanics, medical materials science and prosthetics.

  4. The impact of a cervical spine diagnosis on the careers of National Football League athletes.

    Science.gov (United States)

    Schroeder, Gregory D; Lynch, T Sean; Gibbs, Daniel B; Chow, Ian; LaBelle, Mark W; Patel, Alpesh A; Savage, Jason W; Nuber, Gordon W; Hsu, Wellington K

    2014-05-20

    Cohort study. To determine the effect of cervical spine pathology on athletes entering the National Football League. The association of symptomatic cervical spine pathology with American football athletes has been described; however, it is unknown how preexisting cervical spine pathology affects career performance of a National Football League player. The medical evaluations and imaging reports of American football athletes from 2003 to 2011 during the combine were evaluated. Athletes with a cervical spine diagnosis were matched to controls and career statistics were compiled. Of a total of 2965 evaluated athletes, 143 players met the inclusion criteria. Athletes who attended the National Football League combine without a cervical spine diagnosis were more likely to be drafted than those with a diagnosis (P = 0.001). Players with a cervical spine diagnosis had a decreased total games played (P = 0.01). There was no difference in the number of games started (P = 0.08) or performance score (P = 0.38). In 10 athletes with a sagittal canal diameter of less than 10 mm, there was no difference in years, games played, games started, or performance score (P > 0.24). No neurological injury occurred during their careers. In 7 players who were drafted with a history of cervical spine surgery (4 anterior cervical discectomy and fusion, 2 foraminotomy, and 1 suboccipital craniectomy with a C1 laminectomy), there was no difference in career longevity or performance when compared with matched controls. This study suggests that athletes with preexisting cervical spine pathology were less likely to be drafted than controls. Players with preexisting cervical spine pathology demonstrated a shorter career than those without; however, statistically based performance and numbers of games started were not different. Players with cervical spinal stenosis and those with a history of previous surgery demonstrated no difference in performance-based outcomes and no reports of neurological

  5. CT imaging techniques for describing motions of the cervicothoracic junction and cervical spine during flexion, extension, and cervical traction.

    Science.gov (United States)

    Simon, Scott; Davis, Martin; Odhner, Dewey; Udupa, Jayaram; Winkelstein, Beth

    2006-01-01

    Computerized tomographic study of human cadavers undergoing traction and flexion-extension bending. To investigate the feasibility of using computerized tomography techniques to quantify relative vertebral motions of the cervical spine and cervicothoracic junction (CTJ), and to define normative CTJ kinematics. Despite developing an understanding of the mechanical behavior of the cervical spine, little remains known about the cervicothoracic junction. The CTJ is more difficult to image than other cervical regions given the anatomic features of the surrounding bones obstructing CTJ visualization. As such, limited data have been reported describing the responses of the CTJ for motions and loading in the sagittal plane, confounding the clinical assessment of its injuries and surgical treatments used at this region. Helical CT images of the cervical spine and CTJ were acquired incrementally during each of flexion, extension, and cervical traction. Vertebral surfaces were reconstructed using the specialized image analysis software, 3DVIEWNIX. A mathematical description of relative vertebral motions was derived by computing rigid transformations. Euler angles and translations were calculated. Regional spine stiffness was defined for traction. The CTJ was found to be much stiffer (779 N/mm) than the cervical spine (317 N/mm) in tension. In flexion-extension bending, the CTJ was similar to the lower cervical spine. The CTJ demonstrated significantly less coupled motion than the cervical spine. The CTJ, as a transition region between the cervical and thoracic spines, has unique kinematic characteristics. This application of kinematic CT methods is useful for quantifying unreported normative ranges of motion for the CTJ, difficult by other conventional radiologic means.

  6. Anterior cervical spine surgery-associated complications in a retrospective case-control study

    OpenAIRE

    Tasiou, Anastasia; Giannis, Theofanis; Brotis, Alexandros G.; Siasios, Ioannis; Georgiadis, Iordanis; Gatos, Haralampos; Tsianaka, Eleni; Vagkopoulos, Konstantinos; Paterakis, Konstantinos; Fountas, Kostas N.

    2017-01-01

    Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration. The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. ...

  7. Utility of MRI for cervical spine clearance in blunt trauma patients after a negative CT.

    Science.gov (United States)

    Malhotra, Ajay; Durand, David; Wu, Xiao; Geng, Bertie; Abbed, Khalid; Nunez, Diego B; Sanelli, Pina

    2018-07-01

    To determine the utility of cervical spine MRI in blunt trauma evaluation for instability after a negative non-contrast cervical spine CT. A review of medical records identified all adult patients with blunt trauma who underwent CT cervical spine followed by MRI within 48 h over a 33-month period. Utility of subsequent MRI was assessed in terms of findings and impact on outcome. A total of 1,271 patients with blunt cervical spine trauma underwent both cervical spine CT and MRI within 48 h; 1,080 patients were included in the study analysis. Sixty-six percent of patients with a CT cervical spine study had a negative study. Of these, the subsequent cervical spine MRI had positive findings in 20.9%; 92.6% had stable ligamentous or osseous injuries, 6.0% had unstable injuries and 1.3% had potentially unstable injuries. For unstable injury, the NPV for CT was 98.5%. In all 712 patients undergoing both CT and MRI, only 1.5% had unstable injuries, and only 0.42% had significant change in management. MRI for blunt trauma evaluation remains not infrequent at our institution. MRI may have utility only in certain patients with persistent abnormal neurological examination. • MRI has limited utility after negative cervical CT in blunt trauma. • MRI is frequently positive for non-specific soft-tissue injury. • Unstable injury missed on CT is infrequent.

  8. Significance of magnetic resonance imaging in the diagnosis of vertebral artery injury associated with blunt cervical spine trauma

    International Nuclear Information System (INIS)

    Yokota, Hiroyuki; Atsumi, Takahiro; Araki, Takashi; Fuse, Akira; Sato, Hidetaka; Kawai, Makoto; Yamamoto, Yasuhiro

    2007-01-01

    Vertebral artery injury associated with non-penetrating cervical trauma is rare. We report 11 cases of vertebral artery injury diagnosed with magnetic resonance imaging (MRI) after blunt trauma to the cervical spine and discuss about the importance of MRI in the diagnosis of this injury. Seven cases were caused by motor vehicle accidents, three by diving accidents, and one by static compression of the neck. All of the patients had documented cervical spine fractures and dislocations. In three patients, the diagnosis of complete occlusion of the vertebral artery was made on the basis of MRI and digital subtraction angiography (DSA). In the other patients, mural injuries of the vertebral artery were demonstrated with DSA. These 11 patients presented with acute, nonspecific changes in neurological status. Two had infarctions of the cerebellum and brainstem. None were treated with anticoagulants. All of them survived and were discharged to other hospitals for physical and occupational therapy. Although DSA remains the gold standard for diagnosing vertebral artery injuries, MRI is a newer modality for assessing cervical cord injury, and it may be useful for evaluating the presence of vertebral injury after blunt cervical spine trauma. (author)

  9. Informative value of radiological findings recorded from cervical spine with reference to clinical symptoms in patients with cervical syndrome

    International Nuclear Information System (INIS)

    Loreck, D.; Kuehn, A.; Conradi, E.

    1991-01-01

    Static X-rays recorded at two planes from the cervical spine of 286 patients were evaluated and were compared to findings obtained from 50 probands without complaints. The patients complained about problems relating to vertebrogenic pain syndrome of the cervical spine, including vertigo of cervical origin. They were grouped by four sets of clinical symptoms (cephalgia, vertigo, locally delimited complaints and cervicobrachial syndrome). No statistically significant differences were found to exist among the groups of probands with regard to radiographic morphology, static condition nor impairment of relations. Particular reference is made in this paper to reversible function disorders and their major role among the multifactorial causes of the cervical syndrome. Indications are derived from these observations for primary X-ray examination of the cervical spine. (orig.) [de

  10. Rare cause of neck pain: tumours of the posterior elements of the cervical spine.

    Science.gov (United States)

    Katsuura, Yoshihiro; Cason, Garrick; Osborn, James

    2016-12-15

    Here we present two cases of primary bone tumours of the cervical spine in patients who had persistent neck pain-in one case, lasting 8 years. In each case, there was a delay in diagnosis and referral to a spine specialist was prolonged. Primary bone tumours of the spine are rare, which is in contrast to the wide prevalence of cervical neck pain. Many primary care providers may go an entire career without encountering a symptomatic primary cervical spine tumour. In this paper, we discuss the clinical course and treatment of each patient and review the current literature on primary bone tumours of the spine. Owing to the subtle roentgenographic findings of primary cervical tumours, we highlight the importance of advanced imaging in the clinical work-up of simple axial neck pain lasting >6 weeks to avoid misdiagnosis of serious pathology. 2016 BMJ Publishing Group Ltd.

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

    Directory of Open Access Journals (Sweden)

    Karolina Walczyńska-Dragon

    2014-01-01

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

  12. Pediatric cervical spine in emergency: radiographic features of normal anatomy, variants and pitfalls

    International Nuclear Information System (INIS)

    Adib, Omar; Berthier, Emeline; Loisel, Didier; Aube, Christophe

    2016-01-01

    Injuries of the cervical spine are uncommon in children. The distribution of injuries, when they do occur, differs according to age. Young children aged less than 8 years usually have upper cervical injuries because of the anatomic and biomechanical properties of their immature spine, whereas older children, whose biomechanics more closely resemble those of adults, are prone to lower cervical injuries. In all cases, the pediatric cervical spine has distinct radiographic features, making the emergency radiological analysis of it difficult. Such features as hypermobility between C2 and C3, pseudospread of the atlas on the axis, pseudosubluxation, the absence of lordosis, anterior wedging of vertebral bodies, pseudowidening of prevertebral soft tissue and incomplete ossification of synchondrosis can be mistaken for traumatic injuries. The interpretation of a plain radiograph of the pediatric cervical spine following trauma must take into account the age of the child, the location of the injury and the mechanism of trauma. Comprehensive knowledge of the specific anatomy and biomechanics of the childhood spine is essential for the diagnosis of suspected cervical spine injury. With it, the physician can, on one hand, differentiate normal physes or synchondroses from pathological fractures or ligamentous disruptions and, on the other, identify any possible congenital anomalies that may also be mistaken for injury. Thus, in the present work, we discuss normal radiological features of the pediatric cervical spine, variants that may be encountered and pitfalls that must be avoided when interpreting plain radiographs taken in an emergency setting following trauma. (orig.)

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

    Science.gov (United States)

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

    2014-01-01

    Temporomandibular dysfunction (TMD) is considered to be associated with imbalance of the whole body. This study aimed to evaluate the influence of TMD therapy on cervical spine range of movement (ROM) and reduction of spinal pain. The study group consisted of 60 patients with TMD, cervical spine pain, and limited cervical spine range of movements. Subjects were interviewed by a questionnaire about symptoms of TMD and neck pain and had also masticatory motor system physically examined (according to RDC-TMD) and analysed by JMA ultrasound device. The cervical spine motion was analysed using an MCS device. Subjects were randomly admitted to two groups, treated and control. Patients from the treated group were treated with an occlusal splint. Patients from control group were ordered to self-control parafunctional habits. Subsequent examinations were planned in both groups 3 weeks and 3 months after treatment was introduced. The results of tests performed 3 months after the beginning of occlusal splint therapy showed a significant improvement in TMJ function (P > 0.05), cervical spine ROM, and a reduction of spinal pain. The conclusion is that there is a significant association between TMD treatment and reduction of cervical spine pain, as far as improvement of cervical spine mobility. PMID:25050363

  14. Pediatric cervical spine in emergency: radiographic features of normal anatomy, variants and pitfalls.

    Science.gov (United States)

    Adib, Omar; Berthier, Emeline; Loisel, Didier; Aubé, Christophe

    2016-12-01

    Injuries of the cervical spine are uncommon in children. The distribution of injuries, when they do occur, differs according to age. Young children aged less than 8 years usually have upper cervical injuries because of the anatomic and biomechanical properties of their immature spine, whereas older children, whose biomechanics more closely resemble those of adults, are prone to lower cervical injuries. In all cases, the pediatric cervical spine has distinct radiographic features, making the emergency radiological analysis of it difficult. Such features as hypermobility between C2 and C3, pseudospread of the atlas on the axis, pseudosubluxation, the absence of lordosis, anterior wedging of vertebral bodies, pseudowidening of prevertebral soft tissue and incomplete ossification of synchondrosis can be mistaken for traumatic injuries. The interpretation of a plain radiograph of the pediatric cervical spine following trauma must take into account the age of the child, the location of the injury and the mechanism of trauma. Comprehensive knowledge of the specific anatomy and biomechanics of the childhood spine is essential for the diagnosis of suspected cervical spine injury. With it, the physician can, on one hand, differentiate normal physes or synchondroses from pathological fractures or ligamentous disruptions and, on the other, identify any possible congenital anomalies that may also be mistaken for injury. Thus, in the present work, we discuss normal radiological features of the pediatric cervical spine, variants that may be encountered and pitfalls that must be avoided when interpreting plain radiographs taken in an emergency setting following trauma.

  15. Pediatric cervical spine in emergency: radiographic features of normal anatomy, variants and pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Adib, Omar; Berthier, Emeline; Loisel, Didier; Aube, Christophe [University Hospital of Angers, Department of Radiology, Angers (France)

    2016-12-15

    Injuries of the cervical spine are uncommon in children. The distribution of injuries, when they do occur, differs according to age. Young children aged less than 8 years usually have upper cervical injuries because of the anatomic and biomechanical properties of their immature spine, whereas older children, whose biomechanics more closely resemble those of adults, are prone to lower cervical injuries. In all cases, the pediatric cervical spine has distinct radiographic features, making the emergency radiological analysis of it difficult. Such features as hypermobility between C2 and C3, pseudospread of the atlas on the axis, pseudosubluxation, the absence of lordosis, anterior wedging of vertebral bodies, pseudowidening of prevertebral soft tissue and incomplete ossification of synchondrosis can be mistaken for traumatic injuries. The interpretation of a plain radiograph of the pediatric cervical spine following trauma must take into account the age of the child, the location of the injury and the mechanism of trauma. Comprehensive knowledge of the specific anatomy and biomechanics of the childhood spine is essential for the diagnosis of suspected cervical spine injury. With it, the physician can, on one hand, differentiate normal physes or synchondroses from pathological fractures or ligamentous disruptions and, on the other, identify any possible congenital anomalies that may also be mistaken for injury. Thus, in the present work, we discuss normal radiological features of the pediatric cervical spine, variants that may be encountered and pitfalls that must be avoided when interpreting plain radiographs taken in an emergency setting following trauma. (orig.)

  16. Cervical spine mobilisation forces applied by physiotherapy students.

    Science.gov (United States)

    Snodgrass, Suzanne J; Rivett, Darren A; Robertson, Val J; Stojanovski, Elizabeth

    2010-06-01

    Postero-anterior (PA) mobilisation is commonly used in cervical spine treatment and included in physiotherapy curricula. The manual forces that students apply while learning cervical mobilisation are not known. Quantifying these forces informs the development of strategies for learning to apply cervical mobilisation effectively and safely. This study describes the mechanical properties of cervical PA mobilisation techniques applied by students, and investigates factors associated with force application. Physiotherapy students (n=120) mobilised one of 32 asymptomatic subjects. Students applied Grades I to IV central and unilateral PA mobilisation to C2 and C7 of one asymptomatic subject. Manual forces were measured in three directions using an instrumented treatment table. Spinal stiffness of mobilised subjects was measured at C2 and C7 using a device that applied a standard oscillating force while measuring this force and its concurrent displacement. Analysis of variance was used to determine differences between techniques and grades, intraclass correlation coefficients (ICC) were used to calculate the inter- and intrastudent repeatability of forces, and linear regression was used to determine the associations between applied forces and characteristics of students and mobilised subjects. Mobilisation forces increased from Grades I to IV (highest mean peak force, Grade IV C7 central PA technique: 63.7N). Interstudent reliability was poor [ICC(2,1)=0.23, 95% confidence interval (CI) 0.14 to 0.43], but intrastudent repeatability of forces was somewhat better (0.83, 95% CI 0.81 to 0.86). Higher applied force was associated with greater C7 stiffness, increased frequency of thumb pain, male gender of the student or mobilised subject, and a student being earlier in their learning process. Lower forces were associated with greater C2 stiffness. This study describes the cervical mobilisation forces applied by students, and the characteristics of the student and mobilised

  17. Surgeon Reported Outcome Measure for Spine Trauma an International Expert Survey Identifying Parameters Relevant for The Outcome of Subaxial Cervical Spine Injuries

    NARCIS (Netherlands)

    Sadiqi, Said; Verlaan, Jorrit Jan; Lehr, A. M.; Dvorak, Marcel F.; Kandziora, Frank; Rajasekaran, S.; Schnake, Klaus J.; Vaccaro, Alexander R.; Oner, F. C.

    2016-01-01

    STUDY DESIGN.: International web-based survey OBJECTIVE.: To identify clinical and radiological parameters that spine surgeons consider most relevant when evaluating clinical and functional outcomes of subaxial cervical spine trauma patients. SUMMARY OF BACKGROUND DATA.: While an outcome instrument

  18. Gout Initially Mimicking Rheumatoid Arthritis and Later Cervical Spine Involvement

    Directory of Open Access Journals (Sweden)

    Eduardo Araújo Santana Nunes

    2014-01-01

    Full Text Available Gout is clinically characterized by episodes of monoarthritis, but if not treated properly, it can lead to a chronic polyarthritis, which may eventually mimic rheumatoid arthritis (RA. We present the case of a 59-year-old man, with a history of symmetrical polyarthritis of the large and small joints with later development of subcutaneous nodules, which was initially misdiagnosed as RA, being treated with prednisone and methotrexate for a long period of time. He complained of occipital pain and paresthesia in his left upper limb, and computed tomography (CT and magnetic resonance imaging (MRI revealed the presence of an expansive formation in the cervical spine with compression of the medulla. He was admitted for spinal decompressive surgery and the biopsy specimen demonstrated a gouty tophus. Chronic gout can mimic RA and rarely involves the axial skeleton, and thus its correct diagnosis and the implementation of adequate therapy can halt the development of such damaging complications.

  19. [Muscle strength of the cervical and lumbar spine in triathletes].

    Science.gov (United States)

    Miltner, O; Siebert, C H; Müller-Rath, R; Kieffer, O

    2010-12-01

    The goal of this study was to analyse the muscle strength of the cervical and lumbar spine in ironman triathletes. The values were compared to the results obtained from a reference group. The test of the triathletes was carried out in an attempt to define a specific strength profile for these athletes. In this study, 20 long-distance triathletes (∅ 37.3 ± 7.6 years of age, ∅ 1.80 ± 0.1 m, ∅ 73.7 ± 6.0 kg) were evaluated with regard to their individual and sport-specific strengths of the cervical spine in 2 planes and of the trunk strengths in all 3 planes of motion. The trunk strength profile of the triathletes revealed good average results in the trunk extensors and the lateral flexors of the left trunk. The reference group is the data base of the company Proxomed®, Alzenau. It is based on results of 1045 untrained, symptom-free subjects of different ages. Lumbar extension: The extension of the force values shows no significant difference from the reference group. Lumbar flexion: The flexion tests show highly significantly lower force values (5.025 ± 0.81 N/kg vs. 6.67 ± 0.6 N/kg) than the reference group. Flexion/extension: In the sagittal plane values for the triathletes demonstrate an imbalance in muscle strength ratios. The abdominal muscles turn in relation to the back extensor muscles too weakly to be very significant. Lumbar rotation: The force values of the athletes in both directions (right: 6.185 ± 1.46 N/kg, left: 7.1 ± 1.57 N/kg vs. 10.05 ± 0.34 N/kg) are highly significantly (p ≤ 0.001) lower than the reference values. Ratio of rotation left/right: The ratio of left/right rotation in the reference group is set at 1 and thus shows an equally strong force level between the two sides. Lumbar lateral flexion: The triathletes do not show any significant differences between the force values. Compared to the reference group there is no significant difference to the left side flexion. In the lateral bending the athletes have significantly

  20. History of cervical spine surgery: from nihilism to advanced reconstructive surgery.

    Science.gov (United States)

    Dweik, A; Van den Brande, E; Kossmann, T; Maas, A I R

    2013-11-01

    Review of literature. To review and analyze the evolution of cervical spine surgery from ancient times to current practice. The aim is to present an accessible overview, primarily intended for a broad readership. Descriptive literature review and analysis of the development of cervical spine surgery from the prehistoric era until today. The first evidence for surgical treatment of spinal disorders dates back to approximately 1500 BC. Conservative approaches to treatment have been the hallmark for thousands of years, but over the past 50 years progress has been rapid. We illustrate how nations have added elements to this complex subject and how knowledge has surpassed borders and language barriers. Transferral of knowledge occurred from Babylon (Bagdad) to Old Egypt, to the Greek and Roman empires and finally via the Middle East (Bagdad and Damascus) back to Europe. Recent advances in the field of anesthesia, imaging and spinal instrumentation have changed long-standing nihilism in the treatment of cervical spine pathologies to the current practice of advanced reconstructive surgery of the cervical spine. A critical approach to the evaluation of benefits and complications of these advanced surgical techniques for treatment of cervical spine disorders is required. Advances in surgery now permit full mechanical reconstruction of the cervical spine. However, despite substantial experimental progress, spinal cord repair and restoration of lost functions remain a challenge. Modern surgeons are still looking for the best way to manage spine disorders.

  1. [The implications of cervical spine degenerative and traumatic diseases in the pathogenesis of cervical vertigo and hearing loss].

    Science.gov (United States)

    Cobzeanu, M D; Rusu, Daniela; Moraru, R; Boboc, Andreea; Hănţăscu, I; Imbrea, Alice; Stratulat, S; Gheorghe, Liliana; Indrei, Anca

    2009-01-01

    Cervical spine together with vestibular system,visual system and proprioceptive afferents plays an important role in mentaining balance. Spine damage causes distortions in transmitting informations to the brain,favoring vertigo. The authors point out the occurrence of positional vertigo on 23 patients (20 patients with cervical spondylosis and 3 patients with cervical spine injury) due to blood flow disturbance through vertebral artery. The mechano-receptors located in intervertebral disks and cervical spine muscles are activated by column movement. Changes of blood flow in the vertebral and basilar arteries are showed up by cervical X-Rays, intracranial Doppler ultrasound or angio-MRI, an audiogram marking out the degree of hearing loss or tinnitus occurence. ENT complex treatment outcomes are analyzed and balneo-physio-therapy performed in order to improve vertigo and hearing loss. Stress beside muscle overload and cervical spine injures causes alteration in the ear blood-flow circulation that leads to hearing loss, vertigo and tinnitus. It emphasies the need for collaboration between balneologist and ENT specialist in solving balance and hearing disorders with cervicogenic cause.

  2. Analysis of cervical and global spine alignment under Roussouly sagittal classification in Chinese cervical spondylotic patients and asymptomatic subjects.

    Science.gov (United States)

    Yu, Miao; Zhao, Wen-Kui; Li, Mai; Wang, Shao-Bo; Sun, Yu; Jiang, Liang; Wei, Feng; Liu, Xiao-Guang; Zeng, Lin; Liu, Zhong-Jun

    2015-06-01

    To explore the relationship between cervical spine and the global spine alignment and to postulate the hypotheses that a lordotic alignment of cervical spine is not the only standard to identify asymptomatic subjects, and the degenerative modification of cervical curves depends primarily on their spinal-pelvic alignment. A cohort of 120 cases of Chinese asymptomatic subjects and a cohort of 121 cases of Chinese cervical spondylotic patients were recruited prospectively from 2011 to 2012. Roussouly Classification was utilized to categorize all subjects and patients according to their thoracic spine, lumbar spine and pelvic alignment. The cervical alignments were evaluated as lordosis, straight, sigmoid or kyphosis. Through the lateral X-ray images of neutral cervical and global spine, a number of parameters were measured and analyzed, including pelvic incidence, pelvic tilt, sacral slope, thoracic kyphosis (TK), lumbar lordosis, global cervical angles (angles between two lines parallel with posterior walls of C2 and C7), practical cervical angles (the addition of different cervical end plate angles from C3 to C7, and inter-vertebral angles from C23 to C67), T1 slope, spinal sacral angles (SSA), Hip to C7/Hip to Sacrum and C0-C2 angle. The percentages of cervical lordosis were 28.3% and 36.4% in asymptomatic and spondylotic group, respectively. The cervical spine alignments correlated with Roussouly types of global spine alignment in both asymptomatic and cervical spondylotic group (P inter-vertebral angle in Roussouly Type 2 at C4-5 and C5-6 levels (P = 0.04 and 0.04, respectively), and in Roussouly Type 3 at C6-7 level (P = 0.01). The SSA showed significant difference between Roussouly Type 2 and 4 in asymptomatic subjects (P = 0.00), and between Type 1 and 3, 1 and 4, 2 and 3, 2 and 4 in cervical spondylotic patients (P = 0.01, 0.02, 0.00 and 0.01, respectively). The T1 slope was significantly different among Roussouly types (P = 0.04) with its largest value in

  3. Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Kadom, Nadja [Children' s National Medical Center, Department of Diagnostic Imaging and Radiology, Washington, DC (United States); Boston University Medical Center, Boston, MA (United States); Khademian, Zarir; Vezina, Gilbert; Shalaby-Rana, Eglal [Children' s National Medical Center, Department of Diagnostic Imaging and Radiology, Washington, DC (United States); Rice, Amy [Independent Consultant (Biostatistics), Chevy Chase, MD (United States); Hinds, Tanya [Children' s National Medical Center, Child and Adolescent Protection Center, Washington, DC (United States)

    2014-07-15

    statistically significant relationship with a study outcome of abusive head trauma or help discriminate between accidental and abusive head trauma. Of the 30 children with supratentorial brain injury, 16 (53%) had a bilateral hypoxic-ischemic pattern. There was a statistically significant relationship between bilateral hypoxic-ischemic brain injury pattern and abusive head trauma (P < 0.05). In addition, the majority (81%) of children with bilateral hypoxic-ischemic brain injuries had cervical injuries. Although detection of cervical spine injuries by MRI does not discriminate between accidental and abusive head trauma, it can help to distinguish a traumatic from non-traumatic intracranial subdural hemorrhage. Cervical MRI should be considered in children with acute intracranial bleeds and otherwise non-contributory history, physical examination and ophthalmological findings. There is a statistically significant relationship between diffuse hypoxic-ischemic brain injury patterns and abusive head trauma. The high incidence of cervical injuries in children with hypoxic-ischemic injuries suggests a causal relationship. Overall, increased utilization of brain and spine MRI in children being evaluated for abusive head trauma can be helpful. (orig.)

  4. Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma

    International Nuclear Information System (INIS)

    Kadom, Nadja; Khademian, Zarir; Vezina, Gilbert; Shalaby-Rana, Eglal; Rice, Amy; Hinds, Tanya

    2014-01-01

    statistically significant relationship with a study outcome of abusive head trauma or help discriminate between accidental and abusive head trauma. Of the 30 children with supratentorial brain injury, 16 (53%) had a bilateral hypoxic-ischemic pattern. There was a statistically significant relationship between bilateral hypoxic-ischemic brain injury pattern and abusive head trauma (P < 0.05). In addition, the majority (81%) of children with bilateral hypoxic-ischemic brain injuries had cervical injuries. Although detection of cervical spine injuries by MRI does not discriminate between accidental and abusive head trauma, it can help to distinguish a traumatic from non-traumatic intracranial subdural hemorrhage. Cervical MRI should be considered in children with acute intracranial bleeds and otherwise non-contributory history, physical examination and ophthalmological findings. There is a statistically significant relationship between diffuse hypoxic-ischemic brain injury patterns and abusive head trauma. The high incidence of cervical injuries in children with hypoxic-ischemic injuries suggests a causal relationship. Overall, increased utilization of brain and spine MRI in children being evaluated for abusive head trauma can be helpful. (orig.)

  5. Tomographic imaging of the cervical spine of horses; Aspectos tomograficos da coluna cervical de equinos

    Energy Technology Data Exchange (ETDEWEB)

    Souza, L.P.; Machado, V.M.V.; Santos, R.V.; Evangelista, F.C.; Vulcano, L.C. [Universidade Estadual Paulista, Botucatu, SP (Brazil). Faculdade de Medicina Veterinaria e Zootecnia

    2012-09-15

    The anatomy of the cervical spine of mature horses based on images obtained with a helical computed tomography examination performed on anatomic specimens was studied. Computed tomography was the diagnostic imaging method of choice and allowed three-dimensional reconstructions of images and other anatomical planes, such as coronal and sagittal. All images were acquired and evaluated in the filter and window to bone tissue. It was possible to demonstrate the anatomical differences and peculiarities of the normal vertebrae, particularly the occipito-atlantoaxial region, which has a higher incidence of changes to assist in the visualization of any change of the bone pattern on CT studies. (author)

  6. Endotracheal intubation in patients with cervical spine immobilization: a comparison of macintosh and airtraq laryngoscopes.

    LENUS (Irish Health Repository)

    Maharaj, Chrisen H

    2007-07-01

    The Airtraq laryngoscope (Prodol Ltd., Vizcaya, Spain) is a novel single-use tracheal intubation device. The authors compared ease of intubation with the Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization in a randomized, controlled clinical trial.

  7. Carotid Artery Injury in Anterior Cervical Spine Surgery: Multicenter Cohort Study and Literature Review

    OpenAIRE

    H?rtl, Roger; Alimi, Marjan; Abdelatif Boukebir, Mohamed; Berlin, Connor D.; Navarro-Ramirez, Rodrigo; Arnold, Paul M.; Fehlings, Michael G.; Mroz, Thomas E.; Riew, K. Daniel

    2017-01-01

    Study Design: Retrospective study and literature review. Objective: To provide more comprehensive data about carotid artery injury (CAI) or cerebrovascular accident (CVA) related to anterior cervical spine surgery. Methods: We conducted a retrospective, multicenter, case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records of 17?625 patients who went through cervical spine surgery (levels from C2 to C7) between Januar...

  8. Recurrent Laryngeal Nerve Palsy After Cervical Spine Surgery: A Multicenter AOSpine Clinical Research Network Study

    OpenAIRE

    Gokaslan, Ziya L.; Bydon, Mohamad; De la Garza-Ramos, Rafael; Smith, Zachary A.; Hsu, Wellington K.; Qureshi, Sheeraz A.; Cho, Samuel K.; Baird, Evan O.; Mroz, Thomas E.; Fehlings, Michael; Arnold, Paul M.; Riew, K. Daniel

    2017-01-01

    Study Design: Multicenter retrospective study. Objectives: To investigate the risk of symptomatic recurrent laryngeal nerve palsy (RLNP) following cervical spine surgery, to examine risk factors for its development, and to report its treatment and outcomes. Methods: A multicenter study from 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was performed. Each center screened for rare complications following cervical spine surgery, including RLNP. Patient...

  9. Thoracic Duct Injury Following Cervical Spine Surgery: A Multicenter Retrospective Review

    OpenAIRE

    Derakhshan, Adeeb; Lubelski, Daniel; Steinmetz, Michael P.; Corriveau, Mark; Lee, Sungho; Pace, Jonathan R.; Smith, Gabriel A.; Gokaslan, Ziya; Bydon, Mohamad; Arnold, Paul M.; Fehlings, Michael G.; Riew, K. Daniel; Mroz, Thomas E.

    2017-01-01

    Study Design: Multicenter retrospective case series. Objective: To determine the rate of thoracic duct injury during cervical spine operations. Methods: A retrospective case series study was conducted among 21 high-volume surgical centers to identify instances of thoracic duct injury during anterior cervical spine surgery. Staff at each center abstracted data for each identified case into case report forms. All case report forms were collected by the AOSpine North America Clinical Research Ne...

  10. Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report and Review of the Literature

    OpenAIRE

    Hershman, Stuart H.; Kunkle, William A.; Kelly, Michael P.; Buchowski, Jacob M.; Ray, Wilson Z.; Bumpass, David B.; Gum, Jeffrey L.; Peters, Colleen M.; Singhatanadgige, Weerasak; Kim, Jin Young; Smith, Zachary A.; Hsu, Wellington K.; Nassr, Ahmad; Currier, Bradford L.; Rahman, Ra?Kerry K.

    2017-01-01

    Study Design: Multicenter retrospective case series and review of the literature. Objective: To determine the rate of esophageal perforations following anterior cervical spine surgery. Methods: As part of an AOSpine series on rare complications, a retrospective cohort study was conducted among 21 high-volume surgical centers to identify esophageal perforations following anterior cervical spine surgery. Staff at each center abstracted data from patients? charts and created case report forms fo...

  11. Asymptomatic grotesque deformities of the cervical spine. An occupational hazard in railway porters.

    Science.gov (United States)

    Kelkar, P; O'Callaghan, B; Lovblad, K O

    1998-03-15

    A case report. To illustrate an extremely rare occurrence of chronic, occupational, low-grade trauma leading to asymptomatic grotesque cervical spine deformities in railroad station porters. Occupational trauma causing spinal deformities has been described in relation to thoracic and lumbar spines in miners. To the authors' knowledge, this is the first reported case of asymptomatic cervical spinal deformity in railway porters as a result of chronic occupational trauma. A magnetic resonance imaging study was performed on both patients. The magnetic resonance images showed advanced degenerative changes in the cervical spine causing obvious deformities, along with apparently normal cord signal intensity. Chronic, occupational, low-grade trauma of the cervical vertebral region is extremely unusual in industrialized countries. Nevertheless, in view of the increasing mobility of people in general and of the labor force in particular, this complication of an occupational exposure deserves attention as an unusual cause of cervical spinal deformity.

  12. Carotid Artery Injury in Anterior Cervical Spine Surgery: Multicenter Cohort Study and Literature Review.

    Science.gov (United States)

    Härtl, Roger; Alimi, Marjan; Abdelatif Boukebir, Mohamed; Berlin, Connor D; Navarro-Ramirez, Rodrigo; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Retrospective study and literature review. To provide more comprehensive data about carotid artery injury (CAI) or cerebrovascular accident (CVA) related to anterior cervical spine surgery. We conducted a retrospective, multicenter, case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records of 17 625 patients who went through cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were analyzed. Also, we performed a literature review using Medline and PubMed databases. The following terms were used alone, and in combination, to search for relevant articles: cervical, spine, surgery, complication, iatrogenic, carotid artery, injury, cerebrovascular accident, CVA, and carotid stenosis. Among 17 625 patients that were analyzed, no cases were reported to experienced CAI or CVA after cervical spine surgery. Nevertheless, in our PubMed search we found 157 articles, but only 5 articles matched our study objective criteria; 2 cases were reported to present CAI and 3 cases presented CVA. CAI and CVA related to anterior cervical spine surgeries are extremely rare. We were not able to find neither in our retrospective study nor in our literature research a correlation between the type or length of anterior cervical spine procedure with CVA or CAI complications. However, surgeons should be aware of the possibility of vascular complications and minimize intraoperative direct vascular manipulations or retraction. Preoperative screening for underlying vascular pathology and risk factors is also important.

  13. Osteochondromatosis of the cervical spine causing compressive myelopathy in a dog

    International Nuclear Information System (INIS)

    Caporn, T.M.; Read, R.A.

    1996-01-01

    A 10-month-old Alaskan malamute presented with cervical pain and hindlimb proprioceptive deficits. Plain and myelographic radiographic studies of the cervical spine demonstrated extradural compression of the spinal cord at the level of C7 and C5. Computed tomography assisted presurgical characterisation of the lesions as osteochondromatosis. Laminectomy permitted successful removal of the lesions

  14. Airway obstruction due to tracheomalacia caused by innominate artery compression and a kyphotic cervical spine.

    Science.gov (United States)

    Liu, Chia-Hsin; Huang, Wen-Sheng; Wang, Hong-Hau; Wu, Chin-Pyng; Chian, Chih-Feng; Perng, Wann-Cherng; Tsai, Chen-Liang

    2015-02-01

    Tracheomalacia can cause variable degrees of intrathoracic airway obstruction and is an easily overlooked cause of respiratory distress in adults. Here, we report a case of acute respiratory failure in which subglottic stenosis was accidentally identified during endotracheal intubation. Subsequent bronchoscopy and computed tomography of the thorax and neck revealed tracheal compression with tracheomalacia caused by a tortuous innominate artery and a kyphotic cervical spine. The patient underwent rigid bronchoscopy with metal stent implantation, and her symptoms were alleviated. These findings outline the importance of precise diagnosis and interventions for preventing recurrent life-threatening respiratory failure in such cases. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Tschoeke Sven K

    2008-06-01

    Full Text Available Abstract Patients with ankylosing spondylitis are at significant risk for sustaining cervical spine injuries following trauma predisposed by kyphosis, stiffness and osteoporotic bone quality of the spine. The risk of sustaining neurological deficits in this patient population is higher than average. The present review article provides an outline on the specific injury patterns in the cervical spine, diagnostic algorithms and specific treatment modalities dictated by the underlying disease in patients with ankylosing spondylitis. An emphasis is placed on the risks and complication patterns in the treatment of these rare, but challenging injuries.

  16. Detailed examination of the lower cervical spine facet joints in a road traffic crash fatality - a case study

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Nielsen, Edith; Vesterby, Annie

    2005-01-01

    The lower cervical spine facet joints of a road traffic crash fatality were examined using diagnostic imaging and histological techniques. No injuries to the cervical spine facet joints could be identified with diagnostic imaging including conventional radiology, CT and MRI. Examination of stained...... histological sections visualised the morphology and integrity of the facet joints in detail. Occult injuries to and in close proximity of the cervical spine facet joints were identified only on histological examination....

  17. Assessment of temporomandibular and cervical spine disorders in tinnitus patients.

    Science.gov (United States)

    Björne, Assar

    2007-01-01

    In treating patients with temporomandibular joint (TMJ) dysfunction it was noticed that tinnitus and vertigo were common in such patients and there was also muscular tension in jaw and neck. During treatment of these patients it was also noted that injection of lidocaine in a jaw muscle (m. pt. lat.) reduced not only their muscular problems but also that the tinnitus was reduced while the local anesthetic was active. Evaluation of 39 patients with disabling tinnitus, and all suffered from tinnitus, revealed that 10 of them had bilateral tinnitus and TMJ disorders revealed that pain in the face, temples or jaw occurred often among these patients. Many of such patients had also symptoms of cervical spine disorders, head, neck and shoulder pain, and limitations in side bending and rotation were also frequent complaints. One-third of these patients could influence tinnitus by jaw movements and 75% could trigger vertigo by head or neck movements. Treatment of jaw and neck disorders in 24 patients with Ménière's disease had a beneficial effect on not only their episodic vertigo but also on their tinnitus and aural fullness. At the 3-year follow-up, intensity of all symptoms were significantly reduced (p<0.001).

  18. Steadily promoting the technical research and the clinical application of interventional radiology for cervical spine

    International Nuclear Information System (INIS)

    Wu Chungen; Zhou Bing

    2009-01-01

    Many interventional procedures have been practiced in the treatment of cervical spine diseases for recent years. There are percutaneous biopsy, periradicular therapy for cervical never pain, percutaneous vertebroplasty and many kinds of intervertebral disc decompression. However, because of the manipulation difficulties and high risks of these procedures the popularization of interventional techniques in treating cervical spine disorders has actually been beset with difficulties. The main risks caused by interventional operation are puncture injuries and side-effect of therapeutic design. Therefore, how to reduce the procedure's risk is a great challenge to interventional radiologists as well as an urgent research task. (authors)

  19. Investigation of whiplash injuries in the upper cervical spine using a detailed neck model.

    Science.gov (United States)

    Fice, Jason B; Cronin, Duane S

    2012-04-05

    Whiplash injuries continue to have significant societal cost; however, the mechanism and location of whiplash injury is still under investigation. Recently, the upper cervical spine ligaments, particularly the alar ligament, have been identified as a potential whiplash injury location. In this study, a detailed and validated explicit finite element model of a 50th percentile male cervical spine in a seated posture was used to investigate upper cervical spine response and the potential for whiplash injury resulting from vehicle crash scenarios. This model was previously validated at the segment and whole spine levels for both kinematics and soft tissue strains in frontal and rear impact scenarios. The model predicted increasing upper cervical spine ligament strain with increasing impact severity. Considering all upper cervical spine ligaments, the distractions in the apical and alar ligaments were the largest relative to their failure strains, in agreement with the clinical findings. The model predicted the potential for injury to the apical ligament for 15.2 g frontal or 11.7 g rear impacts, and to the alar ligament for a 20.7 g frontal or 14.4 g rear impact based on the ligament distractions. Future studies should consider the effect of initial occupant position on ligament distraction. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Pathologic evaluation of the cervical spine following surgical and chiropractic interventions.

    Science.gov (United States)

    Matshes, Evan W; Joseph, Jeffrey

    2012-01-01

    When patients die after chiropractic or surgical interventions of the cervical spine, pathologists tasked with the autopsy are frequently overwhelmed by the complicated anatomy, laborious dissections, complex operative procedures and surgical hardware, and the necessity to differentiate artifacts from trauma and disease. However, abundant data can be obtained from careful evaluation of the cervical spine in situ; extensive postmortem diagnostic imaging procedures; detailed dissections of the removed, formalin-fixed and decalcified spine; and histology. This study presents a regimented, stepwise approach to the evaluation of the cervical spine in these difficult cases, promotes uniform assessment, facilitates diagnoses, and supports the accumulation of otherwise hard-to-come-by reference material that can be of value in future cases. The resultant detailed autopsy findings may prove useful in the medico-legal death investigation process. Autopsy findings may also be of great value to health care providers involved in quality assurance processes. © 2011 American Academy of Forensic Sciences.

  1. Effects of Maitland manual therapy on the treatment of pain syndromes of the cervical spine

    Directory of Open Access Journals (Sweden)

    Ireneusz Dzierżek

    2017-03-01

    Full Text Available Introduction: The aim of this study was evaluate the effect of Maitland's manual therapy on selected motor function parameters in cervical spine pain syndromes. Material and Methods: 30 subjects were enrolled, in the age from 27 to 66, including 15 men and 15 women with chronic functional cervical spine syndrome who had a 10-day physiotherapy cycle that did not produce the expected results. The study included: pain assessment in the Dziak scale, measurements of mobility of the cervical spine and shoulder joints, functional evaluation by Hautanta, De`Klein, Jackson, and palpation of muscle irritation. Results: A comparison of average pain scores before and after therapy indicated that the pain level after treatment decreased (p 0.05. There has been a decrease in positive clinical trials and muscle irritation after therapy. Conclusions: Maitland manual therapy is effective in the treatment of cervical spine pain syndromes. The technique results in a significant increase in the mobility of the cervical spine as well as an improvement in the functional state of the cervical segment without affecting the mobility of the shoulder ridge. There was a decrease in palpate tenderness of the soft tissue studied.

  2. Cervical spine immobilization during extrication of the awake patient: a narrative review.

    Science.gov (United States)

    Cowley, Alan; Hague, Ashley; Durge, Neal

    2017-06-01

    Techniques for extricating vehicle occupants after road-traffic collisions have evolved largely through fear of worsening a cervical spine injury, rather than being evidence-based. Recent research has looked at the safety of allowing the alert patient to self-extricate, rather than being assisted with equipment such as long spinal boards and semirigid cervical collars. This review aims to elucidate whether it is safe to allow an alert, ambulant patient to self-extricate from a vehicle with minimal or no cervical spine immobilization. A literature search was conducted looking for papers that discussed cervical spine motion during extrication from a vehicle. Five papers were yielded, and their methodology, results and limitations were assessed. Motion capture studies suggest that a patient who is allowed to self-extricate from a vehicle will move their cervical spine no more than a patient who is extricated by traditional methods, and may move their neck up to four times less. Furthermore, an alert patient with a neck injury will demonstrate a self-protection mechanism, ensuring injuries are not worsened. Evidence is now building that self-extrication in alert patients with minimal or no cervical spine immobilization is safe. Self-extrication should become more commonplace, conferring not only a potential safety benefit but also advantages in time to definitive care and resource use.

  3. Acute cervical cord injury without fracture or dislocation of the spinal column.

    Science.gov (United States)

    Koyanagi, I; Iwasaki, Y; Hida, K; Akino, M; Imamura, H; Abe, H

    2000-07-01

    It is known that the spinal cord can sustain traumatic injury without associated injury of the spinal column in some conditions, such as a flexible spinal column or preexisting narrowed spinal canal. The purpose of this study was to characterize the clinical features and to understand the mechanisms in cases of acute cervical cord injury in which fracture or dislocation of the cervical spine has not occurred. Eighty-nine patients who sustained an acute cervical cord injury were treated in our hospitals between 1990 and 1998. In 42 patients (47%) no bone injuries of the cervical spine were demonstrated, and this group was retrospectively analyzed. There were 35 men and seven women, aged 19 to 81 years (mean 58.9 years). The initial neurological examination indicated complete injury in five patients, whereas incomplete injury was demonstrated in 37. In the majority of the patients (90%) the authors found degenerative changes of the cervical spine such as spondylosis (22 cases) or ossification of the posterior longitudinal ligament (16 cases). The mean sagittal diameter of the cervical spinal canal, as measured on computerized tomography scans, was significantly narrower than that obtained in the control patients. Magnetic resonance (MR) imaging revealed spinal cord compression in 93% and paravertebral soft-tissue injuries in 58% of the patients. Degenerative changes of the cervical spine and developmental narrowing of the spinal canal are important preexisting factors. In the acute stage MR imaging is useful to understand the level and mechanisms of spinal cord injury. The fact that a significant number of the patients were found to have spinal cord compression despite the absence of bone injuries of the spinal column indicates that future investigations into surgical treatment of this type of injury are necessary.

  4. Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures.

    Science.gov (United States)

    Peng, Chan W; Chou, Benedict T; Bendo, John A; Spivak, Jeffrey M

    2009-01-01

    Vertebral artery (VA) injury can be a catastrophic iatrogenic complication of cervical spine surgery. Although the incidence is rare, it has serious consequences including fistulas, pseudoaneurysm, cerebral ischemia, and death. It is therefore imperative to be familiar with the anatomy and the instrumentation techniques when performing anterior or posterior cervical spine surgeries. To provide a review of VA injury during common anterior and posterior cervical spine procedures with an evaluation of the surgical anatomy, management, and prevention of this injury. Comprehensive literature review. A systematic review of Medline for articles related to VA injury in cervical spine surgery was conducted up to and including journal articles published in 2007. The literature was then reviewed and summarized. Overall, the risk of VA injury during cervical spine surgery is low. In anterior cervical procedures, lateral dissection puts the VA at the most risk, so sound anatomical knowledge and constant reference to the midline are mandatory during dissection. With the development and rise in popularity of posterior cervical stabilization and instrumentation, recognition of the dangers of posterior drilling and insertion of transarticular screws and pedicle screws is important. Anomalous vertebral anatomy increases the risk of injury and preoperative magnetic resonance imaging and/or computed tomography (CT) scans should be carefully reviewed. When the VA is injured, steps should be taken to control local bleeding. Permanent occlusion or ligation should only be attempted if it is known that the contralateral VA is capable of providing adequate collateral circulation. With the advent of endovascular repair, this treatment option can be considered when a VA injury is encountered. VA injury during cervical spine surgery is a rare but serious complication. It can be prevented by careful review of preoperative imaging studies, having a sound anatomical knowledge and paying attention

  5. Spontaneous cervical epidural hematomas with acute hemiparesis should be considered a contraindication for intravenous thrombolysis: a case report with a literature review of 50 cases.

    Science.gov (United States)

    Ito, Hirotaka; Takai, Keisuke; Taniguchi, Makoto

    2014-01-01

    We herein report the case of a 63-year-old woman with an acute spontaneous cervical epidural hematoma who presented with acute hemiparesis and was successfully managed with surgery. Based on a literature review of 50 cases of spontaneous cervical epidural hematomas, we concluded that the relatively high frequency of hemiparesis (12 of 50 cases, 24%) is the result of the fact that epidural hematomas are predominantly distributed dorsolaterally in the region of the mid and lower cervical spine, leading to unilateral cervical cord compression. Clinicians should keep in mind that acute hemiparesis can be caused by spontaneous cervical epidural hematomas for which intravenous thrombolysis is contraindicated.

  6. Cervical spine alignment in the youth football athlete: recommendations for emergency transportation.

    Science.gov (United States)

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

    2008-08-01

    Substantial literature exists regarding recommendations for the on-field treatment and subsequent transportation of adult collision-sport athletes with a suspected injury to the cervical spine. To develop an evidence-based recommendation for transportation of suspected spine-injured youth football players. Descriptive laboratory study. Three lateral radiographs were obtained in supine to include the occiput to the cervical thoracic junction from 31 youth football players (8-14 years). Each child was imaged while wearing helmet and shoulder pads, without equipment, and with shoulder pads only. Two independent observers measured cervical spine angulation as Cobb angle from C1 to C7 and subaxial angulation from C2 to C7. We calculated intraclass correlation coefficients for intraobserver reliability analysis and compared Cobb and C2 to C7 angles between equipment conditions with t tests. Interobserver analysis showed excellent reliability among measurements. Cobb and subaxial angle measurements indicated significantly greater cervical lordosis while children wore shoulder pads only, compared with the other 2 conditions (no equipment and helmet and shoulder pads) (P .05). Equipment removal for the youth football athlete with suspected cervical spine injury should abide by the "all or none" policy that has been widely accepted for adult athletes. Helmet and shoulder pads should be left in place during emergency transport of the suspected spine-injured youth athlete. Despite differences in head to torso size ratios between youth and adult players, helmet removal alone is not recommended for either during emergency transportation.

  7. Radiographic evaluation of cervical spine of subjects with temporomandibular joint internal disorder.

    Science.gov (United States)

    Munhoz, Wagner Cesar; Marques, Amélia Pasqual; Siqueira, José Tadeu Tesseroli de

    2004-01-01

    Although the etiopathophysiology of internal temporomandibular joint internal disorders (TMJ ID) is still unknown, it has been suggested that head and body posture could be related to its initial onset, development and perpetuation. The purpose of the present study was to observe the relationship between cervical spine X-ray abnormalities and TMJ ID. This investigation evaluated 30 subjects with internal TMJ disorder symptoms (test group) and 20 healthy subjects (control group). Subjects were submitted to clinical and radiographic evaluation. Clinical evaluation comprised anamnesis and stomatognathic system physical examination. Radiographic evaluation comprised analysis of lateral cervical spine X-rays by three physical therapists and tracing on the same images. The test group presented twice as much cervical spine hyperlordosis as the control group (20.7% versus 10.5%), but almost half of rectification prevalence (41.4 versus 79.0%, p = 0.03). After that, the test group was divided into three subgroups according to TMJ dysfunction severity, evaluated by Helkimo's index. These subgroups were not significantly different, but the subgroup with more severe TMD showed a tendency to cervical spine hyperlordosis prevalence. Results showed a tendency for subjects with more severe TMD to exhibit cervical spine hyperlordosis. Nevertheless, studies with a larger number of subjects suffering from severe TMD are encouraged in order to corroborate the present findings.

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

    Science.gov (United States)

    Hill, Suvimol C; Dwyer, Andrew J; Kaler, Stephen G

    2012-11-01

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

  9. Outlines and Outcomes of Instrumented Posterior Fusion in the Pediatric Cervical Spine: A Review Article

    Directory of Open Access Journals (Sweden)

    Kaveh Haddadi

    2016-01-01

    Full Text Available Context The most common source of cervical spine arthrodesis in the pediatric populace is the instability related to congenital or traumatic damage. Surgery of cervical spine can be challenging given slighter anatomical constructions, fewer hardened bone, and upcoming growth potential and growth. Evidence Acquisition Trainings in adult patients recommended that consuming screw constructs results in enhanced consequences with inferior amounts of instrumentation catastrophe. But, the pediatric literature is inadequate for minor retrospective series. Authors reviewed the existing pediatric cervical spine arthrodesis literature. They studied 184 abstracts from January 1976 to December 2014. An entire of 883 patients in 82 articles were involved in the evaluation. Patients were characterized as taking either posterior cervical fusion with wiring or posterior cervical fusion with screws or occipitocervical fusion. Results The etiologies faced most frequently were inherited abnormalities (54% shadowed by trauma (28%, Down syndrome (8%, and infectious, oncological, iatrogenic, or mixed causes (10%. The mean duration of follow-up was 32.5 months. Conclusions The consequences of this training are restricted by deviations in construct policy, usage of orthoses, follow-up period and fresher adjuvant produces stimulating fusions. But, a literature review recommend that instrumentation of the cervical spine in children may be harmless and more effective than using screw concepts rather than wiring methods.

  10. Acute Cervical Dystonia Induced by Clebopride.

    Science.gov (United States)

    Choi, Jin Kyo; Hong, Jin Yong

    2017-01-01

    Antidopaminergic drugs are known to induce extrapyramidal symptoms. Clebopride, a dopamine antagonist, also can produce parkinsonism, tardive dyskinesia, tardive dystonia, hemifacial dystonia, or oculogyric crisis; however, acute dystonic reaction caused by clebopride has not been reported in adults. We report two young men who experienced acute cervical dystonia within a few days of taking clebopride. The patients recovered after discontinuation of the drug. Physicians prescribing clebopride should be aware of the adverse effects of this drug.

  11. Acute Cervical Dystonia Induced by Clebopride

    OpenAIRE

    Choi, Jin Kyo; Hong, Jin Yong

    2017-01-01

    Antidopaminergic drugs are known to induce extrapyramidal symptoms. Clebopride, a dopamine antagonist, also can produce parkinsonism, tardive dyskinesia, tardive dystonia, hemifacial dystonia, or oculogyric crisis; however, acute dystonic reaction caused by clebopride has not been reported in adults. We report two young men who experienced acute cervical dystonia within a few days of taking clebopride. The patients recovered after discontinuation of the drug. Physicians prescribing clebopride...

  12. Acute Cervical Dystonia Induced by Clebopride

    Directory of Open Access Journals (Sweden)

    Jin Kyo Choi

    2017-01-01

    Full Text Available Antidopaminergic drugs are known to induce extrapyramidal symptoms. Clebopride, a dopamine antagonist, also can produce parkinsonism, tardive dyskinesia, tardive dystonia, hemifacial dystonia, or oculogyric crisis; however, acute dystonic reaction caused by clebopride has not been reported in adults. We report two young men who experienced acute cervical dystonia within a few days of taking clebopride. The patients recovered after discontinuation of the drug. Physicians prescribing clebopride should be aware of the adverse effects of this drug.

  13. Lower cervical levels: Increased risk of early dysphonia following anterior cervical spine surgery.

    Science.gov (United States)

    Zeng, Ji-Huan; Li, Xiao-Dan; Deng, Liang; Xiao, Qiang

    2016-10-01

    The present study aimed to re-evaluate the incidence of early dysphonia after anterior cervical spine surgery (ACSS) and to determine the related risk factors. Patients underwent ACSS between January 2011 and December 2013 at two sites were identified retrospectively from hospital's patient databases. A total of 233 cases were included in this study. Dysphonia developed 1 month postoperatively was recorded. Follow-up was conducted in all positive-response patients. Those reporting severe or persistent voice symptoms were referred to otolaryngologists for further assessments and (or) treatments. Pre and intraoperative factors were collected to determine their relationships with dysphonia one month postoperatively. 45 patients developed dysphonia at one month, including 23 males and 22 females, yielding to an incidence of 19.3%. 34 cases resolved themselves in 3 months, leaving the remaining 11 patients considered to be severe or persistent cases. However, 10 of them recovered spontaneously in the next 9 months, while the last case received vocal cord medialization and returned to almost normal speech function at 18 months. In univariate analysis, only approaching level involving C6-C7 or (and) C7-T1 was significantly associated with postoperative dysphonia (Pdysphonia following ACSS was relatively high and approaching at lower cervical levels was an independent predictive factor. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Cervical spine signs and symptoms: perpetuating rather than predisposing factors for temporomandibular disorders in women

    Directory of Open Access Journals (Sweden)

    Débora Bevilaqua-Grossi

    2007-08-01

    Full Text Available 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.

  15. Anterior cervical spine surgery-associated complications in a retrospective case-control study.

    Science.gov (United States)

    Tasiou, Anastasia; Giannis, Theofanis; Brotis, Alexandros G; Siasios, Ioannis; Georgiadis, Iordanis; Gatos, Haralampos; Tsianaka, Eleni; Vagkopoulos, Konstantinos; Paterakis, Konstantinos; Fountas, Kostas N

    2017-09-01

    Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration. The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded. The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF). Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.

  16. Calcification of the alar ligament of the cervical spine: imaging findings and clinical course

    Energy Technology Data Exchange (ETDEWEB)

    Kobayashi, Yuka; Mochida, J.; Toh, E. [Dept. of Orthopaedic Surgery, Tokai Univ., Isehara, Kanagawa (Japan); Saito, Ikuo; Matui, Sizuka [Dept. of Orthopaedic Surgery, Odawara Hospital, Printing Bureau, Ministry of Finance, Sakawa, Odawara, Kanagawa (Japan)

    2001-05-01

    Ligamentous calcification of the cervical spine has been reported in the yellow ligament, anterior and posterior longitudinal ligaments and interspinous ligament. Calcification in the upper cervical spine is rare, although some cases with calcification of the transverse ligament of the atlas have been reported. Two patients with calcification of the alar ligament with an unusual clinical presentation and course are described. Examination by tomography and computed tomography (CT) showed calcification of the alar ligament and the transverse ligament of the atlas. CT documented decreased calcification as symptoms resolved. There may be a role for CT in the search for calcifications in the upper cervical spine in patients presenting with neck pain and pharyngodynia if radiographs are normal. (orig.)

  17. The radiographic distinction of degenerative slippage (spondylolisthesis and retrolisthesis) from traumatic slippage of the cervical spine

    International Nuclear Information System (INIS)

    Lee, C.; Woodring, J.H.; Rogers, L.F.; Kim, K.S.

    1986-01-01

    In a review of 42 cases of degenerative arthritis of the cervical spine and 22 cases of cervical spine trauma with an observed anterior slip-page (spondylolisthesis) or posterior slippage (retrolisthesis) of the vertebral bodies of 2 mm or more, characteristic features were observed which allowed distinction between degenerative and traumatic slippage of the cervical spine. In degenerative slippage the shape of the articular facets and width of the facet joint space may remain normal; however, in most cases the articular facets become 'ground-down' with narrowing of the facet joint space and the articular facets themselves becoming thinned or ribbon-like. In traumatic slippage the articular facets will either be normally shaped or fractured and the facet joint space will be abnormally widened. Plain radiographs will usually allow this distinction to be made; however, in difficult cases polytomography may be required. (orig.)

  18. Calcification of the alar ligament of the cervical spine: imaging findings and clinical course

    International Nuclear Information System (INIS)

    Kobayashi, Yuka; Mochida, J.; Toh, E.; Saito, Ikuo; Matui, Sizuka

    2001-01-01

    Ligamentous calcification of the cervical spine has been reported in the yellow ligament, anterior and posterior longitudinal ligaments and interspinous ligament. Calcification in the upper cervical spine is rare, although some cases with calcification of the transverse ligament of the atlas have been reported. Two patients with calcification of the alar ligament with an unusual clinical presentation and course are described. Examination by tomography and computed tomography (CT) showed calcification of the alar ligament and the transverse ligament of the atlas. CT documented decreased calcification as symptoms resolved. There may be a role for CT in the search for calcifications in the upper cervical spine in patients presenting with neck pain and pharyngodynia if radiographs are normal. (orig.)

  19. Histological Osteoarthritic Changes in the Human Cervical Spine Facet Joints Related to Age and Gender

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Charles, Annie Vesterby; Gregersen, Markil

    2018-01-01

    STUDY DESIGN: Cross-sectional autopsy study. OBJECTIVE: Quantify histological changes in the lower cervical spine facet joints with regard to age and gender using systematic random sampling of entire joints. SUMMARY OF BACKGROUND DATA: Neck pain is a common debilitating musculoskeletal condition...... and one of the highest ranked causes of years lived with disability. The cause of neck pain is multifactorial and osteoarthritis is one potential cause. The cervical spine facet joints have been implicated in the aetiology of chronic neck pain. Hence, a detailed description of their anatomy and age......- and gender related changes is needed. METHODS: The lower four cervical spine segments (C4-C7 included) were obtained from 72 subjects during autopsy; 29 females (median age 53 years [22-77]) and 43 males (median age 38 years [20-78]). A total of 1132 articular facets were embedded in toto in hard plastic...

  20. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion

    Science.gov (United States)

    Huang, H.; Nightingale, R. W.

    2018-01-01

    Objectives Loss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine. Methods A previously validated FE model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash exposure in accordance with Euro NCAP (the European New Car Assessment Programme) testing using the whole human FE model. The coupled motions between the cervical spine and lumbar spine were assessed by evaluating the biomechanical effects of simulated cervical fusion and lumbar fusion. Results Peak anterior longitudinal ligament (ALL) strain ranged from 0.106 to 0.382 in a normal spine, and from 0.116 to 0.399 in a fused cervical spine. Strain increased from cranial to caudal levels. The mean strain increase in the motion segment immediately adjacent to the site of fusion from C2-C3 through C5-C6 was 26.1% and 50.8% following single- and two-level cervical fusion, respectively (p = 0.03, unpaired two-way t-test). Peak cervical strains following various lumbar-fusion procedures were 1.0% less than those seen in a healthy spine (p = 0.61, two-way ANOVA). Conclusion Cervical arthrodesis increases peak ALL strain in the adjacent motion segments. C3-4 experiences greater changes in strain than C6-7. Lumbar fusion did not have a significant effect on cervical spine strain. Cite this article: H. Huang, R. W. Nightingale, A. B. C. Dang. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study. Bone

  1. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study.

    Science.gov (United States)

    Huang, H; Nightingale, R W; Dang, A B C

    2018-01-01

    Loss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine. A previously validated FE model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash exposure in accordance with Euro NCAP (the European New Car Assessment Programme) testing using the whole human FE model. The coupled motions between the cervical spine and lumbar spine were assessed by evaluating the biomechanical effects of simulated cervical fusion and lumbar fusion. Peak anterior longitudinal ligament (ALL) strain ranged from 0.106 to 0.382 in a normal spine, and from 0.116 to 0.399 in a fused cervical spine. Strain increased from cranial to caudal levels. The mean strain increase in the motion segment immediately adjacent to the site of fusion from C2-C3 through C5-C6 was 26.1% and 50.8% following single- and two-level cervical fusion, respectively (p = 0.03, unpaired two-way t -test). Peak cervical strains following various lumbar-fusion procedures were 1.0% less than those seen in a healthy spine (p = 0.61, two-way ANOVA). Cervical arthrodesis increases peak ALL strain in the adjacent motion segments. C3-4 experiences greater changes in strain than C6-7. Lumbar fusion did not have a significant effect on cervical spine strain. Cite this article : H. Huang, R. W. Nightingale, A. B. C. Dang. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study. Bone Joint Res 2018;7:28-35. DOI: 10

  2. Diagnostic imaging of cervical spine injuries following blunt trauma: A review of the literature and practical guideline

    NARCIS (Netherlands)

    Saltzherr, T. P.; Fung Kon Jin, P. H. P.; Beenen, L. F. M.; Vandertop, W. P.; Goslings, J. C.

    2009-01-01

    - Patients with a (potential) cervical spine injury can be subdivided into low-risk and high-risk patients. - With a detailed history and physical examination the cervical spine of patients in the 'low-risk' group can be 'cleared' without further radiographic examinations. - X-ray imaging (3-view

  3. Treatment of unstable fractures, dislocations and fracture-dislocations of the cervical spine with Senegas plate fixation

    NARCIS (Netherlands)

    Moerman, J.; Harth, A.; Trimpont, van I.; Uyttendaele, D.; Verdonk, R.; Claessens, H.A.; Verbeke, S.

    1994-01-01

    The results of the anterior approach to the cervical spine for the treatment of fractures and dislocations by arthrodesis and Senegas plate fixation are described. Twenty-two patients underwent a one- or two-level arthrodesis of the cervical spine. Their mean age was 42 years. The injuries were

  4. A Multicenter Review of Superior Laryngeal Nerve Injury Following Anterior Cervical Spine Surgery.

    Science.gov (United States)

    Tempel, Zachary J; Smith, Justin S; Shaffrey, Christopher; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel; Kanter, Adam S

    2017-04-01

    A retrospective multicenter case-series study; case report and review of the literature. The anatomy and function of the superior laryngeal nerve (SLN) are well described; however, the consequences of SLN injury remain variable and poorly defined. The prevalence of SLN injury as a consequence of cervical spine surgery is difficult to discern as its clinical manifestations are often inconstant and frequently of a subclinical degree. A multicenter study was performed to better delineate the risk factors, prevalence, and outcomes of SLN injury. A retrospective multicenter case-series study involving 21 high-volume surgical centers from the AO Spine North America Clinical Research Network. Medical records for 17 625 patients who received subaxial cervical spine surgery from 2005 to 2011 were reviewed to identify occurrence of 21 predefined treatment complications. Descriptive statistics were provided for baseline patient characteristics. A retrospective review of the neurosurgical literature on SLN injury was also performed. A total of 8887 patients who underwent anterior cervical spine surgery at the participating institutions were screened, and 1 case of SLN palsy was identified. The prevalence ranged from 0% to 1.25% across all centers. The patient identified underwent a C4 corpectomy. The SLN injury was identified after the patient demonstrated difficulty swallowing postoperatively. He underwent placement of a percutaneous gastrostomy tube and his SLN palsy resolved by 6 weeks. This multicenter study demonstrates that identification of SLN injury occurs very infrequently. Symptomatic SLN injury is an exceedingly rare complication of anterior cervical spine surgery. The SLN is particularly vulnerable when exposing the more rostral levels of the cervical spine. Careful dissection and retraction of the longus coli may decrease the risk of SLN injury during anterior cervical surgery.

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

    Science.gov (United States)

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

    2013-12-01

    Although a number of finite element (FE) adult cervical spine models have been developed to understand the injury mechanisms of the neck in automotive related crash scenarios, there have been fewer efforts to develop a child neck model. In this study, a 10-year-old ligamentous cervical spine FE model was developed for application in the improvement of pediatric safety related to motor vehicle crashes. The model geometry was obtained from medical scans and meshed using a multi-block approach. Appropriate properties based on review of literature in conjunction with scaling were assigned to different parts of the model. Child tensile force-deformation data in three segments, Occipital-C2 (C0-C2), C4-C5 and C6-C7, were used to validate the cervical spine model and predict failure forces and displacements. Design of computer experiments was performed to determine failure properties for intervertebral discs and ligaments needed to set up the FE model. The model-predicted ultimate displacements and forces were within the experimental range. The cervical spine FE model was validated in flexion and extension against the child experimental data in three segments, C0-C2, C4-C5 and C6-C7. Other model predictions were found to be consistent with the experimental responses scaled from adult data. The whole cervical spine model was also validated in tension, flexion and extension against the child experimental data. This study provided methods for developing a child ligamentous cervical spine FE model and to predict soft tissue failures in tension.

  6. Thoracic Duct Injury Following Cervical Spine Surgery: A Multicenter Retrospective Review.

    Science.gov (United States)

    Derakhshan, Adeeb; Lubelski, Daniel; Steinmetz, Michael P; Corriveau, Mark; Lee, Sungho; Pace, Jonathan R; Smith, Gabriel A; Gokaslan, Ziya; Bydon, Mohamad; Arnold, Paul M; Fehlings, Michael G; Riew, K Daniel; Mroz, Thomas E

    2017-04-01

    Multicenter retrospective case series. To determine the rate of thoracic duct injury during cervical spine operations. A retrospective case series study was conducted among 21 high-volume surgical centers to identify instances of thoracic duct injury during anterior cervical spine surgery. Staff at each center abstracted data for each identified case into case report forms. All case report forms were collected by the AOSpine North America Clinical Research Network Methodological Core for data processing, cleaning, and analysis. Of a total of 9591 patients reviewed that underwent cervical spine surgery, 2 (0.02%) incurred iatrogenic injury to the thoracic duct. Both patients underwent a left-sided anterior cervical discectomy and fusion. The interruption of the thoracic duct was addressed intraoperatively in one patient with no residual postoperative effects. The second individual developed a chylous fluid collection approximately 2 months after the operation that required drainage via needle aspiration. Damage to the thoracic duct during cervical spine surgery is a relatively rare occurrence. Rapid identification of the disruption of this lymphatic vessel is critical to minimize deleterious effects of this complication.

  7. Efficacy of limited CT for nonvisualized lower cervical spine in patients with blunt trauma

    Energy Technology Data Exchange (ETDEWEB)

    Tehranzadeh, J. (Dept. of Radiological Sciences, Univ. of California, Irvine, Medical Center, Orange, CA (United States)); Bonk, R.T. (Dept. of Radiological Sciences, Univ. of California, Irvine, Medical Center, Orange, CA (United States)); Ansari, A. (Dept. of Radiological Sciences, Univ. of California, Irvine, Medical Center, Orange, CA (United States)); Mesgarzadeh, M. (Dept. of Diagnostic Imaging, Temple Univ., Health Sciences Center, Philadelphia, PA (United States))

    1994-07-01

    Records of 100 patients with blunt injury and nonvisualization of C7 and T1 on cross-table lateral and swimmer's views were reviewed to evaluate the usefulness of limited computed tomographic (CT) scans in ''clearing'' the lower cervical vertebrae of injury. CT was deemed necessary and performed in all of these cases because the lower cervical spine could not be evaluated clinically or with plain radiographs. Ninety-seven of these 100 patients had normal findings on CT and only three patients showed cervical spine fractures. All three had isolated and stable fractures. Two of these patients had ''clay-shoveler'' fractures at C6 and C7, respectively, and one had a single laminar fracture at C7. All three patients were conservatively treated. This study emphasizes the value of clinical correlation in the evaluation of cervical spine trauma. When deemed necessary in symptomatic patients, CT is useful to exclude skeletal injury in the lower cervical spine thus avoiding delay in the patient's workup and unnecessary hospitalization, and expediting patient discharge. Lack of pain and neurological findings in nonintoxicated, conscious, and alert patients is generally not associated with significant soft tissue or skeletal injury. (orig.)

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

    Science.gov (United States)

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

    2010-06-01

    The central objective of this investigation was to focus on the development of the cervical spine observed by lateral cephalometric radiological images of children and adolescents (6-16 years old). A sample of 26 individuals (12 girls and 14 boys) was classified according to stages of cervical spine maturation in two subcategories: group I (initiation phase) and group II (acceleration phase). The morphology of the cervical spine was assessed by lateral cephalometric radiographs obtained in accordance with an innovative method for establishing a standardized head posture. A total of 29 linear variables and 5 angular variables were used to clarify the dimensions of the cervical vertebrae. The results suggest that a few measurements can be used as parameters of vertebral maturation both for males and females. The aforementioned measurements include the inferior depth of C2-C4, the inferior depth of C5, the anterior height of C4-C5, and the posterior height of C5. We propose original morphological parameters that may prove remarkably useful in the determination of bone maturational stages of the cervical spine in children and adolescents.

  9. Efficacy of limited CT for nonvisualized lower cervical spine in patients with blunt trauma

    International Nuclear Information System (INIS)

    Tehranzadeh, J.; Bonk, R.T.; Ansari, A.; Mesgarzadeh, M.

    1994-01-01

    Records of 100 patients with blunt injury and nonvisualization of C7 and T1 on cross-table lateral and swimmer's views were reviewed to evaluate the usefulness of limited computed tomographic (CT) scans in ''clearing'' the lower cervical vertebrae of injury. CT was deemed necessary and performed in all of these cases because the lower cervical spine could not be evaluated clinically or with plain radiographs. Ninety-seven of these 100 patients had normal findings on CT and only three patients showed cervical spine fractures. All three had isolated and stable fractures. Two of these patients had ''clay-shoveler'' fractures at C6 and C7, respectively, and one had a single laminar fracture at C7. All three patients were conservatively treated. This study emphasizes the value of clinical correlation in the evaluation of cervical spine trauma. When deemed necessary in symptomatic patients, CT is useful to exclude skeletal injury in the lower cervical spine thus avoiding delay in the patient's workup and unnecessary hospitalization, and expediting patient discharge. Lack of pain and neurological findings in nonintoxicated, conscious, and alert patients is generally not associated with significant soft tissue or skeletal injury. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Young Jun Lee

    2013-01-01

    Full Text Available 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 (. Changes of subjective symptom severity also showed significant improvement (. 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.

  11. Efficacy of limited CT for nonvisualized lower cervical spine in patients with blunt trauma

    Energy Technology Data Exchange (ETDEWEB)

    Tehranzadeh, J [Dept. of Radiological Sciences, Univ. of California, Irvine, Medical Center, Orange, CA (United States); Bonk, R T [Dept. of Radiological Sciences, Univ. of California, Irvine, Medical Center, Orange, CA (United States); Ansari, A [Dept. of Radiological Sciences, Univ. of California, Irvine, Medical Center, Orange, CA (United States); Mesgarzadeh, M [Dept. of Diagnostic Imaging, Temple Univ., Health Sciences Center, Philadelphia, PA (United States)

    1994-07-01

    Records of 100 patients with blunt injury and nonvisualization of C7 and T1 on cross-table lateral and swimmer's views were reviewed to evaluate the usefulness of limited computed tomographic (CT) scans in ''clearing'' the lower cervical vertebrae of injury. CT was deemed necessary and performed in all of these cases because the lower cervical spine could not be evaluated clinically or with plain radiographs. Ninety-seven of these 100 patients had normal findings on CT and only three patients showed cervical spine fractures. All three had isolated and stable fractures. Two of these patients had ''clay-shoveler'' fractures at C6 and C7, respectively, and one had a single laminar fracture at C7. All three patients were conservatively treated. This study emphasizes the value of clinical correlation in the evaluation of cervical spine trauma. When deemed necessary in symptomatic patients, CT is useful to exclude skeletal injury in the lower cervical spine thus avoiding delay in the patient's workup and unnecessary hospitalization, and expediting patient discharge. Lack of pain and neurological findings in nonintoxicated, conscious, and alert patients is generally not associated with significant soft tissue or skeletal injury. (orig.)

  12. Adherence to the guidelines of paediatric cervical spine clearance in a level I trauma centre: A single centre experience

    NARCIS (Netherlands)

    Slaar, Annelie; Fockens, M. Matthijs; van Rijn, Rick R.; Maas, Mario; Goslings, J. Carel; Bakx, Roel; Streekstra, Geert J.; Beenen, Ludo F. M.; Schep, Niels W. L.

    2016-01-01

    International guidelines define if and what type of radiography is advised in children to clear the cervical spine (C-spine). However, adherence to these guidelines has never been evaluated in a paediatric population. Therefore, we wanted to assess the adherence to the guidelines for C-spine

  13. Local Muscle Fatigue and 3D Kinematics of the Cervical Spine in Healthy Subjects.

    Science.gov (United States)

    Niederer, Daniel; Vogt, Lutz; Pippig, Torsten; Wall, Rudolf; Banzer, Winfried

    2016-01-01

    The authors aimed to further explore the effects of local muscle fatigue on cervical 3D kinematics and the interrelationship between these kinematic characteristics and local muscle endurance capacity in the unimpaired cervical spine. Twenty healthy subjects (38 ± 10 years; 5 women) performed 2 × 10 maximal cervical flexion-extension movements. Isometric muscle endurance tests (prone/supine lying) were applied between sets to induce local muscle fatigue quantified by Borg scale rates of perceived exertion (RPE) and slope in mean power frequency (MPF; surface electromyography; m. sternocleidomastoideus, m. splenius capitis). Cervical motion characteristics (maximal range of motion [ROM], coefficient of variation of the 10 repetitive movements, mean angular velocity, conjunct movements in transversal and frontal plane) were calculated from raw 3D ultrasonic movement data. Average isometric strength testing duration for flexion and extension correlated to the cervical ROM (r = .49/r = .48; p .05). Although subjects' cervical muscle endurance capacity and motor output seems to be conjugated, no impact of local cervical muscle fatigue on motor function was shown. These findings underline the importance of complementary measures to address muscular performance and kinematic characteristics in outcome assessment and functional rehabilitation of the cervical spine.

  14. Acute severe neck pain and dysphagia following cervical maneuver: diagnostic approach.

    Science.gov (United States)

    Trendel, D; Bonfort, G; Lapierre-Combes, M; Salf, E; Barberot, J-P

    2014-04-01

    Overlooking an etiologic hypothesis in acute neck pain with dysphagia may lead to misdiagnosis. A 51-year-old man who had received cervical manipulation came to the emergency unit with evolutive acute neck pain, cervical spine stiffness and odynophagia, without fever or other signs of identified pathology. Cervical X-ray and CT angiography of the supra-aortic vessels ruled out traumatic etiology (fracture or arterial dissection) and revealed an accessory bone, orienting diagnosis toward retropharyngeal abscess, which was, however, belied by endoscopy performed under general anesthesia. A second CT scan with contrast injection and tissue phase ruled out infection, revealing a retropharyngeal calcification inducing retropharyngeal edema. Evolution under analgesics was favorable within 13 days. Given a clinical triad associating acute neck pain, cervical spine stiffness and odynophagia, traumatic or infectious etiology was initially suspected. Cervical CT diagnosed calcific tendinitis of the longus colli, revealing a pathognomic retropharyngeal calcification. Secondary to hydroxyapatite deposits anterior to the odontoid process of the axis, this is a rare form of tendinopathy, usually showing favorable evolution in 10-15 days under analgesic and anti-inflammatory treatment. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  15. Cervical Spine Involvement as Initial Manifestation of Rheumatoid Arthritis: a case report

    Directory of Open Access Journals (Sweden)

    Filipe Araújo

    2015-01-01

    Full Text Available Rheumatoid arthritis’ synovitis affects mostly small hand and feet joints, although it may compromise any joint with a synovial lining. Cervical involvement occurs usually in longstanding disease in over half of these patients. We report the case of a 35-year old male patient who was referred to our outpatient clinic for a 2-year severe and disabling inflammatory neck pain, with incomplete response to intramuscular non-steroidal anti-inflammatory drugs and unremarkable cervical imaging studies. He also mentioned self-limited episodes of symmetric polyarthralgia involving hands, wrists, elbows, knees and feet, which started after his cervical complaints. On laboratorial workup, positive rheumatoid factor and anti-citrullinated peptide antibody and negative HLA-B27 were found. Cervical spine magnetic resonance imaging revealed atlantoaxial subluxation and odontoid process inflammatory pannus and erosions. Rheumatoid arthritis with cervical spine involvement as initial manifestation of disease was the definite diagnosis. The patient was started on methotrexate and prednisone and he was referred to neurosurgery outpatient clinic for cervical spine fixation.

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

    Directory of Open Access Journals (Sweden)

    Beauchamp Kathryn M

    2011-07-01

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

  17. Cervical spine surgery performed in ambulatory surgical centers: Are patients being put at increased risk?

    Science.gov (United States)

    Epstein, Nancy E

    2016-01-01

    Spine surgeons are being increasingly encouraged to perform cervical operations in outpatient ambulatory surgical centers (ASC). However, some studies/data coming out of these centers are provided by spine surgeons who are part or full owners/shareholders. In Florida, for example, there was a 50% increase in ASC (5349) established between 2000-2007; physicians had a stake (invested) in 83%, and outright owned 43% of ASC. Data regarding "excessive" surgery by ASC surgeon-owners from Idaho followed shortly thereafter. The risks/complications attributed to 3279 cervical spine operations performed in 6 ASC studies were reviewed. Several studies claimed 99% discharge rates the day of the surgery. They also claimed major complications were "picked up" within the average postoperative observation window (e.g., varying from 4-23 hours), allowing for appropriate treatment without further sequelae. Morbidity rates for outpatient cervical spine ASC studies (e.g. some with conflicts of interest) varied up to 0.8-6%, whereas morbidity rates for 3 inpatient cervical studies ranged up to 19.3%. For both groups, morbidity included postoperative dysphagia, epidural hematomas, neck swelling, vocal cord paralysis, and neurological deterioration. Although we have no clear documentation as to their safety, "excessive" and progressively complex cervical surgical procedures are increasingly being performed in ASC. Furthermore, we cannot rely upon ASC-based data. At least some demonstrate an inherent conflict of interest and do not veridically report major morbidity/mortality rates for outpatient procedures. For now, cervical spine surgery performed in ASC would appear to be putting patients at increased risk for the benefit of their surgeon-owners.

  18. Short-term combined effects of thoracic spine thrust manipulation and cervical spine nonthrust manipulation in individuals with mechanical neck pain: a randomized clinical trial.

    Science.gov (United States)

    Masaracchio, Michael; Cleland, Joshua A; Hellman, Madeleine; Hagins, Marshall

    2013-03-01

    Randomized clinical trial. To investigate the short-term effects of thoracic spine thrust manipulation combined with cervical spine nonthrust manipulation (experimental group) versus cervical spine nonthrust manipulation alone (comparison group) in individuals with mechanical neck pain. Research has demonstrated improved outcomes with both nonthrust manipulation directed at the cervical spine and thrust manipulation directed at the thoracic spine in patients with neck pain. Previous studies have not determined if thoracic spine thrust manipulation may increase benefits beyond those provided by cervical nonthrust manipulation alone. Sixty-four participants with mechanical neck pain were randomized into 1 of 2 groups, an experimental or comparison group. Both groups received 2 treatment sessions of cervical spine nonthrust manipulation and a home exercise program consisting of active range-of-motion exercises, and the experimental group received additional thoracic spine thrust manipulations. Outcome measures were collected at baseline and at a 1-week follow-up, and included the numeric pain rating scale, the Neck Disability Index, and the global rating of change. Participants in the experimental group demonstrated significantly greater improvements (Ppain rating scale and Neck Disability Index at the 1-week follow-up compared to those in the comparison group. In addition, 31 of 33 (94%) participants in the experimental group, compared to 11 of 31 participants (35%) in the comparison group, indicated a global rating of change score of +4 or higher at the 1-week follow-up, with an associated number needed to treat of 2. Individuals with neck pain who received a combination of thoracic spine thrust manipulation and cervical spine nonthrust manipulation plus exercise demonstrated better overall short-term outcomes on the numeric pain rating scale, the Neck Disability Index, and the global rating of change.

  19. Osteoid Osteoma of Cervical Spine in two adjacent Vertebrae

    Directory of Open Access Journals (Sweden)

    MR Etemadifar

    2005-09-01

    Full Text Available Osteoid osteoma is a benign bone tumor, mainly seen in 10-30 years male. Spine is a relatively common site and almost always, posterior elements are involved. Plain X-Ray-, CT scan and Isotope scan help to identify and localize spine lesions. We described one 18 years old boy with 3 years low neck pain. Isotope scan, MRI and CT scan showed two lesions in C7 and T1. Gross inspection and histopathology examination confirmed osteoid osteoma in two adjacent vertebrae which has not been reported elsewhere in the literature. Key words: Osteoid Osteoma, Spine, Multifocal

  20. The impact of spine stability on cervical spinal cord injury with respect to demographics, management, and outcome: a prospective cohort from a national spinal cord injury registry.

    Science.gov (United States)

    Paquet, Jérôme; Rivers, Carly S; Kurban, Dilnur; Finkelstein, Joel; Tee, Jin W; Noonan, Vanessa K; Kwon, Brian K; Hurlbert, R John; Christie, Sean; Tsai, Eve C; Ahn, Henry; Drew, Brian; Bailey, Christopher S; Fourney, Daryl R; Attabib, Najmedden; Johnson, Michael G; Fehlings, Michael G; Parent, Stefan; Dvorak, Marcel F

    2018-01-01

    Emergent surgery for patients with a traumatic spinal cord injury (SCI) is seen as the gold standard in acute management. However, optimal treatment for those with the clinical diagnosis of central cord syndrome (CCS) is less clear, and classic definitions of CCS do not identify a unique population of patients. The study aimed to test the authors' hypothesis that spine stability can identify a unique group of patients with regard to demographics, management, and outcomes, which classic CCS definitions do not. This is a prospective observational study. The sample included participants with cervical SCI included in a prospective Canadian registry. The outcome measures were initial hospitalization length of stay, change in total motor score from admission to discharge, and in-hospital mortality. Patients with cervical SCI from a prospective Canadian SCI registry were grouped into stable and unstable spine cohorts. Bivariate analyses were used to identify differences in demographic, injury, management, and outcomes. Multivariate analysis was used to better understand the impact of spine stability on motor score improvement. No conflicts of interest were identified. Compared with those with an unstable spine, patients with cervical SCI and a stable spine were older (58.8 vs. 44.1 years, p<.0001), more likely male (86.4% vs. 76.1%, p=.0059), and have more medical comorbidities. Patients with stable spine cervical SCI were more likely to have sustained their injury by a fall (67.4% vs. 34.9%, p<.0001), and have high cervical (C1-C4; 58.5% vs. 43.3%, p=.0009) and less severe neurologic injuries (ASIA Impairment Scale C or D; 81.3% vs. 47.5%, p<.0001). Those with stable spine injuries were less likely to have surgery (67.6% vs. 92.6%, p<.0001), had shorter in-hospital lengths of stay (median 84.0 vs. 100.5 days, p=.0062), and higher total motor score change (20.7 vs. 19.4 points, p=.0014). Multivariate modeling revealed that neurologic severity of injury and spine stability

  1. Magnetic resonance imaging of the cervical spine in rheumatoid arthritis

    International Nuclear Information System (INIS)

    Okada, Susumu; Igarashi, Yoshiaki; Kato, Tomizo; Kawamura, Haruya; Yoshino, Shinichi

    1985-01-01

    11 patients of rheumatoid arthritis with radiological changes of the cervical vertebrae were studied by 0.5 tesla super conducting MRI unit. Clear images were obtained in all patients. The degree of upper cervical cord compression is appreciated easily. MRI is thought to be the most usefull technique in the diagnosis of this disease. (author)

  2. Does the ratio and thickness of prevertebral soft tissue provide benefit in blunt cervical spine injury?

    Science.gov (United States)

    Shiau, J-P; Chin, C-C; Yeh, C-N; Chen, J-F; Lee, S-T; Fang, J-F; Liao, C-C

    2013-06-01

    Although many reports advocate computed tomography (CT) as the initial surveillance tool for occult cervical spine injury (CSI) at the emergency department (ED), the role of a lateral cervical spine radiograph (LCSX) has still not been replaced. We hypothesized that the increased width of the prevertebral soft tissue on an LCSX provides helpful information for selecting the high-risk patients who need to be evaluated with more accurate diagnostic tools. This was a retrospective and consecutive series of injured patients requiring cervical spine evaluation who were first imaged with three-view plain films at the ED. The prevertebral soft tissue thickness (PVST) and ratio of prevertebral soft tissue thickness to the cervical vertebrae diameter (PVST ratio) were calculated on the LCSX. Suspicion of CSI was confirmed by either CT or magnetic resonance imaging (MRI) scans. A total of 826 adult trauma patients requiring cervical spine evaluation were enrolled. The C3 PVST and PVST ratio were significantly different between patients with or without upper cervical area injury (UCAI, 8.64 vs. 5.49 mm, and 0.394 vs. 0.276, respectively), and, likewise, the C6 PVST and PVST ratio for patients with or without lower cervical area injury (LCAI, 16.89 vs. 14.66 mm, and 0.784 vs. 0.749, respectively). The specificity was greater than 90 % in predicting UCAI and LCAI when combining these two parameters. This method maximizes the usefulness of LCSX during the initial assessment of a conscious patient with blunt head and neck injury, especially for the identification of high-risk patients requiring prompt CT or MRI; on the other hand, it prevents the overuse of these high-cost imaging studies as initial diagnostic tools.

  3. Comparative analysis of cervical spine management in a subset of severe traumatic brain injury cases using computer simulation.

    Directory of Open Access Journals (Sweden)

    Kimbroe J Carter

    Full Text Available BACKGROUND: No randomized control trial to date has studied the use of cervical spine management strategies in cases of severe traumatic brain injury (TBI at risk for cervical spine instability solely due to damaged ligaments. A computer algorithm is used to decide between four cervical spine management strategies. A model assumption is that the emergency room evaluation shows no spinal deficit and a computerized tomogram of the cervical spine excludes the possibility of fracture of cervical vertebrae. The study's goal is to determine cervical spine management strategies that maximize brain injury functional survival while minimizing quadriplegia. METHODS/FINDINGS: The severity of TBI is categorized as unstable, high risk and stable based on intracranial hypertension, hypoxemia, hypotension, early ventilator associated pneumonia, admission Glasgow Coma Scale (GCS and age. Complications resulting from cervical spine management are simulated using three decision trees. Each case starts with an amount of primary and secondary brain injury and ends as a functional survivor, severely brain injured, quadriplegic or dead. Cervical spine instability is studied with one-way and two-way sensitivity analyses providing rankings of cervical spine management strategies for probabilities of management complications based on QALYs. Early collar removal received more QALYs than the alternative strategies in most arrangements of these comparisons. A limitation of the model is the absence of testing against an independent data set. CONCLUSIONS: When clinical logic and components of cervical spine management are systematically altered, changes that improve health outcomes are identified. In the absence of controlled clinical studies, the results of this comparative computer assessment show that early collar removal is preferred over a wide range of realistic inputs for this subset of traumatic brain injury. Future research is needed on identifying factors in

  4. The use of radiological guidelines to achieve a sustained reduction in the number of radiographic examinations of the cervical spine, lumbar spine and knees performed for GPs

    International Nuclear Information System (INIS)

    Glaves, J.

    2005-01-01

    AIM: To determine if the use of request guidelines can achieve a sustained reduction in the number of radiographic examinations of the cervical spine, lumbar spine and knee joints performed for general practitioners (GPs). METHODS: GPs referring to three community hospitals and a district general hospital were circulated with referral guidelines for radiography of the cervical spine, lumbar spine and knee, and all requests for these three examinations were checked. Requests that did not fit the guidelines were returned to the GP with an explanatory letter and a further copy of the guidelines. Where applicable, a large-joint replacement algorithm was also enclosed. If the GP maintained the opinion that the examination was indicated, she or he had the option of supplying further justifying information in writing or speaking to a consultant radiologist. RESULTS: Overall the number of radiographic examinations fell by 68% in the first year, achieving a 79% reduction in the second year. For knees, lumbar spine and cervical spine radiographs the total reductions were 77%, 78% and 86%, respectively. CONCLUSION: The use of referral guidelines, reinforced by request checking and clinical management algorithms, can produce a dramatic and sustained reduction in the number of radiographs of the cervical spine, lumbar spine and knees performed for GPs

  5. The relationship between chronic type III acromioclavicular joint dislocation and cervical spine pain

    Directory of Open Access Journals (Sweden)

    Vestri Anna R

    2009-12-01

    Full Text Available Abstract Background This study was aimed at evaluating whether or not patients with chronic type III acromioclavicular dislocation develop cervical spine pain and degenerative changes more frequently than normal subjects. Methods The cervical spine of 34 patients with chronic type III AC dislocation was radiographically evaluated. Osteophytosis presence was registered and the narrowing of the intervertebral disc and cervical lordosis were evaluated. Subjective cervical symptoms were investigated using the Northwick Park Neck Pain Questionnaire (NPQ. One-hundred healthy volunteers were recruited as a control group. Results The rate and distribution of osteophytosis and narrowed intervertebral disc were similar in both of the groups. Patients with chronic AC dislocation had a lower value of cervical lordosis. NPQ score was 17.3% in patients with AC separation (100% = the worst result and 2.2% in the control group (p Conclusions Our study shows that chronic type III AC dislocation does not interfere with osteophytes formation or intervertebral disc narrowing, but that it may predispose cervical hypolordosis. The higher average NPQ values were observed in patients with chronic AC dislocation, especially in those that developed cervical hypolordosis.

  6. Pain drawings predict outcome of surgical treatment for degenerative disc disease in the cervical spine.

    Science.gov (United States)

    MacDowall, Anna; Robinson, Yohan; Skeppholm, Martin; Olerud, Claes

    2017-08-01

    Pain drawings have been frequently used in the preoperative evaluation of spine patients. For lumbar conditions comprehensive research has established both the reliability and predictive value, but for the cervical spine most of this knowledge is lacking. The aims of this study were to validate pain drawings for the cervical spine, and to investigate the predictive value for treatment outcome of four different evaluation methods. We carried out a post hoc analysis of a randomized controlled trial, comparing cervical disc replacement to fusion for radiculopathy related to degenerative disc disease. A pain drawing together with Neck Disability Index (NDI) was completed preoperatively, after 2 and 5 years. The inter- and intraobserver reliability of four evaluation methods was tested using κ statistics, and its predictive value investigated by correlation to change in NDI. Included were 151 patients, mean age of 47 years, female/male: 78/73. The interobserver reliability was fair for the modified Ransford and Udén methods, good for the Gatchel method, and very good for the modified Ohnmeiss method. Markings in the shoulder and upper arm region on the pain drawing were positive predictors of outcome after 2 years of follow-up, and markings in the upper arm region remained a positive predictor of outcome even after 5 years of follow-up. Pain drawings were a reliable tool to interpret patients' pain prior to cervical spine surgery and were also to some extent predictive for treatment outcome.

  7. Tuberculosis of the Subaxial cervical spine: a case series from Tema, Ghana.

    Science.gov (United States)

    Andrews, N B

    2010-01-01

    Tuberculosis (TB) is endemic in West Africa. However, TB of the cervical spine is rare. To report a series of patients with TB of the sub-axial cervical spine (SACS), in order to illustrate its presentation, treatment and outcome. The patients were studied with respect to clinical history and physical examination. Laboratory tests, plain cervical spine X ray studies and myelography with post-myelographic CT scans were used for diagnosis. All patients underwent surgery and antituberculous therapy (ATT). Histopathologic results of surgical specimens were also analysed. All the patients were male and presented with severe neck pain and long tract signs. Osteomyelitis of the SACS was evident with disc space involvement and prevertebral soft tissue swelling. None of the patients had a history of pulmonary TB or TB meningitis; none had a positive Mantoux test. All patients improved neurologically after surgery and ATT. Although tuberculosis of the cervical spine is rare, the possibility of the disease should be considered when patients from areas in which the disease is endemic report with severe neck pain. Surgery could be indicated in cases with associated neurologic deficit and or spinal column instability. Anti-tuberculosis therapy should be continued for at least six months.

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

    Science.gov (United States)

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

    2006-08-01

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

  9. The ability of external immobilizers to restrict movement of the cervical spine: a systematic review

    NARCIS (Netherlands)

    Holla, M.; Huisman, J.M.; Verdonschot, N.; Goosen, J.; Hosman, A.J.; Hannink, G.

    2016-01-01

    PURPOSE: To review the ability of various types of external immobilizers to restrict cervical spine movement. METHODS: With a systematical review of original scientific articles, data on range of motion, type of used external immobilization device and risk of bias were extracted. The described

  10. The ability of external immobilizers to restrict movement of the cervical spine: a systematic review

    NARCIS (Netherlands)

    Holla, M.; Huisman, J.M.; Verdonschot, Nicolaas Jacobus Joseph; Goosen, J.; Hosman, A.J.; Hannink, G.

    2016-01-01

    Purpose To review the ability of various types of external immobilizers to restrict cervical spine movement. Methods With a systematical review of original scientific articles, data on range of motion, type of used external immobilization device and risk of bias were extracted. The described

  11. INFORMATIVE VALUE OF FRACTAL PORTRAIT OF PATIENTS WITH NEUROLOGICAL SYNDROMES OF OSTEOCHONDROSIS OF THE CERVICAL SPINE

    Directory of Open Access Journals (Sweden)

    D. V. Vakulenko

    2013-05-01

    Full Text Available Patients with neurological syndromes of degenerative disc disease of the cervical spine are characterized by decrease of the fractal dimension of electrocardiosignals compared to healthy. This indicates about a low level of energy, immune status, biorhythms harmonization of different organs and systems, psycho-emotional and physiological activity of the body of patients

  12. Experience of Using Tocilizumab in a Patient with Polyarticular Juvenile Rheumatoid Arthritis with Cervical Spine Lesions

    Directory of Open Access Journals (Sweden)

    E. A. Ligostaeva

    2015-01-01

    Full Text Available The article describes a case of polyarticular juvenile idiopathic arthritis lesions of the cervical spine. This clinical example demonstrates the high efficiency of tocilizumab in a patient with polyarticular juvenile idiopathic arthritis with lesions of the cervical spine. After the first injection of tocilizumab a decrease in the following was observed: pain in the cervical spine and affected joints, severity of functional disorders in the temporomandibular joint and the interphalangeal joints, cervical spine; a 30% improvement in the JADAS, ACRpedi30 was achieved. By the 8th week of therapy the proliferative changes in the joints of the hands and arthralgia decreased, as well as the duration of morning stiffness. After 3 months there was a decrease in the activity of Jia (DAS28, and the erythrocyte sedimentation rate and serum concentrations of C-reactive protein. Adverse effects during therapy with tocilizumab were not observed. The disease activity decreased, (assessed using the visual analog scale (VAS, as well as the functional impairment (assessed using the Children Health Assessment Questionnaire (CHAQ. The emotional status and quality of life of the child and her family improved significantly.

  13. Triage tools for detecting cervical spine injury in pediatric trauma patients

    NARCIS (Netherlands)

    Slaar, Annelie; Fockens, M. M.; Wang, Junfeng; Maas, Mario; Wilson, David J.; Goslings, J. Carel; Schep, Niels Wl; van Rijn, Rick R.

    2017-01-01

    Pediatric cervical spine injury (CSI) after blunt trauma is rare. Nonetheless, missing these injuries can have severe consequences. To prevent the overuse of radiographic imaging, two clinical decision tools have been developed: The National Emergency X-Radiography Utilization Study (NEXUS) criteria

  14. The Subaxial Cervical Spine Injury Classification System: an external agreement validation study

    NARCIS (Netherlands)

    Middendorp, J.J. van; Audige, L.; Bartels, R.H.M.A.; Bolger, C.; Deverall, H.; Dhoke, P.; Diekerhof, C.H.; Govaert, G.A.; Guimera, V.; Koller, H.; Morris, S.A.; Setiobudi, T.; Hosman, A.J.F.

    2013-01-01

    BACKGROUND CONTEXT: In 2007, the Subaxial Cervical Spine Injury Classification (SLIC) system was introduced demonstrating moderate reliability in an internal validation study. PURPOSE: To assess the agreement on the SLIC system using clinical data from a spinal trauma population and whether the SLIC

  15. The Subaxial Cervical Spine Injury Classification System : an external agreement validation study

    NARCIS (Netherlands)

    van Middendorp, Joost J.; Audige, Laurent; Bartels, Ronald H.; Bolger, Ciaran; Deverall, Hamish; Dhoke, Priyesh; Diekerhof, Carel H.; Govaert, Geertje A. M.; Guimera, Vicente; Koller, Heiko; Morris, Stephen A. C.; Setiobudi, Tony; Hosman, Allard J. F.

    BACKGROUND CONTEXT: In 2007, the Subaxial Cervical Spine Injury Classification (SLIC) system was introduced demonstrating moderate reliability in an internal validation study. PURPOSE: To assess the agreement on the SLIC system using clinical data from a spinal trauma population and whether the SLIC

  16. Cervical Spine Injury: A ten‑year multicenter analysis of evolution of ...

    African Journals Online (AJOL)

    Study Design: Retrospective study. Objective: To describe the evolution of care and risk factors for poor outcome in patients with cervical spine injury (CSI) treated at three centers in southeast Nigeria. Setting: Nigeria, southeast. Materials and Methods: A 10‑year retrospective multicenter analysis of patients with CSI, ...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-10-15

    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

  18. Magnetic resonance imaging of the cervical and thoracic spine and the spinal cord

    International Nuclear Information System (INIS)

    Larsson, E.M.

    1989-01-01

    Magnetic resonance imaging (MR), using a 0.3 T resistive scanner with an iron core and a vertical magnetic field, was evaluated in patients with different diseases affecting the cervical and thoracic spine and the spinal cord. The results indicate that MR is well suited as the procedure of choice for emergency examination of patients with spinal cord symptoms, for examination of patients with suspected spinal multiple sclerosis and for pre-operative evaluation of patients with rheumatoid arthritis with neurological symptoms emanating from the cranio-cervical junction. In patients with cervical radiculapathy and/or myelopathy, caused by spondylosis or disk herniation, MR was found to be equivalent with myelography and CT myelography but MR has several practical advantages. MR at 0.3 T using a vertical magnetic field provided information comparable to that reported from examinations performed with superconducting MR scanners. In order to optimize the MR examinations of the spine, the signal characteristics of different coils available when using a vertical magnetic field were determined by phantom studies. Recommendations for optimal coil selection for different levels of the cervical and thoracic spine are given. In addition, the paramagnetic contrast medium gadolinium-DTPA was administered intravenously to patients with suspected spinal multiple sclerosis. Enhancement of clinically active lesions in the cervical spinal cord was observed. Serial MR examinations with gadolinium-DTPA showed that a decrease in enhancement could be correlated with decrease in clinical symptoms and signs. (author)

  19. Primary epidural liposarcoma of the cervical spine: Technical case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Hamid Borghei-Razavi

    2015-03-01

    Full Text Available Liposarcoma is the most common soft tissue sarcoma in adults. These tumors have a high incidence of osseous metastases, with a propensity to the spine; however, primary spinal involvement is very rare. A 56-year-old female patient presented with a 4 month history of cervical pain, including radiation to both upper limbs, without radicular distribution. Magnetic resonance imaging (MRI showed an epidural lesion with gadolinium enhancement and bilateral extension into the intervertebral neural foramina (C5–C7, with spreading on the right side of the tumor into paravertebral tissue. The histopathological diagnosis was myxoid liposarcoma. To our knowledge it is the first case of primary myxoid liposarcoma of the cervical spine in the literature. Although rare, our case demonstrates that liposarcoma should be considered in the differential diagnosis of cervical tumors.

  20. Congenital spondylolysis of the cervical spine with spinal cord compression: MR and CT studies

    International Nuclear Information System (INIS)

    Martinez, M.J.; Marti-Bonmati, L.; Molla, E.; Poyatos, C.; Cerda, E. de la; Urrizola, J.

    1997-01-01

    Spondylolysis of the cervical spine is a rare disorder that is characterized by a defect in the articular mass between the superior and inferior facets of a cervical vertebra. It is considered to be congenital because it is usually associated with dysplastic changes, especially involving the posterior arch of the vertebra, which differentiates it from its traumatic equivalent. We present two cases of spondylolysis of the cervical spine without spondylolisthesis, which were studied by means of magnetic resonance (MR) and computerized tomography (CT). One patient showed contralateral involvement at two levels and the other had a single lesion presenting canal stenosis with chronic spinal cord compression, an unusual association in previously reported series. the combination of MR and CT makes it possible to limit the spectrum of bone changes and their impact on the spinal cord in these patients. (Author) 12 refs

  1. Comparison of film/screen and PCR digital lateral cervical spine radiographs

    International Nuclear Information System (INIS)

    Silver, D.I.; Kreipke, D.L.; Tarver, R.; Braunstein, E.M.

    1988-01-01

    The authors compared film/screen and Phillips computed radiography (PCR) radiographs of the cervical spine. In 109 patients. fiilm/screen and digital radiographs were compared for adequate visualization (readability) of bone, soft tissue, and trachea. The lowest cervical vertebra seen was noted in each case. The radiographs were interpreted by four radiologists, and both interobserver and intraobserver consistency were measured. Of the PCR radiographs, 97% were readable with a viewbox alone. Of the film/screen radiographs, 9% were readable with a viewbox. With a hotlight, 83% of the film/screen radiographs became readable. Bone, soft tissue, and trachea were better seen on PCR radiographs than on film/screen radiographs (P<.001). There was less interobserver variation on digital radiographs. Readability of cervical spine radiographs was significantly improved with PCR

  2. Changes in use of cervical spine magnetic resonance imaging for pediatric patients with nonaccidental trauma.

    Science.gov (United States)

    Oh, Ahyuda; Sawvel, Michael; Heaner, David; Bhatia, Amina; Reisner, Andrew; Tubbs, R Shane; Chern, Joshua J

    2017-09-01

    OBJECTIVE Past studies have suggested correlations between abusive head trauma and concurrent cervical spine (c-spine) injury. Accordingly, c-spine MRI (cMRI) has been increasingly used in radiographic assessments. This study aimed to determine trends in cMRI use and treatment, and outcomes related to c-spine injury in children with nonaccidental trauma (NAT). METHODS A total of 503 patients with NAT who were treated between 2009 and 2014 at a single pediatric health care system were identified from a prospectively maintained database. Additional data on selected clinical events were retrospectively collected from electronic medical records. In 2012, a clinical pathway on cMRI usage for patients with NAT was implemented. The present study compared cMRI use and clinical outcomes between the prepathway (2009-2011) and postpathway (2012-2014) periods. RESULTS There were 249 patients in the prepathway and 254 in the postpathway groups. Incidences of cranial injury and Injury Severity Scores were not significantly different between the 2 groups. More patients underwent cMRI in the years after clinical pathway implementation than before (2.8% vs 33.1%, p spine injury in this population increased the use of cMRI and cervical collar immobilization over a 6-year period. However, severe c-spine injury remains rare, and increased use of cMRI might not affect outcomes markedly.

  3. Recurrent Laryngeal Nerve Palsy After Cervical Spine Surgery: A Multicenter AOSpine Clinical Research Network Study.

    Science.gov (United States)

    Gokaslan, Ziya L; Bydon, Mohamad; De la Garza-Ramos, Rafael; Smith, Zachary A; Hsu, Wellington K; Qureshi, Sheeraz A; Cho, Samuel K; Baird, Evan O; Mroz, Thomas E; Fehlings, Michael; Arnold, Paul M; Riew, K Daniel

    2017-04-01

    Multicenter retrospective study. To investigate the risk of symptomatic recurrent laryngeal nerve palsy (RLNP) following cervical spine surgery, to examine risk factors for its development, and to report its treatment and outcomes. A multicenter study from 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was performed. Each center screened for rare complications following cervical spine surgery, including RLNP. Patients were included if they underwent cervical spine surgery (levels from C2 to C7) between January 1, 2005 and December 31, 2011. Data were analyzed with regard to complication treatment and outcome. Cases were compared to a control group from the AOSpine CSM and CSM-I studies. Three centers reported 19 cases of RLNP from a cohort of 1345 patients. The reported incidence of RLNP ranged from 0.6% to 2.9% between these 3 centers. Fifteen patients (79%) in the RLNP group were approached from the left side. Ten patients (52.6%) required treatment for RLNP-6 required medical therapy (steroids), 1 interventional treatment (injection laryngoplasty), and 3 conservative therapy (speech therapy). When examining outcomes, 73.7% (14/19) of cases resolved completely, 15.8% (3/19) resolved with residual effects, and in 10.5% (2/19) of cases this could not be determined. In this multicenter study examining rare complications following cervical spine surgery, the risk of RLNP after cervical spine surgery ranged from 0.6% to 2.9% between centers. Though rare, it was found that 16% of patients may experience partial resolution with residual effects, and 74% resolve completely.

  4. Evaluation of cervical spine fractures in adults in spiral computed tomography

    International Nuclear Information System (INIS)

    Siemianowicz, A.; Wawrzynek, W.; Koczy, B.; Kasprowska, S.; Siemianowicz, A.; Wawrzynek, W.; Pilch-Kowalczyk, J.; Kwasniewska, A.; Baron, J.

    2005-01-01

    Cervical spine injury as a frequent cause of disability is a very important diagnostic problem. The purpose of this study is to evaluate cervical spine fractures in adults in spiral computed tomography (CT) including multiplanar and three-dimensional (3D) reconstructions. 62 patients (53 men and 9 women, aged 19-75) after cervical spine trauma, admitted to Emergency Room of Self-Financing Public District Hospital of Trauma Surgery at Piekary Slaskie were studied retrospectively. In all cases the spiral CT was performed using helical CT scanner - Hi Speed CT/e GE Medical System. Following settings were applied: slice thickness 2 or 3 mm; reconstruction 2 mm; pitch 1,3 and with automatic mAs selection. Multiplanar and three-dimensional reconstructions were performed. Patients aged 19-75, (mean age 40,2) were classified into 4 age groups; 19-24; 25-45; 46-65, and over 65 years old. The most common cause of cervical spine fracture was traffic accident (51,6%), fall (25,8%), sport accident (17,8%). Clinical symptoms were present in all patients. Neurological deficits in examination performed in Emergency Room (just after admission) were present in 27 patients (43,5%), tetraplegia predominated (59,25%). We often observed multilevel fractures and fractures of different parts of one vertebra. Fractures of C1 vertebra were observed in 7 patients,fractures of C2 in 20 patients, fractures of C3 in 12 patients, fractures of C4 in 12 patients, fractures of C5 in 24 patients, fractures of C6 in 16 patients, fractures of C7 in 8 patients. On levels C3-C7 in 16 cases we observed dislocation of bone parts into the vertebral canal with compression of spinal cord. In some cases not all fractures were visible on x-ray films. CT examination of the cervical spine can be the first and sufficient examination in high risk patients. (author)

  5. Analysis of patients ≥65 with predominant cervical spine fractures: Issues of disposition and dysphagia

    Directory of Open Access Journals (Sweden)

    Lisa M Poole

    2017-01-01

    Full Text Available Background: Cervical spine fractures occur in 2.6% to 4.7% of trauma patients aged 65 years or older. Mortality rates in this population ranges from 19% to 24%. A few studies have specifically looked at dysphagia in elderly patients with cervical spine injury. Aims: The aim of this study is to evaluate dysphagia, disposition, and mortality in elderly patients with cervical spine injury. Settings and Design: Retrospective review at an the American College of Surgeons-verified level 1 trauma center. Methods: Patients 65 years or older with cervical spine fracture, either isolated or in association with other minor injuries were included in the study. Data included demographics, injury details, neurologic deficits, dysphagia evaluation and treatment, hospitalization details, and outcomes. Statistical Analysis: Categorical and continuous data were analyzed using Chi-square analysis and one-way analysis of variance, respectively. Results: Of 136 patients in this study, 2 (1.5% had a sensory deficit alone, 4 (2.9% had a motor deficit alone, and 4 (2.9% had a combined sensory and motor deficit. Nearly one-third of patients (n = 43, 31.6% underwent formal swallow evaluation, and 4 (2.9% had a nasogastric tube or Dobhoff tube placed for enteral nutrition, whereas eight others (5.9% had a gastrostomy tube or percutaneous endoscopic gastrostomy tube placed. Most patients were discharged to a skilled nursing unit (n = 50, 36.8%, or to home or home with home health (n = 48, 35.3%. Seven patients (5.1% died in the hospital, and eight more (5.9% were transferred to hospice. Conclusion: Cervical spine injury in the elderly patient can lead to significant consequences, including dysphagia and need for skilled nursing care at discharge.

  6. Mechanism and patterns of cervical spine fractures-dislocations in vertebral artery injury

    Directory of Open Access Journals (Sweden)

    Pankaj Gupta

    2012-01-01

    Full Text Available Purpose: To identify the fracture patterns and mechanism of injury, based on subaxial cervical spine injury classification system (SLIC, on non-contrast computed tomography (NCCT of cervical spine predictive of vertebral artery injury (VAI. Patients and Methods: We retrospectively analyzed cervical spine magnetic resonance imaging (MRI of 320 patients who were admitted with cervical spine injury in our level I regional trauma center over a period of two years (April 2010 to April 2012. Diagnosis of VAI was based on hyperintensity replacing the flow void on a T2-weighted axial image. NCCT images of the selected 43 patients with MRI diagnosis of VAI were then assessed for the pattern of injury. The cervical spinal injuries were classified into those involving the C1 and C2 and subaxial spine. For the latter, SLIC was used. Results: A total of 47 VAI were analyzed in 43 patients. Only one patient with VAI on MRI had no detectable abnormality on NCCT. C1 and C2 injuries were found in one and six patients respectively. In subaxial injuries, the most common mechanism of injury was distraction (37.5% with facet dislocation with or without fracture representing the most common pattern of injury (55%. C5 was the single most common affected vertebral level. Extension to foramen transversarium was present in 20 (42.5% cases. Conclusion: CT represents a robust screening tool for patients with VAI. VAI should be suspected in patients with facet dislocation with or without fractures, foramina transversarium fractures and C1-C3 fractures, especially type III odontoid fractures and distraction mechanism of injury.

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

    Directory of Open Access Journals (Sweden)

    S Rajasekaran

    2010-01-01

    Full Text Available Background: Cervical pedicle screw fixation is challenging due to the small osseous morphometrics and the close proximity of neurovascular elements. Computer navigation has been reported to improve the accuracy of pedicle screw placement. There are very few studies assessing its efficacy in the presence of deformity. Also cervical pedicle screw insertion in children has not been described before. We evaluated the safety and accuracy of Iso-C 3D-navigated pedicle screws in the deformed cervical spine. Materials and Methods: Thirty-three patients including 15 children formed the study group. One hundred and forty-five cervical pedicle screws were inserted using Iso-C 3D-based computer navigation in patients undergoing cervical spine stabilization for craniovertebral junction anomalies, cervico-thoracic deformities and cervical instabilities due to trauma, post-surgery and degenerative disorders. The accuracy and containment of screw placement was assessed from postoperative computerized tomography scans. Results: One hundred and thirty (89.7% screws were well contained inside the pedicles. Nine (6.1% Type A and six (4.2% Type B pedicle breaches were observed. In 136 levels, the screws were inserted in the classical description of pedicle screw application and in nine deformed vertebra, the screws were inserted in a non-classical fashion, taking purchase of the best bone stock. None of them had a critical breach. No patient had any neurovascular complications. Conclusion: Iso-C navigation improves the safety and accuracy of pedicle screw insertion and is not only successful in achieving secure pedicle fixation but also in identifying the best available bone stock for three-column bone fixation in altered anatomy. The advantages conferred by cervical pedicle screws can be extended to the pediatric population also.

  8. Acute cervicitis and vulvovaginitis may be associated with Cytomegalovirus

    OpenAIRE

    Abou, Magali; Dällenbach, Patrick

    2013-01-01

    Cytomegalovirus (CMV) infection in immunocompetent hosts is generally asymptomatic or may present as a mononucleosic syndrome. Its association with acute cervicitis and vulvovaginitis has rarely been reported.

  9. Cervical spine motion in manual versus Jackson table turning methods in a cadaveric global instability model.

    Science.gov (United States)

    DiPaola, Matthew J; DiPaola, Christian P; Conrad, Bryan P; Horodyski, MaryBeth; Del Rossi, Gianluca; Sawers, Andrew; Bloch, David; Rechtine, Glenn R

    2008-06-01

    A study of spine biomechanics in a cadaver model. To quantify motion in multiple axes created by transfer methods from stretcher to operating table in the prone position in a cervical global instability model. Patients with an unstable cervical spine remain at high risk for further secondary injury until their spine is adequately surgically stabilized. Previous studies have revealed that collars have significant, but limited benefit in preventing cervical motion when manually transferring patients. The literature proposes multiple methods of patient transfer, although no one method has been universally adopted. To date, no study has effectively evaluated the relationship between spine motion and various patient transfer methods to an operating room table for prone positioning. A global instability was surgically created at C5-6 in 4 fresh cadavers with no history of spine pathology. All cadavers were tested both with and without a rigid cervical collar in the intact and unstable state. Three headrest permutations were evaluated Mayfield (SM USA Inc), Prone View (Dupaco, Oceanside, CA), and Foam Pillow (OSI, Union City, CA). A trained group of medical staff performed each of 2 transfer methods: the "manual" and the "Jackson table" transfer. The manual technique entailed performing a standard rotation of the supine patient on a stretcher to the prone position on the operating room table with in-line manual cervical stabilization. The "Jackson" technique involved sliding the supine patient to the Jackson table (OSI, Union City, CA) with manual in-line cervical stabilization, securing them to the table, then initiating the table's lock and turn mechanism and rotating them into a prone position. An electromagnetic tracking device captured angular motion between the C5 and C6 vertebral segments. Repeated measures statistical analysis was performed to evaluate the following conditions: collar use (2 levels), headrest (3 levels), and turning technique (2 levels). For all

  10. Multilevel 3D Printing Implant for Reconstructing Cervical Spine With Metastatic Papillary Thyroid Carcinoma.

    Science.gov (United States)

    Li, Xiucan; Wang, Yiguo; Zhao, Yongfei; Liu, Jianheng; Xiao, Songhua; Mao, Keya

    2017-11-15

    MINI: A 3D printing technology is proposed for reconstructing multilevel cervical spine (C2-C4) after resection of metastatic papillary thyroid carcinoma. The personalized porous implant printed in Ti6AL4V provided excellent physicochemical properties and biological performance, including biocompatibility, osteogenic activity, and bone ingrowth effect. A unique case report. A three-dimensional (3D) printing technology is proposed for reconstructing multilevel cervical spine (C2-C4) after resection of metastatic papillary thyroid carcinoma in a middle-age female patient. Papillary thyroid carcinoma is a malignant neoplasm with a relatively favorable prognosis. A metastatic lesion in multilevel cervical spine (C2-C4) destroys neurological functions and causes local instability. Radical excision of the metastasis and reconstruction of the cervical vertebrae sequence conforms with therapeutic principles, whereas the special-shaped multilevel upper-cervical spine requires personalized implants. 3D printing is an additive manufacturing technology that produces personalized products by accurately layering material under digital model control via a computer. Reporting of this recent technology for reconstructing multilevel cervical spine (C2-C4) is rare in the literature. Anterior-posterior surgery was performed in one stage. Radical resection of the metastatic lesion (C2-C4) and thyroid gland, along with insertion of a personalized implant manufactured by 3D printing technology, were performed to rebuild the cervical spine sequences. The porous implant was printed in Ti6AL4V with perfect physicochemical properties and biological performance, such as biocompatibility and osteogenic activity. Finally, lateral mass screw fixation was performed via a posterior approach. Patient neurological function gradually improved after the surgery. The patient received 11/17 on the Japanese Orthopedic Association scale and ambulated with a personalized skull-neck-thorax orthosis on

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

    International Nuclear Information System (INIS)

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

    2002-01-01

    Heading AbstractBackground. In previous studies, typical radiological findings in the cervical spine of patients with diastrophic dysplasia (DD) have been kyphosis, displacement of the vertebrae, spina bifida occulta (SBO), anterior hypoplasia of vertebrae C3-5, and hyperplasia and dysmorphism of the odontoid process.Objectives. To make a radiological analysis of the cervical spine in patients with DD.Materials and methods. The study comprised 122 patients (50 males, 72 females), with an average age of 19 years (range newborn-63 years). Follow-up was available on 62 patients (51%), for an average duration of 11 years. Cervical spine alignment was measured according to Cobb's method. The height (H) and depth (D) of the vertebral body and sagittal diameter (S) of the spinal canal were measured. H/D and S/D ratios were then calculated from the measurements. The shape of the vertebrae was assessed. Displacement and movement of cervical vertebrae in neutral and bending radiographs were measured.Results. The average lordosis in the last radiograph was 17 (range 4 -55 ). Five (4%) patients had a cervical kyphosis with an average of 92 (range 10-165 ) on their last radiograph. The H/D ratio increased slowly during growth and showed significant correlation with age. There was no growth spurt at puberty. The S/D ratio was fairly stable until 7-8 years of age, when it started to decline slowly. The percentage of vertebrae with a flat vertebral body and narrow spinal canal value tended to increase with age. Vertebral hypoplasia and displacement between vertebrae were most common in the mid-cervical region and resolved spontaneously with age. Degenerative changes seemed to increase with age and were already visible during the second decade of life. SBO was noted in 79% of patients.Conclusions. The most common alignment in the cervical spine is lordosis in adulthood. The vertebral bodies are flattened and the spinal canal is narrowed. Vertebral body hypoplasia and displacement

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

    Energy Technology Data Exchange (ETDEWEB)

    Remes, Ville M; Helenius, Ilkka J; Peltonen, Jari I [Hospital for Children and Adolescents, Helsinki University Central Hospital, P.O. Box 281, 00029 HUS (Finland); Marttinen, Eino J [Helsinki University Central Hospital (Finland); Poussa, Mikko S [Orton Orthopaedic Hospital, Helsinki (Finland)

    2002-09-01

    Heading AbstractBackground. In previous studies, typical radiological findings in the cervical spine of patients with diastrophic dysplasia (DD) have been kyphosis, displacement of the vertebrae, spina bifida occulta (SBO), anterior hypoplasia of vertebrae C3-5, and hyperplasia and dysmorphism of the odontoid process.Objectives. To make a radiological analysis of the cervical spine in patients with DD.Materials and methods. The study comprised 122 patients (50 males, 72 females), with an average age of 19 years (range newborn-63 years). Follow-up was available on 62 patients (51%), for an average duration of 11 years. Cervical spine alignment was measured according to Cobb's method. The height (H) and depth (D) of the vertebral body and sagittal diameter (S) of the spinal canal were measured. H/D and S/D ratios were then calculated from the measurements. The shape of the vertebrae was assessed. Displacement and movement of cervical vertebrae in neutral and bending radiographs were measured.Results. The average lordosis in the last radiograph was 17 (range 4 -55 ). Five (4%) patients had a cervical kyphosis with an average of 92 (range 10-165 ) on their last radiograph. The H/D ratio increased slowly during growth and showed significant correlation with age. There was no growth spurt at puberty. The S/D ratio was fairly stable until 7-8 years of age, when it started to decline slowly. The percentage of vertebrae with a flat vertebral body and narrow spinal canal value tended to increase with age. Vertebral hypoplasia and displacement between vertebrae were most common in the mid-cervical region and resolved spontaneously with age. Degenerative changes seemed to increase with age and were already visible during the second decade of life. SBO was noted in 79% of patients.Conclusions. The most common alignment in the cervical spine is lordosis in adulthood. The vertebral bodies are flattened and the spinal canal is narrowed. Vertebral body hypoplasia and displacement

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

    Energy Technology Data Exchange (ETDEWEB)

    Remes, Ville M.; Helenius, Ilkka J.; Peltonen, Jari I. [Hospital for Children and Adolescents, Helsinki University Central Hospital, P.O. Box 281, 00029 HUS (Finland); Marttinen, Eino J. [Helsinki University Central Hospital (Finland); Poussa, Mikko S. [Orton Orthopaedic Hospital, Helsinki (Finland)

    2002-09-01

    Heading AbstractBackground. In previous studies, typical radiological findings in the cervical spine of patients with diastrophic dysplasia (DD) have been kyphosis, displacement of the vertebrae, spina bifida occulta (SBO), anterior hypoplasia of vertebrae C3-5, and hyperplasia and dysmorphism of the odontoid process.Objectives. To make a radiological analysis of the cervical spine in patients with DD.Materials and methods. The study comprised 122 patients (50 males, 72 females), with an average age of 19 years (range newborn-63 years). Follow-up was available on 62 patients (51%), for an average duration of 11 years. Cervical spine alignment was measured according to Cobb's method. The height (H) and depth (D) of the vertebral body and sagittal diameter (S) of the spinal canal were measured. H/D and S/D ratios were then calculated from the measurements. The shape of the vertebrae was assessed. Displacement and movement of cervical vertebrae in neutral and bending radiographs were measured.Results. The average lordosis in the last radiograph was 17 (range 4 -55 ). Five (4%) patients had a cervical kyphosis with an average of 92 (range 10-165 ) on their last radiograph. The H/D ratio increased slowly during growth and showed significant correlation with age. There was no growth spurt at puberty. The S/D ratio was fairly stable until 7-8 years of age, when it started to decline slowly. The percentage of vertebrae with a flat vertebral body and narrow spinal canal value tended to increase with age. Vertebral hypoplasia and displacement between vertebrae were most common in the mid-cervical region and resolved spontaneously with age. Degenerative changes seemed to increase with age and were already visible during the second decade of life. SBO was noted in 79% of patients.Conclusions. The most common alignment in the cervical spine is lordosis in adulthood. The vertebral bodies are flattened and the spinal canal is narrowed. Vertebral body hypoplasia and

  14. A Comparison of Cervical Spine Motion After Immobilization With a Traditional Spine Board and Full-Body Vacuum-Mattress Splint.

    Science.gov (United States)

    Etier, Brian E; Norte, Grant E; Gleason, Megan M; Richter, Dustin L; Pugh, Kelli F; Thomson, Keith B; Slater, Lindsay V; Hart, Joe M; Brockmeier, Stephen F; Diduch, David R

    2017-12-01

    The National Athletic Trainers' Association (NATA) advocates for cervical spine immobilization on a rigid board or vacuum splint and for removal of athletic equipment before transfer to an emergency medical facility. To (1) compare triplanar cervical spine motion using motion capture between a traditional rigid spine board and a full-body vacuum splint in equipped and unequipped athletes, (2) assess cervical spine motion during the removal of a football helmet and shoulder pads, and (3) evaluate the effect of body mass on cervical spine motion. Controlled laboratory study. Twenty healthy male participants volunteered for this study to examine the influence of immobilization type and presence of equipment on triplanar angular cervical spine motion. Three-dimensional cervical spine kinematics was measured using an electromagnetic motion analysis system. Independent variables included testing condition (static lift and hold, 30° tilt, transfer, equipment removal), immobilization type (rigid, vacuum-mattress), and equipment (on, off). Peak sagittal-, frontal-, and transverse-plane angular motions were the primary outcome measures of interest. Subjective ratings of comfort and security did not differ between immobilization types ( P > .05). Motion between the rigid board and vacuum splint did not differ by more than 2° under any testing condition, either with or without equipment. In removing equipment, the mean peak motion ranged from 12.5° to 14.0° for the rigid spine board and from 11.4° to 15.4° for the vacuum-mattress splint, and more transverse-plane motion occurred when using the vacuum-mattress splint compared with the rigid spine board (mean difference, 0.14 deg/s [95% CI, 0.05-0.23 deg/s]; P = .002). In patients weighing more than 250 lb, the rigid board provided less motion in the frontal plane ( P = .027) and sagittal plane ( P = .030) during the tilt condition and transfer condition, respectively. The current study confirms similar motion in the

  15. Tuberculosis of the Cervical Spine Mimicking a Paraplegic Tumour ...

    African Journals Online (AJOL)

    Tuberculosis (TB) of the spine is a common problem in Kenya especially since the spread of HIV infection in the 1980's. However immune-compromised patients do not necessarily present in a similar radiological and histopathological way as patients with a competent immune system. It is against this background that we ...

  16. [Pressure sores secondary to immobilization with cervical collar: a complication of acute cervical injury].

    Science.gov (United States)

    Molano Alvarez, Esteban; Murillo Pérez, María del Ara; Salobral Villegas, María Teresa; Domínguez Caballero, Mireia; Cuenca Solanas, Manuela; García Fuentes, Carlos

    2004-01-01

    Cervical collars are essential in the treatment of patients with suspicion or verification of acute cervical spine injury (ACSI). One of the complications of these devices is the development of pressure scores (PS). This study aims to determine its incidence in our unit, the characteristics of patients with ACSI who suffer PS due to the collar and to describe aspects related with these injuries. We include 92 patients with ACSI hospitalized more than 24 hours from January 2002 to December 2003. We analyze demographic variables, incidence, risk factors and characteristics of the PS that develop. The incidence of these lesions was 23.9%. Patients with PS presented: a higher injury severity score (ISS) (37.5 9.8 vs. 31.3 14.9), a greater percentage of catheter carriers of intracraneal pressure (ICP) (55.6% vs. 16.2%), longer time of mechanical ventilation (15.4 8.2 vs. 6.1 9) and longer stays (24.6 10.9 vs. 10 10.3), all statistically significant (pACSI, elevated ISS, monitoring of ICP, mechanical ventilation and prolonged stays is required. The occipital zone requires special attention due to the seriousness of the injuries recorded. We suggest a specific multidisciplinary protocol for this problem.

  17. Psychological attachment in patients with spondylosis of cervical and lumbar spine.

    Science.gov (United States)

    Pedziwiatr, Henryk

    2013-01-01

    Persons with spondylosis of the cervical spine have a low sense of security, difficulties in relationships with their mothers, difficulties in contact with their own body and in coping with dysphoric affect. The question arises: Are those problems the result of the current medical condition, or one of its causes? In order to find the answer one should look closer at the period of an individual's life when a sense of security and a pattern of emotional relationships are formed, and a sense of own body and defence attitudes are developed. The earliest period of life in which these processes occur is the initial relationship between the child and mother; the period of attachment and object relation. If the attachment style in the group studied does not deviate significantly from the control group, it ought to be assumed that the present problems are situational. The problems would then a result of a chronic difficult (stressful) situation which is spondylosis of cervical or lumbar spine. In an attempt to answer the above question, preliminary studies in a 90-person group were conducted. The group included 30 patients with spondylosis of the cervical spine, 30 patients with spondylosis of the lumbar spine, and 30 control persons without spondylosis.

  18. Reliability and safety of a new upper cervical spine injury treatment algorithm

    Directory of Open Access Journals (Sweden)

    Andrei Fernandes Joaquim

    Full Text Available ABSTRACT In the present study, we evaluated the reliability and safety of a new upper cervical spine injury treatment algorithm to help in the selection of the best treatment modality for these injuries. Methods Thirty cases, previously treated according to the new algorithm, were presented to four spine surgeons who were questioned about their personal suggestion for treatment, and the treatment suggested according to the application of the algorithm. After four weeks, the same questions were asked again to evaluate reliability (intra- and inter-observer using the Kappa index. Results The reliability of the treatment suggested by applying the algorithm was superior to the reliability of the surgeons’ personal suggestion for treatment. When applying the upper cervical spine injury treatment algorithm, an agreement with the treatment actually performed was obtained in more than 89% of the cases. Conclusion The system is safe and reliable for treating traumatic upper cervical spine injuries. The algorithm can be used to help surgeons in the decision between conservative versus surgical treatment of these injuries.

  19. C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases.

    Science.gov (United States)

    Thompson, Sara E; Smith, Zachary A; Hsu, Wellington K; Nassr, Ahmad; Mroz, Thomas E; Fish, David E; Wang, Jeffrey C; Fehlings, Michael G; Tannoury, Chadi A; Tannoury, Tony; Tortolani, P Justin; Traynelis, Vincent C; Gokaslan, Ziya; Hilibrand, Alan S; Isaacs, Robert E; Mummaneni, Praveen V; Chou, Dean; Qureshi, Sheeraz A; Cho, Samuel K; Baird, Evan O; Sasso, Rick C; Arnold, Paul M; Buser, Zorica; Bydon, Mohamad; Clarke, Michelle J; De Giacomo, Anthony F; Derakhshan, Adeeb; Jobse, Bruce; Lord, Elizabeth L; Lubelski, Daniel; Massicotte, Eric M; Steinmetz, Michael P; Smith, Gabriel A; Pace, Jonathan; Corriveau, Mark; Lee, Sungho; Cha, Peter I; Chatterjee, Dhananjay; Gee, Erica L; Mayer, Erik N; McBride, Owen J; Roe, Allison K; Yanez, Marisa Y; Stroh, D Alex; Than, Khoi D; Riew, K Daniel

    2017-04-01

    A multicenter, retrospective review of C5 palsy after cervical spine surgery. Postoperative C5 palsy is a known complication of cervical decompressive spinal surgery. The goal of this study was to review the incidence, patient characteristics, and outcome of C5 palsy in patients undergoing cervical spine surgery. We conducted a multicenter, retrospective review of 13 946 patients across 21 centers who received cervical spine surgery (levels C2 to C7) between January 1, 2005, and December 31, 2011, inclusive. P values were calculated using 2-sample t test for continuous variables and χ 2 tests or Fisher exact tests for categorical variables. Of the 13 946 cases reviewed, 59 patients experienced a postoperative C5 palsy. The incidence rate across the 21 sites ranged from 0% to 2.5%. At most recent follow-up, 32 patients reported complete resolution of symptoms (54.2%), 15 had symptoms resolve with residual effects (25.4%), 10 patients did not recover (17.0%), and 2 were lost to follow-up (3.4%). C5 palsy occurred in all surgical approaches and across a variety of diagnoses. The majority of patients had full recovery or recovery with residual effects. This study represents the largest series of North American patients reviewed to date.

  20. A case of myositis ossificans in the upper cervical spine of a young child.

    Science.gov (United States)

    Findlay, Iain; Lakkireddi, Prabhat Reddy; Gangone, Ravinder; Marsh, Gavin

    2010-12-01

    Case report. We present a case of myositis ossificans (MO) of the upper cervical spine in a young child. The literature is reviewed with the classification, etiology, and treatment of MO discussed. Calcification of joint capsule, muscle, cartilage, and ligaments is a well-known phenomenon and is known as myositis ossificans. It is very rarely seen in the head and neck, with no reports of MO of the soft tissues surrounding the first 2 cervical vertebrae. An 8-year-old boy presented with severe neck pain after a fall. He had had a similar neck injury 4 years before, but made a full recovery. Radiographs showed a large ossified lesion between the posterior elements of C1 and C2. After further imaging, a diagnosis of MO was made. The child was treated with simple analgesia and observation. With no evidence of neurologic compromise and minimal symptoms, there was no indication for surgical intervention. Although rare, MO should be suspected as one of the possible causes of persistent pain following cervical spine injury in children. We would advise a low threshold for cervical spine imaging in the child presenting with persistent neck pain and stiffness, even years after injury.

  1. MRI findings of cervical spine lesions among symptomatic patient and their risk factors

    International Nuclear Information System (INIS)

    Hashemi, H.; Firouznia, K.; Soroush, H.; Amir orang, J.; Foghani, A.; Pakravan, M.

    2003-01-01

    Background: Cervical spine and intervertebral discs are potentially prone to functional disorders. Objectives: This study sought type and distribution of different pathologies in the cervical spine and a possible relationship between the MRI findings and the probable risk factors of the degenerative disorders. Materials and Methods: This descriptive cross-sectional research was carried out from october 2000 to january 2002 in three referral centers in Tehran. All the patients had referred for cervical MRI for neck pain and/or radicular pain. Results: Totally 342 patients entered the study. Sixty percent of patients were male. The mean age was 55.1± 12.1 years. Seventy-nine percent of patients had abnormal MRI findings (238 patients (70%) had signs of degenerative processes and 31 patients (9%) had the other findings ) with a total 308 pathologies. The most common findings were disc bulging /protrusion (%21.1), disc dehydration (%20.1), disc herniation (%18.1), and canal stenosis (%17.5). Older age, male gender and history of neck trauma were associated with increasing probability of degenerative changes (P-values<0.05). Conclusion: Types of cervical spine pathologies are comparable to other reports. The anatomical distribution of disc bulging and protrusion in our study are similar to other reports. Likewise age, gender and a history of trauma the neck were closely associated with the degenerative signs on the MR images

  2. On the relative importance of bending and compression in cervical spine bilateral facet dislocation.

    Science.gov (United States)

    Nightingale, Roger W; Bass, Cameron R; Myers, Barry S

    2018-03-08

    Cervical bilateral facet dislocations are among the most devastating spine injuries in terms of likelihood of severe neurological sequelae. More than half of patients with tetraparesis had sustained some form of bilateral facet fracture dislocation. They can occur at any level of the sub-axial cervical spine, but predominate between C5 and C7. The mechanism of these injuries has long been thought to be forceful flexion of the chin towards the chest. This "hyperflexion" hypothesis comports well with intuition and it has become dogma in the clinical literature. However, biomechanical studies of the human cervical spine have had little success in producing this clinically common and devastating injury in a flexion mode of loading. The purpose of this manuscript is to review the clinical and engineering literature on the biomechanics of bilateral facet dislocations and to describe the mechanical reasons for the causal role of compression, and the limited role of head flexion, in producing bilateral facet dislocations. Bilateral facet dislocations have only been produced in experiments where compression is the primary loading mode. To date, no biomechanical study has produced bilateral facet dislocations in a whole spine by bending. Yet the notion that it is primarily a hyper-flexion injury persists in the clinical literature. Compression and compressive buckling are the primary causes of bilateral facet dislocations. It is important to stop using the hyper-flexion nomenclature to describe this class of cervical spines injuries because it may have a detrimental effect on designs for injury prevention. Copyright © 2018 Elsevier Ltd. All rights reserved.

  3. A systematic review of the need for MRI for the clearance of cervical spine injury in obtunded blunt trauma patients after normal cervical spine CT

    Directory of Open Access Journals (Sweden)

    Iyore AO James

    2014-01-01

    Full Text Available Clearance of cervical spine injury (CSI in the obtunded or comatose blunt trauma patient remains controversial. In patients with unreliable physical examination and no evidence of CSI on computed tomography (CT, magnetic resonance imaging of the cervical spine (CS-MRI is the typical follow-up study. There is a growing body of evidence suggesting that CS-MRI is unnecessary with negative findings on a multi-detector CT (MDCT scan. This review article systematically analyzes current literature to address the controversies surrounding clearance of CSI in obtunded blunt trauma patients. A literature search through MEDLINE database was conducted using all databases on the National Center for Biotechnology Information (NCBI website (www.ncbi.nlm.nih.gov for keywords: "cervical spine injury," "obtunded," and "MRI." The search was limited to studies published within the last 10 years and with populations of patients older than 18 years old. Eleven studies were included in the analysis yielding data on 1535 patients. CS-MRI detected abnormalities in 256 patients (16.6%. The abnormalities reported on CS-MRI resulted in prolonged rigid c-collar immobilization in 74 patients (4.9%. Eleven patients (0.7% had unstable injury detected on CS-MRI alone that required surgical intervention. In the obtunded blunt trauma patient with unreliable clinical examination and a normal CT scan, there is still a role for CS-MRI in detecting clinically significant injuries when MRI resources are available. However, when a reliable clinical exam reveals intact gross motor function, CS-MRI may be unnecessary.

  4. A novel index for quantifying the risk of early complications for patients undergoing cervical spine surgeries.

    Science.gov (United States)

    Passias, Peter G; Diebo, Bassel G; Marascalchi, Bryan J; Jalai, Cyrus M; Horn, Samantha R; Zhou, Peter L; Paltoo, Karen; Bono, Olivia J; Worley, Nancy; Poorman, Gregory W; Challier, Vincent; Dixit, Anant; Paulino, Carl; Lafage, Virginie

    2017-11-01

    OBJECTIVE It is becoming increasingly necessary for surgeons to provide evidence supporting cost-effectiveness of surgical treatment for cervical spine pathology. Anticipating surgical risk is critical in accurately evaluating the risk/benefit balance of such treatment. Determining the risk and cost-effectiveness of surgery, complications, revision procedures, and mortality rates are the most significant limitations. The purpose of this study was to determine independent risk factors for medical complications (MCs), surgical complications (SCs), revisions, and mortality rates following surgery for patients with cervical spine pathology. The most relevant risk factors were used to structure an index that will help quantify risk and anticipate failure for such procedures. METHODS The authors of this study performed a retrospective review of the National Inpatient Sample (NIS) database for patients treated surgically for cervical spine pathology between 2001 and 2010. Multivariate models were performed to calculate the odds ratio (OR) of the independent risk factors that led to MCs and repeated for SCs, revisions, and mortality. The models controlled for age ( 65 years old), sex, race, revision status (except for revision analysis), surgical approach, number of levels fused/re-fused (2-3, 4-8, ≥ 9), and osteotomy utilization. ORs were weighted based on their predictive category: 2 times for revision surgery predictors and 4 times for mortality predictors. Fifty points were distributed among the predictors based on their cumulative OR to establish a risk index. RESULTS Discharges for 362,989 patients with cervical spine pathology were identified. The mean age was 52.65 years, and 49.47% of patients were women. Independent risk factors included medical comorbidities, surgical parameters, and demographic factors. Medical comorbidities included the following: pulmonary circulation disorder, coagulopathy, metastatic cancer, renal failure, congestive heart failure

  5. Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine.

    Directory of Open Access Journals (Sweden)

    Fei Guo

    Full Text Available Pedicle screw fixation in the upper cervical spine is a difficult and high-risk procedure. The screw is difficult to place rapidly and accurately, and can lead to serious injury of spinal cord or vertebral artery. The aim of this study was to design an individualized 3D printing navigation template for pedicle screw fixation in the upper cervical spine.Using CT thin slices data, we employed computer software to design the navigation template for pedicle screw fixation in the upper cervical spine (atlas and axis. The upper cervical spine models and navigation templates were produced by 3D printer with equal proportion, two sets for each case. In one set (Test group, pedicle screws fixation were guided by the navigation template; in the second set (Control group, the screws were fixed under fluoroscopy. According to the degree of pedicle cortex perforation and whether the screw needed to be refitted, the fixation effects were divided into 3 types: Type I, screw is fully located within the vertebral pedicle; Type II, degree of pedicle cortex perforation is 1 mm or with the poor internal fixation stability and in need of renovation. Type I and Type II were acceptable placements; Type III placements were unacceptable.A total of 19 upper cervical spine and 19 navigation templates were printed, and 37 pedicle screws were fixed in each group. Type I screw-placements in the test group totaled 32; Type II totaled 3; and Type III totaled 2; with an acceptable rate of 94.60%. Type I screw placements in the control group totaled 23; Type II totaled 3; and Type III totaled 11, with an acceptable rate of 70.27%. The acceptability rate in test group was higher than the rate in control group. The operation time and fluoroscopic frequency for each screw were decreased, compared with control group.The individualized 3D printing navigation template for pedicle screw fixation is easy and safe, with a high success rate in the upper cervical spine surgery.

  6. Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine.

    Science.gov (United States)

    Guo, Fei; Dai, Jianhao; Zhang, Junxiang; Ma, Yichuan; Zhu, Guanghui; Shen, Junjie; Niu, Guoqi

    2017-01-01

    Pedicle screw fixation in the upper cervical spine is a difficult and high-risk procedure. The screw is difficult to place rapidly and accurately, and can lead to serious injury of spinal cord or vertebral artery. The aim of this study was to design an individualized 3D printing navigation template for pedicle screw fixation in the upper cervical spine. Using CT thin slices data, we employed computer software to design the navigation template for pedicle screw fixation in the upper cervical spine (atlas and axis). The upper cervical spine models and navigation templates were produced by 3D printer with equal proportion, two sets for each case. In one set (Test group), pedicle screws fixation were guided by the navigation template; in the second set (Control group), the screws were fixed under fluoroscopy. According to the degree of pedicle cortex perforation and whether the screw needed to be refitted, the fixation effects were divided into 3 types: Type I, screw is fully located within the vertebral pedicle; Type II, degree of pedicle cortex perforation is stability and no need to renovate; Type III, degree of pedicle cortex perforation is >1 mm or with the poor internal fixation stability and in need of renovation. Type I and Type II were acceptable placements; Type III placements were unacceptable. A total of 19 upper cervical spine and 19 navigation templates were printed, and 37 pedicle screws were fixed in each group. Type I screw-placements in the test group totaled 32; Type II totaled 3; and Type III totaled 2; with an acceptable rate of 94.60%. Type I screw placements in the control group totaled 23; Type II totaled 3; and Type III totaled 11, with an acceptable rate of 70.27%. The acceptability rate in test group was higher than the rate in control group. The operation time and fluoroscopic frequency for each screw were decreased, compared with control group. The individualized 3D printing navigation template for pedicle screw fixation is easy and safe

  7. Columna cervical reumática Artrite reumatoide da coluna cervical Rheumatoid arthritis of the cervical spine

    Directory of Open Access Journals (Sweden)

    Nicolás Macchiavello Cornejo

    2009-03-01

    como uma opção terapêutica. A recuperação neurológica pós-cirurgica depende do nível de compromisso neurológico prévio, o que reforça a importância da detecção e derivação rápida do paciente com risco. O tratamento cirúrgico deve fazer-se em centros especializados, por grupos multidisciplinares. Isto, junto com a intervenção rápida, ajudaria a reduzir as complicações peri-operatórias.Rheumatoid arthritis affects millions of people all over the world. Up to 86% of cases involve cervical spine alterations. Cervical spine instability patterns related to rheumatoid arthritis are: atlanto-axial subluxation, basilar invagination and subaxial instability. Once neurological deficit develops, progression can be fast and even lead to death. Rheumatoid arthritis treatment is mainly nonsurgical. Current medication and treatment protocols may prevent or delay the development of atlanto-axial disease. Periodical clinical and radiological examination help diagnose patients who already have neurological symptoms or those who are at risk of developing them, and who should thus be considered for surgical treatment. Preoperative neurological deficit is a predictor of postoperative neurological recovery, thus the importance of early detection and referral of patients at risk. Surgical treatment should be performed in specialized centers, by multidisciplinary groups. Along with early intervention, this should help reduce perioperative complications.

  8. Osteoid osteoma of the cervical spine. A case report

    International Nuclear Information System (INIS)

    Holl, K.; Wurm, G.

    2001-01-01

    The clinical picture of an OO in the 5th cervical vertebra is illustrated with the case history of a 13 year-old boy. Although in fact a rare case, it becomes evident through reference to and comparison with the literature that this case is a typical one in all aspects. (orig./CB) [de

  9. Cervical spine cord injury in pregnancy. Conservative management ...

    African Journals Online (AJOL)

    Study design A prospective study of 3 patients with incomplete cervical spinal cord injury in the 3rd trimester of pregnancy. Objectives To determine the effect of spinal cord injury and treatment with Gardner-Wells\\' Tong traction on pregnancy, labour and parturition; and ascertain the effectiveness and safety of this ...

  10. Achieving a neutral cervical spine position in suspected spinal cord injury in children: analysing the use of a thoracic elevation device for imaging the cervical spine in paediatric patients.

    Science.gov (United States)

    Pandie, Zaahid; Shepherd, Mike; Lamont, Tony; Walsh, Mark; Phillips, Mark; Page, Colin

    2010-08-01

    Paediatric patients with suspected cervical spine injury (CSI) are routinely immobilised on a firm surface using a hard collar, which results in excessive flexion of the cervical spine due to the relatively large size of the occiput. The objective of this study was to determine whether the use of a thoracic elevation device (TED) results in a more neutral cervical spine position and reduces the occurrence of cervical spine hyperflexion. A prospective cohort study was conducted at two Emergency Departments (sites A and B) from January 2006 to May 2007. Children TED and those at site B did not. x-Rays from both sites were analysed for flexion, extension or neutrality of the cervical spine as defined by the Cobb angle. A total of 76 patients were identified at site A and site B. There were four exclusions at each site for poor quality images. 51 patients in the site A group were found to be in neutral position (71%), compared to 29 patients in the site B group (43%) (p=0.001). One patient (1%) who had a TED was found to be hyperflexed (>10 degrees), whereas 12 (18%) patients at site B were hyperflexed (p=0.001). The use of a TED appears to produce a greater proportion of neutral cervical spine films in children < or =10 years of age presenting for suspected CSI.

  11. Upper thoracic-spine disc degeneration in patients with cervical pain.

    Science.gov (United States)

    Arana, Estanislao; Martí-Bonmatí, Luis; Mollá, Enrique; Costa, Salvador

    2004-01-01

    To study the relationship of upper thoracic spine degenerative disc contour changes on MR imaging in patients with neck pain. The relation between upper thoracic and cervical spine degenerative disc disease is not well established. One hundred and fifty-six patients referred with cervical pain were studied. There were 73 women and 77 men with a mean age of 48.6 +/- 14.6 years (range, 19 to 83 years). All MR studies were performed with a large 23-cm FOV covering at least from the body of T4 to the clivus. Discs were coded as normal, protrusion/bulge or extrusion. Degenerative thoracic disc contour changes were observed in 13.4% of patients with cervical pain. T2-3 was the most commonly affected level of the upper thoracic spine, with 15 bulge/protrusions and one extrusion. Upper degenerative thoracic disc contour changes presented in older patients than the cervical levels (Student-Newman-Keuls test, P < 0.001). Degenerative disc contour changes at the C7-T1, T1-2, T2-3 and T3-4 levels were significantly correlated ( P = 0.001), but unrelated to any other disc disease, patient's gender or age. Degenerative cervical disc disease was closely related together ( P < 0.001), but not with any thoracic disc. A statistically significant relation was found within the upper thoracic discs, reflecting common pathoanatomical changes. The absence of relation to cervical segments is probably due to differences in their pathomechanisms.

  12. Upper thoracic-spine disc degeneration in patients with cervical pain

    Energy Technology Data Exchange (ETDEWEB)

    Arana, Estanislao; Marti-Bonmati, Luis; Costa, Salvador [Department of Radiology, Clinica Quiron, Avda Blasco Ibanez 14, 46010, Valencia (Spain); Molla, Enrique [Department of Radiology, Clinica Quiron, Avda Blasco Ibanez 14, 46010, Valencia (Spain); Department of Morphological Sciences, University of Valencia, Valencia (Spain)

    2004-01-01

    To study the relationship of upper thoracic spine degenerative disc contour changes on MR imaging in patients with neck pain. The relation between upper thoracic and cervical spine degenerative disc disease is not well established. One hundred and fifty-six patients referred with cervical pain were studied. There were 73 women and 77 men with a mean age of 48.6{+-}14.6 years (range, 19 to 83 years). All MR studies were performed with a large 23-cm FOV covering at least from the body of T4 to the clivus. Discs were coded as normal, protrusion/bulge or extrusion. Degenerative thoracic disc contour changes were observed in 13.4% of patients with cervical pain. T2-3 was the most commonly affected level of the upper thoracic spine, with 15 bulge/protrusions and one extrusion. Upper degenerative thoracic disc contour changes presented in older patients than the cervical levels (Student-Newman-Keuls test, P<0.001). Degenerative disc contour changes at the C7-T1, T1-2, T2-3 and T3-4 levels were significantly correlated (P=0.001), but unrelated to any other disc disease, patient's gender or age. Degenerative cervical disc disease was closely related together (P<0.001), but not with any thoracic disc. A statistically significant relation was found within the upper thoracic discs, reflecting common pathoanatomical changes. The absence of relation to cervical segments is probably due to differences in their pathomechanisms. (orig.)

  13. Upper thoracic-spine disc degeneration in patients with cervical pain

    International Nuclear Information System (INIS)

    Arana, Estanislao; Marti-Bonmati, Luis; Costa, Salvador; Molla, Enrique

    2004-01-01

    To study the relationship of upper thoracic spine degenerative disc contour changes on MR imaging in patients with neck pain. The relation between upper thoracic and cervical spine degenerative disc disease is not well established. One hundred and fifty-six patients referred with cervical pain were studied. There were 73 women and 77 men with a mean age of 48.6±14.6 years (range, 19 to 83 years). All MR studies were performed with a large 23-cm FOV covering at least from the body of T4 to the clivus. Discs were coded as normal, protrusion/bulge or extrusion. Degenerative thoracic disc contour changes were observed in 13.4% of patients with cervical pain. T2-3 was the most commonly affected level of the upper thoracic spine, with 15 bulge/protrusions and one extrusion. Upper degenerative thoracic disc contour changes presented in older patients than the cervical levels (Student-Newman-Keuls test, P<0.001). Degenerative disc contour changes at the C7-T1, T1-2, T2-3 and T3-4 levels were significantly correlated (P=0.001), but unrelated to any other disc disease, patient's gender or age. Degenerative cervical disc disease was closely related together (P<0.001), but not with any thoracic disc. A statistically significant relation was found within the upper thoracic discs, reflecting common pathoanatomical changes. The absence of relation to cervical segments is probably due to differences in their pathomechanisms. (orig.)

  14. Modic changes of the cervical spine: T1 slope and its impact on axial neck pain.

    Science.gov (United States)

    Li, Jia; Qin, Shuhui; Li, Yongqian; Shen, Yong

    2017-01-01

    The purpose of the research was to evaluate cervical sagittal parameters on magnetic resonance imaging (MRI) in patients with Modic changes and its impact on axial neck pain. This study consisted of 266 consecutive asymptomatic or symptomatic patients with Modic changes, whose average age was 50.9±12.6 years from January 2015 to December 2016. Cervical sagittal parameters included sagittal alignment of the cervical spine (SACS), T1 slope, thoracic inlet angle (TIA), and neck tilt (NT). The Modic changes group was compared with an asymptomatic control group of 338 age- and gender-matched adults. In the Modic changes group, T1 slope was significantly higher (25.8°±6.3°) compared with that in the control group (22.5°±6.8°) ( P =0.000). However, there was no significant difference of the NT, TIA, and SACS between the two groups. Patients in the Modic changes group were more likely to have experienced historical axial neck pain compared with the control group ( P =0.000). With regard to the disc degeneration, it indicated that the disc in the Modic changes group had more severe disc degeneration ( P =0.032). T1 slope in the Modic changes group was significantly higher compared to that of the control group. The findings suggested that a higher T1 slope with broken compensation of cervical sagittal mechanism may be associated with the development of Modic changes in the cervical spine.

  15. Maxillo-nasal dysplasia (Binder syndrome) and associated malformations of the cervical spine

    Energy Technology Data Exchange (ETDEWEB)

    Olow-Nordenram, M.A.K.; Raadberg, C.T.

    1984-01-01

    Forty-three patients with maxillo-nasal dysplasia have been subjected to a radiographic examination of the cervical spine. In 44.2 per cent malformations of the cervical vertebrae of a minor or major type were revealed. Dysplasia of the vertebral bodies related to persistence of the chorda dorsalis, a very rare malformation, was found in six cases. No correlation between the incidence or serverity of the malformations and the degree of malocclusion of the jaws and facial deformity, characteristic of Binder syndrome, were noted. The maxillo-nasal dysplasia and the spinal malformations probably have a common cause during the embryologic stage.

  16. Maxillo-nasal dysplasia (Binder syndrome) and associated malformations of the cervical spine

    International Nuclear Information System (INIS)

    Olow-Nordenram, M.A.K.; Raadberg, C.T.

    1984-01-01

    Forty-three patients with maxillo-nasal dysplasia have been subjected to a radiographic examination of the cervical spine. In 44.2 per cent malformations of the cervical vertebrae of a minor or major type were revealed. Dysplasia of the vertebral bodies related to persistence of the chorda dorsalis, a very rare malformation, was found in six cases. No correlation between the incidence or serverity of the malformations and the degree of malocclusion of the jaws and facial deformity, characteristic of Binder syndrome, were noted. The maxillo-nasal dysplasia and the spinal malformations probably have a common cause during the embryologic stage. (orig.)

  17. Noncontiguous multifocal brucellar spondylitis involving the cervical, thoracic, and lumbar spine: A case report

    Directory of Open Access Journals (Sweden)

    Rong Wang

    2017-06-01

    Full Text Available Brucellosis is a zoonosis infectious disease, brucellar spondylitis primarily infects the lumbar, the cervical is uncommon. Multiple-level involvement is extremely rare. This report describes a 46-year-old man with noncontiguous multifocal brucellar spondylitis involving the cervical, thoracic, and lumbar spine. Brucellar spondylitis is difficult to diagnose. Routine laboratory findings for the disease have little diagnostic value. Manifestations and radiological features are usually nonspecific. Radiological features of brucellar spondylitis are similar to tuberculous spondylitis and pyogenic spondylitis. MRI findings have diagnostic value. Suspicious patients with unexplained fever, musculoskeletal complaints at risk of infection should be considered.

  18. HAVE RECENT CHANGES TO THE RUGBY UNION LAWS OF SCRUMMAGE REDUCED SERIOUS CERVICAL SPINE INJURIES?

    Directory of Open Access Journals (Sweden)

    Terence F. McLoughlin

    2009-03-01

    Full Text Available All areas of play in rugby union are acknowledged to be potentially dangerous but it is in the scrum where the most frequent and serious spinal injuries occur (McIntosh & McCrory, 2005. This letter addresses the questions: what is it about the scrum which accounts for the alleged increased frequency of scrummage associated spinal cord injury (particular in the cervical region and what has the Rugby Football Union [RFU] done to minimise the chance of cervical cord damage by changes to the Laws? Scrums are used to restart play after infringement of Law 20.1. The team which is successful in winning the ball from the scrum can provide quality possession and space to their attacking backs (IRB, 2005.The three front row players are especially vulnerable to serious cervical spine injury. The majority of neck injuries are caused by heads not being properly aligned when opposing front row players make initial contact as the scrum is being formed. If the scrum collapses then excessive forward flexion/rotation of the cervical spine can occur and by wheeling the scrum this can result in increased abnormal lateral flexion/rotation. Added to these possible abnormal increases in directional movement of the cervical spine is the force generated at engagement. It has been calculated that in the front row a static weight of up to 1600kg is placed on each player's neck. Fracture dislocation (usually between C4/C6 of the spine can be the resulting injury which if the cord is involved can cause tetra paresis.In response to this evidence the IRB amended the law of scrummage which was put into effect 2007 in the hope of reducing the incidence of serious cervical spine injury. This is summarised as a 4 step Law of engagement which is: "crouch, touch, pause, engage". The distance between the front rows must now be less than arms length before making contact. Prior to the introduction of this Law with the stipulated distance apart before engagement, the front row

  19. Cervical spine imaging in trauma: Does the use of grid and filter combination improve visualisation of the cervicothoracic junction?

    International Nuclear Information System (INIS)

    Goyal, Nimit; Rachapalli, Vamsidhar; Burns, Helen; Lloyd, David C.F.

    2011-01-01

    Purpose: To evaluate the usefulness of filter and anti-scatter grid combination in demonstrating the cervicothoracic junction in lateral cervical spine radiographs performed for trauma patients. Methods: Following a change in departmental protocol in our hospital, anti-scatter grid and filter are routinely used for lateral cervical spine radiograph in all trauma patients with immobilised cervical spine. A retrospective study was done to compare the efficacy of lateral cervical spine radiographs in demonstrating the cervicothoracic junction for a period of three months before and after the implementation of the change. All images were independently evaluated by two observers. Results: 253 trauma patients had a lateral cervical spine radiograph done in January to March 2003 without using the anti-scatter grid and filter while 309 patients in January to March 2007, using filter and grid. Inter-observer variability between the two observers was calculated using Cohen's Kappa which showed good and very good agreement for 2003 and 2007 respectively. 126 (49.8%) images adequately demonstrated the cervicothoracic junction without using filter and grid while 189 (61.1%) were adequate following their use. This was statistically significant (Fischer exact test, p value = 0.0081). Conclusion: The use of filter and anti-scatter grids improves the visualisation of cervicothoracic junction in lateral cervical spine imaging and reduces the need to repeat exposure.

  20. Cervical spine imaging in trauma: Does the use of grid and filter combination improve visualisation of the cervicothoracic junction?

    Energy Technology Data Exchange (ETDEWEB)

    Goyal, Nimit, E-mail: nimitgoyal@doctors.org.u [University Hospital of Wales, Heath Park, Cardiff, CF14 4XW (United Kingdom); Rachapalli, Vamsidhar; Burns, Helen; Lloyd, David C.F. [University Hospital of Wales, Heath Park, Cardiff, CF14 4XW (United Kingdom)

    2011-02-15

    Purpose: To evaluate the usefulness of filter and anti-scatter grid combination in demonstrating the cervicothoracic junction in lateral cervical spine radiographs performed for trauma patients. Methods: Following a change in departmental protocol in our hospital, anti-scatter grid and filter are routinely used for lateral cervical spine radiograph in all trauma patients with immobilised cervical spine. A retrospective study was done to compare the efficacy of lateral cervical spine radiographs in demonstrating the cervicothoracic junction for a period of three months before and after the implementation of the change. All images were independently evaluated by two observers. Results: 253 trauma patients had a lateral cervical spine radiograph done in January to March 2003 without using the anti-scatter grid and filter while 309 patients in January to March 2007, using filter and grid. Inter-observer variability between the two observers was calculated using Cohen's Kappa which showed good and very good agreement for 2003 and 2007 respectively. 126 (49.8%) images adequately demonstrated the cervicothoracic junction without using filter and grid while 189 (61.1%) were adequate following their use. This was statistically significant (Fischer exact test, p value = 0.0081). Conclusion: The use of filter and anti-scatter grids improves the visualisation of cervicothoracic junction in lateral cervical spine imaging and reduces the need to repeat exposure.

  1. The functional relationship between the craniomandibular system, cervical spine, and the sacroiliac joint: a preliminary investigation.

    Science.gov (United States)

    Fink, Matthias; Wähling, Knut; Stiesch-Scholz, Meike; Tschernitschek, Harald

    2003-07-01

    The hypothesis of a functional coupling between the muscles of the craniomandibular system and the muscles of other body areas is still controversial. The purpose of this pilot study was to examine whether there is a relationship between the craniomandibular system, the craniocervical system and the sacropelvic region. To test this hypothesis, the prevalence and localization of dysfunction of the cervical spine and the sacroiliac joint were examined in a prospective, experimental trial. Twenty healthy students underwent an artificial occlusal interference, which caused an occlusal interference. The upper cervical spine (CO-C3) and the sacroiliac joint were examined before, during and after this experimental test. The primary outcome with these experimental conditions was the occurrence of hypomobile functional abnormalities. In the presence of occlusal interference, functional abnormalities were detected in both regions examined and these changes were statistically significant. The clinical implications of these findings may be that a complementary examination of these areas in CMD patients could be useful.

  2. Health resource utilisation costs in acute patients with persistent midline cervical tenderness following road trauma.

    Science.gov (United States)

    Ackland, Helen M; Wolfe, Rory; Cameron, Peter A; Cooper, D James; Malham, Gregory M; Varma, Dinesh K; Fitt, Gregory J; Rosenfeld, Jeffrey V; Liew, Susan M

    2012-11-01

    The costs associated with patients discharged with isolated clinician-elicited persistent midline tenderness and negative computed tomography (CT) findings have not been reported. Our aim was to determine the association of acute and post-acute patient and injury characteristics with health resource costs in such patients following road trauma. In a prospective cohort study, road trauma patients presenting with isolated persistent midline cervical tenderness and negative CT, who underwent additional acute imaging with MRI, were recruited. Patients were reviewed in the outpatient spine clinic following discharge, and were followed up at 6 and 12 months post-trauma. Multivariate linear regression was used to assess the association of injury mechanism, clinical assessment, socioeconomic factors and outcome findings with health resource costs generated in the acute hospital and post-acute periods. There were 64 patients recruited, of whom 24 (38%) had cervical spine injury detected on MRI. Of these, 2 patients were managed operatively, 6 were treated in cervical collars and 16 had the cervical spine cleared and were discharged. At 12 months, there were 25 patients (44%) with residual neck pain, and 22 (39%) with neck-related disability. The mean total cost was AUD $10,153 (SD=10,791) and the median was $4015 (IQR: 3044-6709). Transient neurologic deficit, which fully resolved early in the emergency department, was independently associated with higher marginal mean acute costs (represented in the analysis by the β coefficient) by $3521 (95% CI: 50-6880). Low education standard (β coefficient: $5988, 95% CI: 822-13,317), neck pain at 6 months (β coefficient: $4017, 95% CI: 426-9254) and history of transient neurologic deficit (β coefficient: $8471, 95% CI: 1766-18,334) were associated with increased post-acute costs. In a homogeneous group of road trauma patients with non fracture-related persistent midline cervical tenderness, health resource costs varied

  3. Sagittal alignment of the cervical spine in adolescent idiopathic scoliosis treated by posteromedial translation.

    Science.gov (United States)

    Ilharreborde, Brice; Vidal, Christophe; Skalli, Wafa; Mazda, Keyvan

    2013-02-01

    To analyze postoperative changes in the cervical sagittal alignment (CSA) of patients with AIS treated by posteromedial translation. 49 patients with thoracic AIS underwent posterior arthrodesis with hybrid constructs, combining lumbar pedicle screws and thoracic universal clamps. Posteromedial translation was the main correction technique used. 3D radiological parameters were measured from low-dose biplanar radiographs. CSA was assessed using the C2C6 angle, and the central hip vertical axis (CHVA) was used as a reference axis to evaluate patients' balance. Preoperatively, 58 % of patients had thoracic hypokyphosis, and 79 % had a kyphotic CSA. Significant correlation was found (r = 0.45, P = 0.01) between thoracic hypokyphosis and cervical kyphosis. Increase in T4-T12 thoracic kyphosis (average 14.5° ± 10°) was associated with significant decrease in cervical kyphosis in the early postoperative period. The CSA further improved spontaneously during follow-up by 7.6° (P < 0.0001). Significant positive correlation (r = 0.32, P = 0.03) was found between thoracic and cervical improvements. At latest follow-up, 94 % of the patients were normokyphotic and 67 % had a CSA in the physiological range. Sagittal balance of the thoracolumbar spine was not significantly modified postoperatively. However, the procedure significantly changed the position of C2 in regard to the CHVA (C2-CHVA), which reflects headposition (P = 0.012). At last follow-up, the patients sagittal imbalance was not significantly different from the preoperative imbalance (P = 0.34). Thoracic hypokyphosis and cervical hypolordosis, observed in AIS, can be improved postoperatively, when the posteromedial translation technique is used for correction. The cervical spine remains adaptable in most patients, but the proportion of patients with physiological cervical lordosis at final follow-up remained low (24.5 %).

  4. Development of Ultrasound to Measure In-vivo Dynamic Cervical Spine Intervertebral Disc Mechanics

    Science.gov (United States)

    2014-01-01

    The deformation between C4 and C6 measured by the US probe was affected by bulging of the IVD and soft tissues during compressive loading as...endplates of the vertebrae and cartilaginous endplate of the discs were added to all segments. Figure 28 Coronal views of the updated C4-T1 FEM (a...the ligaments and soft tissue connections that provide stability to the cervical spine FSUs were added (Figures 30 and 31). For the anterior

  5. Effect of unilateral dominance of the cerebral hemispheres on the radiographic appearance of the cervical spine

    Energy Technology Data Exchange (ETDEWEB)

    Jirout, J

    1980-10-01

    The results of dynamic radiographic studies of the cervical spine following isometric exercise of the shoulders and the upper extremities appear to indicate that the commonly seen asymmetries of the joints in the craniocervical and cervicothoracic junction are due to asymmetry in the function of the muscles. The obvious dominance of the muscles on the right side demonstrates the dominance of the left cerebral hemisphere. The clinical importance of this is pointed out.

  6. Cervical Spine Injuries: A Whole-Body Musculoskeletal Model for the Analysis of Spinal Loading.

    Directory of Open Access Journals (Sweden)

    Dario Cazzola

    Full Text Available Cervical spine trauma from sport or traffic collisions can have devastating consequences for individuals and a high societal cost. The precise mechanisms of such injuries are still unknown as investigation is hampered by the difficulty in experimentally replicating the conditions under which these injuries occur. We harness the benefits of computer simulation to report on the creation and validation of i a generic musculoskeletal model (MASI for the analyses of cervical spine loading in healthy subjects, and ii a population-specific version of the model (Rugby Model, for investigating cervical spine injury mechanisms during rugby activities. The musculoskeletal models were created in OpenSim, and validated against in vivo data of a healthy subject and a rugby player performing neck and upper limb movements. The novel aspects of the Rugby Model comprise i population-specific inertial properties and muscle parameters representing rugby forward players, and ii a custom scapula-clavicular joint that allows the application of multiple external loads. We confirm the utility of the developed generic and population-specific models via verification steps and validation of kinematics, joint moments and neuromuscular activations during rugby scrummaging and neck functional movements, which achieve results comparable with in vivo and in vitro data. The Rugby Model was validated and used for the first time to provide insight into anatomical loading and cervical spine injury mechanisms related to rugby, whilst the MASI introduces a new computational tool to allow investigation of spinal injuries arising from other sporting activities, transport, and ergonomic applications. The models used in this study are freely available at simtk.org and allow to integrate in silico analyses with experimental approaches in injury prevention.

  7. Endotracheal Intubation in Patients with Unstable Cervical Spine Using LMA-Fastrach and Gum Elastic Bogie

    International Nuclear Information System (INIS)

    Khan, M. U.

    2014-01-01

    Objective: To evaluate the success of alternative technique of ET- intubation in patients with unstable cervical spine with Philadelphia collar around the neck. Study Design: Case series. Place and Duration of Study: The Department of Anaesthesia, College of Medicine, King Saud University, Riyadh, Saudi Arabia, from June 2009 to June 2012. Methodology: Adult patients of either gender with unstable cervical spine wearing Philadelphia collar electively scheduled for cervical spine decompression and fixation more than one level were included. Those with anticipated difficult intubation, mouth opening 27 kg/m2 were excluded. After induction of anaesthesia FT-LMA was inserted. Correct position of FT-LMA was confirmed then soft straight end of gum elastic bogie was passed through FTLMA into trachea. FT-ILMA was removed on bogie. Reinforced silicon ET- tube was rail road on bogie. The bogie was pulled out and position of ET- tube was confirmed with ETCO2, chest movement and auscultation on bag ventilation. The ease of insertion of FT-LMA, ET- intubation and maximum time taken for successful intubation was noted. Results: 26 patients were studied with mean age of 59.3 A +- 2.93 years and M: F ratio of 7:3. The mean time taken from the insertion of gum elastic bogie to the ET intubation was 38.9 A +- 1.20 seconds. The success rate of ET- intubation in the first attempt was 88.4% and 7.6% in two attempts. Intubation failed in one patient. The mean ease of insertion of FT-LMA and ET- intubation in all patients was 46.7 A +- 2.59 and 46.5 A +- 2.66 respectively on VAS ( 0-100). No complication was noted in any patient. Conclusion: This technique is safe and reliable for achieving adequate ventilation and intubation in patients with unstable cervical spine with Philadelphia collar in place. (author)

  8. Gorham syndrome of the thorax and cervical spine: CT and MRI findings

    International Nuclear Information System (INIS)

    Chung, C.; Yu, J.S.; Resnick, D.; Vaughan, L.M.; Haghighi, P.

    1997-01-01

    Gorham syndrome is a rare disorder that is characterized by local osseous invasion and surrounding soft tissues by an angiomatous mass, eventually causing lysis of the affected bone. To date, only four cases have reported the MR imaging appearance of this disease and the findings have been variable. We present a case involving the cervical and thoracic spine and part of the osseous hemithorax with attention to the MR findings. (orig.). With 4 figs

  9. Reconstruction of Low Speed Rear-End collisions - Technical Means of Assessing Cervical Spine Injuries

    Directory of Open Access Journals (Sweden)

    Martin Hitzemann

    2003-01-01

    Full Text Available In recent years, an increasing number of cervical spine injuries sustained by vehicle occupants in collisions at comparatively low speeds have been reported to insurance companies and in civil litigation. The reported injuries occur in both rear-end and side impact collisions. The paper describes how a detailed assessment of such cases requires interdisciplinary teamwork involving technical, biomechanical and medical experts.

  10. Risk factors of neurological lesions in low cervical spine fractures and dislocations

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    COELHO DANILO GONÇALVES

    2000-01-01

    Full Text Available Eighty-nine patients with lower cervical spine fractures or dislocations were evaluated for risk factors of neurological lesion. The age, sex, level and pattern of fracture and sagittal diameter of the spinal canal were analysed. There were no significant differences on the age, gender, level and Torg's ratio between intact patients and those with nerve root injury, incomplete or complete spinal cord injuries. Bilateral facet dislocations and burst fractures are a significant risk factor of spinal cord injury.

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

    Science.gov (United States)

    Leonard, Heather; Joffe, Ari R

    2009-02-01

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

  12. Thyroid cancer after x-ray treatment of benign disorders of the cervical spine in adults

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    Damber, Lena; Johansson, Lennart; Johansson, Robert; Larsson, Lars-Gunnar [Univ. Hospital, Umeaa (Sweden). Oncology Centre

    2002-02-01

    While there is very good epidemiological evidence for induction of thyroid cancer by radiation exposure in children, the risk for adults after exposure is still uncertain, especially when concerning relatively small radiation doses. A cohort of 27415 persons which in 1950 through 1964 had received x-ray treatment for various benign disorders in the locomotor system (such as painful arthrosis and spondylosis) was selected from three hospitals in Northern Sweden. A proportion of this cohort, consisting of 8144 persons (4075 men and 4069 women), had received treatment to the cervical spine and thereby received an estimated average dose in the thyroid gland of about 1 Gy. Standard incidence rates (SIR) were calculated by using the Swedish Cancer Register. In the cervical spine cohort, 22 thyroid cancers were found versus 13.77 expected (SIR 1.60; CI 1.00-2.42). The corresponding figures for women were 16 observed cases versus 9.60 expected cases (SIR 1.67; CI 0.75-2.71). Most thyroid cancers (15 out of 22) were diagnosed >15 years after the exposure. In the remaining part of the total cohort, i.e. those without cervical spine exposure, no increased risk of thyroid cancer was found (SIR 0.98; CI 0.64-1.38). The study strongly suggests that external radiation exposure of adults at relatively small doses increases the risk of thyroid cancer but also that this increase is very much lower than that reported after exposure in children.

  13. Relationship between Northwick Park neck pain questionnaire and cervical spine MR imaging findings.

    Science.gov (United States)

    Arana, Estanislao; Martí-Bonmatí, Luis; Montijano, Ruben; Bautista, Daniel; Molla, Enrique; Costa, Salvador

    2006-08-01

    The study was aimed at determining the association between the self-report of pain and disability by means of Northwick neck pain questionnaire (NPQ) and cervical spine MR imaging findings. A random sample of 251 patients, 132 men and 119 women aged 43+/-13 years, submitted with neck pain were investigated. Patients with previous discitis, surgery, neoplasm or hospitalized for cervical spine trauma were excluded. All patients completed the NPQ and were studied with sagittal gradient-echo T1 and turbo spin-echo T2, axial gradient-echo T2* and heavily T2 weighted MR myelographic weighted images. MR images of the two most affected disc levels were read, offering an MR imaging score from 0 to 30. There was no statistically significant correlation between NPQ and MR imaging scores. From the NPQ items, only difficulty in sleeping and numbness were related to the MR imaging score. Disc extrusion was the only MR finding almost significantly associated with NPQ (P=0.054). Neck injury did not increase NPQ scores. In patients with neck pain, NPQ scores do not correlate with MR imaging findings. NPQ and cervical spine MR imaging show different facets of the multidimensional complex of neck pain.

  14. Comorbidity of internal derangement of the temporomandibular joint and silent dysfunction of the cervical spine.

    Science.gov (United States)

    Stiesch-Scholz, M; Fink, M; Tschernitschek, H

    2003-04-01

    The aim of this evaluation was to examine correlations between internal derangement of the temporomandibular joint (TMJ) and cervical spine disorder (CSD). A prospective controlled clinical study was carried out. Thirty patients with signs and symptoms of internal derangement but without any subjective neck problems and 30 age- and gender-matched control subjects without signs and symptoms of internal derangement were examined. The investigation of the temporomandibular system was carried out using a 'Craniomandibular Index'. Afterwards an examiner-blinded manual medical investigation of the craniocervical system was performed. This included muscle palpation of the cervical spine and shoulder girdle as well as passive movement tests of the cervical spine, to detect restrictions in the range of movement as well as segmental intervertebral dysfunction. The internal derangement of the TMJ was significantly associated with 'silent' CSD (t-test, P temporomandibular system exhibited significantly more often pain on pressure of the neck muscles than patients without muscle tenderness of the temporomandibular system (t-test, P < 0.05). As a result of the present study, for patients with internal derangement of the TMJ an additional examination of the craniocervical system should be recommended.

  15. Thyroid cancer after x-ray treatment of benign disorders of the cervical spine in adults

    International Nuclear Information System (INIS)

    Damber, Lena; Johansson, Lennart; Johansson, Robert; Larsson, Lars-Gunnar

    2002-01-01

    While there is very good epidemiological evidence for induction of thyroid cancer by radiation exposure in children, the risk for adults after exposure is still uncertain, especially when concerning relatively small radiation doses. A cohort of 27415 persons which in 1950 through 1964 had received x-ray treatment for various benign disorders in the locomotor system (such as painful arthrosis and spondylosis) was selected from three hospitals in Northern Sweden. A proportion of this cohort, consisting of 8144 persons (4075 men and 4069 women), had received treatment to the cervical spine and thereby received an estimated average dose in the thyroid gland of about 1 Gy. Standard incidence rates (SIR) were calculated by using the Swedish Cancer Register. In the cervical spine cohort, 22 thyroid cancers were found versus 13.77 expected (SIR 1.60; CI 1.00-2.42). The corresponding figures for women were 16 observed cases versus 9.60 expected cases (SIR 1.67; CI 0.75-2.71). Most thyroid cancers (15 out of 22) were diagnosed >15 years after the exposure. In the remaining part of the total cohort, i.e. those without cervical spine exposure, no increased risk of thyroid cancer was found (SIR 0.98; CI 0.64-1.38). The study strongly suggests that external radiation exposure of adults at relatively small doses increases the risk of thyroid cancer but also that this increase is very much lower than that reported after exposure in children

  16. Base of skull and cervical spine chordomas in children treated by high-dose irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Benk, Veronique; Liebsch, Norbert J; Munzenrider, John E; Efird, John; McManus, Patricia; Suit, Herman

    1995-02-01

    Purpose: To evaluate the outcome of children with base of skull or cervical spine chordomas treated by high dose irradiation. Methods and Materials: Eighteen children, 4 to 18 years of age, with base of skull or cervical spine chordomas, received fractionated high-dose postoperative radiation using mixed photon and 160 MeV proton beams. The median tumor dose was 69 Cobalt Gray-equivalent (CGE) with a 1.8 CGE daily fraction. Results: The median follow-up was 72 months. The 5-year actuarial survival was 68% and the 5-year disease-free survival (DFS) was 63%. The only significant prognostic factor was the location: patients with cervical spine chordomas had a worse survival than those with base of skull lesions (p = 0.008). The incidence of treatment-related morbidity was acceptable: two patients developed a growth hormone deficit corrected by hormone replacement, one temporal lobe necrosis, and one fibrosis of the temporalis muscle, improved by surgery. Conclusion: Chordomas in children behave similarly to those in adults: children can receive the same high-dose irradiation as adults with acceptable morbidity.

  17. Base of skull and cervical spine chordomas in children treated by high-dose irradiation

    International Nuclear Information System (INIS)

    Benk, Veronique; Liebsch, Norbert J.; Munzenrider, John E.; Efird, John; McManus, Patricia; Suit, Herman

    1995-01-01

    Purpose: To evaluate the outcome of children with base of skull or cervical spine chordomas treated by high dose irradiation. Methods and Materials: Eighteen children, 4 to 18 years of age, with base of skull or cervical spine chordomas, received fractionated high-dose postoperative radiation using mixed photon and 160 MeV proton beams. The median tumor dose was 69 Cobalt Gray-equivalent (CGE) with a 1.8 CGE daily fraction. Results: The median follow-up was 72 months. The 5-year actuarial survival was 68% and the 5-year disease-free survival (DFS) was 63%. The only significant prognostic factor was the location: patients with cervical spine chordomas had a worse survival than those with base of skull lesions (p = 0.008). The incidence of treatment-related morbidity was acceptable: two patients developed a growth hormone deficit corrected by hormone replacement, one temporal lobe necrosis, and one fibrosis of the temporalis muscle, improved by surgery. Conclusion: Chordomas in children behave similarly to those in adults: children can receive the same high-dose irradiation as adults with acceptable morbidity

  18. Functional MR imaging of the cervical spine in patients with rheumatoid arthritis

    International Nuclear Information System (INIS)

    Allmann, K.H.; Uhl, M.; Uhrmeister, P.; Neumann, K.; Langer, M.; Kempis, J. von

    1998-01-01

    Purpose: To evaluate functional MR imaging in patients with rheumatoid arthritis (RA) involving the cervical spine. Material and Methods: We used a device that allows MR examination to be made of the cervical spine in infinitely variable degrees of flexion and extension. Dynamic functional MR imaging was performed on 25 patients with RA. Results: Functional MR imaging was able to show the degree of vertebral instability of the occipito-atlantal or atlanto-axial level as well as the subaxial level. By performing functional MR imaging, we were able to demonstrate the extent of synovial tissue around the dens, and the impingement and displacement of the spinal cord during flexion and extension. The basilar impression, the cord impingement into the foramen magnum, the cord compression, the slipping of vertebrae, and the angulation of the cord were all much more evident in functional than in static MR imaging. Conclusion: Functional MR imaging provided additional information in patients with RA, and is valuable in patients who have a normal MR study in the neutral position and yet have signs of a neurological deficit. Functional MR imaging is important in the planning of stabilizing operations of the cervical spine. (orig.)

  19. Epidemiology, pathomechanics, and prevention of athletic injuries to the cervical spine.

    Science.gov (United States)

    Torg, J S

    1985-06-01

    Athletic injuries to the cervical spine associated with quadriplegia most commonly occur as a result of axial loading. Whether it be a football player striking an opponent with the top or crown of his helmet, a poorly executed dive into a shallow body of water where the subject strikes his head on the bottom, or a hockey player pushed into the boards head first, the fragile cervical spine is compressed between the rapidly decelerated head and the continued momentum of the body. Appropriate rule changes recognizing this mechanism have resulted in a reduction of football quadriplegia by two-thirds. Presumably, educational efforts designed to inform the public of the dangers of diving would have a similar effect. The predominance of the axial loading mechanism is not as clearly defined in trampoline and minitrampoline injuries. However, both of these devices are dangerous when used in the best of circumstances, and their use has no place in recreational, educational, or competitive gymnastics. The emergence of severe cervical spine injuries resulting from ice hockey is recognized. Methods, based on sound scientific evidence, to modify the games so as to prevent these injuries are lacking.

  20. Epidemiology and predictors of cervical spine injury in adult major trauma patients: a multicenter cohort study.

    Science.gov (United States)

    Hasler, Rebecca M; Exadaktylos, Aristomenis K; Bouamra, Omar; Benneker, Lorin M; Clancy, Mike; Sieber, Robert; Zimmermann, Heinz; Lecky, Fiona

    2012-04-01

    Patients with cervical spine injuries are a high-risk group, with the highest reported early mortality rate in spinal trauma. This cohort study investigated predictors for cervical spine injury in adult (≥ 16 years) major trauma patients using prospectively collected data of the Trauma Audit and Research Network from 1988 to 2009. Univariate and multivariate logistic regression analyses were used to determine predictors for cervical fractures/dislocations or cord injury. A total of 250,584 patients were analyzed. Median age was 47.2 years (interquartile range, 29.8-66.0) and Injury Severity Score 9 (interquartile range, 4-11); 60.2% were male. Six thousand eight hundred two patients (2.3%) sustained cervical fractures/dislocations alone. Two thousand sixty-nine (0.8%) sustained cervical cord injury with/without fractures/dislocations; 39.9% of fracture/dislocation and 25.8% of cord injury patients suffered injuries to other body regions. Age ≥ 65 years (odds ratio [OR], 1.45-1.92), males (females OR, 0.91; 95% CI, 0.86-0.96), Glasgow Coma Scale (GCS) score sports injuries (OR, 3.51; 95% CI, 2.87-4.31), road traffic collisions (OR, 3.24; 95% CI, 3.01-3.49), and falls >2 m (OR, 2.74; 95% CI, 2.53-2.97) were predictive for fractures/dislocations. Age sports injuries (OR, 4.42; 95% CI, 3.28-5.95), road traffic collisions (OR, 2.58; 95% CI, 2.26-2.94), and falls >2 m (OR, 2.24; 95% CI, 1.94-2.58) were predictors for cord injury. 3.5% of patients suffered cervical spine injury. Patients with a lowered GCS or systolic blood pressure, severe facial fractures, dangerous injury mechanism, male gender, and/or age ≥ 35 years are at increased risk. Contrary to common belief, head injury was not predictive for cervical spine involvement.

  1. Relationship between facet tropism and facet joint degeneration in the sub-axial cervical spine

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    Xin Rong

    2017-02-01

    Full Text Available Abstract Background Facet tropism is the angular asymmetry between the left and right facet joint orientation. Although debatable, facet tropism was suggested to be associated with disc degeneration, facet degeneration and degenerative spondylolisthesis in the lumbar spine. The purpose of this study was to explore the relationship between facet tropism and facet degeneration in the sub-axial cervical spine. Methods A total of 200 patients with cervical spondylosis were retrospectively analyzed. Facet degeneration was categorized into 4 grade: grade I, normal; grade II, degenerative changes including joint space narrowing, cyst formation, small osteophytes (3 mm without fusion of the joint; grade IV, bony fusion of the facet joints. Facet orientations and facet tropisms with respect to the transverse, sagittal and coronal plane were calculated from the reconstructed cervical spine, which was based on the axial CT scan images. The paired facet joints were then categorized into three types: symmetric, moderated tropism and severe tropism. Univariate and multivariate analysis were performed to evaluate the relationship between any demographic and anatomical factor and facet degeneration. Results The mean age of enrolled patients was 46.23 years old (ranging from 30 to 64 years old. There were 114 males and 86 females. The degrees of facet degeneration varied according to cervical levels and ages. Degenerated facet joints were most common at C2-C3 level and more common in patients above 50 years old. The facet orientations were also different from level to level. By univariate analysis, genders, ages, cervical levels, facet orientations and facet tropisms were all significantly different between the normal facets and degenerated facets. However, results from multivariate logistic regression suggested only age and facet tropism with respect to the sagittal plane were related to facet degeneration. Conclusion Facet degeneration were more common at

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

    International Nuclear Information System (INIS)

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

    2009-01-01

    Purpose: With 54 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Peter H. [Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (United States)], E-mail: phahn@mdanderson.org; Ahn, Andrew I [Albert Einstein College of Medicine of Yeshiva University, Bronx, NY (United States); Lee, C Joe; Jin, Shen; Miller, Ekeni; Lukaj, Alex; Milan, Elissa; Yaparpalvi, Ravindra; Kalnicki, Shalom; Garg, Madhur K [Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (United States)

    2009-02-01

    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.

  4. EMS Adherence to a Pre-hospital Cervical Spine Clearance Protocol

    Directory of Open Access Journals (Sweden)

    Johnson, David

    2001-10-01

    Full Text Available Purpose: To determine the degree of adherence to a cervical spine (c-spine clearance protocol by pre-hospital Emergency Medical Services (EMS personnel by both self-assessment and receiving hospital assessment, to describe deviations from the protocol, and to determine if the rate of compliance by paramedic self-assessment differed from receiving hospital assessment. Methods: A retrospective sample of pre-hospital (consecutive series and receiving hospital (convenience sample assessments of the compliance with and appropriateness of c-spine immobilization. The c-spine clearance protocol was implemented for Orange County EMS just prior to the April-November 1999 data collection period. Results: We collected 396 pre-hospital and 162 receiving hospital data forms. From the pre-hospital data sheet. the percentage deviation from the protocol was 4.096 (16/396. Only one out of 16 cases that did not comply with the protocol was due to over immobilization (0.2%. The remaining 15 cases were under immobilized, according to protocol. Nine of the under immobilized cases (66% that should have been placed in c-spine precautions met physical assessment criteria in the protocol, while the other five cases met mechanism of injury criteria. The rate of deviations from protocol did not differ over time. The receiving hospital identified 8.0% (13/162; 6/16 over immobilized, 7/16 under immobilized of patients with deviations from the protocol; none was determined to have actual c-spine injury. Conclusion: The implementation of a pre-hospital c-spine clearance protocol in Orange County was associated with a moderate overall adherence rate (96% from the pre-hospital perspective, and 92% from the hospital perspective, p=.08 for the two evaluation methods. Most patients who deviated from protocol were under immobilized, but no c-spine injuries were missed. The rate of over immobilization was better than previously reported, implying a saving of resources.

  5. Follow-up radiographs of the cervical spine after anterior fusion with titanium intervertebral disc

    International Nuclear Information System (INIS)

    Biederer, J.; Hutzelmann, A.; Heller, M.; Rama, B.

    1999-01-01

    Purpose: We examined the postoperative changes of the cervical spine after treatment of cervical nerve root compression with anterior cervical discectomy and fusion with a new titanium intervertebral disc. Patients and Methods: 37 patients were examined prior to, as well as 4 days, 6 weeks, and 7 months after surgery. Lateral view X-rays and functional imaging were used to evaluate posture and mobility of the cervical spine, the position of the implants, and the reactions of adjacent bone structures. Results: Implantation of the titanium disc led to post-operative distraction of the intervertebral space and slight lordosis. Within the first 6 months a slight loss of distraction and re-kyphosis due to impression of the implants into the vertebral end-plates were found in all patients. We noted partial infractions into the vertebral end-plates in 10/42 segments and slight mobility of the implants in 14/42 segments. Both groups of patients showed reactive spondylosis and local symptoms due to loosening of the implants. The pain subsided after onset of bone bridging and stable fixation of the loosened discs. Conclusions: The titanium intervertebral disc provides initial distraction of the fusioned segments with partial recurrence of kyphosis during the subsequent course. Loosening of the implants with local symptoms can be evaluated with follow-up X-rays and functional imaging. (orig.) [de

  6. The pattern and prevalence of vertebral artery injury in patients with cervical spine fractures

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    Farzanah Ismail

    2013-06-01

    Method: A retrospective review of patients who had undergone CTA of the vertebral arteries was undertaken. Reports were reviewed to determine which patients met the inclusion criteria of having had both cervical spine fractures and CTA of the vertebral arteries. Images of patients who met the inclusion criteria were analysed by a radiologist. Results: The prevalence of vertebral artery injury was 33%. Four out of the 11 patients who had vertebral artery injury, had post-traumatic spasm of the artery, with associated thrombosis or occlusion of the vessel. In terms of blunt carotid vertebral injury (BCVI grading, most of the patients sustained grade IV injuries. Four patients who had vertebral artery injury had fractures of the upper cervical vertebrae, i.e. C1 to C3. Fifteen transverse process fractures were associated with vertebral artery injury. No vertebral artery injury was detected in patients who had facet joint subluxations. Conclusion: Patients with transverse process fractures of the cervical spine and upper cervical vertebral body fractures should undergo CTA to exclude vertebral artery injury.

  7. Pathology and Treatment of Traumatic Cervical Spine Syndrome: Whiplash Injury

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    Nobuhiro Tanaka

    2018-01-01

    Full Text Available Traumatic cervical syndrome comprises the various symptoms that occur as a result of external force such as that of a traffic accident. In 1995, the Quebec Task Force on whiplash-associated disorders (WAD formulated the Quebec classification, with accompanying clinical practice guidelines. These guidelines were in accordance with the stated clinical isolated or combined symptoms of the syndrome: neck pain, headaches, dizziness, numbness of head or face, eye pain, vision loss, double vision, tinnitus, hearing loss, nausea, and numbness and/or weakness of extremities. In recent years, cerebrospinal fluid hypovolemia or fibromyalgia has been recognized as a major notable cause of a variety of symptoms, although many clinical questions remain regarding the pathology of this syndrome. Therefore, its diagnosis and treatment should be conducted extremely carefully. While the Quebec classification and its guidelines are very useful for the normalization and standardization of symptoms of traumatic cervical syndrome, in the future, we would like to see the emergence of new guidelines that better address the diversity of this disease.

  8. Cervical spine dysfunction signs and symptoms in individuals with temporomandibular disorder.

    Science.gov (United States)

    Weber, Priscila; Corrêa, Eliane Castilhos Rodrigues; Ferreira, Fabiana dos Santos; Soares, Juliana Corrêa; Bolzan, Geovana de Paula; Silva, Ana Maria Toniolo da

    2012-01-01

    To study the frequency of cervical spine dysfunction (CCD) signs and symptoms in subjects with and without temporomandibular disorder (TMD) and to assess the craniocervical posture influence on TMD and CCD coexistence. Participants were 71 women (19 to 35 years), assessed about TMD presence; 34 constituted the TMD group (G1) and 37 comprised the group without TMD (G2). The CCD was evaluated through the Craniocervical Dysfunction Index and the Cervical Mobility Index. Subjects were also questioned about cervical pain. Craniocervical posture was assessed by cephalometric analysis. There was no difference in the craniocervical posture between groups. G2 presented more mild CCD frequency and less moderate and severe CCD frequency (p=0.01). G1 presented higher percentage of pain during movements (p=0.03) and pain during cervical muscles palpation (p=0.01) compared to G2. Most of the TMD patients (88.24%) related cervical pain with significant difference when compared to G2 (p=0.00). Craniocervical posture assessment showed no difference between groups, suggesting that postural alterations could be more related to the CCD. Presence of TMD resulted in higher frequency of cervical pain symptom. Thus the coexistence of CCD and TMD signs and symptoms appear to be more related to the common innervations of the trigeminocervical complex and hyperalgesia of the TMD patients than to craniocervical posture deviations.

  9. Effect of Unifocal versus Multifocal Lenses on Cervical Spine Posture in Patients with Presbyopia.

    Science.gov (United States)

    Abbas, Rami L; Houri, Mohamad T; Rayyan, Mohammad M; Hamada, Hamada Ahmad; Saab, Ibtissam M

    2018-04-04

    There are many environmental considerations which may or may not lead to the development of faulty cervical mechanics. The design of near vision lenses could contribute to the development of such cervical dysfunction and consequently neck pain. Decision making regarding proper type of lens prescription seems important for presbyopic individuals. To investigate the effect of unifocal and multifocal lenses on cervical posture. Thirty subjects (18 females and 12 males) participated in the study with an age range from 40 to 64 years. Each subject wore consequently both unifocal and multifocal lenses randomly while reading. Then lateral cervical spine X-ray films were taken for each subject during each lens wearing. X-ray films were analyzed with digital software (Autocad software, 2 D) to measure segmental angles of the cervical vertebrae (Occiput/C1, C1/C2, C2/C3, C3/C4, C4/C5, C5/C6, C6/C7, C3/C7, C0/C3, and occiput/C7). Higher significant extension angle in the segments C0/C7, C1/C2, C5/C6, C6/C7, and C3/C7 (p<0.05) during multifocal lenses wearing were observed in contrast with higher flexion angle between C3/C4 and C4/C5 (p<0.05) with unifocal lenses wear. Multifocal lens spectacles produces increased extension in the cervical vertebrae angles when compared with the use of unifocal lenses.

  10. MRI of the cervical spine with T1-weighted multislice flash sequences

    International Nuclear Information System (INIS)

    Schubeus, P.; Sander, B.; Schoerner, W.; Tosch, U.; Lanksch, W.R.; Felix, R.; Klinikum Rudolf Virchow, Berlin

    1990-01-01

    A study has been carried out to evaluate contrast and image quality of cervical structures using multislice 2D-flash sequences with long repetition times (TR = 400 ms.) and short echo delay times (TE = 5.8 ms.). The examinations were carried out using ten normals with an MRI of 1.5 Tesla and flip angles of 10, 20, 30, 50, 70 and 90deg. The best contrast between intervertebral disc and surrounding tissue was obtained between 50 and 70deg, best contrast between compact bone and CSF with 10deg. In order to demonstrate degenerative changes of the cervical spine, it appears sensible to use a combination of these angles. The described sequences produce good images of the cervical structures with little image degradation. Compared to T 1 -weighted spin-echo sequences, the method has a number of significant advantages, such as variations in image contrast, higher maximal number of slices, continuous imaging and less imaging time. (orig.) [de

  11. Radiographic findings of degeneration in cervical spines of middle-aged soccer players

    International Nuclear Information System (INIS)

    Kurosawa, Hideki; Yamakoshi, Ken-ichi

    1991-01-01

    Twelve amateur veteran soccer players (average age 40.1 ± 5.4 years), who began playing in their teens and who were admitted with symptoms most likely to be related to cervical spondylosis, were examined by cervical radiography. Abnormal radiographic findings included: calcification of anterior longitudinal ligament (25%), anterior (75%) and posterior vertebral spurs (75%), ossicle between spinous processes (75%), calcification of nuchal ligament (Barsony) (58%), ossicle on spinous process (25%), and bony spur of Luschka's joints (83%). It was shown in the stress distribution by finite element method analysis that the stress in heading the ball was applied mainly to the lower parts of the cervical spine. The results of this analysis also corresponded well with some of the radiographic findings. (orig.)

  12. Radiographic findings of degeneration in cervical spines of middle-aged soccer players

    Energy Technology Data Exchange (ETDEWEB)

    Kurosawa, Hideki; Yamakoshi, Ken-ichi (Hokkaido Univ., Sapporo (Japan). Research Inst. of Applied Electricity); Yamanoi, Takahiro (Hokkaigakuen Univ., Sapporo (Japan))

    1991-08-01

    Twelve amateur veteran soccer players (average age 40.1 {+-} 5.4 years), who began playing in their teens and who were admitted with symptoms most likely to be related to cervical spondylosis, were examined by cervical radiography. Abnormal radiographic findings included: calcification of anterior longitudinal ligament (25%), anterior (75%) and posterior vertebral spurs (75%), ossicle between spinous processes (75%), calcification of nuchal ligament (Barsony) (58%), ossicle on spinous process (25%), and bony spur of Luschka's joints (83%). It was shown in the stress distribution by finite element method analysis that the stress in heading the ball was applied mainly to the lower parts of the cervical spine. The results of this analysis also corresponded well with some of the radiographic findings. (orig.).

  13. Cervical spine injuries in suicidal hanging without a long-drop--patterns and possible underlying mechanisms of injury: an autopsy study.

    Science.gov (United States)

    Nikolić, Slobodan; Zivković, Vladimir

    2014-06-01

    The incidence of cervical spine injuries in suicidal hangings with a short-drop has been reported to be extremely low or non-existent. The aim of this study was to determine the frequency and pattern of cervical spine injuries in suicidal hanging. A retrospective autopsy study was performed and short-drop suicidal hanging cases with documented cervical spine injuries were identified. This group was further analyzed with regard to the gender and age of the deceased, the position of the ligature knot, the presence of hyoid-laryngeal fractures, and the level of cervical spine injury. Cervical spine injuries were present in 25 of the 766 cases, with an average age of 71.9 ± 10.7 years (range 39-88 years). In 16 of these 25 cases, the ligature knot was in the anterior position. The most common pattern of cervical spine injury included partial or complete disruption of the anterior longitudinal ligament and widening of the lower cervical spine disk spaces, associated with absence of hyoid-laryngeal fractures. Cervical spine injuries are not commonly found in short-drop suicidal hanging, occurring in only 3.3 % of all observed cases. Cervical spine injury may be occurring in 80 % of subjects aged 66.5 years and above. The most common pattern of cervical spine injury included anterior longitudinal ligament disruption of the lower cervical spine, disk space widening, and no vertebral body displacement. These injuries were mainly associated with an anterior knot position, and may be a consequence of loop pressure to the posterior neck and cervical spine hyperextension.

  14. Role of imagining diagnostics in assessing the involvement of the cervical spine in patients with rheumatoid arthritis

    International Nuclear Information System (INIS)

    Cyrylowski, L.; Walecka, A.; Koryzma, A.; Brzosko, M.; Brzosko, I.; Prajs, K.

    2005-01-01

    Rheumatoid arthritis (RA) is a polyarthritis caused by inflammatory overgrowth of synnovium known as pannus. Small joints of hands and feet are most frequently involved, followed by cervical spine, particularly the craniocervical junction. The cervical spine involvement may be a cause of a range of neurological complications. Imaging diagnostics of the spine in RA patients include radiograms, CT and MRI. Their purposes is to evaluate type, extension and advancing of the changes. The following lesions can be found in the cervical spine at least in 30% of RA patients with disease duration more than 10 years: subaxial subluxations, apophyseal joint erosions, odontoid erosions, apophyseal joint sclerosis, intervertebral space narrowing, and osteophytosis.These lesions can be easily detected with radiographic examinations whereas the presence of the pannus can be found only with MRI or contrast enhanced CT. The most dangerous complication of RA in the cervical spine is atlantoaxial subluxation. It can be well demonstrated with MRI.Even it is frequently asymptomatic, there is always the possibility of neurological symptoms from compression of the spinal cord by the odontoid process. Therefore, MRI of the cervical spine should be considered in all RA patients. (author)

  15. Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients

    Science.gov (United States)

    Murphy, M.; Connolly, P.; O’Byrne, J.

    2008-01-01

    We analysed the morbidity, mortality and outcome of cervical spine injuries in patients over the age of 65 years. This study was a retrospective review of 107 elderly patients admitted to our tertiary referral spinal injuries unit with cervical spine injuries between 1994 and 2002. The data was acquired by analysis of the national spinal unit database, hospital inpatient enquiry system, chart and radiographic review. Mean age was 74 years (range 66–93 years). The male to female ratio was 2.1:1 (M = 72, F = 35). The mean follow-up was 4.4 years (1–9 years) and mean in-hospital stay was 10 days (2–90 days). The mechanism of injury was a fall in 75 and road traffic accident in the remaining 32 patients. The level involved was atlanto-axial in 44 cases, sub-axial in 52 cases and the remaining 11 had no bony injury. Multilevel involvement occurred in 48 patients. C2 dominated the single level injury and most of them were type II odontoid fractures. Four patients had complete neurology, 27 had incomplete neurology, and the remaining 76 had no neurological deficit. Treatment included cervical orthosis in 67 cases, halo immobilization in 25, posterior stabilization in 12 patients and anterior cervical fusion in three patients. The overall complication rate was 18.6% with an associated in-hospital mortality of 11.2%. The complications included loss of reduction due to halo and Minerva loosening, non-union and delayed union among conservatively treated patients, pin site and wound infection, gastrointestinal bleeding and complication due to associated injuries. Among the 28.9% patients with neurological involvement, 37.7% had significant neurological recovery. Outcome was assessed using a cervical spine outcome questionnaire from Johns Hopkins School of Medicine. Sixty-seven patients (70%) completed the form, 20 patients (19%) were deceased at review and 8 patients (7%) were uncontactable. Functional disability was more marked in the patients with

  16. Profile of acute traumatic spine injuries in Bobo-Dioulasso, Burkina ...

    African Journals Online (AJOL)

    Eleven (14.7%) patients died in hospital; they all had cervical spine injury. The follow-up was poor. Conclusion: Young men in the productive stage of their lives are those most affected. The causes are preventable. A control strategy based on prevention and on creating a spine center could reduce the incidence of such ...

  17. Effect of pelvic irradiation on the bone mineral content of lumbar spine in cervical cancer

    International Nuclear Information System (INIS)

    Youn, S. M.; Choi, T. J.; Koo, E. S.; Kim, O. B.; Lee, S. M.; Suh, S. J.

    1997-01-01

    To evaluate the loss of bone mineral contents(BMC) in lumbar spine within the radiation field for cervical cancer treatment, BMC in the irradiated patient group was compared with that of a normal control group. Measurements of BMC in the trabecular bone in lumbar spines(L3-L5) were performed in the both patient and normal control groups. Investigators used dual-energy quantitative computerized tomography(DEQCD) using photon energy of 120 and 80kVp. The numbers of patient and control groups were 43 in each with age distribution of fifth to seventh decade of women. The numbers of control group were 22 in fifth, 10 in sixth, and 11 in seventh decade, those of patient group were 14 in fifth, 14 in sixth, and 15 in seventh decade of women. The radiation field was extended to L5 spine for pelvic irradiation with 45-54Gy of external radiation dose and 30Gy of high dose rate brachytherapy in cervical cancer. The BMC is decreased as increasing age in both control and patient groups. BMC in lumbar spine of patient group was decreased by about 13% to 40% maximally. The BMC of L3 and L4 a region that is out of a radiation field for the patient group demonstrated 119.5 ±30.6, 117.0 ±31.7 for fifth, 83.3 ± 37.8, 88.3 ± 46.8 for sixth and 61.5 ± 18.3, 56.2 ± 26.6 mg/cc for seventh. Contrasted by the normal control group has shown 148.0 ± 19.9, 153.2 ± 23.2 for fifth, 96.1 ± 30.2, 105.6 ± 26.5 for sixth and 73.9 ± 27.9, 77.2 ± 27.2 mg/cc for seventh decade, respectively. The BMC of patient group was decreased as near the radiation field, while the lower lumbar spine has shown more large amounts of BMC in the normal control group. In particular, the BMC of L5 within the radiation field was significantly decreased to 33%, 31%, 40% compared with the control group of the fifth, sixth and seventh decades, respectively. The pelvic irradiation in cervical cancer has much effected on the loss of bone mineral content of lumbar spine within the radiation field, as the lower

  18. The impact of generalized joint laxity (GJL) on the posterior neck pain, cervical disc herniation, and cervical disc degeneration in the cervical spine.

    Science.gov (United States)

    Lee, Sun-Mi; Oh, Su Chan; Yeom, Jin S; Shin, Ji-Hoon; Park, Sam-Guk; Shin, Duk-Seop; Ahn, Myun-Whan; Lee, Gun Woo

    2016-12-01

    Generalized joint laxity (GJL) can have a negative impact on lumbar spine pathology, including low back pain, disc degeneration, and disc herniation, but the relationship between GJL and cervical spine conditions remains unknown. To investigate the relationship between GJL and cervical spine conditions, including the prevalence of posterior neck pain (PNP), cervical disc herniation (CDH), and cervical disc degeneration (CDD), in a young, active population. Retrospective 1:2 matched cohort (case-control) study from prospectively collected data PATIENT SAMPLE: Of a total of 1853 individuals reviewed, 73 individuals with GJL (study group, gruop A) and 146 without GJL (control group, Group B) were included in the study according to a 1:2 case-control matched design for age, sex, and body mass index. The primary outcome measure was the prevalence and intensity of PNP at enrollment based on a visual analogue scale score for pain. The secondary outcome measures were (1) clinical outcomes as measured with the neck disability index (NDI) and 12-item short form health survey (SF-12) at enrollment, and (2) radiological outcomes of CDH and CDD at enrollment. We compared baseline data between groups. Descriptive statistical analyses were performed to compare the 2 groups in terms of the outcome measures. The prevalence and intensity of PNP were significantly greater in group A (patients with GJL) than in group B (patients without GJL) (prevalence: p=.02; intensity: p=.001). Clinical outcomes as measured with NDI and SF-12 did not differ significantly between groups. For radiologic outcomes, the prevalence of CDD was significantly greater in group A than in group B (p=.04), whereas the prevalence of CDH did not differ significantly between groups (p=.91). The current study revealed that GJL was closely related to the prevalence and intensity of PNP, suggesting that GJL may be a causative factor for PNP. In addition, GJL may contribute to the occurrence of CDD, but not CDH. Spine

  19. The effect of chlorzoxazone on acute pain after spine surgery

    DEFF Research Database (Denmark)

    Nielsen, R V; Fomsgaard, J S; Siegel, M H

    2016-01-01

    BACKGROUND: Chlorzoxazone is a muscle relaxant administered for musculoskeletal pain, and as an analgesic adjunct for post-operative pain. Chlorzoxazone for low back pain is currently not advised due to the lack of placebo-controlled trials. We explored the effect of chlorzoxazone on acute pain...... after spine surgery. METHODS: One hundred and ten patients were randomly assigned to 500 mg oral chlorzoxazone or placebo in this blinded study of patients having spine surgery under general anaesthesia. In the 4 h trial period analgesia consisted of IV patient-controlled analgesia (morphine bolus 2.......5 mg). Primary outcome was pain during mobilization (visual analogue scale) 2 h after the intervention. Secondary outcomes were pain at rest, opioid consumption, nausea, vomiting, sedation and dizziness. RESULTS: For pain during mobilization 2 h after intervention, there was no significant difference...

  20. Do subjects with acute/subacute temporomandibular disorder have associated cervical impairments: A cross-sectional study.

    Science.gov (United States)

    von Piekartz, Harry; Pudelko, Ani; Danzeisen, Mira; Hall, Toby; Ballenberger, Nikolaus

    2016-12-01

    There is preliminary evidence of cervical musculoskeletal impairment in some temporomandibular disorder (TMD) pain states. To determine whether people with TMD, classified as either mild or moderate/severe TMD, have more cervical signs of dysfunction than healthy subjects. Cross-sectional survey. Based on the Conti Amnestic Questionnaire and examination of the temporomandibular joint (Axis I classification of the Research Diagnostic Criteria for TMD), of 144 people examined 59 were classified to a mild TMD group, 40 to a moderate/severe TMD group and 45 to an asymptomatic control group without TMD. Subjects were evaluated for signs of cervical musculoskeletal impairment and disability including the Neck Disability Index, active cervical range of motion, the Flexion-Rotation Test, mechanical pain threshold of the upper trapezius and obliquus capitis inferior muscles, Cranio-Cervical Flexion test and passive accessory movements of the upper 3 cervical vertebrae. According to cervical musculoskeletal dysfunction, the control group without TMD were consistently the least impaired and the group with moderate/severe TMD were the most impaired. These results suggest, that the more dysfunction and pain is identified in the temporomandibular region, the greater levels of dysfunction is observable on a number of cervical musculoskeletal function tests. The pattern of cervical musculoskeletal dysfunction is distinct to other cervical referred pain phenomenon such as cervicogenic headache. These findings provide evidence that TMD in an acute/subacute pain state is strongly related with certain cervical spine musculoskeletal impairments which suggests the cervical spine should be examined in patients with TMD as a potential contributing factor. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Management of Esophageal and Pharyngeal Perforation as Complications of Anterior Cervical Spine Surgery.

    Science.gov (United States)

    Kang, Moo Sung; Kim, Kyung Hyun; Park, Jeong Yoon; Kuh, Sung Uk; Chin, Dong Kyu; Jin, Byung Ho; Kim, Keun Su; Cho, Yong Eun

    2017-06-01

    To describe our experience in treating esophageal and pharyngeal perforation after anterior cervical spine surgery. Six patients with esophageal injury and one patient with pharyngeal injury after anterior cervical spinal surgery, managed at our department between 2000 and 2015, were analyzed retrospectively. During the study period, 7 patients (6 male and 1 female; mean age, 45 years) presented with esophageal perforation. The original anterior cervical spinal surgery was performed due to trauma in 2 patients and because of a degenerative cervical disorder in 5. Early esophageal perforation was diagnosed in 2 patients, and delayed esophageal injury due to chronic irritation with the cervical implants was noted in 5. Three of the five delayed perforation cases were related to cervical instrument displacement. Two patients showed no definite signs of infection, whereas 5 patients had various symptoms, including fever, neck pain, odynophagia, neck swelling, and upper extremity weakness. Two patients with a large defect underwent surgical repair and three with minimal perforation due to chronic irritation from the implants underwent instrument removal without direct repair of defect. Two asymptomatic patients received no intervention. Six patients with infection completely recovered from esophageal injury after treatment for a mean duration of 5.2 weeks (range, 4-8 weeks). One patient died because of postoperative pneumonia and sepsis after implant removal. Esophageal and pharyngeal injury after cervical spinal surgery may occur either directly due to spinal trauma and vigorous intraoperative retraction or due to chronic irritation with cervical implants. In cases of perforation associated with infection, various surgical modalities, including primary closure and reinforcement with a flap, could be considered depending on factors such as esophageal defect size, infection severity, and timing of recognition of injury. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Maintaining neutral sagittal cervical alignment after football helmet removal during emergency spine injury management.

    Science.gov (United States)

    Decoster, Laura C; Burns, Matthew F; Swartz, Erik E; Murthi, Dinakar S; Hernandez, Adam E; Vailas, James C; Isham, Linda L

    2012-04-15

    Descriptive laboratory study. To determine whether the placement of padding beneath the occiput after helmet removal is an effective intervention to maintain neutral sagittal cervical spine alignment in a position comparable with the helmeted condition. Current on-field recommendations for managing football athletes with suspected cervical spine injuries call for face mask removal, rather than helmet removal, because the combination of helmet and shoulder pads has been shown to maintain neutral cervical alignment. Therefore, in cases when helmet removal is required, recommendations also call for shoulder pad removal. Because removal of equipment causes motion, any technique that postpones the need to remove the shoulder pads would reduce prehospital motion. Four lateral radiographs of 20 male participants were obtained (age = 23.6 ± 2.7 years). Radiographs of participants wearing shoulder pads and helmet were first obtained. The helmet was removed and radiographs of participants with occipital padding were obtained immediately and 20 minutes later and finally without occipital padding. Cobb angle measurements for C2-C6 vertebral segments were determined by an orthopedic spine surgeon blinded to the study's purpose. Intraobserver reliability was determined using intraclass coefficient analysis. Measurements were analyzed using a 1×4 repeated-measures analysis of variance and post hoc pairwise comparisons with Bonferroni correction. Intraobserver analysis showed excellent reliability (intraclass correlation = 1.0; 95% confidence interval [CI], 0.999-1.0). Repeated-measures analysis of variance detected significant differences (F(3,17) = 13.34; P football helmet in the field, occipital padding (along with full body/head immobilization techniques) may be used to limit cervical lordosis, allowing safe delay of shoulder pad removal.

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

    Science.gov (United States)

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

    1999-02-01

    To investigate the incidence and risk factors of disabling injuries to the cervical spine in rugby in Argentina. A retrospective review of all cases reported to the Medical Committee of the Argentine Rugby Union (UAR) and Rugby Amistad Foundation was carried out including a follow up by phone. Cumulative binomial distribution, chi 2 test, Fisher test, and comparison of proportions were used to analyse relative incidence and risk of injury by position and by phase of play (Epi Info 6, Version 6.04a). Eighteen cases of disabling injury to the cervical spine were recorded from 1977 to 1997 (0.9 cases per year). The forwards (14 cases) were more prone to disabling injury of the cervical spine than the backs (four cases) (p = 0.03). Hookers (9/18) were at highest risk of injury (p < 0.01). The most frequent cervical injuries occurred at the 4th, 5th, and 6th vertebrae. Seventeen of the injuries occurred during match play. Set scrums were responsible for most of the injuries (11/18) but this was not statistically significant (p = 0.44). The mean age of the injured players was 22. Tetraplegia was initially found in all cases. Physical rehabilitation has been limited to the proximal muscles of the upper limbs, except for two cases of complete recovery. One death, on the seventh day after injury, was reported. The forwards suffered a higher number of injuries than the backs and this difference was statistically significant. The chance of injury for hookers was statistically higher than for the rest of the players and it was particularly linked to scrummaging. However, the number of injuries incurred in scrums was not statistically different from the number incurred in other phases of play.

  4. Emergency removal of football equipment: a cadaveric cervical spine injury model.

    Science.gov (United States)

    Gastel, J A; Palumbo, M A; Hulstyn, M J; Fadale, P D; Lucas, P

    1998-10-01

    To determine the influence of football helmet and shoulder pads, alone or in combination, on alignment of the unstable cervical spine. The alignment of the intact cervical spine in 8 cadavers was assessed radiographically under 4 different football equipment conditions: (1) no equipment, (2) helmet only, (3) helmet and shoulder pads, and (4) shoulder pads only. Each specimen was then surgically destabilized at C5-C6 to simulate a flexion-distraction injury. Repeat radiographs were obtained under the same 4 equipment conditions, and alignment of the unstable segment was analyzed. Before the destabilization, neutral alignment was maintained when both helmet and shoulder pads were in place. The "helmet only" condition caused a significant decrease in lordosis (mean, 9.6 +/- 4.7 degrees), whereas the "shoulder pads only" condition caused increased lordosis (13.6 +/- 6.3 degrees). After destabilization, the "helmet-only" condition demonstrated significant mean increases in C5-C6 forward angulation (16.5 +/- 8.6 degrees), posterior disc space height (3.8 +/- 2.3 mm), and dorsal element distraction (8.3 +/- 5.4 mm). Our flexion-distraction model demonstrated that immobilization of the neck-injured football player with only the helmet in place violates the principle of splinting the cervical spine in neutral alignment. By extrapolation to an extension-type injury, immobilization with only the shoulder pads left in place similarly violates this principle. In order to maintain a neutral position and minimize secondary injury to the cervical neural elements, the helmet and shoulder pads should be either both left on or both removed in the emergency setting.

  5. CT-guided percutaneous vertebroplasty for the treatment of metastases in the cervical spine

    International Nuclear Information System (INIS)

    Wang Jianhua; Wang Zhentang; Zuo Changjing; Shao Chenwei; Chen Wei; Lv Taozhen; Dong Aisheng

    2009-01-01

    Objective: To assess the clinical efficacy and complications of CT-guided percutaneous vertebroplasty in the treatment of metastases of the cervical spine, and to discuss the proper needle path for different cervical vertebra. Methods: CT-guided percutaneous vertebroplasty was performed in 17 patients with cervical vertebral metastatic neoplasm, and the results of the treatment were retrospectively analyzed. Close observation was carded out after the procedure and a follow-up of 3-17 months was conducted. A comparison of the visual analogue pain scale (VAS) and Frankel's classification between pre-and post- operation was made. The occurrence of complications was recorded. The optimal needle path was summarized. Results: (1) The successful puncture was achieved in all 17 cases. The needle pathway included: the front of carotid sheath (n=4), between carotid sheath and vertebral artery (n=11) and behind the vertebral artery and carotid sheath (n=2). (2) Before the procedure the VAS was 7.24 ± 1.01, and at the time of one hour, one week and three months after the procedure it was decreased to 3.24 ± 1.09, 2.40 ± 0.80 and 1.82 ± 0.53 respectively. Wilcoxon signed-rank test showed that the difference in VAS between pre-and post- operation was statistically significant (T=76.5, P 2 =4.52, P=0.033 and P<0.05 when Kruskal-Wallis test was adopted. (3) CT scanning immediately after the procedure showed that slight leakage of cement to the adjacent disc, epidural fat, parosteal tissue or to the needle path occurred in 35.3% with no serious complications. In a follow-up period of 3-17 months, the metastatic lesions remained stable in 14 cases (82.4%). Conclusion: (1) The optimal needle path for upper cervical vertebrae is posterolateral transpedicular approach while for the lower cervical vertebrae it is more reasonable to puncture via the front carotid sheath or between carotid sheath and vertebral artery. Nevertheless, the puncture pathway should be devised individually

  6. EXPERIENCE OF SURGICAL TREATMENT OF INJURIES OF MIDDLE AND LOWER CERVICAL SPINE WHILE DIVING

    Directory of Open Access Journals (Sweden)

    I. P. Ardashev

    2012-01-01

    Full Text Available Objective - to analyze the long-term results of surgical treatment of patients with injuries of middle- and lower cervical spine in diving. Materials and methods. An analysis of surgical treatment of 27 patients and assessment of the long-term results of 20 patients in a period of 6 months to 6 years were performed with analysis of clinical, neurological, radiographic data and mortality. Results. Mostly the C5 vertebra was damaged - in 17 patients (63%. Compression fractures of vertebral bodies met in 6 (22%, compression-comminuted fractures - in 16 (59% patients, dislocations - in 5 (19%. All patients had neurological disorders. All observations noted rigid stabilization of the spine with an implant made of porous nickel-titanium, the presence of bone-metal block at the level of the damaged vertebral body Mortality in the postoperative period was 26%. In the long-term period the initial neurological symptoms were observed in 7 (30% patients, 13 (48% patients had marked regression of neurological symptoms. Full functional maladjustment was observed in 6 patients with no motor function below the damaged segment, originally belonging to groups A and B on the classification of H.L. Frankel. Moderate and mild degree of functional adaptation disorders were present in 5 and 4 patients respectively. In the remaining patients we did not reveal a functional maladjustment. Range of motion in the cervical spine in all patients was considered as good. Conclusions. Anterior decompressive-stabilizing surgeries on the spine with an implant made of porous nickel-titanium and metal plate CSLP allows reliably stabilization of the injured spine and the rehabilitation of this severe category of patients.

  7. A scoping review on health economics in neurosurgery for acute spine trauma.

    Science.gov (United States)

    Chan, Brian C F; Craven, B Catharine; Furlan, Julio C

    2018-05-01

    OBJECTIVE Acute spine trauma (AST) has a relatively low incidence, but it often results in substantial individual impairments and societal economic burden resulting from the associated disability. Given the key role of neurosurgeons in the decision-making regarding operative management of individuals with AST, the authors performed a systematic search with scoping synthesis of relevant literature to review current knowledge regarding the economic burden of AST. METHODS This systematic review with scoping synthesis included original articles reporting cost-effectiveness, cost-utility, cost-benefit, cost-minimization, cost-comparison, and economic analyses related to surgical management of AST, whereby AST is defined as trauma to the spine that may result in spinal cord injury with motor, sensory, and/or autonomic impairment. The initial literature search was carried out using MEDLINE, EMBASE, CINAHL, CCTR, and PubMed. All original articles captured in the literature search and published from 1946 to September 27, 2017, were included. Search terms used were the following: (cost analysis, cost effectiveness, cost benefit, economic evaluation or economic impact) AND (spine or spinal cord) AND (surgery or surgical). RESULTS The literature search captured 5770 titles, of which 11 original studies met the inclusion/exclusion criteria. These 11 studies included 4 cost-utility analyses, 5 cost analyses that compared the cost of intervention with a comparator, and 2 studies examining direct costs without a comparator. There are a few potentially cost-saving strategies in the neurosurgical management of individuals with AST, including 1) early surgical spinal cord decompression for acute traumatic cervical spinal cord injury (or traumatic thoracolumbar fractures, traumatic cervical fractures); 2) surgical treatment of the elderly with type-II odontoid fractures, which is more costly but more effective than the nonoperative approach among individuals with age at AST between 65

  8. A Unique Case of Primary Ewing’s Sarcoma of the Cervical Spine in a 53-Year-Old Male: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Marshall T. Holland

    2015-01-01

    Full Text Available Extraskeletal Ewing’s sarcoma (EES is a rare presentation, representing only 15% of all primary Ewing’s sarcoma cases. Even more uncommon is EES presenting as a primary focus in the spinal canal. These rapidly growing tumors often present with focal neurological symptoms of myelopathy or radiculopathy. There are no classic characteristic imaging findings and thus the physician must keep a high index of clinical suspicion. Diagnosis can only be definitively made by histopathological studies. In this report, we discuss a primary cervical spine EES in a 53-year-old man who presented with a two-month history of left upper extremity pain and acute onset of weakness. Imaging revealed a cervical spinal canal mass. After undergoing cervical decompression, histopathological examination confirmed a diagnosis of Ewing’s sarcoma. A literature search revealed fewer than 25 reported cases of primary cervical spine EES published in the past 15 years and only one report demonstrating this pathology in a patient older than 30 years of age age=38. Given the low incidence of this pathology presenting in this age group and the lack of treatment guidelines, each patient’s plan should be considered on a case-by-case basis until further studies are performed to determine optimal evidence based treatment.

  9. Safe cervical spine clearance in adult obtunded blunt trauma patients on the basis of a normal multidetector CT scan--a meta-analysis and cohort study.

    Science.gov (United States)

    Raza, Mushahid; Elkhodair, Samer; Zaheer, Asif; Yousaf, Sohail

    2013-11-01

    A true gold standard to rule out a significant cervical spine injury in subset of blunt trauma patients with altered sensorium is still to be agreed upon. The objective of this study is to determine whether in obtunded adult patients with blunt trauma, a clinically significant injury to the cervical spine be ruled out on the basis of a normal multidetector cervical spine computed tomography. Comprehensive database search was conducted to include all the prospective and retrospective studies on blunt trauma patients with altered sensorium undergoing cervical spine multidetector CT scan as core imaging modality to "clear" the cervical spine. The studies used two main gold standards, magnetic resonance imaging of the cervical spine and/or prolonged clinical follow-up. The data was extracted to report true positive, true negatives, false positives and false negatives. Meta-analysis of sensitivity, specificity, negative and positive predictive values was performed using Meta Analyst Beta 3.13 software. We also performed a retrospective investigation comparing a robust clinical follow-up and/or cervical spine MR findings in 53 obtunded blunt trauma patients, who previously had undergone a normal multidetector CT scan of the cervical spine reported by a radiologist. A total of 10 studies involving 1850 obtunded blunt trauma patients with initial cervical spine CT scan reported as normal were included in the final meta-analysis. The cumulative negative predictive value and specificity of cervical spine CT of the ten studies was 99.7% (99.4-99.9%, 95% confidence interval). The positive predictive value and sensitivity was 93.7% (84.0-97.7%, 95% confidence interval). In the retrospective review of our obtunded blunt trauma patients, none was later diagnosed to have significant cervical spine injury that required a change in clinical management. In a blunt trauma patient with altered sensorium, a normal cervical spine CT scan is conclusive to safely rule out a clinically

  10. [The "window" surgical exposure strategy of the upper anterior cervical retropharyngeal approach for anterior decompression at upper cervical spine].

    Science.gov (United States)

    Wu, Xiang-Yang; Zhang, Zhe; Wu, Jian; Lü, Jun; Gu, Xiao-Hui

    2009-11-01

    To investigate the "window" surgical exposure strategy of the upper anterior cervical retropharyngeal approach for the exposure and decompression and instrumentation of the upper cervical spine. From Jan. 2000 to July 2008, 5 patients with upper cervical spinal injuries were treated by surgical operation included 4 males and 1 female with and average age of 35 years old ranging from 16 to 68 years. There were 2 cases of Hangman's fractures (type II ), 2 of C2.3 intervertebral disc displacement and 1 of C2 vertebral body tuberculosis. All patients underwent the upper cervical anterior retropharyngeal approach through the "window" between the hypoglossal nerve and the superior laryngeal nerve and pharynx and carotid artery. Two patients of Hangman's fractures underwent the C2,3 intervertebral disc discectomy, bone graft fusion and internal fixation. Two patients of C2,3 intervertebral disc displacement underwent the C2,3 intervertebral disc discectomy, decompression bone graft fusion and internal fixation. One patient of C2 vertebral body tuberculosis was dissected and resected and the focus and the cavity was filled by bone autografting. C1 anterior arch to C3 anterior vertebral body were successful exposed. Lesion resection or decompression and fusion were successful in all patients. All patients were followed-up for from 5 to 26 months (means 13.5 months). There was no important vascular and nerve injury and no wound infection. Neutral symptoms was improved and all patient got successful fusion. The "window" surgical exposure surgical technique of the upper cervical anterior retropharyngeal approach is a favorable strategy. This approach strategy can be performed with full exposure for C1-C3 anterior anatomical structure, and can get minimally invasive surgery results and few and far between wound complication, that is safe if corresponding experience is achieved.

  11. A technical case report on use of tubular retractors for anterior cervical spine surgery.

    Science.gov (United States)

    Kulkarni, Arvind G; Patel, Ankit; Ankith, N V

    2017-12-19

    The authors put-forth this technical report to establish the feasibility of performing an anterior cervical corpectomy and fusion (ACCF) and a two-level anterior cervical discectomy and fusion (ACDF) using a minimally invasive approach with tubular retractors. First case: cervical spondylotic myelopathy secondary to a large postero-inferiorly migrated disc treated with corpectomy and reconstruction with a mesh cage and locking plate. Second case: cervical disc herniation with radiculopathy treated with a two-level ACDF. Both cases were operated with minimally invasive approach with tubular retractor using a single incision. Technical aspects and clinical outcomes have been reported. No intra or post-operative complications were encountered. Intra-operative blood loss was negligible. The patients had a cosmetic scar on healing. Standard procedure of placement of tubular retractors is sufficient for adequate surgical exposure with minimal invasiveness. Minimally invasive approach to anterior cervical spine with tubular retractors is feasible. This is the first report on use of minimally invasive approach for ACCF and two-level ACDF.

  12. Computed tomography of the cervical spine with iv injection of contrast medium

    International Nuclear Information System (INIS)

    Magnaldi, S.; Pozzi-Mucelli, R.S.; Cova, M.A.; De Morpurgo, P.

    1989-01-01

    Computed Tomography (CT) without contrast medium is largely applied to the study of intervertebral disk pathology in the lumbar spine, but has not been widely accepted in cervical spine, due to technical and anatomical limitations. For these reasons many neuroradiologists still prefer myelography or myelo-CT. CT may yield better results if combined with iv contrast medium injection, which allows a better visualization of disk herniation. This technique is aimed at enhancing the density of the venous plexus which is located close to the intervertebral disk the vertebral bodies and the neural foramina. A better contrast enhancement is thus obtained between the disk and the spinal cord. The authors' experience is based on 61 patients who underwent contrast enhanced CT; in 22 cases myelography and myelo-CT were also performed. The authors describe their technique and the most frequent CT findings of disk hernation: the typical finding includes a focal hypodensity surrounded by a linear blush, due to a posteriorly dislocated epidural vein. The posterior linear blush alone may be present in few cases. Contrast enhanced CT is very useful in the study of disk pathology of the cervical spine, even when compared with myelography and myelo-CT, due the increase in the density of epidural plexus it allows. However, the technique must be very accurate if the same results as those of myelo-CT are to be obtained

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

    Science.gov (United States)

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

    2013-01-01

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

  14. Are patient-reported outcomes predictive of patient satisfaction 5 years after anterior cervical spine surgery?

    Science.gov (United States)

    Schroeder, Gregory D; Coric, Dom; Kim, Han Jo; Albert, Todd J; Radcliff, Kris E

    2017-07-01

    Patient satisfaction is becoming an increasing common proxy for surgical quality; however, the correlation between patient satisfaction and surgical outcomes 2 and 5 years after anterior cervical surgery has not been evaluated. The study aimed to determine if patient satisfaction is predicted by improvement in patient-reported outcomes (PRO) 2 and 5 years after anterior cervical spine surgery. This is a retrospective analysis of prospectively collected data. The sample included patients enrolled in the Food and Drug Administration investigational device exemption clinical trial comparing total disc replacement with Mobi-C cervical artificial disc and anterior cervical discectomy and fusion. The outcome measures were visual analog scale (VAS) neck pain score, Neck Disability Index (NDI), and Short-Form 12-Item scores, as well as patient satisfaction. Receiver operating characteristic curves were used to determine if improvement in different PRO metrics can accurately identify patient satisfaction. Additionally, a logistic regression analysis was performed on the results at 24 months and 60 months to identify independent predictors of patient satisfaction. This research was supported by LDR (Zimmer Biomet) 13785 Research Boulevard - Suite 200 Austin, TX 78750. Data were available for 512 patients at 60 months. At 24 months postoperatively, NDI score improvement (area under the curve [AUC]=0.806), absolute NDI score (AUC=0.823), and absolute VAS neck pain score (AUC=0.808) were all excellent predictors of patient satisfaction. At 60 months postoperatively, NDI score improvement (AUC=0.815), absolute NDI score (AUC=0.839), VAS neck pain score improvement (AUC=0.803), and absolute VAS neck pain score (AUC=0.861) were all excellent predictors of patient satisfaction. In patients undergoing one- and two-level anterior cervical spine surgery, between 2 and 5 years postoperatively, patient satisfaction is significantly predicted by PROs, including the VAS neck score and the

  15. MRI of the cervical spine with 3D gradient echo sequence at 3 T: initial experience

    International Nuclear Information System (INIS)

    Xiao, L.; Siu, C.W.J.; Yeung, K.; Leung, A.; Yuen, M.K.; Wong, Y.C.

    2015-01-01

    Aim: The aim of this study was to compare three-dimensional (3D) high resolution T2*-weighted gradient echo (3D FFE) magnetic resonance (MR) sequence with conventional 2D T2-weighted turbo spin echo (TSE) MR sequence for imaging of the cervical spine, especially to assess the detectability of the internal anatomy of the cervical spinal cord, i.e. to distinguish the grey and white matter. Methods: Fifteen volunteers were examined at 3.0T MR unit. Signal-to-noise (SNR), contrast-to-noise (CNR) and image homogeneity were evaluated. In the visual analysis, the visibility of anatomical structures of the cervical spine and artifacts were assessed. The nonparametric method of paired sample t-test was adopted to evaluate the differences between the sequences. Results: The 3D FFE sequence provided better results for CNR, cerebrospinal fluid (CSF) versus white matter, grey matter, disk and bone. Moreover, it yielded good results for the CNR grey matter versus white matter. The butterfly-shaped “H” is clearly displayed in the 3D FFE sequence. The statistical analysis revealed the statistically significant difference between the 2D TSE and 3D FFE sequences for the contrast of CSF versus spinal cord (both grey matter and white matter). Conclusion: The 3D FFE sequence in MR imaging of the cervical spinal cord is superior in delineation of spinal cord anatomical structures compared to 2D TSE sequence. -- Highlights: •We investigate the potential of 3D FFE sequence to distinguish the grey-white of the cervical spinal cord at 3T MRI system. •We optimized The 3D FFE sequence was optimized to increase the grey-white contrast. •Utilizing medium TE for T2W and the shortest TR for reduction of susceptibility related artifacts and motion artefacts. •This technique may increase the confidence in the diagnosis of disease with the improved delineation of cord anatomy

  16. Evaluation in the use of bismuth shielding on cervical spine CT scan using a male phantom

    International Nuclear Information System (INIS)

    Aleme, C.; Mourao, A. P.; Lyra, M. A.

    2014-08-01

    The cervical spine is the region of the column that articulates the head and chest. The tests of computed tomography (CT) performed in this region have as main objectives to diagnose fractures, dislocations and tumors. In CT scans the cervical spine volume is limited by the foramen Magnum and the first thoracic vertebra. In this region is the thyroid that is directly irradiated by X-ray beam during cervical scan. Based on this information, it was studied the dose variation deposited in thyroid and in nearby organs, such as: lenses, spinal cord in the foramen Magnum region and breasts, with and without the use of bismuth protector. In this study was used a male anthropomorphic phantom and thermoluminescent s dosimeters (TLD-100) were required to register the individual doses in the organs of interest. CT scans were performed on a GE Bright Speed scanner of 32 channels. With the data obtained, it was found the organ dose variation. The largest recorded dose was in the thyroid. Comparing two scans it was possible to note that the use of the bismuth protector promoted a 26% reduction in the thyroid dose and an increase in the lens dose. (Author)

  17. Evaluation in the use of bismuth shielding on cervical spine CT scan using a male phantom

    Energy Technology Data Exchange (ETDEWEB)

    Aleme, C.; Mourao, A. P. [Centro Federal de Educacion Tecnologica de Minas Gerais, Biomedical Engineering Center, Belo Horizonte - MG (Brazil); Lyra, M. A., E-mail: carolinaaleme@gmail.com [Universidad Federal de Minas Gerais, Department of Nuclear Engineering, Av. Pdte. Antonio Carlos 6627, Pampulha, 31270-91 Belo Horizonte - MG (Brazil)

    2014-08-15

    The cervical spine is the region of the column that articulates the head and chest. The tests of computed tomography (CT) performed in this region have as main objectives to diagnose fractures, dislocations and tumors. In CT scans the cervical spine volume is limited by the foramen Magnum and the first thoracic vertebra. In this region is the thyroid that is directly irradiated by X-ray beam during cervical scan. Based on this information, it was studied the dose variation deposited in thyroid and in nearby organs, such as: lenses, spinal cord in the foramen Magnum region and breasts, with and without the use of bismuth protector. In this study was used a male anthropomorphic phantom and thermoluminescent s dosimeters (TLD-100) were required to register the individual doses in the organs of interest. CT scans were performed on a GE Bright Speed scanner of 32 channels. With the data obtained, it was found the organ dose variation. The largest recorded dose was in the thyroid. Comparing two scans it was possible to note that the use of the bismuth protector promoted a 26% reduction in the thyroid dose and an increase in the lens dose. (Author)

  18. Management of neglected cervical spine dislocation: a study of six cases

    Directory of Open Access Journals (Sweden)

    Goni Vijay

    2013-08-01

    Full Text Available 【Abstract】Objective: To report a case series of six neglected cervical spine dislocations without neurological deficit, which were managed operatively. Methods: The study was conducted from August 2010 to December 2011 and cases were selected from the out-patient department of Postgraduate Institute of Medical Education and Research, India. The patients were in the age group of 30 to 50 years. All patients were operated via both anterior and posterior approaches. Results: During the immediate postoperative period, five (83.33% patients had normal neurological status. One (16.67% patient who had C 5 -C 6 subluxation developed neu-rological deficit with sensory loss below C 6 level and motor power of 2/5 in the lower limb and 3/5 in the upper limb below C 6 level. Conclusion: There is no role of skull traction in ne-glected distractive flexion injuries to cervical spine delayed for more than 3 weeks. Posterior followed by anterior ap-proach saves much time. If both approaches are to be done in the same sitting, there is no need for instrumentation posteriorly. But if staged procedure is planed, posterior sta-bilization is recommended, as there is a risk of deterioration in neurological status. Key words: Cervical vertebrae; Neck; Postoperative complications

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

    Science.gov (United States)

    Waddell, Roger K.

    2005-01-01

    Abstract Objective To discuss the diagnosis and response to treatment of spasmodic dysphonia in a 25-year-old female vocalist following an auto accident. Clinical Features The voice disorder and neck pain appeared after the traumatic incident. Examination of the cervical spine revealed moderate pain, muscle spasm and restricted joint motion at C-1 and C-5 on the left side. Cervical range of motion was reduced on left rotation. Bilateral manual muscle testing of the trapezius and sternocleidomastoid muscles, which share innervation with the laryngeal muscles by way of the spinal accessory nerve, were weak on the left side. Pre and post accident voice range profiles (phonetograms) that measure singing voice quality were examined. The pre- and post-accident phonetograms revealed significant reduction in voice intensity and fundamental frequency as measured in decibels and hertz. Intervention and Outcome Low-force chiropractic spinal manipulative therapy to C-1 and C-5 was employed. Following a course of care, the patient's singing voice returned to normal, as well as a resolution of her musculo- skeletal complaints. Conclusion It appears that in certain cases, the singing voice can be adversely affected if neck or head trauma is severe enough. This case proposes that trauma with irritation to the cervical spine nerve roots as they communicate with the spinal accessory, and in turn the laryngeal nerves, may be contributory in some functional voice disorders or muscle tension dysphonia. PMID:19674642

  20. Injuries of the upper cervical spine: A series of 28 cases

    Directory of Open Access Journals (Sweden)

    Basu Saumyajit

    2007-01-01

    Full Text Available Background: There are very few published reports of upper cervical spine injuries from our country and there is a heavy bias towards operative treatment of these injuries. We present below our experience of upper cervical injuries over the last four years. Materials and Methods: Twenty eight patients (20 males, 8 females with upper cervical spine injury (including Occiput, Atlas and Axis were treated and were followed-up for an average of 11.2 months. The data was analyzed retrospectively with regards to the location and type of injury, the treatment offered (conservative or operative as well as the final clinical and radiological outcome. Results: The clinico-radiological outcome of treatment of these injuries is mostly very good with few complications. Other than a single case of mortality due to associated head injury there were no major complications. Conclusion: Management of these patients needs a proper evaluation to arrive at the type of injury and prompt conservative or operative treatment. Treatment is usually safe and effective with good clinical and radiological outcome.

  1. The effect of ex vivo flexion and extension on intervertebral foramina dimensions in the equine cervical spine.

    Science.gov (United States)

    Sleutjens, J; Voorhout, G; Van Der Kolk, J H; Wijnberg, I D; Back, W

    2010-11-01

    In dressage, the head and neck position has become an issue of concern as certain extreme positions may imply a welfare risk for the horse. In man, extension and flexion of the cervical spine cause a decrease and increase in intervertebral foramina dimensions, respectively. However, in horses, the influence of flexion and extension on foramina dimensions and its possible interference with peripheral nerve functioning remains unknown. To determine the effect of ex vivo flexion and extension on intervertebral foramina dimensions in the equine cervical spine. Computed tomography was performed on 6 cadaver cervical spines from adult Warmblood horses subjected to euthanasia for reasons unrelated to cervical spine abnormalities, in a neutral position, in 20 and 40° extension, and in 20 and 40° flexion. Multiplanar reconstructions were made to obtain transverse images perpendicular to the long axis of each pair of intervertebral foramina from C2-T1. Intervertebral foramina dimensions were measured in the 5 positions. Compared to the neutral position, 40° extension caused a decrease in foramina dimensions at segments C4-C5, C5-C6, C6-C7 (P dimensions at segments C5-C6 (P dimensions at segments C4-T1, similar to that found in man. In vivo extension of the cervical spine could possibly interfere with peripheral nerve functioning at segments C4-T1. This effect may be even more profound in patients with a reduced intervertebral foramina space, for example in the presence of facet joint arthrosis. © 2010 EVJ Ltd.

  2. Role of age and injury mechanism on cervical spine injury tolerance from head contact loading.

    Science.gov (United States)

    Yoganandan, Narayan; Chirvi, Sajal; Voo, Liming; Pintar, Frank A; Banerjee, Anjishnu

    2018-02-17

    The objective of this study was to determine the influence of age and injury mechanism on cervical spine tolerance to injury from head contact loading using survival analysis. This study analyzed data from previously conducted experiments using post mortem human subjects (PMHS). Group A tests used the upright intact head-cervical column experimental model. The inferior end of the specimen was fixed, the head was balanced by a mechanical system, and natural lordosis was removed. Specimens were placed on a testing device via a load cell. The piston applied loading at the vertex region. Spinal injuries were identified using medical images. Group B tests used the inverted head-cervical column experimental model. In one study, head-T1 specimens were fixed distally, and C7-T1 joints were oriented anteriorly, preserving lordosis. Torso mass of 16 kg was added to the specimen. In another inverted head-cervical column study, occiput-T2 columns were obtained, an artificial head was attached, T1-T2 was fixed, C4-C5 disc was maintained horizontal in the lordosis posture, and C7-T1 was unconstrained. The specimens were attached to the drop test carriage carrying a torso mass of 15 kg. A load cell at the inferior end measured neck loads in both studies. Axial neck force and age were used as the primary response variable and covariate to derive injury probability curves using survival analysis. Group A tests showed that age is a significant (P < .05) and negative covariate; that is, increasing age resulted in decreasing force for the same risk. Injuries were mainly vertebral body fractures and concentrated at one level, mid-to-lower cervical spine, and were attributed to compression-related mechanisms. However, age was not a significant covariate for the combined data from group B tests. Both group B tests produced many soft tissue injuries, at all levels, from C1 to T1. The injury mechanism was attributed to mainly extension. Multiple and noncontiguous injuries occurred

  3. Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers

    International Nuclear Information System (INIS)

    Ernst, C.W.; Stadnik, T.W.; Peeters, E.; Breucq, C.; Osteaux, M.J.C.

    2005-01-01

    Study design: Prospective MR analysis of the cervical spine of 30 asymptomatic volunteers. Objectives: To evaluate the prevalence of annular tears, bulging discs, disc herniations and medullary compression on T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance (MR) images of the cervical spine in symptom free volunteers. Summary of background data: Few studies have reported the prevalence of cervical disc herniations in asymptomatic people, none have reported the prevalence of cervical annular tears on MR images of symptom free volunteers. Materials and methods: Thirty symptom-free volunteers (no history or symptoms related to the cervical spine) were examined using sagittal T2-weighted fast spin-echo (SE), sagittal gadolinium-enhanced T1-weighted SE imaging and axial T2 * -weighted gradient echo (GRE). The prevalence of bulging discs, focal protrusions, extrusions, nonenhancing or enhancing annular tears and medullary compression were assessed. Results: The prevalence of bulging disk and focal disk protrusions was 73% (22 volunteers) and 50% (15 volunteers), respectively. There was one extrusion (3%). Eleven volunteers had annular tears at one or more levels (37%) and 94% of the annular tears enhanced after contrast injection. Asymptomatic medullary compression was found in four patients (13%). Conclusion: Annular tears and focal disk protrusions are frequently found on MR imaging of the cervical spine, with or without contrast enhancement, in asymptomatic population. The extruded disk herniation and medullary compression are unusual findings in a symptom-free population

  4. Histological, magnetic resonance imaging, and discographic findings on cervical disc degeneration in cadaver spines. A comparative study

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    Maruyama, Yuichiro [Juntendo Univ., Tokyo (Japan). School of Medicine

    1995-11-01

    A total of 210 cervical intervertebral discs were taken at autopsy from 36 cadavers, and underwent both magnetic resonance imaging (MRI) and discography to compare their diagnostic efficacies for investigating degenerative changes in the cervical spine. The age of the subjects had ranged from 43 to 92 years with an average of 68.1 years. Following the autopsy, MRI and discography were performed on the excised cervical spinal column, and the specimen was then prepared for histological examination. The findings were compared with those of the lumbar spine that had previously been reported by Yasuma et al. on 1238 lumbar discs from 197 cadavers ranging in age from 11 to 92 years. The results were as follows: Low intensity in the T2-weighted MRI was well correlated with histological degeneration in the cervical disc. The rate of appearance of the posterior protrusion of the cervical disc on the MRI was in accordance with the degree of histological disc degeneration, but it did not always correspond with histological posterior protrusion. There was a remarkably high incidence for false-positive posterior protrusion on the MRI, which should be kept in mind on reading the MRI. In the comparison of the MRI with the discography, a certain positive correlation was found as for disc degeneration, but not in complete accordance. There was a considerable difference in the patterns of degeneration and in posterior protrusion of the discs between the cervical spine and the lumbar spine. The posterior protrusion in the cervical disc was more likely related to horizontal fissure and hyalinization of the posterior annulus, while posterior protrusion in the lumbar disc was often related to reversed orientation of the bundles and myxomatous degeneration of the posterior annulus. This difference was attributed to the difference in the mechanical properties of the cervical and lumbar spines. (author).

  5. Histological, magnetic resonance imaging, and discographic findings on cervical disc degeneration in cadaver spines. A comparative study

    International Nuclear Information System (INIS)

    Maruyama, Yuichiro

    1995-01-01

    A total of 210 cervical intervertebral discs were taken at autopsy from 36 cadavers, and underwent both magnetic resonance imaging (MRI) and discography to compare their diagnostic efficacies for investigating degenerative changes in the cervical spine. The age of the subjects had ranged from 43 to 92 years with an average of 68.1 years. Following the autopsy, MRI and discography were performed on the excised cervical spinal column, and the specimen was then prepared for histological examination. The findings were compared with those of the lumbar spine that had previously been reported by Yasuma et al. on 1238 lumbar discs from 197 cadavers ranging in age from 11 to 92 years. The results were as follows: Low intensity in the T2-weighted MRI was well correlated with histological degeneration in the cervical disc. The rate of appearance of the posterior protrusion of the cervical disc on the MRI was in accordance with the degree of histological disc degeneration, but it did not always correspond with histological posterior protrusion. There was a remarkably high incidence for false-positive posterior protrusion on the MRI, which should be kept in mind on reading the MRI. In the comparison of the MRI with the discography, a certain positive correlation was found as for disc degeneration, but not in complete accordance. There was a considerable difference in the patterns of degeneration and in posterior protrusion of the discs between the cervical spine and the lumbar spine. The posterior protrusion in the cervical disc was more likely related to horizontal fissure and hyalinization of the posterior annulus, while posterior protrusion in the lumbar disc was often related to reversed orientation of the bundles and myxomatous degeneration of the posterior annulus. This difference was attributed to the difference in the mechanical properties of the cervical and lumbar spines. (author)

  6. Evaluation of a dedicated MDCT protocol using iterative image reconstruction after cervical spine trauma.

    Science.gov (United States)

    Geyer, L L; Körner, M; Hempel, R; Deak, Z; Mueck, F G; Linsenmaier, U; Reiser, M F; Wirth, S

    2013-07-01

    To evaluate radiation exposure for 64-row computed tomography (CT) of the cervical spine comparing two optimized protocols using filtered back projection (FBP) and adaptive statistical iterative reconstruction (ASIR), respectively. Sixty-seven studies using FBP (scanner 1) were retrospectively compared with 80 studies using ASIR (scanner 2). The key scanning parameters were identical (120 kV dose modulation, 64 × 0.625 mm collimation, pitch 0.531:1). In protocol 2, the noise index (NI) was increased from 5 to 25, and ASIR and the high-definition (HD) mode were used. The scan length, CT dose index (CTDI), and dose-length product (DLP) were recorded. The image quality was analysed subjectively by using a three-point scale (0; 1; 2), and objectively by using a region of interest (ROI) analysis. Mann-Whitney U and Wilcoxon's test were used. In the FBP group, the mean CTDI was 21.43 mGy, mean scan length 186.3 mm, and mean DLP 441.15 mGy cm. In the ASIR group, the mean CTDI was 9.57 mGy, mean scan length 195.21 mm, and mean DLP 204.23 mGy cm. The differences were significant for CTDI and DLP (p 0.05). The estimated mean effective dose decreased from 2.38 mSv (FBP) to 1.10 mSv (ASIR). The radiation dose of 64-row MDCT can be reduced to a level comparable to plain radiography without loss of subjective image quality by implementation of ASIR in a dedicated cervical spine trauma protocol. These results might contribute to an improved relative risk-to-benefit ratio and support the justification of CT as a first-line imaging tool to evaluate cervical spine trauma. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  7. Cervical spine trauma radiographs: Swimmers and supine obliques; an exploration of current practice

    Energy Technology Data Exchange (ETDEWEB)

    Fell, Michael, E-mail: michael.fell@mkgeneral.nhs.u [Milton Keynes General Hospital, Radiology Standing Way, Eaglestone, Milton Keynes, Buckinghamshire MK6 5LD (United Kingdom)

    2011-02-15

    The study objectives were: to investigate current cervical spine radiographic imaging practices in conscious adult patients with suspected neck injury; reasons behind variation and consideration of dose estimates were explored. Comparison with a previous survey has been made. Questionnaires were sent to superintendent radiographers responsible for accident and emergency X-ray departments in English trusts with over 8500 emergency admissions per year, with a response rate of 97% (n = 181/186). Departmental cervical spine imaging protocols were reported by 82% of respondents. None use fewer than the three standard projections; if the cervicothoracic junction (C7/T1), is not adequately demonstrated 87% use swimmers projections, 9% supine obliques, 3% CT alone. Following projectional radiography, 97% perform CT. A significant (p = 0.018) increase was found since 1999 in CT use once the swimmers projection fails; fewer now use obliques at this point, continuing with CT instead. No significant difference (p = 0.644) was found in choice of first supplementary radiographs; despite British Trauma Society's recommendation to undertake supine obliques, swimmers remain the most widespread technique. An 85% response rate (n = 103/121) completed a second questionnaire, exploring reasons behind the various practices. Several reported a perceived difficulty in interpreting oblique radiographs, some a concern over high dose of the swimmers. Numerous issues affect the acquisition of cervical spine radiographs. Patient radiation dose should be a major consideration in selection of technique. A potential need for training in interpretation of obliques is highlighted. Specific guidelines for optimum projections should be researched, and protocols issued to ensure best practice.

  8. Evaluation of a dedicated MDCT protocol using iterative image reconstruction after cervical spine trauma

    International Nuclear Information System (INIS)

    Geyer, L.L.; Körner, M.; Hempel, R.; Deak, Z.; Mueck, F.G.; Linsenmaier, U.; Reiser, M.F.; Wirth, S.

    2013-01-01

    Aim: To evaluate radiation exposure for 64-row computed tomography (CT) of the cervical spine comparing two optimized protocols using filtered back projection (FBP) and adaptive statistical iterative reconstruction (ASIR), respectively. Materials and methods: Sixty-seven studies using FBP (scanner 1) were retrospectively compared with 80 studies using ASIR (scanner 2). The key scanning parameters were identical (120 kV dose modulation, 64 × 0.625 mm collimation, pitch 0.531:1). In protocol 2, the noise index (NI) was increased from 5 to 25, and ASIR and the high-definition (HD) mode were used. The scan length, CT dose index (CTDI), and dose–length product (DLP) were recorded. The image quality was analysed subjectively by using a three-point scale (0; 1; 2), and objectively by using a region of interest (ROI) analysis. Mann–Whitney U and Wilcoxon's test were used. Results: In the FBP group, the mean CTDI was 21.43 mGy, mean scan length 186.3 mm, and mean DLP 441.15 mGy cm. In the ASIR group, the mean CTDI was 9.57 mGy, mean scan length 195.21 mm, and mean DLP 204.23 mGy cm. The differences were significant for CTDI and DLP (p 0.05). The estimated mean effective dose decreased from 2.38 mSv (FBP) to 1.10 mSv (ASIR). Conclusion: The radiation dose of 64-row MDCT can be reduced to a level comparable to plain radiography without loss of subjective image quality by implementation of ASIR in a dedicated cervical spine trauma protocol. These results might contribute to an improved relative risk-to-benefit ratio and support the justification of CT as a first-line imaging tool to evaluate cervical spine trauma

  9. Analysis of absorbed dose in cervical spine scanning by computerized tomography using simulator objects

    International Nuclear Information System (INIS)

    Lyra, Maria Henriqueta Freire

    2015-01-01

    The Computed tomography (CT) has become an important diagnostic tool after the continued development of Multidetector CT (MDCT), which allows faster acquisition of images with better quality than the previous technology. However, there is an increased radiation exposure, especially in examinations that require more than one acquisition, as dynamic exams and enhancement studies in order to discriminate low contrast soft tissue injury from normal tissue. Cervical spine MDCT examinations are used for diagnosis of soft tissue and vascular changes, fractures, dysplasia and other diseases with instability, which guide the patient treatment and rehabilitation. This study aims at checking the absorbed dose range in the thyroid and other organs during MDCT scan of cervical spine, with and without bismuth thyroid shield. In this experiment a cervical spine MDCT scan was performed on anthropomorphic phantoms, from the occipital to the first thoracic vertebra, using a 64 and a 16 – channel CT scanners. Thermoluminescent dosimeters were used to obtain the absorbed dose in thyroid, lenses, magnum foramen and breasts of the phantom. The results show that the thyroid received the highest dose, 60.0 mGy, in the female phantom, according to the incidence of the primary X-ray beam. The absorbed doses in these tests showed significant differences in the evaluated organs, p value < 0.005, except for the magnum foramen and breasts. With the bismuth thyroid shield applied on the female phantom, the doses in the thyroid and in the lenses were reduced by 27% and 52%, respectively. On the other hand, a reduction of 23.3% in the thyroid and increasing of 49.0% in the lens were measured on the male phantom. (author)

  10. Total disc replacement using tissue-engineered intervertebral discs in the canine cervical spine.

    Directory of Open Access Journals (Sweden)

    Yu Moriguchi

    Full Text Available The most common reason that adults in the United States see their physician is lower back or neck pain secondary to degenerative disc disease. To date, approaches to treat degenerative disc disease are confined to purely mechanical devices designed to either eliminate or enable flexibility of the diseased motion segment. Tissue engineered intervertebral discs (TE-IVDs have been proposed as an alternative approach and have shown promise in replacing native IVD in the rodent tail spine. Here we demonstrate the efficacy of our TE-IVDs in the canine cervical spine. TE-IVD components were constructed using adult canine annulus fibrosis and nucleus pulposus cells seeded into collagen and alginate hydrogels, respectively. Seeded gels were formed into a single disc unit using molds designed from the geometry of the canine spine. Skeletally mature beagles underwent discectomy with whole IVD resection at levels between C3/4 and C6/7, and were then divided into two groups that received only discectomy or discectomy followed by implantation of TE-IVD. Stably implanted TE-IVDs demonstrated significant retention of disc height and physiological hydration compared to discectomy control. Both 4-week and 16-week histological assessments demonstrated chondrocytic cells surrounded by proteoglycan-rich matrices in the NP and by fibrocartilaginous matrices in the AF portions of implanted TE-IVDs. Integration into host tissue was confirmed over 16 weeks without any signs of immune reaction. Despite the significant biomechanical demands of the beagle cervical spine, our stably implanted TE-IVDs maintained their position, structure and hydration as well as disc height over 16 weeks in vivo.

  11. Radiotherapy in metastatic diseases of the cervical spine and the craniospinal region

    International Nuclear Information System (INIS)

    Mende, U.; Braun, A.; Reiden, K.; Voth, D.; Glees, P.

    1987-01-01

    The results of large autopsy studies indicate that 20 to 30% of all patients with carcinoma will develop sooner or later bone metastases. According to the incidence of the primary tumor itself as well as to its tendency to metastasize into the skeletal system more than 80% of all bone metastases are due to neoplasms of the breast, prostate, bronchus, kidney and thyroid. Most of the metastases are found in the red marrow with an unequivocal preference to the axial skeleton. This article discusses radiotherapy in metastatic diseases of the cervical spine and the craniospinal region

  12. Extradural spinal schwannoma at cervical spine in 12 year old child

    Directory of Open Access Journals (Sweden)

    Madoori Srinivas

    2016-10-01

    Full Text Available Spinal schwannomas are benign tumors arising from spinal nerve root sheaths. It is a primary spinal tumor which are rare in children. We report a case of a 12 year old girl who presented with weakness of all limbs and unable to walk. Imaging studies demonstrated an extradural spinal tumor at cervical spine. The patient was operated and tumor was totally removed. The postoperative course was uneventful. Histology confirmed the diagnosis of schwannoma. After surgery there was improvement in signs and symptoms. After two months of operation, child could able to walk normally.

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

    Science.gov (United States)

    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.

  14. Osseous osteoarthritic-like changes and joint mobility of the temporomandibular joints and upper cervical spine

    DEFF Research Database (Denmark)

    Sonnesen, Liselotte; Petersson, Arne; Wiese, Mie

    2017-01-01

    OBJECTIVES: To compare 1) temporomandibular joint (TMJ) mobility between patients with and without reduced upper cervical spine (UCS) mobility and with and without TMJ osseous osteoarthritic-like changes, and 2) UCS osseous changes between patients with and without TMJ osseous osteoarthritic......-like changes and with and without reduced UCS mobility. STUDY DESIGN: The study comprised 39 patients without pain from TMJ or UCS and with obstructive sleep apnea, 15 women (age range 26-72 years, mean 56.0) and 24 men (age range 27-71 years, mean 49.8). The range of motion (ROM) of the mandible and UCS...

  15. Percutaneous aspiration biopsy in cervical spine lytic lesions. Indications and technique

    Energy Technology Data Exchange (ETDEWEB)

    Tampieri, D; Weill, A; Melanson, D; Ethier, R [Montreal Neurological Inst. and Hospital, PQ (Canada). Dept. of Neuroradiology

    1991-02-01

    We describe the technique and the results of the percutaneous aspiration biopsy (PAB) in a series of 9 patients presenting with neck pain and different degrees of myelopathy, in whom the cervical spine X-ray demonstrated lytic lesions of unknown origin. PAB is a useful, relatively safe technique, and leads to histological diagnosis between metastatic and inflammatory processes. Furthermore, in inflammatory lesions with negative hemoculture, PAB may help in detecting the micro-organism responsible and therefore allow a better antibiotic treatment. (orig.).

  16. Cervical spine injury outcome – a review of 101 cases treated in a ...

    African Journals Online (AJOL)

    Cervical spinal cord injury (SCI) is a devastating event for the patient and family. It has a huge impact on society because of the intensive resources required to manage the patient in both the acute and rehabilitation phases. Given the resource-limited setting in South Africa, questions are often raised regarding whether the ...

  17. The role of the faceguard in the production of flexion injuries to the cervical spine in football.

    Science.gov (United States)

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

    1965-11-20

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

  18. [The role of the cervical spine and the craniomandibular system in the pathogenesis of tinnitus. Somatosensory tinnitus].

    Science.gov (United States)

    Biesinger, E; Reisshauer, A; Mazurek, B

    2008-07-01

    The causes of tinnitus, vertigo, and hearing disturbances may be pathological processes in the cervical spine and temporomaxillary joint. In these cases, tinnitus is called somatosensory tinnitus (SST). For afferences of the cervical spine, projections of neuronal connections in the cochlear nucleus were found. A reflex-like impact of the cervical spine on the cochlear nucleus can be assumed. The tinnitus treatment concept of the Charité University Hospital in Berlin involves the cooperation of ENT specialists with many other disciplines in an outpatient clinic. A standardized examination protocol has been established, and physical therapy has been integrated into the interdisciplinary tinnitus treatment. For tinnitus-modulating therapy of muscular trigger points, local anesthetics as well as self-massage or treatment by a physiotherapist or osteopath are useful.

  19. Neurophysiological evaluation of patients with degenerative diseases of the cervical spine

    Directory of Open Access Journals (Sweden)

    Ilić Tihomir V.

    2011-01-01

    Full Text Available Bacground/Aim. Diagnostic protocol for patients with degenerative diseases of the cervical spine demands, in parallel with neuroimaging methods, functional evaluation through neurophysiological methods (somatosensitive and motor evoked potentials and electromyoneurography aiming to evaluate possible subclinical affection of spinal medula resulting in neurological signs of long tract abnormalities. Considering diversities of clinical outcomes for these patients, complex diagnostic evaluation provides a prognosis of the disease progression. Methods. The study included 21 patients (48.24 ± 11.01 years of age with clinical presentation of cervical spondylarthropathy, without neuroradiological signs of myelopathy. For each patient, in addition to conventional neurophysiological tests (somatisensory evoked potentials - SSEP, motor evoked potentials - MEP, electromyoneurography - EMG, nerve conduction studies, we calculated central motor conduction time (CMCTF, as well the same parameter in relation to a different position of the head (maximal anteflexion and retroflexion, so-called dynamic tests. Results. Abnormalities of the peripheral motor neurone by conventional EMNeG was established in 2/3 of the patients, correponding to the findings of root condution time. Prolonged conventional CVMPF were found in 29% of the patients, comparing to 43% CVMPF abnormalities found with the dynamic tests. In addition, the SSEP findings were abnormal in 38% of the patients with degenerative diseases of the cervical spine. Conclusion. An extended neurophysiological protocol of testing corticospinal functions, including dynamic tests of central and periheral motor neurons are relevant for detection of subclinical forms of cervical spondylothic myelopathy, even at early stages. In addition to the conventional neurophysiological tests, we found usefull to include the dynamic motor tests and root conduction time measurement in diagnostic evaluation.

  20. Risk factors for postoperative retropharyngeal hematoma after anterior cervical spine surgery.

    Science.gov (United States)

    O'Neill, Kevin R; Neuman, Brian; Peters, Colleen; Riew, K Daniel

    2014-02-15

    Retrospective review of prospective database. To investigate risk factors involved in the development of anterior cervical hematomas and determine any impact on patient outcomes. Postoperative (PO) hematomas after anterior cervical spine surgery require urgent recognition and treatment to avoid catastrophic patient morbidity or death. Current studies of PO hematomas are limited. Cervical spine surgical procedures performed on adults by the senior author at a single academic institution from 1995 to 2012 were evaluated. Demographic data, surgical history, operative data, complications, and neck disability index (NDI) scores were recorded prospectively. Cases complicated by PO hematoma were reviewed, and time until hematoma development and surgical evacuation were determined. Patients who developed a hematoma (HT group) were compared with those that did not (no-HT group) to identify risk factors. NDI outcomes were compared at early (11 mo) time points. There were 2375 anterior cervical spine surgical procedures performed with 17 occurrences (0.7%) of PO hematoma. In 11 patients (65%) the hematoma occurred within 24 hours PO, whereas 6 patients (35%) presented at an average of 6 days postoperatively. All underwent hematoma evacuation, with 2 patients (12%) requiring emergent cricothyroidotomy. Risk factors for hematoma were found to be (1) the presence of diffuse idiopathic skeletal hyperostosis (relative risk = 13.2, 95% confidence interval = 3.2-54.4), (2) presence of ossification of the posterior longitudinal ligament (relative risk = 6.8, 95% confidence interval = 2.3-20.6), (3) therapeutic heparin use (relative risk 148.8, 95% confidence interval = 91.3-242.5), (4) longer operative time, and (5) greater number of surgical levels. The occurrence of a PO hematoma was not found to have a significant impact on either early (HT: 30, no-HT: 28; P = 0.86) or late average NDI scores (HT: 28, no-HT 31; P = 0.76). With fast recognition and treatment, no long-term detriment

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

    Science.gov (United States)

    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.

  2. Epidemiology and risk factors of cervical spine injury during heating season in the patients with cervical trauma: a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Sidong Yang

    Full Text Available 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.

  3. Comparison of tracheal intubation using the Airtraq® and Mc Coy laryngoscope in the presence of rigid cervical collar simulating cervical immobilisation for traumatic cervical spine injury

    Directory of Open Access Journals (Sweden)

    Padmaja Durga

    2012-01-01

    Full Text Available Background: It is difficult to visualise the larynx using conventional laryngoscopy in the presence of cervical spine immobilisation. Airtraq® provides for easy and successful intubation in the neutral neck position. Objective: To evaluate the effectiveness of Airtraq in comparison with the Mc Coy laryngoscope, when performing tracheal intubation in patients with neck immobilisation using hard cervical collar and manual in-line axial cervical spine stabilisation. Methods: A randomised, cross-over, open-labelled study was undertaken in 60 ASA I and II patients aged between 20 and 50 years, belonging to either gender, scheduled to undergo elective surgical procedures. Following induction and adequate muscle relaxation, they were intubated using either of the techniques first, followed by the other. Intubation time and Intubation Difficulty Score (IDS were noted using Mc Coy laryngoscope and Airtraq. The anaesthesiologist was asked to grade the ease of intubation on a Visual Analogue Scale (VAS of 1-10. Chi-square test was used for comparison of categorical data between the groups and paired sample t-test for comparison of continuous data. IDS score and VAS were compared using Wilcoxon Signed ranked test. Results: The mean intubation time was 33.27 sec (13.25 for laryngoscopy and 28.95 sec (18.53 for Airtraq (P=0.32. The median IDS values were 4 (interquartile range (IQR 1-6 and 0 (IQR 0-1 for laryngoscopy and Airtraq, respectively (P=0.007. The median Cormack Lehane glottic view grade was 3 (IQR 2-4 and 1 (IQR 1-1 for laryngoscopy and Airtraq, respectively (P=0.003. The ease of intubation on VAS was graded as 4 (IQR 3-5 for laryngoscopy and 2 (IQR 2-2 for Airtraq (P=0.033. There were two failures to intubate with the Airtraq. Conclusion: Airtraq improves the ease of intubation significantly when compared to Mc Coy blade in patients immobilised with cervical collar and manual in-line stabilisation simulating cervical spine injury.

  4. The effect of halo-vest length on stability of the cervical spine. A study in normal subjects.

    Science.gov (United States)

    Wang, G J; Moskal, J T; Albert, T; Pritts, C; Schuch, C M; Stamp, W G

    1988-03-01

    In order to study how the efficiency of the halo vest is affected by different lengths of the vest, an experimental headband was devised that allowed the head of a normal person to be held securely in the halo attachment. The vest was then modified to allow it to be adjusted to three different lengths (Fig. 2): a full vest extended to the iliac crests, a short vest extended to the twelfth ribs, and a half vest extended to the level of the nipples. Twenty normal, healthy adult men participated in the study. For each vest length, radiographs were made of each subject demonstrating rotation, flexion-extension, and lateral bending of the cervical spine. There was no rotation of the cervical spine, regardless of the length of the vest. There was a variable degree of motion in flexion or extension of the upper part of the cervical spine with all vest lengths, but this was not statistically significant. There was definite increase of motion caudad to the level of the fifth cervical vertebra regardless of the length of the vest. We concluded that a lesion of the upper part of the cervical spine can be treated effectively by halo traction with a half vest. This will improve the comfort and care of the patient and avoid the necessity of removing the vest if emergency cardiovascular resuscitation is needed. In the treatment of lesions of the lower part of the cervical spine (caudad to the level of the fourth cervical vertebra), the use of a halo vest that extends caudad to the level of the twelfth ribs does provide additional stability.

  5. Patterns of radiographic damage to cervical spine in polyarticular juvenile idiopathic arthritis patients presenting to tertiary care hospital in pakistan

    International Nuclear Information System (INIS)

    Khyzer, E.; Aftab, T.

    2015-01-01

    Objective: To see the radiographic cervical spine damage in polyarticular juvenile idiopathic arthritis (PJIA) coming to a tertiary care hospital in Islamabad, Pakistan. Study Design: Cross-sectional descriptive study. Place and Duration of Study: The study was conducted in department of Rheumatology at Pakistan Institute of Medical Sciences from Jun 2013 to Dec 2013. Subjects and Methods: A total of 50 patients of PJIA coming to Rheumatology Outpatient Department were recruited in the study after informed consent. Radiographs of cervical spine were performed for each patient in antero-posterior, lateral with flexion and extension and open-mouth views. Radiographs were reviewed for the following eatures: loss of cervical lordosis, odontoid process erosion, anterior atlantoaxial subluxation, C1-C2 arthritis, atlantoaxial impaction, inflammation of disc, apophyseal joint arthritis, anterior ankylosis, apophyseal joint ankylosis, anterior and posterior subaxial subluxation and growth disturbances. Data was analysed using SPSS version 18. Results: Out of the total 50 patients, 28 (56%) were females while 22 (44%) were males. The mean duration of pJIA was 5.54 +- 3.28 years. Radiological cervical spine involvement was seen in 52% patients. The most common structural lesions were anterior atlantoaxial subluxation (30%), C1-C2 arthritis (22%) erosion of the odontoid process (18%), and apophyseal joint arthritis (16%). Loss of cervical lordosis was found in 7(14%) patients. There was no growth disturbances observed in vertebra. Conclusion: Cervical spine involvement is common in patients of PJIA. It is mostly asymptomatic, so routine cervical spine radiographs in all patients suffering from PJIA is recommended. (author)

  6. Development of a computerized intervertebral motion analysis of the cervical spine for clinical application.

    Science.gov (United States)

    Piché, Mathieu; Benoît, Pierre; Lambert, Julie; Barrette, Virginie; Grondin, Emmanuelle; Martel, Julie; Paré, Amélie; Cardin, André

    2007-01-01

    The objective of this study was to develop a measurement method that could be implemented in chiropractic for the evaluation of angular and translational intervertebral motion of the cervical spine. Flexion-extension radiographs were digitized with a scanner at a ratio of 1:1 and imported into a software, allowing segmental motion measurements. The measurements were obtained by selecting the most anteroinferior point and the most posteroinferior point of a vertebral body (anterior and posterior arch, respectively, for C1), with the origin of the reference frame set at the most posteroinferior point of the vertebral body below. The same procedure was performed for both the flexion and extension radiographs, and the coordinates of the 2 points were used to calculate the angular movement and the translation between the 2 vertebrae. This method provides a measure of intervertebral angular and translational movement. It uses a different reference frame for each joint instead of the same reference frame for all joints and thus provides a measure of motion in the plane of each articulation. The calculated values obtained are comparable to other studies on intervertebral motion and support further development to validate the method. The present study proposes a computerized procedure to evaluate intervertebral motion of the cervical spine. This procedure needs to be validated with a reliability study but could provide a valuable tool for doctors of chiropractic and further spinal research.

  7. Computed radiography and the workstation in a study of the cervical spine. Technical and cost implications

    International Nuclear Information System (INIS)

    Garcia, J. M.; Lopez-Galiacho, N.; Martinez, M.

    1999-01-01

    To demonstrate the advantages of computed radiography and the workstation in assessing the images acquired in a study of the cervical spine. Lateral projections of cervical spine obtained using a computed radiography system in 63 ambulatory patients were studied in a workstation. Images of the tip of the odontoid process. C1-C2, basion-opisthion and C7 were visualized prior to and after their transmission and processing, and the overall improvement in their diagnostic quality was assessed. The rate of detection of the tip of the odontoid process, C1-C2, the foramen magnum and C/ increased by 17,6, 11 and 14 percentage points, respectively. Image processing improved the diagnostic quality in over 75% of cases. Image processing in a workstation improved the visualization of the anatomical points being studied and the diagnostic quality of the images. These advantages as well as the possibility of transferring the images to a picture archiving and communication system (PACS) are convincing reasons for using digital radiography. (Author) 7 refs

  8. Evaluation of the SLICS use in the treatment of subaxial cervical spine injuries

    Directory of Open Access Journals (Sweden)

    Halisson Y. F. da Cruz

    2015-05-01

    Full Text Available The SLICS (Sub-axial Cervical Spine Injury Classification System was proposed to help in the decision-making of sub-axial cervical spine trauma (SCST, even though the literature assessing its safety and efficacy is scarce. Method We compared a cohort series of patients surgically treated based on surgeon’s preference with patients treated based on the SLICS. Results From 2009-10, 12 patients were included. The SLICS score ranged from 2 to 9 points (mean of 5.5. Two patients had the SLICS < 4 points. From 2011-13, 28 patients were included. The SLICS score ranged from 4 to 9 points (mean of 6. There was no neurological deterioration in any group. Conclusion After using the SLICS there was a decrease in the number of patients with less severe injuries that were treated surgically. This suggests that the SLICS can be helpful in differentiating mild from severe injuries, potentially improving the results of treatment.

  9. Cervical spine degenerative changes (narrowed intervertebral disc spaces and osteophytes) in coal miners

    International Nuclear Information System (INIS)

    Zejda, J. E.; Stasiow, B.

    2003-01-01

    A series of 685 x-rays films of the cervical spine obtained in coal miners was analyzed to explore the occurrence of narrowed disc spaces and osteophytes in this occupational group, and to examine the association of x-rays changes with age, duration of employment, and duration of occupational exposure to hand-arm vibration. All data were extracted from individual medical files of coal miners examined for suspected hand-arm vibration-related disorders in 1989-1999 at the Occupational Medicine Center in Katowice. The narrowed intervertebral disc spaces were found in 188 coal miners (26.9%) and osteophytes in 332 coal miners (47.5%). The occurrence of degenerative changes in coal miners was similar to that observed in a small group of 68 blue-collar workers (no exposure to hand-arm vibration) employed in the coal industry. Univariate comparisons showed that intervertebral disc spaces and osteophytes were more frequent among older subjects and among subjects with longer duration of employment. The results of logistic regression analysis confirmed statistically significant effect of age, but not of other factors included in the model. When both x-ray changes were grouped together (a combined dependent variable) age remained the only statistically significant explanatory variable. The findings do not support the view that the examined degenerative changes in cervical spine are more prevalent in coal miners and depend on duration of physical work or local exposure to hand-arm vibration in this occupational group. (author)

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

    Science.gov (United States)

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

    2009-05-01

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

  11. Quantification of C2 cervical spine rotatory fixation by X-ray, MRI and CT

    Energy Technology Data Exchange (ETDEWEB)

    Gradl, Georg [Chirurgische Klinik und Poliklinik der Universitaet Rostock, Abteilung Unfall- und Wiederherstellungschirurgie, Rostock (Germany); Maier-Bosse, Tamara; Staebler, Axel [Institut fuer Radiologische Diagnostik der Universitaet Muenchen, Klinikum Grobetahadern, Munich (Germany); Penning, Randolph [Institut fuer Rechtsmedizin der Universitaet Muenchen, Munich (Germany)

    2005-02-01

    Atlanto-axial rotatory displacement is known to be a cause of childhood torticollis and may as well be responsible for chronic neck pain after rear-end automobile collisions. The objective was to determine whether quantification of C2 malrotation is possible by plain radiographs in comparison to CT as the golden standard. MR imaging was evaluated as to whether it was of equal value in the detection of bony landmarks. C2 vertebra of five human cadaveric cervical spine specimens, ligamentously intact, were rotated using a Steinmann pin in steps of 5 up to 15 right and 15 left. Plain radiographs, CT and MRI images were taken in each rotational step. Data were analyzed for quantification of C2 rotation by three independent examiners. A rotation of 5 led to a spinous process deviation (SPD) from the midline of 3 mm as measured on an a.p. plain radiograph. A coefficient of rotation was calculated (1.62 mm{sup -1}). Data analyzed by three examiners revealed a small coefficient of variation (0.03). MRI and CT measurements showed comparable results for the quantification of rotation; however, in both techniques the 15 rotation was underestimated. Quantification of upper cervical spine malrotation was possible on plain radiographs using the SPD and a rotation coefficient. MRI and CT were equally successful in the assessment of C2 malrotation. (orig.)

  12. A biomechanical evaluation of magnetic resonance imaging-compatible wire in cervical spine fixation.

    Science.gov (United States)

    Scuderi, G J; Greenberg, S S; Cohen, D S; Latta, L L; Eismont, F J

    1993-10-15

    In a bovine cervical spine model, the ultimate and fatigue strengths as well as relative magnetic resonance imaging artifact produced by titanium, cobalt chrome, and stainless-steel wires in various gauges were assessed. Single-cycle and fatigue strength of wire constructs were measured. Although larger wires generally had greater static strength, fatigue strength was mixed. Sixteen-gauge titanium, and all stainless-steel models (22-gauge braided, 18-gauge, and Songer cable) withstood 10,000 cycles without failure, whereas all other constructs rarely could withstand a similar 10,000 cycles. Magnetic resonance imaging was performed on calf cervical spines instrumented with the various materials. Titanium exhibited the least artifact, stainless-steel showed the greatest artifact, and cobalt chrome an intermediate amount. Although titanium wire produces the least amount of magnetic resonance imaging artifact, it remains a poor choice for implant fixation because its notch sensitivity reduces its fatigue resistance compared with stainless steel, which remains the more dependable choice.

  13. Systematic review of flexion/extension radiography of the cervical spine in trauma patients

    International Nuclear Information System (INIS)

    Sierink, J.C.; Lieshout, W.A.M. van; Beenen, L.F.M.; Schep, N.W.L.; Vandertop, W.P.; Goslings, J.C.

    2013-01-01

    Introduction: The aim of this review was to investigate whether Flexion/Extension (F/E) radiography adds diagnostic value to CT or MRI in the detection of cervical spine ligamentous injury and/or clinically significant cervical spine instability of blunt trauma patients. Methods: A systematic search of literature was done in Pubmed, Embase and Cochrane Library databases. Primary outcome was sensitivity and specificity of F/E radiography. Secondary outcomes were the positive predicting value (PPV) and negative predicting value (NPV) (with CT or MRI as reference tests due to the heterogeneity of the included studies) of each modality and the quality of F/E radiography. Results: F/E radiography was overall regarded to be inferior to CT or MRI in the detection of ligamentous injury. This was reflected by the high specificity and NPV for CT with F/E as reference test (ranging from 97 to 100% and 99 to 100% respectively) and the ambiguous results for F/E radiography with MRI as its reference test (0–98% and 0–83% for specificity and NPV respectively). Image quality of F/E radiography was reported to have 31 to 70% adequacy, except in two studies which reported an adequacy of respectively 4 and 97%. Conclusion: This systematic review of the literature shows that F/E radiography adds little diagnostic value to the evaluation of blunt trauma patients compared to CT and MRI, especially in those cases where CT or MRI show no indication of ligamentous injury

  14. Cervical spine injury. Diagnosis, prognosis and management; Trauma der Halswirbelsaeule. Diagnose, Prognose und Management

    Energy Technology Data Exchange (ETDEWEB)

    Schueller-Weidekamm, C. [AKH, Medizinische Universitaet Wien (Austria). Abteilung fuer Neuroradiologie und Muskuloskelettale Radiologie

    2008-05-15

    Cervical spine injuries are a common occurrence in multi-trauma patients and should be taken into account when planning further clinical management. This review describes in detail upper and lower cervical spine injuries and introduces the sub-axial injury classification (SLIC) that is based on three components: injury morphology, integrity of the discoligamentous complex and the neurologic status of the patient. If the total SLIC score is <3, non-surgical treatment is recommended. If the total is {>=}5, operative treatment is indicated as such a score is associated with instability and probably neurologic deficits. The precise diagnosis of the radiologist, which would include the SLIC classification, should facilitate clinical decision-making about further management. (orig.) [German] Halswirbelsaeulenverletzungen sind bei polytraumatisierten Patienten haeufig und sollten beim klinischen Management des Patienten beruecksichtigt werden. Verletzungen der oberen Halswirbelsaeule werden als Sonderformen eingeteilt. Die subaxialen Verletzungen koennen nach der SLIC-Klassifikation ('sub-axial injury classification') gescort werden, die auf der Morphologie der Verletzung, dem diskoligamentaeren Komplex und dem neurologischen Status basiert. Bei einem Score <3 wird ein konservatives Management empfohlen. Bei einem Score {>=}5 sollte eine operative Versorgung der Halswirbelsaeule vorgenommen werden, da die Verletzung eine Instabilitaet und moeglicherweise auch ein neurologisches Defizit verursacht. Anhand einer praezisen Diagnose des Radiologen unter Beruecksichtigung der SLIC-Klassifikation sollte dem Kliniker die Entscheidung fuer das weitere Management erleichtert werden. (orig.)

  15. Systematic review of flexion/extension radiography of the cervical spine in trauma patients

    Energy Technology Data Exchange (ETDEWEB)

    Sierink, J.C., E-mail: j.c.sierink@amc.nl [Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Lieshout, W.A.M. van, E-mail: w.a.vanlieshout@amc.nl [Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Beenen, L.F.M., E-mail: l.f.beenen@amc.nl [Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Schep, N.W.L., E-mail: n.w.schep@amc.nl [Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Vandertop, W.P., E-mail: w.p.vandertop@amc.nl [Neurosurgical Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Goslings, J.C., E-mail: j.c.goslings@amc.nl [Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands)

    2013-06-15

    Introduction: The aim of this review was to investigate whether Flexion/Extension (F/E) radiography adds diagnostic value to CT or MRI in the detection of cervical spine ligamentous injury and/or clinically significant cervical spine instability of blunt trauma patients. Methods: A systematic search of literature was done in Pubmed, Embase and Cochrane Library databases. Primary outcome was sensitivity and specificity of F/E radiography. Secondary outcomes were the positive predicting value (PPV) and negative predicting value (NPV) (with CT or MRI as reference tests due to the heterogeneity of the included studies) of each modality and the quality of F/E radiography. Results: F/E radiography was overall regarded to be inferior to CT or MRI in the detection of ligamentous injury. This was reflected by the high specificity and NPV for CT with F/E as reference test (ranging from 97 to 100% and 99 to 100% respectively) and the ambiguous results for F/E radiography with MRI as its reference test (0–98% and 0–83% for specificity and NPV respectively). Image quality of F/E radiography was reported to have 31 to 70% adequacy, except in two studies which reported an adequacy of respectively 4 and 97%. Conclusion: This systematic review of the literature shows that F/E radiography adds little diagnostic value to the evaluation of blunt trauma patients compared to CT and MRI, especially in those cases where CT or MRI show no indication of ligamentous injury.

  16. Primary bony non-Hodgkin lymphoma of the cervical spine: a case report

    Directory of Open Access Journals (Sweden)

    Sedrak Mark F

    2010-02-01

    Full Text Available Abstract Introduction Non-Hodgkin lymphoma primarily originating from the bone is exceedingly rare. To our knowledge, this is the first report of primary bone lymphoma presenting with progressive cord compression from an origin in the cervical spine. Herein, we discuss the unusual location in this case, the presenting symptoms, and the management of this disease. Case presentation We report on a 23-year-old Caucasian-American man who presented with two months of night sweats, fatigue, parasthesias, and progressive weakness that had progressed to near quadriplegia. Magnetic resonance (MR imaging demonstrated significant cord compression seen primarily at C7. Surgical management, with corpectomy and dorsal segmental fusion, in combination with adjuvant chemotherapy and radiation therapy, halted the progression of the primary disease and preserved neurological function. Histological analysis demonstrated an aggressive anaplastic large cell lymphoma. Conclusion Isolated primary bony lymphoma of the spine is exceedingly rare. As in our case, the initial symptoms may be the result of progressive cervical cord compression. Anterior corpectomy with posterolateral decompression and fusion succeeded in preventing progressive neurologic decline and maintaining quality of life. The reader should be aware of the unique presentation of this disease and that surgical management is a successful treatment strategy.

  17. A Discussion of the Issue of Football Helmet Removal in Suspected Cervical Spine Injuries

    Science.gov (United States)

    Segan, Ross D.; Cassidy, Christine; Bentkowski, Jamie

    1993-01-01

    In some areas, it is a commonly accepted emergency medical technician protocol to remove a helmet during the initial management of suspected cervical spine injures. After a comprehensive survey of relevant literature, four primary reasons why Emergency Medical Services professionals would desire to remove a helmet emerge. Sources suggest that the presence of a helmet might: 1) interfere with immobilization of the athlete; 2) interfere with the ability to visualize injuries; 3) cause hyperflexion of the cervical spine; and 4) prevent proper airway management during a cardiorespiratory emergency. Many available protocols are designed for the removal of closed chamber motorcycle helmets that do not have removable face masks. There are a great number of differing viewpoints regarding this issue. The varying viewpoints are results of the failure of many emergency medical technician management protocols to address the unique situation presented by a football helmet. We: 1) demonstrate that football helmet removal is potentially dangerous and unnecessary, 2) suggest that cardiorespiratory emergencies can be effectively managed without removing the helmet, and 3) provide sports medicine professional with information that may be used to establish a joint Emergency Medical Services/Sports Medicine emergency action plan. ImagesFig. 1.Fig 2.Fig 3.Fig 4.Fig 5.Fig 6. PMID:16558244

  18. Quantification of C2 cervical spine rotatory fixation by X-ray, MRI and CT

    International Nuclear Information System (INIS)

    Gradl, Georg; Maier-Bosse, Tamara; Staebler, Axel; Penning, Randolph

    2005-01-01

    Atlanto-axial rotatory displacement is known to be a cause of childhood torticollis and may as well be responsible for chronic neck pain after rear-end automobile collisions. The objective was to determine whether quantification of C2 malrotation is possible by plain radiographs in comparison to CT as the golden standard. MR imaging was evaluated as to whether it was of equal value in the detection of bony landmarks. C2 vertebra of five human cadaveric cervical spine specimens, ligamentously intact, were rotated using a Steinmann pin in steps of 5 up to 15 right and 15 left. Plain radiographs, CT and MRI images were taken in each rotational step. Data were analyzed for quantification of C2 rotation by three independent examiners. A rotation of 5 led to a spinous process deviation (SPD) from the midline of 3 mm as measured on an a.p. plain radiograph. A coefficient of rotation was calculated (1.62 mm -1 ). Data analyzed by three examiners revealed a small coefficient of variation (0.03). MRI and CT measurements showed comparable results for the quantification of rotation; however, in both techniques the 15 rotation was underestimated. Quantification of upper cervical spine malrotation was possible on plain radiographs using the SPD and a rotation coefficient. MRI and CT were equally successful in the assessment of C2 malrotation. (orig.)

  19. Trauma related changes in cervical spine and spinal cord in myelography and MRI; Zmiany pourazowe kregoslupa i rdzenia w odcinku szyjnym, w mielografii i w obrazie NMR

    Energy Technology Data Exchange (ETDEWEB)

    Wozniak, E.; Bronarski, J.; Kiwerski, J.; Krasuski, M. [Akademia Medyczna, Warsaw (Poland)]|[Stoleczny Zespol Rehabilitacji, Konstancin (Poland)

    1993-12-31

    Myelographic and MRI results in 14 patients treated in 1992 because of cervical spine injury with neurological complications have been presented. Myelography proves to be useful in posttraumatic spine diagnostics but in some cases does not render sufficient information, especially if the trauma superimposes previously existing pathological changes. MRI is exceptionally valuable diagnostic modality in cervical spine injuries offering an advantage of both early and late evaluation of the post-traumatic spinal cord changes. (author). 12 refs, 6 figs, 2 tabs.

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

    OpenAIRE

    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...

  1. Spinal cord injuries related to cervical spine fractures in elderly patients: factors affecting mortality.

    Science.gov (United States)

    Daneshvar, Parham; Roffey, Darren M; Brikeet, Yasser A; Tsai, Eve C; Bailey, Chris S; Wai, Eugene K

    2013-08-01

    Spinal cord injuries (SCIs) related to cervical spine (C-spine) fractures can cause significant morbidity and mortality. Aggressive treatment often required to manage instability associated with C-spine fractures is complicated and hazardous in the elderly population. To determine the mortality rate of elderly patients with SCIs related to C-spine fractures and identify factors that contribute toward a higher risk for negative outcomes. Retrospective cohort study at two Level 1 trauma centers. Thirty-seven consecutive patients aged 60 years and older who had SCIs related to C-spine fractures. Level of injury, injury severity, preinjury medical comorbidities, treatment (operative vs. nonoperative), and cause of death. Hospital medical records were reviewed independently. Baseline radiographs and computed tomography or magnetic resonance imaging scans were examined to permit categorization according to the mechanistic classification by Allen and Ferguson of subaxial C-spine injuries. Univariate logistic regression analyses were performed to identify factors related to in-hospital mortality and ambulation at discharge. There were no funding sources or potential conflicts of interest to disclose. The in-hospital mortality rate was 38%. Respiratory failure was the leading cause of death. Preinjury medical comorbidities, age, and operative versus nonoperative treatment did not affect mortality. Injury level at or above C4 was associated with a 7.1 times higher risk of mortality compared with injuries below C4 (p=.01). Complete SCI was associated with a 5.1 times higher risk of mortality compared with incomplete SCI (p=.03). Neurological recovery was uncommon. Apart from severity of initial SCI, no other factor was related to ambulatory disposition at discharge. In this elderly population, neurological recovery was poor and the in-hospital mortality rate was high. The strongest risk factors for mortality were injury level and severity of SCI. Although each case of SCI

  2. A Nearly Lethal Screw: An Unusual Cause of Recurrent Bradycardia and Asystole Episodes after Fixation of the Cervical Spine

    Directory of Open Access Journals (Sweden)

    Amit Frenkel

    2017-01-01

    Full Text Available We present a case of a 51-year-old man who was injured in a bicycle accident. His main injury was an unstable fracture of the cervical and thoracic vertebral column. Several hours after his arrival to the hospital the patient underwent open reduction and internal fixation (ORIF of the cervical and thoracic spine. The patient was hospitalized in our critical care unit for 99 days. During this time patient had several episodes of severe bradycardia and asystole; some were short with spontaneous return to sinus and some required pharmacological treatment and even Cardiopulmonary Resuscitation (CPR. Initially, these episodes were attributed to the high cervical spine injury, but, later on, CT scan suggested that a fixation screw abutted on the esophagus and activated the vagus nerve by direct pressure. After repositioning of the cervical fixation, the bradycardia and asystole episodes were no longer observed and the patient was released to a rehabilitation ward. This case is presented in order to alert practitioners to the possibility that, after operative fixation of cervical spine injuries, recurrent episodes of bradyarrhythmia can be caused by incorrect placement of the fixation screws and might be confused with the natural history of the high cervical cord injury.

  3. Variability in Treatment for Patients with Cervical Spine Fracture and Dislocation: An Analysis of 107,152 Patients.

    Science.gov (United States)

    Wang, Jing; Eltorai, Adam E M; DePasse, J Mason; Durand, Wesley; Reid, Daniel; Daniels, Alan H

    2018-06-01

    Cervical spine injuries are a common cause of morbidity and mortality; however, the optimal treatment of many of these injuries is debated, and previous studies have shown substantial variation in treatment. We sought to examined treatment variation in arthrodesis and halo/tong placement in cervical spine injury patients over a 12-year period. Data from the Healthcare Cost and Utilization Project National Inpatient Sample, from 2000 to 2011, were used for this study. Patients were identified with a cervical vertebral facture or dislocation based on the International Classification of Diseases, 9th Revision codes. Using χ 2 analysis, spinal arthrodesis rates and halo/tong placement rates were compared between hospitals based on teaching status for patients with and without spinal cord injury (SCI). The records of 107,152 patients with cervical fractures were examined. From 2000 to 2011, the overall arthrodesis rates fell from 25.2% to 20.6% (P < 0.001), and halo/tong placement rates fell from 13.2% to 3.6% (P < 0.001). In patients with cervical fracture without SCI, arthrodesis rates fell from 17.6% to 13.9% (P < 0.001), in cervical fracture patients with SCI, arthrodesis rates rose from 50.0% to 58.9% (P < 0.001), and in cervical dislocation patients, arthrodesis rates rose from 47.6% to 57.5% (P < 0.001). During the 12-year period, teaching hospitals had higher arthrodesis rates compared with nonteaching hospitals for patients with cervical fractures with SCI (57.3% vs. 53.4%, P = 0.001) and higher halo/tong placement rates for patients with cervical dislocations (2.7% vs. 1.7%, P = 0.004). Individual hospital variation showed a 3.5-fold variation in arthrodesis rates in 2000 to 2002, which fell to 3.0-fold by 2009 to 2011. Arthrodesis rates for cervical fracture patients significantly decreased, and arthrodesis rates for cervical dislocation and SCI patients increased from 2000 to 2011, with variability in treatment based on hospital teaching status

  4. Heterogeneity in cervical spine assessment in paediatric trauma: A survey of physicians' knowledge and application at a paediatric major trauma centre.

    Science.gov (United States)

    Buckland, Aaron J; Bressan, Silvia; Jowett, Helen; Johnson, Michael B; Teague, Warwick J

    2016-10-01

    Evidence-based decision-making tools are widely used to guide cervical spine assessment in adult trauma patients. Similar tools validated for use in injured children are lacking. A paediatric-specific approach is appropriate given important differences in cervical spine anatomy, mechanism of spinal injury and concerns over ionising radiation in children. The present study aims to survey physicians' knowledge and application of cervical spine assessment in injured children. A cross-sectional survey of physicians actively engaged in trauma care within a paediatric trauma centre was undertaken. Participation was voluntary and responses de-idenitified. The survey comprised 20 questions regarding initial assessment, imaging, immobilisation and perioperative management. Physicians' responses were compared with available current evidence. Sixty-seven physicians (28% registrars, 17% fellows and 55.2% consultants) participated. Physicians rated altered mental state, intoxication and distracting injury as the most important contraindications to cervical spine clearance in children. Fifty-four per cent considered adequate plain imaging to be 3-view cervical spine radiographs (anterior-posterior, lateral and odontoid), whereas 30% considered CT the most sensitive modality for detecting unstable cervical spine injuries. Physicians' responses reflected marked heterogeneity regarding semi-rigid cervical collars and what constitutes cervical spine 'clearance'. Greater consensus existed for perioperative precautions in this setting. Physicians actively engaged in paediatric trauma care demonstrate marked heterogeneity in their knowledge and application of cervical spine assessment. This is compounded by a lack of paediatric-specific evidence and definitions, involvement of multiple specialties and staff turnover within busy departments. A validated decision-making tool for cervical spine assessment will represent an important advance in paediatric trauma. © 2016 Australasian

  5. COMPARISON OF INTRAOPERATIVE KETAMINE VS. FENTANYL USE DECREASES POSTOPERATIVE OPIOID REQUIREMENTS IN TRAUMA PATIENTS UNDERGOING CERVICAL SPINE SURGERY.

    Science.gov (United States)

    Berkowitz, Aviva C; Ginsburg, Aryeh M; Pesso, Raymond M; Angus, George L D; Kang, Amiee; Ginsburg, Dov B

    2016-02-01

    Postoperative airway compromise following cervical spine surgery is a potentially serious adverse event. Residual effects of anesthesia and perioperative opioids that can cause both sedation and respiratory depression further increase this risk. Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that provides potent analgesia without noticeable respiratory depression. We investigated whether intraoperative ketamine administration could decrease perioperative opioid requirements in trauma patients undergoing cervical spine surgery. We retrospectively reviewed anesthesia records identifying cervical spine surgeries performed between March 2014 and February 2015. All patients received a balanced anesthetic technique utilizing sevoflurane 0.5 minimum alveolar concentration (MAC) and propofol infusion (50-100 mcg/kg/min). For intraoperative analgesia, one group of patients received ketamine (N=25) and a second group received fentanyl (N=27). Cumulative opioid doses in the recovery room and until 24 hours postoperatively were recorded. Fewer patients in the ketamine group (11/25 [44%] vs. 20/27 [74%], respectively; p = 0.03) required analgesics in the recovery room. Additionally, the total cumulative opioid requirements in the ketamine group decreased postoperatively at both 3 and 6 hours (p = 0.01). Ketamine use during cervical spine surgery decreased opioid requirements in both the recovery room and in the first 6 hours postoperatively. This may have the potential to minimize opioid induced respiratory depression in a population at increased risk of airway complications related to the surgical procedure.

  6. Tracheal intubation in patients with cervical spine immobilization: a comparison of the Airwayscope, LMA CTrach, and the Macintosh laryngoscopes.

    LENUS (Irish Health Repository)

    Malik, M A

    2009-05-01

    The purpose of this study was to evaluate the effectiveness of the Pentax AWS, and the LMA CTrach, in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with neck immobilization using manual in-line axial cervical spine stabilization.

  7. Inter-examiner reliability of passive assessment of intervertebral motion in the cervical and lumbar spine: A systematic review

    NARCIS (Netherlands)

    van Trijffel, E.; Anderegg, Q.; Bossuyt, P. M. M.; Lucas, C.

    2005-01-01

    A systematic review was conducted to determine inter-examiner reliability of passive assessment of segmental intervertebral motion in the cervical and lumbar spine as well as to explore sources of heterogeneity. Passive assessment of motion is used to decide on treatments for neck and low-back pain

  8. No trauma of the cervical spine. Automatic headrest adjustment; Kein HWS-Trauma. Kopfstuetze automatisch naeher am Kopf

    Energy Technology Data Exchange (ETDEWEB)

    Schmuck, M.; Gaebelein, J. [Proma GmbH, Lichtenfels (Germany)

    2005-06-01

    A new headrest system developed by Proma considerably reduces the risk of injuries of the cervical spine. The idea behind it is simple and innovative: Apart from the automatic height adjustment, the headrest also has an automatic adjustment function to keep it in a position close to the head. (orig.)

  9. Comparison of Macintosh, Truview EVO2, Glidescope, and Airwayscope laryngoscope use in patients with cervical spine immobilization.

    LENUS (Irish Health Repository)

    Malik, M A

    2008-11-01

    The purpose of this study was to evaluate the effectiveness of the Pentax AWS, Glidescope, and the Truview EVO2, in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with neck immobilization using manual in-line axial cervical spine stabilization.

  10. Usefulness of polyetheretherketone (PEEK) cage with plate augmentation for anterior arthrodesis in traumatic cervical spine injury.

    Science.gov (United States)

    Song, Kyung-Jin; Choi, Byung-Wan; Kim, Gyu-Hyung; Song, Ji-Hun

    2010-01-01

    Even though many clinical reports about cages have been documented in patients with degenerative disorders, reports were scarce for traumatic injury cases, and those cases using metal cages were restricted to only one-level injury. To evaluate the usefulness of polyetheretherketone (PEEK) cage and plate construction in anterior interbody fusions (AIF) for traumatic cervical spine injuries by analyzing radiographic changes and clinical outcomes. Retrospective study. Fifty-eight patients (91 levels) underwent cage and plate construction for treatment of traumatic cervical spine injury. The fusion rate, fusion time, changes of Cobb angle, subsidence rate, and adjacent level changes were assessed as a radiographic outcome. Clinical analysis includes the recovery rate on the American Spinal Injury Association (ASIA) impairment scale and the presence of the complications. We evaluated 58 patients (91 levels) who underwent surgery and had at least 24 months in follow-up study. Radiographic evaluation included the assessment of interbody fusion rate, fusion time, changes of Cobb angle, subsidence rate, and adjacent level changes. Clinical assessment was done by analyzing recovery state of ASIA impairment scale from preoperative period to the last follow-up and by evaluating complications. Fifty-four cases showed bony fusion within 3 months after the surgery. The mean Cobb angle between the vertebral bodies was 2.54 degrees before operation, 9.13 degrees after operation, and 8.39 degrees at the latest follow-up. The mean intervertebral disc height was increased by 3.01 mm after the operation, but the mean height was 2.17 mm shorter at the last follow-up than after postoperation. In terms of clinical results, five Grade A cases and one Grade B case as assessed by the ASIA impairment scale were unchanged until the last follow-up. Twenty-three cases of Grade C, 16 cases of Grade D, and 13 cases of Grade E improved to seven cases, 26 cases, and 19 cases, respectively. Three

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

    Science.gov (United States)

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

    2013-01-01

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

  12. Geometrical properties of the human child cervical spine with a focus on the C1 vertebra.

    Science.gov (United States)

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

    2014-01-01

    Child dummies and injury criteria used in automotive crashworthiness environments are based on scaling from the adult and/or between children of different ages. Cartilage-to-bone ossification, spinal canal and joint developments of the spine, and strength attainments do not grow linearly from birth to maturity. Though this is known to medical professionals, age-based quantitative analyses are needed to accurately model the pediatric spine. The objective of this study was to quantify longitudinal growths of various regions of the first cervical vertebrae, responsible for transmitting the axial load from the base of the skull through the condyles to the neck/torso. Computed tomography (CT) images of 54 children from one day to 18 years of age were retrospectively used to determine the following geometrical properties: bilateral neurocentral synchondroses widths, the width of posterior synchondrosis, outer and inner anteroposterior and transverse diameters, spinal canal area, and depths of the anterior and posterior arches of the C1 vertebra. Both axial and sagittal CT images were used in the analysis. Sagittal images were used to quantify data for the anterior and posterior arches and axial images were used for all described cross-sectional parameters. Geometrical properties were extracted and reported for the various parameters at 6 months; one year; 18 months; and 3, 6, and 10 years of age corresponding to the dummy family ages routinely used in motor vehicle crashworthiness research and other applications. The outer transverse diameter ranged from 4.97 to 7.08 cm; outer and inner antero-posterior diameters ranged from 2.99 to 4.18 and 2.19 to 3.03 mm; and spinal canal area ranged from 4.34 to 6.68 mm(2). Other data are given in the body of the article. The growths of the first cervical vertebra quantified in terms of the above variables occurred nonlinearly with age and the degree of nonlinearity depended on the type of the geometrical parameter. Growths did not

  13. Movement coordination and differential kinematics of the cervical and thoracic spines in people with chronic neck pain.

    Science.gov (United States)

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

    2013-07-01

    Research on the kinematics and inter-regional coordination of movements between the cervical and thoracic spines in motion adds to our understanding of the performance and interplay of these spinal regions. The purpose of this study was to examine the effects of chronic neck pain on the three-dimensional kinematics and coordination of the cervical and thoracic spines during active movements of the neck. Three-dimensional spinal kinematics and movement coordination between the cervical, upper thoracic, and lower thoracic spines were examined by electromagnetic motion sensors in thirty-four individuals with chronic neck pain and thirty-four age- and gender-matched asymptomatic subjects. All subjects performed a set of free active neck movements in three anatomical planes in sitting position and at their own pace. Spinal kinematic variables (angular displacement, velocity, and acceleration) of the three defined regions, and movement coordination between regions were determined and compared between the two groups. Subjects with chronic neck pain exhibited significantly decreased cervical angular velocity and acceleration of neck movement. Cross-correlation analysis revealed consistently lower degrees of coordination between the cervical and upper thoracic spines in the neck pain group. The loss of coordination was most apparent in angular velocity and acceleration of the spine. Assessment of the range of motion of the neck is not sufficient to reveal movement dysfunctions in chronic neck pain subjects. Evaluation of angular velocity and acceleration and movement coordination should be included to help develop clinical intervention strategies to promote restoration of differential kinematics and movement coordination. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Ból kręgosłupa szyjnego w przebiegu radikulopatii = The cervical spine pain in radiculopathy

    Directory of Open Access Journals (Sweden)

    Jakub Litak

    2017-02-01

    ²Department of Human Anatomy  Medical University of Lublin     Key words: cervical discopathy, radiculopathy, neck pain         Abstrakt Bóle kręgosłupa szyjnego stanowią poważny problem diagnostyczny w praktyce lekarskiej . Są najczęstszą przyczyną zgłaszania się do lekarza i mają znaczący wymiar ekonomiczny. W związku z rozwojem cywilizacyjnym, stresem , siedzącym trybem życia i ograniczeniem aktywności procesy  degeneracyjno - wytwórcze w kręgosłupie szyjnym stają się bardziej powszechne. Radikulopatia szyjna jest neurologicznym stanem wywołanym kompresją lub uszkodzeniem korzeni nerwowych szyjnego odcinka kręgosłupa. Stan ten generuje ból w obrębie szyi  nie rzadko promieniuje do obręczy barkowej i kończyn górnych. Postępowanie diagnostyczne jest procesem wieloetapowym. Wywiad i badanie fizykalne pełnia znaczącą rolę a badania obrazowe uzupełniają pełną diagnozę. Farmakoterapia i ograniczenie obciążeń redukują ból w ostrej fazie. W przypadku nieskuteczności leczenia zachowawczego , przewlekłego bólu czy tez postępujących deficytów neurologicznych przeprowadzenie zabiegu operacyjnego obarczającego uciśnięte struktury nerwowe staje się jedynym słusznym postępowaniem .   Słowa kluczowe: szyjna dyskopatia, radikulopatia, ból kręgosłupa szyjnego     Abstract The cervical spine pain represents serious diagnostic medical problem .It is the most common reason for visiting the doctor and has economic dimension . According to Development of Civilization , stress , sitting lifestyle and limitation of physical  activity  Degenerative and Osteoarthritic  syndromes become more common. Cervical radiculopathy  is a neurological condition caused by compression or damage of the nerve roots of the cervical spine.  This leads to the occurrence of the neck pain  radiating  to the shoulders and upper extremities. Diagnostic path is a multistage process. Medical interview and physical examination

  15. Surgical treatment of upper cervical spine injuries (c1-c2): experience in 26 patients

    International Nuclear Information System (INIS)

    Pasha, I.F.; Qureshi, M.A.; Khalique, A.B.; Afzal, W.; Qureshi, M.A.

    2013-01-01

    Objective: To describe the spectrum of operations in unstable upper cervical spinal injuries in (atlanto-axial) region at our unit. Study Design: A cross-sectional study. Place And Duration: Spine Unit, Department of Orthopedics, Combined Military Hospital (CMH), Rawalpindi from Jan 2001 to Dec 2008. Patients and Methods: Frequency of different kind of operations in 26 patients operated for upper cervical spinal injuries was reviewed. A performa was made for each patient and records were kept in a custom built Microsoft access database. Results: Average age of patients studied was 27 years with male pre dominance. Total 12(46%) patients had Atlanto-axial instability, 8(31%) had Hangman's fracture and 6(23%) patients had odontoid peg fracture. While 11(42%) patients had no neurological deficit according to American spinal injury association impairment scale (AIS-E) and 15(58%) had partial neurological deficit. The patients were divided into three groups. Group A had odontoid peg fracture, Group B had atlanto-axial instability and Group C had Hangman's fracture. The spine was approached posteriorly in 19(73(Yo) cases and anteriorly in 7(27%). Pedicle screw fixation was done in 6(23%) patients, odontoid peg screw fixation in 6(23%), Gallie's fusion in 5(19%), occipito-cervical fusion in 4(15%), posterior transarticular fixation in 3(12%), anterior transarticular fixation and decompression in others, 9(60%) patients improved neurologically postoperatively and there was no deterioration of neurological status. Nonunion in two (8%) cases and implant failure in one (4%) were complications. Conclusion: Upper cervical injuries (C1-C2) are rare and their management is complex, necessitating lot of experience for their management. Early diagnosis and appropriate treatment is essential for good outcome. Each injury has to be managed at its own merit and a single operation may not be appropriate in all situations. General guidelines can be drawn from our study for the

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

    Science.gov (United States)

    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.

  17. Incorporating ligament laxity in a finite element model for the upper cervical spine.

    Science.gov (United States)

    Lasswell, Timothy L; Cronin, Duane S; Medley, John B; Rasoulinejad, Parham

    2017-11-01

    Predicting physiological range of motion (ROM) using a finite element (FE) model of the upper cervical spine requires the incorporation of ligament laxity. The effect of ligament laxity can be observed only on a macro level of joint motion and is lost once ligaments have been dissected and preconditioned for experimental testing. As a result, although ligament laxity values are recognized to exist, specific values are not directly available in the literature for use in FE models. The purpose of the current study is to propose an optimization process that can be used to determine a set of ligament laxity values for upper cervical spine FE models. Furthermore, an FE model that includes ligament laxity is applied, and the resulting ROM values are compared with experimental data for physiological ROM, as well as experimental data for the increase in ROM when a Type II odontoid fracture is introduced. The upper cervical spine FE model was adapted from a 50th percentile male full-body model developed with the Global Human Body Models Consortium (GHBMC). FE modeling was performed in LS-DYNA and LS-OPT (Livermore Software Technology Group) was used for ligament laxity optimization. Ordinate-based curve matching was used to minimize the mean squared error (MSE) between computed load-rotation curves and experimental load-rotation curves under flexion, extension, and axial rotation with pure moment loads from 0 to 3.5 Nm. Lateral bending was excluded from the optimization because the upper cervical spine was considered to be primarily responsible for flexion, extension, and axial rotation. Based on recommendations from the literature, four varying inputs representing laxity in select ligaments were optimized to minimize the MSE. Funding was provided by the Natural Sciences and Engineering Research Council of Canada as well as GHMBC. The present study was funded by the Natural Sciences and Engineering Research Council of Canada to support the work of one graduate student

  18. Resolution of hypothyroidism after correction of somatovisceral reflex dysfunction by refusion of the cervical spine.

    Science.gov (United States)

    Berkowitz, Murray R

    2015-01-01

    Psychosis is a rare initial presentation of new-onset hypothyroidism. The author describes the case of a 29-year-old woman who presented with psychosis caused by hypothyroidism, or myxedema madness. Although the patient's psychosis resolved after standard monotherapy using levothyroxine sodium, her hypothyroidism persisted. Imaging of the patient's cervical spine showed that previous C5-C6 and C6-C7 fusions had failed. The failed fusions were corrected, and the patient's hypothyroidism resolved, suggesting that the somatovisceral reflex was the cause of the patient's hypothyroidism. Although somatovisceral reflex dysfunctions are rare, physicians should consider them as potential underlying causes of their patients' presenting medical conditions. © 2015 The American Osteopathic Association.

  19. Kirschner Wire Migration to the Cervical Spine: A Complication of Clavicular Fixation in a Child

    Directory of Open Access Journals (Sweden)

    KK Tan

    2007-05-01

    Full Text Available We report a case of a broken K-wire migrating to the cervical spine from the right clavicle in a 9-year-old child. The initial diagnosis, fracture of the clavicle with an acromioclavicular joint dislocation, was treated by open reduction and K-wiring. One K-wire broke and migrated to the neck, posterolateral to the C6 vertebra. The K-wire was removed percutaneously under image intensif ication. Acromioclavicular joint dislocation in children is rare since the distal clavicle does not ossify until the age of 18 or 19 years meaning that almost all closed fractures of the clavicle in children can be treated non- operatively.

  20. Kinematic MRI of the cervical spine in patients with degenerative disease

    International Nuclear Information System (INIS)

    Muhle, C.; Wiskirchen, J.; Brinkmann, G.; Falliner, A.; Weinert, D.; Reuter, M.; Heller, M.

    1995-01-01

    Kinematic MRI of the cervical spine was done from 50 of inclination to 30 of reclination. Depending on the maximum inclination and reclination the range of motion was divided into 9 equal angle positions. At each angle position sagittal T 2 ' weighted gradient echo sequences were performed. In relation to the neutral position a physiological narrowing of the ventral epidural space was seen in healthy volunteers at inclination (50 ) in up to 50% and respectively widening at reclination (30 ) in up to 10%. An increase of spinal canal stenosis or even spinal cord compression was seen at inclination in 5 patients (22%) and in 15 patients (65%) at reclination. No change of spinal canal stenosis was found in three patients (13%). (orig./MG) [de

  1. The Clinical Features, Risk Factors, and Surgical Treatment of Cervicogenic Headache in Patients With Cervical Spine Disorders Requiring Surgery.

    Science.gov (United States)

    Shimohata, Keiko; Hasegawa, Kazuhiro; Onodera, Osamu; Nishizawa, Masatoyo; Shimohata, Takayoshi

    2017-07-01

    To clarify the clinical features and risk factors of cervicogenic headache (CEH; as diagnosed according to the International Classification of Headache Disorders-Third Edition beta) in patients with cervical spine disorders requiring surgery. CEH is caused by cervical spine disorders. The pathogenic mechanism of CEH is hypothesized to involve a convergence of the upper cervical afferents from the C1, C2, and C3 spinal nerves and the trigeminal afferents in the trigeminocervical nucleus of the upper cervical cord. According to this hypothesis, functional convergence of the upper cervical and trigeminal sensory pathways allows the bidirectional (afferent and efferent) referral of pain to the occipital, frontal, temporal, and/or orbital regions. Previous prospective studies have reported an 86-88% prevalence of headache in patients with cervical myelopathy or radiculopathy requiring anterior cervical surgery; however, these studies did not diagnose headache according to the International Classification of Headache Disorders criteria. Therefore, a better understanding of the prevalence rate, clinical features, risk factors, and treatment responsiveness of CEH in patients with cervical spine disorders requiring surgery is necessary. We performed a single hospital-based prospective cross-sectional study and enrolled 70 consecutive patients with cervical spine disorders such as cervical spondylotic myelopathy, ossification of the posterior longitudinal ligament, cervical spondylotic radiculopathy, and cervical spondylotic myeloradiculopathy who had been scheduled to undergo anterior cervical fusion or dorsal cervical laminoplasty between June 2014 and December 2015. Headache was diagnosed preoperatively according to the International Classification of Headache Disorders-Third Edition beta. The Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, Neck Disability Index, and a 0-100 mm visual analog scale (VAS) were used to evaluate clinical

  2. Surgical Anatomy of the Longus Colli Muscle and Uncinate Process in the Cervical Spine

    Science.gov (United States)

    Moon, Seong-Hwan; Kim, Tae-Hwan; Oh, Jae Keun; Kim, Hyung Joon; Park, Kun-Tae; Riew, K. Daniel

    2016-01-01

    Purpose There have been a few previous reports regarding the distances between the medial borders of the longus colli to expose the disc space. However, to our knowledge, there are no reports concerning longus colli dissection to expose the uncinate processes. This study was undertaken to assess the surgical relationship between the longus colli muscle and the uncinate process in the cervical spine. Materials and Methods This study included 120 Korean patients randomly selected from 333 who had cervical spine MRIs and CTs from January 2003 to October 2013. They consisted of 60 males and 60 females. Each group was subdivided into six groups by age from 20 to 70 years or more. We measured three parameters on MRIs from C3 to T1: left and right longus colli distance and inter-longus colli distance. We also measured three parameters on CT: left and right uncinate distance and inter-uncinate distance. Results The longus colli distances, uncinate distances, and inter-uncinate distances increased from C3 to T1. The inter-longus colli distances increased from C3 to C7. There was no difference in longus colli distances and uncinate distances between males and females. There was no difference in the six parameters for the different age groups. Conclusion Although approximate guidelines, we recommend the longus colli be dissected approximately 5 mm at C3–5, 6 mm at C5–6, 7 mm at C6–7, and 8 mm at C7–T1 to expose the uncinate process to its lateral edge. PMID:27189293

  3. Are magnetic resonance flexion views useful in evaluating the cervical spine of patients with rheumatoid arthritis?

    Energy Technology Data Exchange (ETDEWEB)

    Reijnierse, M.; Kroon, H.M.; Bloem, J.L. [Dept. of Radiology, Leiden University Medical Center (Netherlands); Breedveld, F.C. [Dept. of Rheumatology, Leiden University Medical Center, Leiden (Netherlands); Hansen, B. [Dept. of Medical Statistics, Leiden University Medical Center, Leiden (Netherlands); Pope, T.L. [Dept. of Diagnostic Radiology, Bowman Gray School of Medicine, Winston-Salem (United States)

    2000-02-01

    Objective. To determine whether MR imaging in flexion adds value relative to imaging in the neutral position with respect to displaying involvement of the subarachnoid space, brainstem and spinal cord. Design and patients. T1-weighted MR images of the cervical spine in 42 rheumatoid arthritis patients with cervical spine involvement were obtained and analyzed prospectively. We assessed changes between images obtained in the neutral position and following active flexion, especially horizontal atlantoaxial and subaxial motion, presence or absence of brainstem compression, subarachnoid space involvement at the atlantoaxial and subaxial level and the cervicomedullary angle. Vertical atlantoaxial subluxation and the amount of pannus were correlated with motion and change in subarachnoid space. Results. The flexion images showed horizontal atlantoaxial motion in 21 patients and subaxial motion in one patient. The flexion view displayed brainstem compression in only one patient. Involvement of the subarachnoid space increased at the atlantoaxial level in eight (19%) patients (P=0.004) and at the level below C2 in five (12%) patients (P=0.03). There were no patients with a normal subarachnoid space in neutral position and compression in the flexed position. The cervicomedullary angle changed significantly with flexion. Vertical atlantoaxial subluxation and the amount of pannus did not show a significant correlation with motion or subarachnoid space involvement. Conclusion. MR imaging in the flexed position shows a statistically significant narrowing of the subarachnoid space at the atlantoaxial level and below C2. Cord compression is only observed on flexion views if the subarachnoid space in neutral position is already decreased. MR imaging in the flexed position might be useful, since subarachnoid space involvement may be an indicator for the development of neurologic dysfunction. (orig.)

  4. The role of B-mode ultrasonography in the musculoskeletal anatomical evaluation of the cervical region of the dog spine

    Directory of Open Access Journals (Sweden)

    Cibely G. Sarto

    2014-01-01

    Full Text Available This study characterized the normal musculoskeletal anatomy of the cervical segment of the spine of dogs by means of B-mode ultrasonography. The objective was to establish the role of B-mode ultrasonography for the anatomical evaluation of the cervical spine segment in dogs, by comparing the ultrasonographic findings with images by computed tomography and magnetic resonance imaging. The ultrasound examination, in transverse and median sagittal sections, allowed to identify a part of the epaxial cervical musculature, the bone surface of the cervical vertebrae and parts of the spinal cord through restricted areas with natural acoustic windows, such as between the atlanto-occipital joint, axis and atlas, and axis and the third cervical vertebra. The images, on transverse and sagittal planes, by low-field magnetic resonance imaging, were superior for the anatomical identification of the structures, due to higher contrast between the different tissues in this modality. Computed tomography showed superiority for bone detailing when compared with ultrasonography. As for magnetic resonance imaging, in addition to the muscles and cervical vertebrae, it is possible to identify the cerebrospinal fluid and differentiate between the nucleus pulposus and annulus fibrosus of the intervertebral discs. Although not the scope of this study, with knowledge of the ultrasonographic anatomy of this region, it is believed that some lesions can be identified, yet in a limited manner, when compared with the information obtained mainly with magnetic resonance imaging. The ultrasound examination presented lower morphology diagnostic value compared with the other modalities.

  5. Tooth agenesis and craniofacial morphology in pre-orthodontic children with and without morphological deviations in the upper cervical spine

    DEFF Research Database (Denmark)

    Jasemi, Ashkan; Sonnesen, Liselotte

    2016-01-01

    AIM: To analyze differences in prevalence and pattern of tooth agenesis and craniofacial morphology between non syndromic children with tooth agenesis with and without upper cervical spine morphological deviations and to analyze associations between craniofacial morphology and tooth agenesis...... in the two groups together. METHODS: One hundred and twenty-six pre-orthodontic children with tooth agenesis were divided into two groups with (19 children, mean age 11.9) and without (107 children, mean age 11.4) upper spine morphological deviations. Visual assessment of upper spine morphology...... and measurements of craniofacial morphology were performed on lateral cephalograms. Tooth agenesis was evaluated from orthopantomograms. RESULTS: No significant differences in tooth agenesis and craniofacial morphology were found between children with and without upper spine morphological deviations (2.2 ± 1.6 vs...

  6. Radiographic analysis of the correlation between ossification of the nuchal ligament and sagittal alignment and segmental stability of the cervical spine in patients with cervical spondylotic myelopathy.

    Science.gov (United States)

    Ying, Jinwei; Teng, Honglin; Qian, Yunfan; Hu, Yingying; Wen, Tianyong; Ruan, Dike; Zhu, Minyu

    2018-01-01

    Background Ossification of the nuchal ligament (ONL) caused by chronic injury to the nuchal ligament (NL) is very common in instability-related cervical disorders. Purpose To determine possible correlations between ONL, sagittal alignment, and segmental stability of the cervical spine. Material and Methods Seventy-three patients with cervical spondylotic myelopathy (CSM) and ONL (ONL group) and 118 patients with CSM only (control group) were recruited. Radiographic data included the characteristics of ONL, sagittal alignment and segmental stability, and ossification of the posterior longitudinal ligament (OPLL). We performed comparisons in terms of radiographic parameters between the ONL and control groups. The correlations between ONL size, cervical sagittal alignment, and segmental stability were analyzed. Multivariate logistic regression was used to identify the independent risk factors of the development of ONL. Results C2-C7 sagittal vertical axis (SVA), T1 slope (T1S), T1S minus cervical lordosis (T1S-CL) on the lateral plain, angular displacement (AD), and horizontal displacement (HD) on the dynamic radiograph increased significantly in the ONL group compared with the control group. The size of ONL significantly correlated with C2-C7 SVA, T1S, AD, and HD. The incidence of ONL was higher in patients with OPLL and segmental instability. Cervical instability, sagittal malalignment, and OPLL were independent predictors of the development of ONL through multivariate analysis. Conclusion Patients with ONL are more likely to have abnormal sagittal alignment and instability of the cervical spine. Thus, increased awareness and appreciation of this often-overlooked radiographic finding is warranted during diagnosis and treatment of instability-related cervical pathologies and injuries.

  7. Delayed Esophageal Pseudodiverticulum after Anterior Cervical Spine Fixation: Report of 2 Cases

    Directory of Open Access Journals (Sweden)

    Ali Sadrizadeh

    2015-03-01

    Full Text Available Introduction: Although perforation of the esophagus, in the anterior cervical spine fixation, is well established, cases with delayed onset, especially cases that present pseudodiverticulum, are not common. In addition, management of the perforation in this situation is debated.  Case Report:   Delayed esophageal pseudodiverticulum was managed in two patients with a history of anterior spine fixation. Patients were operated on, the loose plate and screws were extracted, the wall of the diverticulum was excised, the perforation on the nasogastric tube was suboptimally repaired, and a closed suction drain was placed there. The NGT was removed on the 7th day and barium swallow demonstrated no leakage at the operation site; therefore, oral feeding was started without any problem.  Conclusion:  In cases with delayed perforation, fistula, or diverticulum removal of anterior fixation instruments, gentle repair of the esophageal wall without persistence on definitive and optimal perforation closure, wide local drainage, early enteral nutrition via NGT, and antibiotic prescription is suggested.

  8. Prospective Validation of Modified NEXUS Cervical Spine Injury Criteria in Low-risk Elderly Fall Patients

    Directory of Open Access Journals (Sweden)

    John Tran

    2016-05-01

    Full Text Available Introduction: The National Emergency X-radiography Utilization Study (NEXUS criteria are used extensively in emergency departments to rule out C-spine injuries (CSI in the general population. Although the NEXUS validation set included 2,943 elderly patients, multiple case reports and the Canadian C-Spine Rules question the validity of applying NEXUS to geriatric populations. The objective of this study was to validate a modified NEXUS criteria in a low-risk elderly fall population with two changes: a modified definition for distracting injury and the definition of normal mentation. Methods: This is a prospective, observational cohort study of geriatric fall patients who presented to a Level I trauma center and were not triaged to the trauma bay. Providers enrolled non-intoxicated patients at baseline mental status with no lateralizing neurologic deficits. They recorded midline neck tenderness, signs of trauma, and presence of other distracting injury. Results: We enrolled 800 patients. One patient fall event was excluded due to duplicate enrollment, and four were lost to follow up, leaving 795 for analysis. Average age was 83.6 (range 65-101. The numbers in parenthesis after the negative predictive value represent confidence interval. There were 11 (1.4% cervical spine injuries. One hundred seventeen patients had midline tenderness and seven of these had CSI; 366 patients had signs of trauma to the face/neck, and 10 of these patients had CSI. Using signs of trauma to the head/neck as the only distracting injury and baseline mental status as normal alertness, the modified NEXUS criteria was 100% sensitive (CI [67.9-100] with a negative predictive value of 100 (98.7-100. Conclusion: Our study suggests that a modified NEXUS criteria can be safely applied to low-risk elderly falls.

  9. Prospective Validation of Modified NEXUS Cervical Spine Injury Criteria in Low-risk Elderly Fall Patients.

    Science.gov (United States)

    Tran, John; Jeanmonod, Donald; Agresti, Darin; Hamden, Khalief; Jeanmonod, Rebecca K

    2016-05-01

    The National Emergency X-radiography Utilization Study (NEXUS) criteria are used extensively in emergency departments to rule out C-spine injuries (CSI) in the general population. Although the NEXUS validation set included 2,943 elderly patients, multiple case reports and the Canadian C-Spine Rules question the validity of applying NEXUS to geriatric populations. The objective of this study was to validate a modified NEXUS criteria in a low-risk elderly fall population with two changes: a modified definition for distracting injury and the definition of normal mentation. This is a prospective, observational cohort study of geriatric fall patients who presented to a Level I trauma center and were not triaged to the trauma bay. Providers enrolled non-intoxicated patients at baseline mental status with no lateralizing neurologic deficits. They recorded midline neck tenderness, signs of trauma, and presence of other distracting injury. We enrolled 800 patients. One patient fall event was excluded due to duplicate enrollment, and four were lost to follow up, leaving 795 for analysis. Average age was 83.6 (range 65-101). The numbers in parenthesis after the negative predictive value represent confidence interval. There were 11 (1.4%) cervical spine injuries. One hundred seventeen patients had midline tenderness and seven of these had CSI; 366 patients had signs of trauma to the face/neck, and 10 of these patients had CSI. Using signs of trauma to the head/neck as the only distracting injury and baseline mental status as normal alertness, the modified NEXUS criteria was 100% sensitive (CI [67.9-100]) with a negative predictive value of 100 (98.7-100). Our study suggests that a modified NEXUS criteria can be safely applied to low-risk elderly falls.

  10. "White Cord Syndrome" of Acute Hemiparesis After Posterior Cervical Decompression and Fusion for Chronic Cervical Stenosis.

    Science.gov (United States)

    Antwi, Prince; Grant, Ryan; Kuzmik, Gregory; Abbed, Khalid

    2018-05-01

    "White cord syndrome" is a very rare condition thought to be due to acute reperfusion of chronically ischemic areas of the spinal cord. Its hallmark is the presence of intramedullary hyperintense signal on T2-weighted magnetic resonance imaging sequences in a patient with unexplained neurologic deficits following spinal cord decompression surgery. The syndrome is rare and has been reported previously in 2 patients following anterior cervical decompression and fusion. We report an additional case of this complication. A 68-year-old man developed acute left-sided hemiparesis after posterior cervical decompression and fusion for cervical spondylotic myelopathy. The patient improved with high-dose steroid therapy. The rare white cord syndrome following either anterior cervical decompression and fusion or posterior cervical decompression and fusion may be due to ischemic-reperfusion injury sustained by chronically compressed parts of the spinal cord. In previous reports, patients have improved following steroid therapy and acute rehabilitation. Copyright © 2018 Elsevier Inc. All rights reserved.

  11. Cine phase-contrast MRI measurement of CSF flow in the cervical spine: a pilot study in patients with spinal cord injury

    Science.gov (United States)

    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.

  12. Association between cervical spine and skull-base fractures and blunt cerebrovascular injury

    Energy Technology Data Exchange (ETDEWEB)

    Buch, Karen; Nguyen, Thanh; Norbash, Alex; Mian, Asim [Boston University School of Medicine, Department of Radiology, Boston Medical Center, Boston, MA (United States); Mahoney, Eric; Burke, Peter [Boston University School of Medicine, Department of Surgery, Boston Medical Center, Boston, MA (United States); Libby, Brandon; Calner, Paul [Boston University School of Medicine, Department of Emergency Medicine, Boston Medical Center, Boston, MA (United States)

    2016-02-15

    Blunt cerebrovascular injuries (BCVI) are associated with high morbidity and mortality and can lead to neurological deficits. The established criteria for patients undergoing CT angiography (CTA) for BCVI are broad, and can expose patients to radiation unnecessarily. This study aimed to examine the prevalence of BCVI in patients on CTA and determine presentations associated with the highest rates of BCVI. With IRB approval, patients were selected for CTA screening for BCVI according to a predefined set of criteria at our hospital between 2007 and 2010. Patients were identified from our institution's trauma database. CTAs were retrospectively reviewed for BCVI including vasospasm and dissection. Electronic medical records were reviewed for clinical presentation and hospital course. Of 432 patients, vasospasm (n = 10) and/or dissection (n = 36) were found in 46 patients (10.6 %). BCVI was associated with cervical spine and/or skull-base fracture in 40/46 patients (87 %, P < 0.0001). Significant correlations were seen between dissection and fracture in 31/36 patients (86.2 %, p < 0.0001) and between BCVI and both neurological deficits and fractures (27/44, P < 0.0001). BCVI was significantly associated with cervical and/or skullbase fractures and neurological deficits with coexistent fractures. Patients with these injuries should be prioritized for rapid CTA evaluation for BCVI. (orig.)

  13. Radiographic measurement of the cervical spine in patients with temporomandibular dysfunction.

    Science.gov (United States)

    de Farias Neto, Jader Pereira; de Santana, Josimari Melo; de Santana-Filho, Valter Joviniano; Quintans-Junior, Lucindo José; de Lima Ferreira, Ana Paula; Bonjardim, Leonardo Rigoldi

    2010-09-01

    To compare the craniocervical angles and distances between temporomandibular dysfunction (TMD) and free TMD subjects. The sample consisted of young adults, of both genders, with age ranging between 18 and 30 years. TMD diagnosis was based on the clinical criteria of the Research Diagnostic Criteria for TMD (RDC/TMD), associated with self-reported symptoms of TMD. For radiological analysis we measured three angles and two distances of craniocervical region. Of the 56 subjects, only 23 completed all stages of research, which were divided into two groups: (1) free TMD group - composed of 11 individuals; (2) TMD group - constituted of 12 subjects. The most common clinical diagnosis of TMD was arthralgia (75.0%) followed by myofascial pain without limited mouth opening (58.4%). Among the self-reported symptoms of TMD, the most frequents were facial (83.4%) and neck (66.6%) pain. Of radiological measurement, only plane atlas angle (APA) (p=0.026) and anterior translation distance (Tz C(2)-C(7)) (p=0.045) showed statistical difference between groups TMD (APA=16.7+/-1.63; Tz C(2)-C(7)=28.7+/-2.58) and free TMD (APA=21.64+/-1.24; Tz C(2)-C(7)=19.82+/-3.29). It could be verified that the symptomatic TMD patients presented a flexion of the first cervical vertebra associated with an anteriorization of the cervical spine (hyperlordosis). Copyright 2010 Elsevier Ltd. All rights reserved.

  14. Treatment of hematomas after anterior cervical spine surgery: A retrospective study of 15 cases.

    Science.gov (United States)

    Miao, Weiliang; Ma, Xiaojun; Liang, Deyong; Sun, Yu

    2018-05-04

    Postoperative hematoma is a rare and dangerous complication of cervical spine surgery. The aim of this study was to investigate the incidence and related factors of postoperative hematoma, and to report on 15 cases at our institution over a 6-year period. Fifteen cases of postoperative hematoma were retrospectively identified. We investigated their neurological outcomes, characteristics, and surgical data, and identified risk factors associated with postoperative (PO) hematoma. Patients with hematoma were compared to those with no hematoma, in order to identify risk factors. Retropharyngeal hematomas developed in seven cases and epidural hematomas in eight. The total incidence of postoperative hematoma was 1.2%: 0.5% retropharyngeal hematomas and 0.6% spinal epidural hematomas. At time of onset, the severity of paralysis was assessed as grade B in one case, grade C in six cases, and grade D in eight cases. Risk factors for PO hematoma were: (1) presence of ossification of the posterior longitudinal ligament (OPLL) (Phematoma group and non-hematoma group (P>0.05). Precise preoperative preparation and systematic evaluation are central to successful management of PO hematoma after anterior cervical surgery. Risk factors for PO hematoma include multilevel decompression, OPLL, higher BMI, and longer operation time. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  15. Imaging suspected cervical spine injury: Plain radiography or computed tomography? Systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Cain, Gavin [Diagnostic Radiographer, Colchester Hospital University NHS Foundation Trust, Colchester General Hospital, Turner Road, Colchester, CO4 5JL Essex (United Kingdom)], E-mail: gavincain8@hotmail.com; Shepherdson, Jane; Elliott, Vicki; Svensson, Jon [Faculty of Health and Social Care, Anglia Ruskin University, East Road, Cambridge, CB1 9PT Cambridgeshire (United Kingdom); Brennan, Patrick [UCD School of Medicine and Medical Sciences, Health Science Building, Belfield, Dublin 4 (Ireland)

    2010-02-15

    Aim: (1) to establish which modality offers the greatest accuracy in the detection of cervical spine injury (CSI) Following trauma: plain radiography or computed tomography (CT), and (2) make an evidence-based recommendation for the initial imaging modality of choice. Method: A systematic literature review was performed to identify primary research studies which compare the diagnostic accuracy of plain radiography and CT with the results of a reference standard in the detection of CSI. A search of MEDLINE, EMBASE, CINAHL, Science Direct and Pubmed Central databases was conducted. Results: Ten studies were identified. Critical appraisal identified limitations among all studies. There was heterogeneity in the sensitivity estimates for plain radiography, whereas estimates for CT were consistently high. Examination of the reported sensitivities shows that CT outperforms plain radiography in the detection of CSI. Conclusion: CT is superior to plain radiography in the detection of CSI. However, the optimal imaging strategy depends on the patients' relative risk of injury. If at high-risk cervical CT is indicated. If at low-risk the increased cost and radiation exposure mean that screening CT may not be warranted, good-quality plain radiographs are sufficient.

  16. Utility of plain radiographs and MRI in cervical spine clearance in symptomatic non-obtunded pediatric patients without high-impact trauma.

    Science.gov (United States)

    Moore, Justin M; Hall, Jonathan; Ditchfield, Michael; Xenos, Christopher; Danks, Andrew

    2017-02-01

    The optimal imaging modality for evaluating cervical spine trauma and optimizing management in the pediatric population is controversial. In pediatric populations, there are no well-established guidelines for cervical spine trauma evaluation and treatment. Currently, there is virtually no literature regarding imaging and management of symptomatic pediatric patients who present with cervical spine trauma without high-impact mechanism. This study aims to establish an optimal imaging strategy for this subgroup of trauma patients. We performed a retrospective review of pediatric patients (aged below 18 years) who were admitted to Monash Medical Centre, Melbourne, Australia between July 2011 and June 2015, who did not suffer a high-impact trauma but were symptomatic for cervical spine injury following cervical trauma. Imaging and management strategies were reviewed and results compared. Forty-seven pediatric patients were identified who met the inclusion criteria. Of these patients, 46 underwent cervical spine series (CSS) plain radiograph imaging. Thirty-four cases underwent magnetic resonance imaging (MRI) and 9 patients underwent CT. MRI was able to detect 4 cases of ligamentous injury, which were not seen in CSS imaging and was able to facilitate cervical spine clearance in a further two patients whose CSS radiographs were abnormal. In this study, MRI has a greater sensitivity and specificity when compared to CSS radiography in a symptomatic pediatric low-impact trauma population. Our data call in to question the routine use of CSS radiographs in children.

  17. induced acute cytotoxicity in human cervical epithelial carcinoma cells

    African Journals Online (AJOL)

    Molecular basis of arsenite (As +3 )-induced acute cytotoxicity in human cervical epithelial carcinoma cells. ... Libyan Journal of Medicine ... Methods: After performing cytotoxic assays on a human epithelial carcinoma cell line, expression analysis was done by quantitative polymerase chain reaction, western blotting, and ...

  18. Does the mesodermal derangement in Chiari Type I malformation extend to the cervical spine? Evidence from an analytical morphometric study on cervical paraspinal muscles.

    Science.gov (United States)

    Thakar, Sumit; Kurudi Siddappa, Avinash; Aryan, Saritha; Mohan, Dilip; Sai Kiran, Narayanam Anantha; Hegde, Alangar S

    2017-10-01

    OBJECTIVE The mesodermal derangement in Chiari Type I malformation (CMI) has been postulated to encompass the cervical spine. The objectives of this study were to assess the cross-sectional areas (CSAs) of cervical paraspinal muscles (PSMs) in patients with CMI without syringomyelia, compare them with those in non-CMI subjects, and evaluate their correlations with various factors. METHODS In this retrospective study, the CSAs of cervical PSMs in 25 patients were calculated on T2-weighted axial MR images and computed as ratios with respect to the corresponding vertebral body areas. These values and the cervical taper ratios were then compared with those of age- and sex-matched non-CMI subjects and analyzed with respect to demographic data and clinicoradiological factors. RESULTS Compared with the non-CMI group, the mean CSA values for the rectus capitis minor and all of the subaxial PSMs were lower in the study group, and those of the deep extensors were significantly lower (p = 0.004). The cervical taper ratio was found to be significantly higher in the study cohort (p = 0.0003). A longer duration of symptoms and a steeper cervical taper ratio were independently associated with lower CSA values for the deep extensors (p = 0.04 and p = 0.03, respectively). The presence of neck pain was associated with a lower CSA value for the deep flexors (p = 0.03). CONCLUSIONS Patients with CMI demonstrate alterations in their cervical paraspinal musculature even in the absence of coexistent syringomyelia. Their deep extensor muscles undergo significant atrophic changes that worsen with the duration of their symptoms. This could be related to a significantly steeper cervical taper ratio that their cervical cords are exposed to. Neck pain in these patients is related to atrophy of their deep flexor muscles. A steeper cervical taper ratio and alterations in the PSMs could be additional indicators for surgery in patients with CMI without syringomyelia.

  19. Interaction of demographic factors with the results of the surgery for degenerative disease of the cervical spine: a retrospective evaluation

    Directory of Open Access Journals (Sweden)

    Celso Garreta Prats Dias

    Full Text Available ABSTRACT Objective: Degenerative disease of the cervical spine is a frequent source of intermittent neck pain, where the predominant symptom is axial neck pain. The indications for surgical treatment are reserved for the cases where the conservative treatment has not relieved the symptoms or the patient presents progressive neurological impairment. The objective of this study was to evaluate the prognostic factors involved in patients submitted to surgical treatment of the cervical spine, Methods: The study analyzed data from patients submitted to cervical spine surgery between July 2011 and November 2015 (n= 58. The evaluated data included smoking habits, hypertension, diabetes, overweight, surgical technique, and number of levels of fusion. The primary outcome was defined as pain and the secondary outcomes were quality of life and disability., Results: A statistically significant difference was found between baseline and the 12-month post-operative results regarding pain in favor of non-hypertensive patients (p= 0.009 and discectomy plus instrumentation (, p= 0.004. There was also significant difference between the results of neck disability in favor of non-hypertensive patients (p= 0.028 and patients with body mass index lower than 25, kg/m2 (p= 0.005. There was no significant interaction between any analyzed data and the quality of life score results. Conclusions: Non-hypertensive patients, those with body mass index lower than 25 kg/m2, and those submitted to discectomy combined with arthrodesis of the cervical spine are the most benefited by cervical degenerative disease surgery.

  20. Interaction of demographic factors with the results of the surgery for degenerative disease of the cervical spine: a retrospective evaluation.

    Science.gov (United States)

    Dias, Celso Garreta Prats; Roberto, Bruno Braga; Basaglia, Lucas; Lenza, Mario; Nicolau, Rodrigo Junqueira; Ferretti, Mario

    2017-01-01

    Degenerative disease of the cervical spine is a frequent source of intermittent neck pain, where the predominant symptom is axial neck pain. The indications for surgical treatment are reserved for the cases where the conservative treatment has not relieved the symptoms or the patient presents progressive neurological impairment. The objective of this study was to evaluate the prognostic factors involved in patients submitted to surgical treatment of the cervical spine. The study analyzed data from patients submitted to cervical spine surgery between July 2011 and November 2015 ( n  = 58). The evaluated data included smoking habits, hypertension, diabetes, overweight, surgical technique, and number of levels of fusion. The primary outcome was defined as pain and the secondary outcomes were quality of life and disability. A statistically significant difference was found between baseline and the 12-month post-operative results regarding pain in favor of non-hypertensive patients ( p  = 0.009) and discectomy plus instrumentation ( p  = 0.004). There was also significant difference between the results of neck disability in favor of non-hypertensive patients ( p  = 0.028) and patients with body mass index lower than 25 kg/m 2 ( p  = 0.005). There was no significant interaction between any analyzed data and the quality of life score results. Non-hypertensive patients, those with body mass index lower than 25 kg/m 2 , and those submitted to discectomy combined with arthrodesis of the cervical spine are the most benefited by cervical degenerative disease surgery.

  1. Cervical spine disease may result in a negative lumbar spinal drainage trial in normal pressure hydrocephalus: case report.

    Science.gov (United States)

    Komotar, Ricardo J; Zacharia, Brad E; Mocco, J; Kaiser, Michael G; Frucht, Stephen J; McKhann, Guy M

    2008-10-01

    In this case report, we present a patient with normal pressure hydrocephalus in whom a lumbar drainage trial yielded a false-negative result secondary to cervical spondylosis. An 80-year-old woman presented with classic symptoms of normal pressure hydrocephalus as well as evidence of cervical myelopathy. Magnetic resonance imaging of the brain and spine showed enlarged ventricles and single-level cervical canal narrowing. An initial lumbar drainage trial was performed, which revealed negative results. The patient then underwent cervical decompression and fusion. Despite this procedure, the patient's symptoms continued to worsen. A repeat lumbar drainage trial was performed with positive results. Subsequently, a ventriculoperitoneal shunt was placed, resulting in significant improvement of her symptoms. This case report illustrates how altered cerebrospinal fluid flow dynamics may impact the accuracy of the lumbar spinal drainage trial in patients with normal pressure hydrocephalus.

  2. C-MAC compared with direct laryngoscopy for intubation in patients with cervical spine immobilization: A manikin trial.

    Science.gov (United States)

    Smereka, Jacek; Ladny, Jerzy R; Naylor, Amanda; Ruetzler, Kurt; Szarpak, Lukasz

    2017-08-01

    The aim of this study was to compare C-MAC videolaryngoscopy with direct laryngoscopy for intubation in simulated cervical spine immobilization conditions. The study was designed as a prospective randomized crossover manikin trial. 70 paramedics with immobilization (Scenario A); manual inline cervical immobilization (Scenario B); cervical immobilization using cervical extraction collar (Scenario C). Scenario A: Nearly all participants performed successful intubations with both MAC and C-MAC on the first attempt (95.7% MAC vs. 100% C-MAC), with similar intubation times (16.5s MAC vs. 18s C-MAC). Scenario B: The results with C-MAC were significantly better than those with MAC (pimmobilization. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2016-03-14

    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. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

  4. The effect of ergonomics in dentistry on the occurrence of pain in the cervical neck region of the spine

    Directory of Open Access Journals (Sweden)

    Jędrzej Płocki

    2015-03-01

    Full Text Available Introduction: The problem of health risks resulting from the performance of the occupation of a dentist concerns, among other things, the cervical region of the spine. Due to the position assumed at work, this part of the spine is overloaded, and the degree of this overload depends, among other things, on the technique used by a dentist, the ergonomic conditions, patient adaptation skills, and cooperation with an assistant or assistants. Aim of the research : The objective of the study was to obtain an answer to the research questions posed: whether dentists possess knowledge concerning the principles of ergonomics; is there any relationship between the period of employment and cervical spine pain, age, technique of work, duration of performing work during the week, and pain in the neck region; and if dentists attach importance to the prophylaxis of musculoskeletal disorders. Material and methods : The study covered 52 dentists – 33 females (63.5% and 19 males (36.5%, and was conducted using an anonymous questionnaire designed by the authors, the Visual Analogue Scale (VAS, a modified pain assessment questionnaire according to Laitinen, and methods of descriptive statistics (Pearson’s χ 2 test for independence. Results : Physicians possess knowledge concerning the ergonomics of work. In addition, more than 60% of respondents possess modern, electrically adjustable equipment, and the technique of work depends on the age of the dentist. There is a relationship between cervical spine pain and the duration of performance of the occupation (p = 0.01122. According to dentists (48.1%, pain in the neck region of the spine is caused by long-lasting maintenance of a static position of the body, and kinesitherapeutic exercises alleviate these complaints in 23.1% of respondents. Conclusions : Despite the use the principles of ergonomics at work, dentists are exposed to the occurrence of pain in the neck region of the spine.

  5. Study on pedicle screw fixation of cervical spine assisted CT-based navigation system compared with the individual cervical peddle screws placement technique

    International Nuclear Information System (INIS)

    He Xishun; Yang Huilin; Zhu Ruofu; Tan Xiangqi; Wang Genlin; Tang Tiansi

    2008-01-01

    Objective: To explore a safe and effective method for placing the cervical pedicle screws. Methods: There were ten adult cadaver specimens of cervica spine (C 1 -C 7 ) with intact structures including ligament and perivertebral muscles. The spiral computed tomography scan (Elscint CT Twin flash) at the section of 1 mm and three-dimensional reconstruction of all 10 cervical specimens were taken. By CT scan, the parameters of the cervical pedicles were measure,Then taking randomly 5 cervical specimens, according to the CT measurements, an appropriate screw was inserted into pedicle individually. In the other 5 human cadaver cervical vertebraes, Φ3.5 mm screws were inserted into the C 2 -C 7 pedicles by assisted by CT-based navigation system. Cortical integrity of every sample was examined by anatomic dissection, the spiral computed tomography scan and arrows,and coronal reconstruction. Results: Sixty screws was inserted into pedicle individually, and the achievement ratio was 90%, the perfectness ratio was 75%, 60 screws was placed into pedicle assisted by CT-based navigation system, and the achievement ratio was 96.6%, the perfectness ratio was 90%. By chi-square test for statistical analysis, there were no statistical significance between the accuracy rate of two methods(P>0.05). However there was statistical significance between the perfectness ratio between two methods(P<0.05). Conclusion: Compared with the individual cervical peddle screws placement technique, the perfectness ratio of pedicle screw fixation of cervical spine assisted by CT-based navigation system is higher, but there are no significant difference in accuracy. (authors)

  6. Image analysis of open-door laminoplasty for cervical spondylotic myelopathy: comparing the influence of cord morphology and spine alignment.

    Science.gov (United States)

    Lin, Bon-Jour; Lin, Meng-Chi; Lin, Chin; Lee, Meei-Shyuan; Feng, Shao-Wei; Ju, Da-Tong; Ma, Hsin-I; Liu, Ming-Ying; Hueng, Dueng-Yuan

    2015-10-01

    Previous studies have identified the factors affecting the surgical outcome of cervical spondylotic myelopathy (CSM) following laminoplasty. Nonetheless, the effect of these factors remains controversial. It is unknown about the association between pre-operative cervical spinal cord morphology and post-operative imaging result following laminoplasty. The goal of this study is to analyze the impact of pre-operative cervical spinal cord morphology on post-operative imaging in patients with CSM. Twenty-six patients with CSM undergoing open-door laminoplasty were classified according to pre-operative cervical spine bony alignment and cervical spinal cord morphology, and the results were evaluated in terms of post-operative spinal cord posterior drift, and post-operative expansion of the antero-posterior dura diameter. By the result of study, pre-operative spinal cord morphology was an effective classification in predicting surgical outcome - patients with anterior convexity type, description of cervical spinal cord morphology, had more spinal cord posterior migration than those with neutral or posterior convexity type after open-door laminoplasty. Otherwise, the interesting finding was that cervical spine Cobb's angle had an impact on post-operative spinal cord posterior drift in patients with neutral or posterior convexity type spinal cord morphology - the degree of kyphosis was inversely proportional to the distance of post-operative spinal cord posterior drift, but not in the anterior convexity type. These findings supported that pre-operative cervical spinal cord morphology may be used as screening for patients undergoing laminoplasty. Patients having neutral or posterior convexity type spinal cord morphology accompanied with kyphotic deformity were not suitable candidates for laminoplasty. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Effects of dual-task conditions on cervical spine movement variability.

    Science.gov (United States)

    Niederer, Daniel; Vogt, Lutz; Vogel, Johanna; Banzer, Winfried

    2017-09-22

    The potential to accurately perform cervical movements during more challenging tasks might be of importance to prevent dysfunctional motion characteristics. Although sensorimotor function during dual-task conditions are of increasing interest in biomedical and rehabilitation research, effects of such conditions on movement consistency of the neck have not yet been investigated. In this crossover MiSpEx(Medicine in Spine Exercise)-diagnostic study, we aimed to explore differences between single and dual-task conditions on cervical movement variability. Nineteen healthy participants (9 male; 24.5 ± 3.3 y) performed 10 repetitive maximal cervical movements in (1) flexion/extension and (2) lateral flexion, during one single- and during two dual-task test conditions (cognitive, motor) in a randomised and cross-over sequence. Latter consisted of a working memory n-back task (n= 2) and a repetitive ankle movement task. Range of motion (RoM) was assessed using an external three-dimensional ultrasonic movement analysis system. Coefficient of variation (CV) for repetitive RoM was analysed for differences between conditions and controlled for variances in intra-individual movement characteristics. Friedman and post-hoc Bonferroni-adjusted confidence intervals for differences from single- to dual-task values revealed changes in CV in flexion/extension from single-task to motor dual-task (+0.02 ± 0.02 (97.5%CI: 0.01; 0.03); pdual-task condition (+0.01 ± 0.02 (97.5%CI: 0.003; 0.02)) nor for lateral flexion (p> 0.05). Pearson regression analyses revealed a linear negative (pdual-task (R=2 0.55). Results for lateral flexion are comparable, baseline CV negatively impacts differences to cognitive (R=2 0.2) and motor dual-task performance (R=2 0.76; pdual-task conditions while participants with a higher variability remained almost stable or showed a decrease. The results point toward a complex interrelationship of motion patterns and adaptation processes during challenging tasks

  8. [Clinical observation on improvement of motion range of cervical spine of patients with cervical spondylotic radiculopathy treated with rotation-traction manipulation and neck pain particles and cervical neck pain rehabilitation exercises].

    Science.gov (United States)

    Zhen, Peng-Chao; Zhu, Li-Guo; Gao, Jing-Hua; Yu, Jie; Feng, Min-Shan; Wei, Xu; Wang, Shang-Quan

    2010-10-01

    To observe the effects of two different therapies on patients whose cervical function were restricted due to cervical spondylotic radiculopathy. Form April 2008 to October 2009, 71 cases with cervical spondylotic radiculopathy were divided into group A (36 cases) and group B (35 cases). Among them, 22 cases were male and 49 cases were female, ranging in age form 45 to 65 years with an average of 52.27 years, course of disease was from 3 days to 5 years. The patients in group A were treated with rotation-traction manipulation, neck pain particles and cervical rehabilitation exercises; and the patients in group B were treated with cervical traction, Diclofenac sodium sustained release tablets and wearing neck collar. Theapeutic time was two weeks. The cervical anteflexion, extension, left and right lateral bending, left and right rotative activity were measured by helmet-style activities instrument before and after treatment (at the 1, 3, 5, 7, 9, 11, 13 days and 1 month after treatment respectively). There were no difference between two groups in cervical activity in all directions before treatment (P > 0.05). Compared with the beginning, cervical anteflexion and extension showed significant difference at the 5th day after treatment in group A (P cervical anteflexion showed significant difference at the 13th day after treatment (P 0.05); cervical extension showed significant difference at the 7th day after treatment compared with the beginning (P cervical anteflexion, left and right lateral bending, left and right rotative activity showed significant difference at the 1 month after treatment (P pain particles and cervical rehabilitation exercises in treating cervicalspondylotic radiculopathy have quick effect to improve the activities of cervical anteflexion, extension, left lateral bending, and have durable effect to improve the activities of cervical spine in all directions.

  9. Selenium-based digital radiography of the cervical spine. Comparison with screen-film radiography for the depiction of anatomic details

    International Nuclear Information System (INIS)

    Ludwig, K.; Diederich, S.; Wormanns, D.; Link, T.M.; Lenzen, H.; Heindel, W.

    2002-01-01

    Purpose: To compare selenium-based digital radiography with conventional screen-film radiography of the cervical spine. Materials and Methods: In a prospective study X-ray images of the cervical spine were obtained in 25 patients using selenium-based digital radiography and conventional screen-film radiography. All images were clinically indicated. Selenium-based digital radiography and conventional screen-film radiography were used in a randomized order. Four radiologists independently evaluated all 50 examinations for the visibility of 76 anatomic details according to a five-level confidence scale (1=not visible, 5=very good visibility). From the evaluation of these anatomic details scores for the upper and middle cervical spine, the cervicothoracic junction and the cervical soft tissues were calculated. The scores for selenium-based digital radiography and conventional screen-film radiography were compared using Wilcoxon's signed rank test. Results: From a total of 15,200 observations (608 per patient) the following scores were calculated for selenium-based digital radiography and for screen-film radiography, respectively: Upper cervical spine 3.88 and 3.94; middle cervical spine 4.60 and 4.48; cervico-thoracic junction 3.64 and 2.62; cervical soft tissue 4.47 and 3.46. The differences between the last two scores were statistically significant (p [de

  10. Longitudinal study of acute haematologic toxicity in cervical cancer patients treated with chemoradiotherapy

    International Nuclear Information System (INIS)

    Zhu, He; Zakeri, Kaveh; Carmona, Ruben; Dadachanji, Kaivan K.; Yashar, Catheryn M.; Mell, Loren K.; Vaida, Florin; Bair, Ryan; Aydogan, Bulent; Hasan, Yasmin

    2015-01-01

    Acute hematologic toxicity (HT) limits optimal delivery of concurrent chemoradiotherapy (CRT) for patients with pelvic malignancies. We tested the hypothesis that pelvic bone marrow (PBM) dose-volume metrics were associated with weekly reductions in peripheral blood cell counts in cervical cancer patients undergoing CRT. We included 102 cervical cancer patients treated with concurrent cisplatin (40 mg/m2/week) and pelvic radiotherapy treated at three US centres. No patient received granulocyte-monocyte colony stimulating factor (GM-CSF) or platelet transfusions. Using linear-mixed effects modelling, we analysed weekly reductions in log-transformed peripheral blood cell counts as a function of time (weeks), mean PBM dose and the PBM volume receiving ≥10 Gy (V 10 ), 20 Gy (V 20 ), 30 Gy (V 30 ) and 40 Gy (V 40 ). Increases in mean PBM radiation dose, V 20 , V 30 and V 40 were all significantly associated with a greater weekly reduction in white blood cell (WBC) and absolute neutrophil counts (ANCs). We estimated that with every 1 Gy increase in mean PBM dose, ln(ANC) was reduced by 9.6/μL per week (95% confidence interval, 1.9–17.3, P = 0.015). Subregion analysis also identified significant associations between weekly reductions in ln(WBC) and ln(ANC) within lumbosacral spine, ischium and proximal femora, as opposed to ilium. PBM radiation dose-volume metrics are significantly associated with weekly reductions in peripheral blood cell counts in cervical cancer patients undergoing CRT, particularly within the lower pelvis and lumbosacral spine.

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

    Directory of Open Access Journals (Sweden)

    Hartwig Erich

    2009-03-01

    Full Text Available Abstract Background The predictive value of trauma impact for the severity of whiplash injuries has mainly been investigated in sled- and crash-test studies. However, very little data exist for real-life accidents. Therefore, the predictive value of the trauma impact as assessed by the change in velocity of the car due to the collision (ΔV for the resulting cervical spine injuries were investigated in 57 cases after real-life car accidents. Methods ΔV was determined for every car and clinical findings related to the cervical spine were assessed and classified according to the Quebec Task Force (QTF. Results In our study, 32 (56% subjects did not complain about symptoms and were therefore classified as QTF grade 0; 25 (44% patients complained of neck pain: 8 (14% were classified as QTF grade I, 6 (10% as QTF grade II, and 11 (19% as QTF grade IV. Only a slight correlation (r = 0.55 was found between the reported pain and ΔV. No relevant correlation was found between ΔV and the neck disability index (r = 0.46 and between ΔV and the QTF grade (r = 0.45 for any of the collision types. There was no ΔV threshold associated with acceptable sensitivity and specificity for the prognosis of a cervical spine injury. Conclusion The results of this study indicate that ΔV is not a conclusive predictor for cervical spine injury in real-life motor vehicle accidents. This is of importance for surgeons involved in medicolegal expertise jobs as well as patients who suffer from whiplash-associated disorders (WADs after motor vehicle accidents. Trial registration The study complied with applicable German law and with the principles of the Helsinki Declaration and was approved by the institutional ethics commission.

  12. The effect of unilateral dominance of the cerebral hemispheres on the radiographic appearance of the cervical spine

    International Nuclear Information System (INIS)

    Jirout, J.

    1980-01-01

    The results of dynamic radiographic studies of the cervical spine following isometric exercise of the shoulders and the upper extremities appear to indicate that the commonly seen asymmetries of the joints in the craniocervical and cervicothoracic junction are due to asymmetry in the function of the muscles. The obvious dominance of the muscles on the right side demonstrates the dominance of the left cerebral hemisphere. The clinical importance of this is pointed out. (orig.) [de

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

    Science.gov (United States)

    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. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  14. CAN A SPECIFIC NECK STRENGTHENING PROGRAM DECREASE CERVICAL SPINE INJURIES IN A MEN'S PROFESSIONAL RUGBY UNION TEAM? A RETROSPECTIVE ANALYSIS

    Directory of Open Access Journals (Sweden)

    Robert Naish

    2013-09-01

    Full Text Available 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

  15. The ossification pattern in paediatric occipito-cervical spine: is it possible to estimate real age?

    International Nuclear Information System (INIS)

    Lee, H.J.; Kim, J.T.; Shin, M.H.; Choi, D.Y.; Park, Y.S.; Hong, J.T.

    2015-01-01

    Aim: To retrospectively analyse the synchondrosis from the occipital bone to the whole cervical spine and determine the feasibility and validity of age estimation using computed tomography (CT) images. Material and methods: A total of 231 cervical spine or neck CT images of young children (<7 years of age) were examined. Twelve ossification centres were assessed (occiput: n = 2; atlas: n = 2; axis, n = 6; whole sub-axial vertebra: n = 2), and the ossification process was graded as open (O, fully lucent), osseous bridging (B, partially ossified), and fusion (F, totally ossified). After the first analysis was completed, the resulting chronological chart was used to estimate the age of 10 new cases in order to confirm the usefulness of the chart. Results: Infancy was easily estimated using the sub-axial or C2 posterior ossification centres, while the posterior occipital regions provided good estimation of age between 1–2 years. The most difficult period for accurate age estimation was between 2–4 years. However, the C2 anterior (neurocentral ossification) and C1 posterior regions did yield information to help determine the age around 3 years. The anterior occipital region was useful for age estimation between 4–5 years, and the C1-anterior region was potentially useful to help decide among the other parameters. The test for age estimation (TAE) had a very high ICC score (0.973) among the three observers. Conclusion: Segmentalised analysis can enhance the ability to estimate real age, at least by the year. The analysis of the occipital bone made a strong contribution to the usefulness of the chorological chart. An organised chronological chart can provide readily available information for age estimation, and the primary application of the above data (TAE) demonstrated the validity of this approach. -- Highlights: •Subaxial or C2 posterior regions was useful for age estimation between 0–1 year. •Posterior occipital regions provided good estimation of

  16. Neurologic dysfunction in patients with rheumatoid arthritis of the cervical spine. Predictive value of clinical, radiographic and MR imaging parameters

    International Nuclear Information System (INIS)

    Reijnierse, M.; Kroon, H.M.; Holscher, H.C.; Bloem, J.L.; Dijkmans, B.A.C.; Breedveld, F.C.; Hansen, B.; Pope, T.L.

    2001-01-01

    The aim of this study was to evaluate if subjective symptoms, radiographic and especially MR parameters of cervical spine involvement, can predict neurologic dysfunction in patients with severe rheumatoid arthritis (RA). Sequential radiographs, MR imaging, and neurologic examination were performed yearly in 46 consecutive RA patients with symptoms indicative of cervical spine involvement. Radiographic parameters were erosions of the dens or intervertebral joints, disc-space narrowing, horizontal and vertical atlantoaxial subluxation, subluxations below C2, and the diameter of the spinal canal. The MR features evaluated were presence of dens and atlas erosion, brainstem compression, subarachnoid space encroachment, pannus around the dens, abnormal fat body caudal to the clivus, cervicomedullary angle, and distance of the dens to the line of McRae. Muscle weakness was associated with a tenfold increased risk of neurologic dysfunction. Radiographic parameters were not associated. On MR images atlas erosion and a decreased distance of the dens to the line of McRae showed a fivefold increased risk of neurologic dysfunction. Subarachnoid space encroachment was associated with a 12-fold increased risk. Rheumatoid arthritis patients with muscle weakness and subarachnoid space encroachment of the entire cervical spine have a highly increased risk of developing neurologic dysfunction. (orig.)

  17. Neurologic dysfunction in patients with rheumatoid arthritis of the cervical spine. Predictive value of clinical, radiographic and MR imaging parameters

    Energy Technology Data Exchange (ETDEWEB)

    Reijnierse, M.; Kroon, H.M.; Holscher, H.C.; Bloem, J.L. [Dept. of Radiology, University Hospital Leiden (Netherlands); Dijkmans, B.A.C.; Breedveld, F.C. [Dept. of Rheumatology, University Hospital Leiden (Netherlands); Hansen, B. [Dept. of Medical Statistics, University Hospital Leiden (Netherlands); Pope, T.L. [Dept. of Diagnostic Radiology, Univ. of South Carolina (United States)

    2001-03-01

    The aim of this study was to evaluate if subjective symptoms, radiographic and especially MR parameters of cervical spine involvement, can predict neurologic dysfunction in patients with severe rheumatoid arthritis (RA). Sequential radiographs, MR imaging, and neurologic examination were performed yearly in 46 consecutive RA patients with symptoms indicative of cervical spine involvement. Radiographic parameters were erosions of the dens or intervertebral joints, disc-space narrowing, horizontal and vertical atlantoaxial subluxation, subluxations below C2, and the diameter of the spinal canal. The MR features evaluated were presence of dens and atlas erosion, brainstem compression, subarachnoid space encroachment, pannus around the dens, abnormal fat body caudal to the clivus, cervicomedullary angle, and distance of the dens to the line of McRae. Muscle weakness was associated with a tenfold increased risk of neurologic dysfunction. Radiographic parameters were not associated. On MR images atlas erosion and a decreased distance of the dens to the line of McRae showed a fivefold increased risk of neurologic dysfunction. Subarachnoid space encroachment was associated with a 12-fold increased risk. Rheumatoid arthritis patients with muscle weakness and subarachnoid space encroachment of the entire cervical spine have a highly increased risk of developing neurologic dysfunction. (orig.)

  18. Validation of Patient-Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests in cervical spine surgery.

    Science.gov (United States)

    Boody, Barrett S; Bhatt, Surabhi; Mazmudar, Aditya S; Hsu, Wellington K; Rothrock, Nan E; Patel, Alpesh A

    2018-03-01

    OBJECTIVE The Patient-Reported Outcomes Measurement Information System (PROMIS), which is funded by the National Institutes of Health, is a set of adaptive, responsive assessment tools that measures patient-reported health status. PROMIS measures have not been validated for surgical patients with cervical spine disorders. The objective of this project is to evaluate the validity (e.g., convergent validity, known-groups validity, responsiveness to change) of PROMIS computer adaptive tests (CATs) for pain behavior, pain interference, and physical function in patients undergoing cervical spine surgery. METHODS The legacy outcome measures Neck Disability Index (NDI) and SF-12 were used as comparisons with PROMIS measures. PROMIS CATs, NDI-10, and SF-12 measures were administered prospectively to 59 consecutive tertiary hospital patients who were treated surgically for degenerative cervical spine disorders. A subscore of NDI-5 was calculated from NDI-10 by eliminating the lifting, headaches, pain intensity, reading, and driving sections and multiplying the final score by 4. Assessments were administered preoperatively (baseline) and postoperatively at 6 weeks and 3 months. Patients presenting for revision surgery, tumor, infection, or trauma were excluded. Participants completed the measures in Assessment Center, an online data collection tool accessed by using a secure login and password on a tablet computer. Subgroup analysis was also performed based on a primary diagnosis of either cervical radiculopathy or cervical myelopathy. RESULTS Convergent validity for PROMIS CATs was supported with multiple statistically significant correlations with the existing legacy measures, NDI and SF-12, at baseline. Furthermore, PROMIS CATs demonstrated known-group validity and identified clinically significant improvements in all measures after surgical intervention. In the cervical radiculopathy and myelopathic cohorts, the PROMIS measures demonstrated similar responsiveness to the

  19. Cervical Spine Collar Removal by Emergency Room Nurses: A Quality Improvement Project.

    Science.gov (United States)

    Fontaine, Guillaume; Forgione, Massimo; Lusignan, Francis; Lanoue, Marc-André; Drouin, Simon

    2018-05-01

    The Canadian C-Spine Rule (CCR) is a clinical decision aid to facilitate the safe removal of cervical collars in the alert, orientated, low-risk adult trauma patient. Few health care settings have assessed initiatives to train charge nurses to use the CCR. This practice improvement project conducted in a secondary trauma center in Canada aimed to (1) train charge nurses of the emergency room to use the CCR, (2) monitor its use throughout the project period, and (3) compare the assessments of the charge nurses with those of emergency physicians. The project began with the creation of an interdisciplinary team. Clinical guidelines were established by the interdisciplinary project team. Nine charge nurses of the emergency room were then trained to use the CCR (3 on each 8-hour shift). The use of the CCR was monitored throughout the project period, from June 1 to October 5, 2016. The 3 aims of this practice improvement project were attained successfully. Over a 5-month period, 114 patients were assessed with the CCR. Charge nurses removed the cervical collars for 54 of 114 patients (47%). A perfect agreement rate (114 of 114 patients, 100%) was attained between the assessments of the nurses and those of physicians. This project shows that the charge nurses of a secondary trauma center can use the CCR safely on alert, orientated, and low-risk adult trauma patients as demonstrated by the agreement in the assessments of emergency room nurses and physicians. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  20. Nail-gun injury of the cervical spine: simple technique for removal of a barbed nail.

    Science.gov (United States)

    Nathoo, Narendra; Sarkar, Atom; Varma, Gandhi; Mendel, Ehud

    2011-07-01

    Although nail-gun injuries are a common form of penetrating low-velocity injury, impalement with barbed nails has been underreported to date. Barbed nails are designed to resist dislodgment once embedded, and any attempt at removal may splay open the barbs along the path of entry, with the potential for significant soft-tissue and neurovascular injury. A 25-year-old man sustained a nail impalement of the cervical spine from accidental discharge of a nail gun. The patient was noted to be fully conscious with no neurological deficits. Cervical Zone 2 impalement was noted, with only the head of the nail visible. Angiography revealed the nail lying just anterior to the right vertebral artery (VA), with compression of the vessel. Preoperatively, analysis of a similar nail revealed that orientation of the head determined position of the barbs. A deep neck dissection was then performed to the lateral aspect of the C-3 body, using the nail as a guide. Prior to removal, the nail was turned 180° to change the position of the barbs, to prevent injury to the VA. Nail removal was uneventful. The authors present a simple technique for treatment of a nail-gun injury with a barbed nail. Prior to removal, radiographic analysis of the impaled nail must be performed to determine the presence of barbs. If possible, the surgeon should request a similar nail for analysis prior to surgery. Last, the treating surgeon must have knowledge of the barbs' position at all times during nail removal, to prevent damage to critical structures.

  1. The surgical treatment of instability of the upper part of the cervical spine in children and adolescents.

    Science.gov (United States)

    Koop, S E; Winter, R B; Lonstein, J E

    1984-03-01

    In a retrospective review of the cases of thirteen skeletally immature children and adolescents (four to eighteen years old) with instability of the upper part of the cervical spine (occiput to fifth cervical vertebra), we determined the efficacy of posterior arthrodesis and halo-cast immobilization in the management of this condition. The patients were divided into two groups: those with congenital vertebral anomalies alone (fusion or structural defects, or both) and those with cervical anomalies and systemic disorders (dwarfism, juvenile rheumatoid arthritis, Down syndrome, and cerebral palsy). Two patterns of instability were found: instabilities at intervertebral joints adjacent to vertebral fusions, and instabilities located in vertebral defects. For all patients treatment included a posterior arthrodesis with external immobilization by a halo cast, and in two patients internal fixation with wire was also used. Solid arthrodesis was obtained in the twelve patients who were treated with autogenous grafts (iliac cancellous bone in eleven and rib bone in one), and a non-union developed in a child who was treated with bank-bone rib segments. Posterior cervical arthrodesis with wire fixation carries some risk of neural injury and often is not applicable in children with anomalous vertebrae. Spine fusion using delicate exposure, decortication using an air-drill, and placement of autogenous cancellous iliac grafts with external immobilization by a halo cast minimizes the risk of neural damage and is a reliable way to obtain a solid arthrodesis.

  2. Three-dimensional computerized mobilization of the cervical spine for the treatment of chronic neck pain: a pilot study.

    Science.gov (United States)

    River, Yaron; Aharony, Shelly; Bracha, Jillian; Levital, Tamir; Gerwin, Robert

    2014-07-01

    Manual therapies for chronic neck pain are imprecise, inconsistent, and brief due to therapist fatigue. A previous study showed that computerized mobilization of the cervical spine in the sagittal plane is a safe and potentially effective treatment of chronic neck pain. To investigate the safety and efficacy of computerized mobilization of the cervical spine in a three-dimensional space for the treatment of chronic neck pain. Pilot, open trial. Physical therapy outpatient department. Nine patients with chronic neck pain. A computerized cradle capable of three-dimensional neck mobilizations was used. Treatment sessions lasted 20 minutes, biweekly, for six weeks. Visual analog scale (VAS) for pain, cervical range of motion (CROM), neck disability index (NDI), joint position error (JPE), and muscle algometry. Comparing baseline at week one with week six (end of treatment), the VAS scores dropped by 2.9 points (P pain threshold in any muscle tested. There were no significant adverse effects. These preliminary results demonstrate that this novel, computerized, three-dimensional cervical mobilization device is probably safe. The data also suggest that this method is effective in alleviating neck pain and associated headache, and in increasing the CROM, although the sample size was small in this open trial. Wiley Periodicals, Inc.

  3. Acute cervicitis and vulvovaginitis may be associated with Cytomegalovirus.

    Science.gov (United States)

    Abou, Magali; Dällenbach, Patrick

    2013-04-19

    Cytomegalovirus (CMV) infection in immunocompetent hosts is generally asymptomatic or may present as a mononucleosic syndrome. Its association with acute cervicitis and vulvovaginitis has rarely been reported. A 24-year-old woman presented with pelvic pain, vulvodynia, abnormal vaginal discharge, burning with urination, fatigue, fever, vomiting and diarrhoea. The vulva and cervix were red with vesicular lesions on the cervix. Genital herpes simplex infection (HSV) was suspected and valacyclovir was given orally. However, serial viral cultures performed 7 weeks apart did not isolate HSV as suspected, but CMV was confirmed by immunofluorescence and early antigen research. Blood tests confirmed an acute CMV infection. Typical inclusions were found at histology. Symptoms resolved slowly with persistence of cervical lesions at 7 weeks from diagnosis. The frequency of CMV genital infection is probably underestimated. The infection is not always asymptomatic and might be confused with genital HSV infection. The clinical course is longer.

  4. Acute quadriplegia following closed traction reduction of a cervical facet dislocation in the setting of ossification of the posterior longitudinal ligament: case report.

    Science.gov (United States)

    Wimberley, David W; Vaccaro, Alexander R; Goyal, Nitin; Harrop, James S; Anderson, D Greg; Albert, Todd J; Hilibrand, Alan S

    2005-08-01

    A case report of acute quadriplegia resulting from closed traction reduction of traumatic bilateral cervical facet dislocation in a 54-year-old male with concomitant ossification of the posterior longitudinal ligament (OPLL). To report an unusual presentation of a spinal cord injury, examine the approach to reversal of the injury, and review the treatment and management controversies of acute cervical facet dislocations in specific patient subgroups. The treatment of acute cervical facet dislocations is an area of ongoing controversy, especially regarding the question of the necessity of advanced imaging studies before closed traction reduction of the dislocated cervical spine. The safety of an immediate closed, traction reduction of the cervical spine in awake, alert, cooperative, and appropriately select patients has been reported in several studies. To date, there have been no permanent neurologic deficits resulting from awake, closed reduction reported in the literature. A case of temporary, acute quadriplegia with complete neurologic recovery following successful closed traction reduction of a bilateral cervical facet dislocation in the setting of OPLL is presented. The clinical neurologic examination, radiographic, and advanced imaging studies before and after closed, traction reduction of a cervical facet dislocation are evaluated and discussed. A review of the literature regarding the treatment of acute cervical facet dislocations is presented. Radiographs showed approximately 50% subluxation of the fifth on the sixth cervical vertebrae, along with computerized tomography revealing extensive discontinuous OPLL. The cervical facet dislocation was successfully reduced with an awake, closed traction reduction, before magnetic resonance imaging (MRI) evaluation. The patient subsequently had acute quadriplegia develop, with the ensuing MRI study illustrating severe spinal stenosis at the C5, C6 level as a result of OPLL or a large extruded disc herniation

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

    Science.gov (United States)

    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

  6. Colliculus atlantis: an insufficiently considered anatomic structure in open-mouth radiography of the cervical spine

    International Nuclear Information System (INIS)

    Schmidberger, H.R.; Weiglein, A.H.

    1998-01-01

    Purpose: To study the time and mode of the development of the colliculus atlantis, the rate of its occurrence, the causes for its absence, and the radiological-clinical importance in the analysis of open-mouth-view radiographs. Material and Methods: Retrospective analysis of standardized radiographs of the cervical spine in more than 20 000 adults and 100 children. Study of 234 human skeletons of different ages and of 38 isolated adult atlases. Cadaveric dissection of 42 adults (age 48-87). Axial radiographs of isolated atlases and analysis of the bony structures of the colliculus atlantis. Results: The colliculus atlantis develops between age 10 and 13 years. It is always present after age 13 years. For the development of the colliculus atlantis a normal function of the craniocervical joints is necessary. In congenital dysmorphias of the craniocervical region with dysfunction of the craniocervical joints and in fractures of the dens axis before age 10 years with instable healing the colliculus atlantis is absent. Conclusions: The colliculus atlantis is developed at age 13 years apart from some rare exceptions as mentioned. Changes of the site and the structure of the colliculus atlantis allow an early diagnosis of certain traumatically and inflammatory diseases of this region. Furthermore, it serves as an additional parameter in functional analysis of the craniocervical joints. (orig.) [de

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

    Science.gov (United States)

    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.

  8. Static and dynamic CT imaging of the cervical spine in patients with rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Soederman, Tomas; Shalabi, Adel; Sundin, Anders [Uppsala University Hospital, Department of Radiology, Uppsala (Sweden); Olerud, Claes; Alavi, Kamran [Uppsala University Hospital, Department of Orthopedic Surgery, Uppsala (Sweden)

    2014-09-18

    To compare CR with CT (static and dynamic) to evaluate upper spine instability and to determine if CT in flexion adds value compared to MR imaging in neutral position to assess compression of the subarachnoid space and of the spinal cord. Twenty-one consecutive patients with atlantoaxial subluxation due to rheumatoid arthritis planned for atlantoaxial fusion were included. CT and MRI were performed with the neck in the neutral position and CT also in flexion. CR in neutral position and flexion were obtained in all patients except for one subject who underwent examination in flexion and extension. CR and CT measurements of atlantoaxial subluxation correlated but were larger by CR than CT in flexion, however, the degree of vertical dislocation was similar with both techniques irrespective of the position of the neck. Cervical motion was larger at CR than at CT. The spinal cord compression was significantly worse at CT obtained in the flexed position as compared to MR imaging in the neutral position. Functional CR remains the primary imaging method but CT in the flexed position might be useful in the preoperative imaging work-up, as subarachnoid space involvement may be an indicator for the development of neurologic dysfunction. (orig.)

  9. Utility of MRI for cervical spine clearance after blunt traumatic injury: a meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Malhotra, Ajay; Wu, Xiao; Kalra, Vivek B.; Liu, Renu; Forman, Howard P. [Yale School of Medicine, Department of Radiology and Biomedical Imaging, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT (United States); Nardini, Holly K.G. [Yale University, Research and Education Librarian, Harvey Cushing/John Hay Whitney Medical Library, New Haven, CT (United States); Abbed, Khalid M. [Yale School of Medicine, Minimally Invasive Spine Surgery and Spine Tumor Surgery, New Haven, CT (United States)

    2017-03-15

    To quantify the rate of unstable injuries detected by MRI missed on CT in blunt cervical spine (CS) trauma patients and assess the utility of MRI in CS clearance. We undertook a systematic review of worldwide evidence across five major medical databases and performed a meta-analysis. Studies were included if they reported the number of unstable injuries or gave enough details for inference. Variables assessed included severity, CT/MRI specifications, imaging timing, and outcome/follow-up. Pooled incidences of unstable injury on follow-up weighted by inverse-of-variance among all included and obtunded or alert patients were reported. Of 428 unique citations, 23 proved eligible, with 5,286 patients found, and 16 unstable injuries reported in five studies. The overall pooled incidence is 0.0029 %. Among studies reporting only obtunded patients, the pooled incidence is 0.017 %. In alert patients, the incidence is 0.011 %. All reported positive findings were critically reviewed, and only 11 could be considered truly unstable. There is significant heterogeneity in the literature regarding the use of imaging after a negative CT. The finding rate on MRI for unstable injury is extremely low in obtunded and alert patients. Although MRI is frequently performed, its utility and cost-effectiveness needs further study. (orig.)

  10. Hypopharyngeal and upper esophageal ulceration after cervical spine radiotherapy concurrent with crizotinib

    International Nuclear Information System (INIS)

    Zimmermann, Marcus H.; Beckmann, Gabriele; Flentje, Michael; Jung, Pius

    2017-01-01

    Herein, the authors describe the case of a 31-year-old female patient with primary metastatic adenocarcinoma of the lung referred for radiation therapy of newly diagnosed intramedullary spinal cord metastasis at C4/5 and an adjacent osteolytic lesion. Radiotherapy of the cervical spine level C3 to C5, including the whole vertebra, was performed with 30 Gy in 10 fractions. The patient's systemic therapy with crizotinib 250 mg twice daily was continued. After 8 fractions of radiation the patient developed increasing dysphagia. Ulceration of the hypopharynx and the upper esophagus were obvious in esophagoscopy and CT. Hospitalization for analgesia and percutaneous endoscopic gastrostomy (PEG) was required. First oral intake was possible 3 weeks after the onset of symptoms. The early onset, severity, and duration of mucositis seemed highly unusual in this case. A review of the literature failed to identify any reference to increased mucositis after radiation therapy concurrent with crizotinib, although references to such an effect with other tyrosine kinase inhibitors (TKI) were found. Nevertheless, the authors presume that a considerable risk of unexpected interactions exists. When crizotinib and radiotherapy are combined, heightened attention toward intensified reactions seems to be warranted. (orig.) [de

  11. PNF and manual therapy treatment results of patients with cervical spine osteoarthritis.

    Science.gov (United States)

    Maicki, Tomasz; Bilski, Jan; Szczygieł, Elżbieta; Trąbka, Rafał

    2017-09-22

    The aim of this study was to evaluate the effectiveness of PNF and manual therapy methods in the treatment of patients with cervical spine osteoarthritis, especially their efficacy in reducing pain and improving functionality in everyday life. Long-term results were also compared in order to determine which method of treatment is more effective. Eighty randomly selected females aged 45-65 were included in the study. They were randomly divided into two groups of 40 persons. One group received PNF treatment and the other received manual therapy (MAN.T). To evaluate functional capabilities, the Functional Rating Index was used. To evaluate changes in pain, a shortened version of the McGill Questionnaire was used. The PNF group achieved a greater reduction in pain than the MAN.T group. The PNF group showed a greater improvement in performing daily activities such as sleeping, personal care, travelling, work, recreation, lifting, walking and standing as well as decreased intensity and frequency of pain compared to the MAN.T group. The PNF method proved to be more effective in both short (after two weeks) and long (after three months) term.

  12. Utility of MRI for cervical spine clearance after blunt traumatic injury: a meta-analysis

    International Nuclear Information System (INIS)

    Malhotra, Ajay; Wu, Xiao; Kalra, Vivek B.; Liu, Renu; Forman, Howard P.; Nardini, Holly K.G.; Abbed, Khalid M.

    2017-01-01

    To quantify the rate of unstable injuries detected by MRI missed on CT in blunt cervical spine (CS) trauma patients and assess the utility of MRI in CS clearance. We undertook a systematic review of worldwide evidence across five major medical databases and performed a meta-analysis. Studies were included if they reported the number of unstable injuries or gave enough details for inference. Variables assessed included severity, CT/MRI specifications, imaging timing, and outcome/follow-up. Pooled incidences of unstable injury on follow-up weighted by inverse-of-variance among all included and obtunded or alert patients were reported. Of 428 unique citations, 23 proved eligible, with 5,286 patients found, and 16 unstable injuries reported in five studies. The overall pooled incidence is 0.0029 %. Among studies reporting only obtunded patients, the pooled incidence is 0.017 %. In alert patients, the incidence is 0.011 %. All reported positive findings were critically reviewed, and only 11 could be considered truly unstable. There is significant heterogeneity in the literature regarding the use of imaging after a negative CT. The finding rate on MRI for unstable injury is extremely low in obtunded and alert patients. Although MRI is frequently performed, its utility and cost-effectiveness needs further study. (orig.)

  13. Investigation of the Effect of Neck Muscle Active Force on Whiplash Injury of the Cervical Spine

    Directory of Open Access Journals (Sweden)

    Yu Yan

    2018-01-01

    Full Text Available The objective of the present study is to investigate the influence of neck muscle activation on whiplash neck injury of the occupants of a passenger vehicle under different severities of frontal and rear-end impact collisions. The finite element (FE model has been used as a versatile tool to simulate and understand the whiplash injury mechanism for occupant injury prevention. However, whiplash injuries and injury mechanisms have rarely been investigated in connection with neck active muscle forces, which restricts the complete reappearance and understanding of the injury mechanism. In this manuscript, a mixed FE human model in a sitting posture with an active head-neck was developed. The response of the cervical spine under frontal and rear-end collision conditions was then studied using the FE model with and without neck muscle activation. The effect of the neck muscle activation on the whiplash injury was studied based on the results of the FE simulations. The results indicated that the neck active force influenced the head-neck dynamic response and whiplash injury during a collision, especially in a low-speed collision.

  14. Functional MRI of the cervical spine after distortion injury; MR-Funktionsdiagnostik der Halswirbelsaeule nach Schleudertrauma

    Energy Technology Data Exchange (ETDEWEB)

    Schnarkowski, P. [Muenchen Univ. (Germany). Inst. fuer Radiologische Diagnostik; Weidenmaier, W. [Muenchen Univ. (Germany). Inst. fuer Radiologische Diagnostik; Heuck, A. [Muenchen Univ. (Germany). Inst. fuer Radiologische Diagnostik; Reiser, M.F. [Muenchen Univ. (Germany). Inst. fuer Radiologische Diagnostik

    1995-04-01

    50 patients with a history of distortion injury of the cervical spine were examined with static and functional MRI. Functional MRI consisted of different patient`s positions from maximal extension to maximal flexion (30 , 0 , 25 , 40 , 50 ). T{sub 2}*-weighted gradient echo sequences were performed in a sagittal view for the different positions. Ligamentous instabilities and disc protrusions were seen only in functional MRI in 17 patients. These findings correlated with the neurological symptoms. Two patients were treated by operative fusion because of these findings. (orig.) [Deutsch] Bei 50 Patienten mit einem Schleudertrauma der Halswirbelsaeule wurden zu den statischen Magnetresonanztomogrammen der Halswirbelsaeule MR-Funktionsaufnahmen durchgefuehrt. Diese Funktionsaufnahmen erfolgten in 5 verschiedenen Flexionsgraden von maximaler Reklination bis zur maximalen Inklination (30 , 0 , 25 , 40 , 50 ). T{sub 2}*-gewichtete Gradienten-Echo-Sequenzen in sagittaler Schnittfuehrung wurden fuer jeden Flexionsgrad angefertigt. Bandinstabilitaeten und Bandscheibenvorwoelbungen konnten bei 17 Patienten nur in bestimmten Flexionsgraden erfasst werden. Diese 17 Patienten zeigten eine umschriebene neurologische Symptomatik, die von ihrer Lokalisation mit den in der MR-Funktionsdiagnostik erhobenen Befunden korrelierten. Zwei Patienten wurden aufgrund diese Befunde mit einer operativen Fusion therapiert. (orig.)

  15. Acceleration-caused injury of the cervical spine. Whiplash injury; Beschleunigungsverletzung der Halswirbelsaeule. HWS-Schleudertrauma

    Energy Technology Data Exchange (ETDEWEB)

    Wedig, Hans-Dieter (eds.) [Kanzlei Dr. W.G. Schmidt, Sonthofen (Germany); Graf, Michael; Grill, Christian

    2009-07-01

    Acceleration injuries of the cervical spine are mostly caused by car accidents. Due to the high traffic density and the increasing number of car accidents with personal injuries the number of concerned persons is also increasing. A large percentage of injured persons suffer ongoing troubles following ineffective therapy trials up to occupational disability. Therefore the whiplash injury is a significant medical and legal problem. The book includes contributions of international experts on the latest state of research and the actual knowledge on the controversial discussed field. An interdisciplinary forum discusses medical, injury-mechanical, consultant-related and legal questions and therapeutic approaches that might be successful. [German] Beschleunigungsverletzungen der Halswirbelsaeule treten ueberwiegend nach Autounfaellen auf. Aufgrund der hohen Verkehrsdichte und der steigenden Anzahl an Verkehrsunfaellen mit Personenschaeden steigt auch die Zahl der Betroffenen stetig an. Einer grossen Zahl von Unfallgeschaedigten, die nach kurzer Zeit beschwerdefrei leben koennen, steht leider eine wachsende Zahl von Betroffenen mit anhaltenden Beschwerden, erfolglosen Therapieversuchen bis hin zur Berufsunfaehigkeit gegenueber. Das 'HWS-Schleudertrauma' stellt nach wie vor ein erhebliches medizinisches und rechtliches Problem dar. In diesem Buch beschreiben international ausgewiesene Experten den neuesten Forschungsstand, das aktuelle Wissen und die Lehrmeinungen auf diesem kontrovers diskutierten und komplexen Gebiet. In einem interdisziplinaeren Ansatz werden medizinische, verletzungsmechanische, gutachterliche und gerichtliche Fragestellungen diskutiert und Erfolg versprechende Therapieansaetze eroertert. Aerzte, Juristen, Versicherungen und Betroffene werden in einen gemeinsamen Dialog gebracht, mit dem Ziel, konstruktive Loesungen zu erarbeiten. Eine praktische Arbeitshilfe - das Buch fuer alle, die mit dieser Problematik befasst sind. (orig.)

  16. Subacromial impingement in patients with whiplash injury to the cervical spine

    Directory of Open Access Journals (Sweden)

    Giddins Grey E

    2008-06-01

    Full Text Available Abstract Background Impingement syndrome and shoulder pain have been reported to occur in a proportion of patients following whiplash injuries to the neck. In this study we aim to examine these findings to establish the association between subacromial impingement and whiplash injuries to the cervical spine. Methods and results We examined 220 patients who had presented to the senior author for a medico-legal report following a whiplash injury to the neck. All patients were assessed for clinical evidence of subacromial impingement. 56/220 patients (26% had developed shoulder pain following the injury; of these, 11/220 (5% had clinical evidence of impingement syndrome. Only 3/11 patients (27% had the diagnosis made prior to evaluation for their medico-legal report. In the majority, other clinicians had overlooked the diagnosis. The seatbelt shoulder was involved in 83% of cases (p Conclusion After a neck injury a significant proportion of patients present with shoulder pain, some of whom have treatable shoulder pathology such as impingement syndrome. The diagnosis is, however, frequently overlooked and shoulder pain is attributed to pain radiating from the neck resulting in long delays before treatment. It is important that this is appreciated and patients are specifically examined for signs of subacromial impingement after whiplash injuries to the neck. Direct seatbelt trauma to the shoulder is one possible explanation for its aetiology.

  17. Extension and flexion in the upper cervical spine in neck pain patients.

    Science.gov (United States)

    Ernst, Markus J; Crawford, Rebecca J; Schelldorfer, Sarah; Rausch-Osthoff, Anne-Kathrin; Barbero, Marco; Kool, Jan; Bauer, Christoph M

    2015-08-01

    Neck pain is a common problem in the general population with high risk of ongoing complaints or relapses. Range of motion (ROM) assessment is scientifically established in the clinical process of diagnosis, prognosis and outcome evaluation in neck pain. Anatomically, the cervical spine (CS) has been considered in two regions, the upper and lower CS. Disorders like cervicogenic headache have been clinically associated with dysfunctions of the upper CS (UCS), yet ROM tests and measurements are typically conducted on the whole CS. A cross-sectional study assessing 19 subjects with non-specific neck pain was undertaken to examine UCS extension-flexion ROM in relation to self-reported disability and pain (via the Neck Disability Index (NDI)). Two measurement devices (goniometer and electromagnetic tracking) were employed and compared. Correlations between ROM and the NDI were stronger for the UCS compared to the CS, with the strongest correlation between UCS flexion and the NDI-headache (r = -0.62). Correlations between UCS and CS ROM were fair to moderate, with the strongest correlation between UCS flexion and CS extension ROM (r = -0.49). UCS flexion restriction is related to headache frequency and intensity. Consistency and agreement between both measurement systems and for all tests was high. The results demonstrate that separate UCS ROM assessments for extension and flexion are useful in patients with neck pain. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. A randomized clinical trial to compare the immediate effects of seated thoracic manipulation and targeted supine thoracic manipulation on cervical spine flexion range of motion and pain.

    Science.gov (United States)

    Karas, Steve; Olson Hunt, Megan J

    2014-05-01

    Randomized clinical trial. To determine the effectiveness of seated thoracic manipulation versus targeted supine thoracic manipulation on cervical spine pain and flexion range of motion (ROM). There is evidence that thoracic spine manipulation is an effective treatment for patients with cervical spine pain. This evidence includes a variety of techniques to manipulate the thoracic spine. Although each of them is effective, no research has compared techniques to determine which produces the best outcomes. A total of 39 patients with cervical spine pain were randomly assigned to either a seated thoracic manipulation or targeted supine thoracic manipulation group. Pain and flexion ROM measures were taken before and after the intervention. Pain reduction (post-treatment-pre-treatment) was significantly greater in those patients receiving the targeted supine thoracic manipulation