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Sample records for cervical spine facet

  1. A Levering Technique for Open Reduction of Traumatic Unilateral Locked Facets of Cervical Spine: Technical Note

    OpenAIRE

    Bunyaratavej, Krishnapundha; Khaoroptham, Surachai

    2011-01-01

    Reduction of traumatic unilateral locked facets of the cervical spine can be accomplished by closed or open means. If closed reduction is unsuccessful, then open reduction is indicated. The previously described techniques of open reduction of a unilateral locked facets of the cervical spine in the literature included drilling facet, forceful manipulation or using special equipment. We describe a reduction technique that uses a basic spinal curette, in a forceless manner, and it does not need ...

  2. 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; Gregersen, Markil Ebbe Gregers; Melsen, Flemming

    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...

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

    OpenAIRE

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

    2009-01-01

    This study investigated the bony ankylosis of the upper cervical spine facet joints in patients with a cervical spine involvement due to rheumatoid arthritis (RA) using computed tomography (CT) and then examined the characteristics of the patients showing such ankylosis. Forty-six consecutive patients who underwent surgical treatment for RA involving the cervical spine were reviewed. The radiographic diagnoses included atlanto-axial subluxation in 30 cases, vertical subluxation (VS) in 10 cas...

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

    OpenAIRE

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

    2004-01-01

    The objective of the study was to investigate the influence of bone cement, length of burr hole and bone density on pullout force and insertional screw torque of cervical spine facet screws. Both facets of 24 human cervical vertebrae were scanned for bone mineral density (BMD) and assigned to two groups for measuring of insertional screw torque and pullout strength. Maximal insertional screw torque was measured and removal of the screws was performed in displacement control (0.25 mm/s) withou...

  5. Optimized cervical spine bone SPET for detection of facet joint injury after whiplash injury

    International Nuclear Information System (INIS)

    Full text: The most frequent origin for chronic cervical pain in patients with a remote history of whiplash injury is the cervical facet joints. Exact localization of facet joint injury is difficult and currently advocated methods include multiple invasive diagnostic injections. Optimization of 99Tcm-HDP cervical SPET (CSPET) to accurately localize facet joint pathology was attempted and the results correlated with clinical localization relying on focal joint tenderness and passive movement methods. Imaging was performed on a dual-headed gamma camera system using an elliptical orbit over 360 deg. The patient's neck was flexed to eliminate the cervical lordosis. Reconstructed CSPET images were reorientated into the long axis of the vertebral bodies. CSPET studies were independently scored by two observers blinded to the clinical and other imaging information and correlated with clinical localization and response to radiofrequency ablation. 54 patients have been studied using this technique in a prospective study. Early patient follow-up data will be presented. CSPET was felt to be clinically useful by pain therapists in targeting treatment

  6. Cervical spine CT scan

    Science.gov (United States)

    ... cervical spine; Computed tomography scan of cervical spine; CT scan of cervical spine; Neck CT scan ... Risks of CT scans include: Being exposed to radiation Allergic reaction to contrast dye CT scans expose you to more radiation than ...

  7. The degenerative cervical spine.

    Science.gov (United States)

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

    2016-04-01

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

  8. Degenerative intraspinal cyst of the cervical spine

    Directory of Open Access Journals (Sweden)

    Hidetoshi Nojiri

    2009-08-01

    Full Text Available We describe two cases of degenerative intraspinal cyst of the cervical spine that caused a gradually progressive myelopathy. One case had a cyst that arose from the facet joint and the other case had a cyst that formed in the ligamentum flavum. The symptoms improved immediately after posterior decompression by cystectomy with laminoplasty.

  9. [Pediatric orthopedic cervical spine problems].

    Science.gov (United States)

    Helenius, Ilkka

    2016-01-01

    Treatment-requiring diseases of the cervical spine in children are rare. The most common cases requiring medical assessment and treatment are acute torticollis and various accidents. A torticollis having lasted for more than a week should be recognized, because it can be treated by skull traction. Cervical spine fractures in children under school age are very rare, the most common being a fracture of the base of the dens of the second cervical vertebra. Cervical spine instability is almost always associated with an underlying disease. PMID:27400588

  10. Treatment of cervical dislocation with locked facets

    Institute of Scientific and Technical Information of China (English)

    YU Ze-sheng; James J.Yue; WEI Feng; LIU Zhong-jun; CHEN Zhong-qiang; DANG Geng-ting

    2007-01-01

    Background Lower cervical dislocation with locked facets is common in cervical injury. The locked facets include unilateral and bilateral types. Different successful closed reduction rates has been achieved between unilateral and bilateral types by using rapid skull traction, which was commonly used to reduce the cervical dislocation. It is important to investigate a suitable management specific to patients with different types of cervical locked facets.Methods A total of 38 patients with cervical dislocation with locked facet due to cervical injury treated by rapid skull traction and operation from 1988 to 2005 were reviewed. Rapid skull traction was used in all the patients. Successful closed reduction rate was 88.0% in patients with bilateral cervical locked facets and that was 15.4% in those with unilateral cervical locked facets. These data were then statistically compared by Chi-square test. Patients who were reduced successfully underwent anterior cervical discectomy and fusion at the injured level, and those who failed in closed reduction received posterior open reduction and fixation.Results In this series, there was statistically significant difference (P<0.05) in the rate of successful closed skull traction reduction between unilateral and bilateral locked facets dislocation. Unilateral cervical locked facets dislocation was not easily reduced by skull traction which was suitable for reduction of bilateral cervical locked facets dislocation. However,unilateral cervical locked facets dislocation can be reduced by posterior open reduction.Conclusions Unilateral cervical locked facets dislocation should be treated immediately with posterior open reduction and instrumentation. Bilateral cervical locked facets dislocation can be reduced by rapid skull traction firstly and anterior cervical discectomy and interbody fusion later.

  11. Cervical facet joint kinematics during bilateral facet dislocation

    OpenAIRE

    Panjabi, Manohar M.; Simpson, Andrew K.; Ivancic, Paul C.; Pearson, Adam M.; Tominaga, Yasuhiro; Yue, James J.

    2007-01-01

    Previous biomechanical models of cervical bilateral facet dislocation (BFD) are limited to quasi-static loading or manual ligament transection. The goal of the present study was to determine the facet joint kinematics during high-speed BFD. Dislocation was simulated using ten cervical functional spinal units with muscle force replication by frontal impact of the lower vertebra, tilted posteriorly by 42.5°. Average peak rotations and anterior sliding (displacement of upper articulating facet s...

  12. CERVICAL FACET JOINT SEPTIC ARTHRITIS: A CASE REPORT

    OpenAIRE

    Stecher, James M.; El-Khoury, Georges Y.; Hitchon, Patrick W.

    2010-01-01

    Facet joint septic arthritis is a rare but severe infection with the possibility of significant morbidity resulting from local or systemic spread of the infection. Pain is the most common complaint on presentation followed by fever, then neurologic impairment. While the lumbar spine is involved in the vast majority of cases presented in the literature, the case presented here occurred in the cervical spine. The patient presented with a three week history of neck and left shoulder pain and was...

  13. Vertebral artery injuries in cervical spine surgery

    OpenAIRE

    Schroeder, Gregory D.; Hsu, Wellington K.

    2013-01-01

    Background: Vertebral artery injuries during cervical spine surgery are rare, but potentially fatal. When performing cervical spine surgery, it is imperative that the surgeon has a systematic approach for avoiding, and if necessary, dealing with a vertebral artery injury. Methods: This is a review paper. Results: Upper posterior cervical spine surgeries put the vertebral artery at the highest risk, as opposed to anterior subaxial cervical spine procedures, which put the artery at the least ri...

  14. Imaging of cervical spine injuries of childhood

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  15. Cervical Spine Instrumentation in Children.

    Science.gov (United States)

    Hedequist, Daniel J; Emans, John B

    2016-06-01

    Instrumentation of the cervical spine enhances stability and improves arthrodesis rates in children undergoing surgery for deformity or instability. Various morphologic and clinical studies have been conducted in children, confirming the feasibility of anterior or posterior instrumentation of the cervical spine with modern implants. Knowledge of the relevant spine anatomy and preoperative imaging studies can aid the clinician in understanding the pitfalls of instrumentation for each patient. Preoperative planning, intraoperative positioning, and adherence to strict surgical techniques are required given the small size of children. Instrumentation options include anterior plating, occipital plating, and a variety of posterior screw techniques. Complications related to screw malposition include injury to the vertebral artery, neurologic injury, and instrumentation failure. PMID:27097300

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

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Ullerup, Rita; Vesterby, Annie; Gregersen, Markil Ebbe Gregers

    2006-01-01

    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...

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

    International Nuclear Information System (INIS)

    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. Radiographic distinction of degenerative slippage (spondylolisthesis and retrolisthesis) from traumatic slippage of the cervical spine

    Energy Technology Data Exchange (ETDEWEB)

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

    1986-08-01

    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.

  19. 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.

  20. Sport injuries of the cervical spine

    International Nuclear Information System (INIS)

    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.)

  1. Clinical treatment of 35 patients with fracture and dislocation of lower cervical spine combined with locked facet%下颈椎骨折脱位伴关节突交锁35例临床治疗分析

    Institute of Scientific and Technical Information of China (English)

    陈新; 杨开舜; 孟庆存; 方达

    2014-01-01

    Objective To explore the safe and effective method for the fracture and dislocation of lower cervical spine combined with locked facet. Methods Retrospective analysis was conducted on the clinical data of 35 patients with fracture and dislocation of lower cervical spine combined with locked facet ,who were received from October 2009 to April 2013. The imaging data including X-ray,CT scan and reconstruction,magnetic resonance imaging(MRI) and neurological function assessment of American Spinal Injury Association(ASIA) had been completed before operation. The 35 cases of fracture and dislocation of lower cervical spine combined with locked facet were treated with sustained skull closed traction reduction ,and the early treatment adopted posterior,anterior or combined anterior-posterior decompressive surgery,bone graft fusion and internal fixation with ac-cording to the result of reset. The therapeutic effect was observed. Results 35 patients were successful with closed reduction ,in-cluding increasing the traction weight in 3 cases in the operating room under general anesthesia. The postoperative follow-up of X-ray showed that cervical vertebra sequence and vertebral height obtained good reconstruction and maintenance. ASIA neurological function assessment increased by about 1 or more after treatment. All cases obtained solid fusion within 4-6 months without com-plications like implants loose,fracture and so on. Conclusion The sustained skull closed traction reduction for patients with fracture and dislocation of lower cervical spine combined with locked facet can achieve satisfactory result by posterior ,anterior or combined anterior-posterior decompressive surgery,bone graft fusion and internal fixation according to the result of reset with sat-isfactory effect.%目的:探讨下颈椎骨折脱位伴关节突交锁安全、有效的治疗方法。方法回顾性分析2009年10月至2013年4月35例下颈椎骨折脱位伴关节突交锁患者的临床资料。术

  2. Unusual cervical spine epidural abscess.

    Science.gov (United States)

    Liou, Jr-Han; Su, Yu-Jang

    2015-10-01

    A 48-year-old man presented to the emergency department with complain of severe neck pain and anterior chest pain. Intermittent fever in the recent 2 days was also noted. There is a track maker over his left side of neck. The laboratory examination showed leukocytosis and high C-reactive protein level. Urine drug screen was positive for opiate. Empirical antibiotic administration was given. Blood culture grew gram-positive cocci in chain, and there was no vegetation found by heart echocardiogram. However, progressive weakness of four limbs was noted, and patient even cannot stand up and walk. The patient also complained of numbness sensation over bilateral hands and legs, and lower abdomen. Acute urine retention occurred. We arranged magnetic resonance imaging survey, which showed evidence of inflammatory process involving the retropharyngeal spaces and epidural spaces from the skull base to the bony level of T5. Epidural inflammatory process resulted in compression of the spinal cord and bilateral neural foramen narrowing. Neurosurgeon was consulted. Operation with laminectomy and posterior fusion with bone graft and internal fixation was done. Culture of epidural abscess and 2 sets of blood culture all yielded methicillin-sensitive Staphylococcus aureus. For epidural abscess, the most common involved spine is lumbar followed by thoracic and cervical spine. Diagnosis and treatment in the drug abusers are still challenging because they lack typical presentation, drug compliance, and adequate follow-up and because it is hard to stop drug abuser habit. Significant improvement of neurological deficit can be expected in most spinal abscess in drug abusers after treatment. PMID:26298050

  3. Cervical spine fractures and dislocations in children

    International Nuclear Information System (INIS)

    A retrospectivce analysis of pediatric admissions over 10 years revealed 29 patients with cervical spine injuries. Eleven patients were below 12 years of age, and 10 of these had injuries involving C1, C2 or the occipitoatlantal articulation. Eighteen patients were between 12 and 16 years of age with injuries distributed throughout the cervical spine similar to injuries in the adult population. Our results suggest that teenagers with suspected cervical injuries are best evaluated by an adult radiographic series including trauma oblique views. In younger patients, careful evaluation of occipitoatlantoaxial alignment and the prevertebral soft tissues is required for diagnosis and selection of additional imaging evaluation. (orig.)

  4. Cervical Spine Axial Rotation Goniometer Design

    Directory of Open Access Journals (Sweden)

    Emin Ulaş Erdem

    2012-06-01

    Full Text Available To evaluate the cervical spine rotation movement is quiet harder than other joints. Configuration and arrangement of current goniometers and devices is not always practic in clinics and some methods are quiet expensive. The cervical axial rotation goniometer designed by the authors is consists of five pieces (head apparatus, chair, goniometric platform, eye pads and camera. With this goniometer design a detailed evaluation of cervical spine range of motion can be obtained. Besides, measurement of "joint position sense" which is recently has rising interest in researches can be made practically with this goniometer.

  5. Sensory and sympathetic innervation of cervical facet joint in rats

    Institute of Scientific and Technical Information of China (English)

    ZHOU Hai-yu; CHEN An-min; GUO Feng-jing; LIAO Guang-jun; XIAO Wei-dong

    2006-01-01

    Objective: To explore the patterns of innervation of cervical facet joints and determine the pathways from facet joints to dorsal root ganglions (DRGs) in order to clarify the causes of diffuse neck pain, headache, and shoulder pain.Methods: Forty-two male Sprague-Dawley rats,weighing 250-300 g, were randomly divided into three groups: Group A ( n = 18), Group B ( n = 18), and Group C (n = 6 ). Under anesthesia with intraperitoneal pentobarbital sodium (45 mg/kg body weight), a midline dorsal longitudinal incision was made over the cervical spine to expose the left cervical facet joint capsule of all the rats under a microscope. The rats in Group A underwent sympathectomy, but the rats in Group B and Group C did not undergo sympathectomy. Then 0.6 μl 5 % bisbenzimide (Bb) were injected into the C1-2, C3-4 and C5-6 facet joints of 6 rats respectively in Group A and Group B. The holes were immediately sealed with mineral wax to prevent leakage of Bb and the fascia and skin were closed. But in Group C, 0.9% normal saline was injected into the corresponding joint capsules. Then under deep reanesthesia with intraperitoneal pentobarbital sodium (45 mg/kg body weight), C1-C8 left DRGs in all rats and the sympathetic ganglions in Group B were obtained and the number of the labeled neurons was determined.Results: Neurons labeled with Bb were present in C1-C8 DRGs in both Group A and Group B, and sympathetic ganglions in Group B. In the C1-2 and C3-4 subgroups,labeled neurons were present from C1 to C8 DRGs, while in C5-6 subgroups they were from C, to C8. The number of Bb ( + ) neurons after sympathectomy was not significantly different in the injected level from that without sympathectomy. But in the other levels, the number of Bb ( + ) neurons after sympathectomy was significantly less than that without sympathectomy.Conclusions: The innervation of the cervical facet joints is derived from both sensory and sympathetic nervous system, and DRGs are associated with

  6. Cervical spine injuries in rugby players.

    Science.gov (United States)

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

    1984-03-15

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

  7. Delayed Esophageal Perforation after Cervical Spine Plating

    OpenAIRE

    Kim, Seong Jung; Ju, Chang Il; Kim, Dong Min; Kim, Seok Won

    2013-01-01

    Although anterior approaches to the cervical spine are popular and safe, they cause some of complications. Esophageal perforation after anterior spinal fusion is a rare but potentially life-threatening complication. We present a rare case of delayed esophageal perforation caused by a cervical screw placed via the anterior approach. A 43-year-old man, who had undergone surgery for complete cord injury at another orthopedic department 8 years previously, was admitted to our institute due to pai...

  8. Impact of intravenous acetaminophen therapy on the necessity of cervical spine imaging in patients with cervical spine trauma

    Institute of Scientific and Technical Information of China (English)

    Koorosh Ahmadi; Amir Masoud Hashemian; Elham Pishbin; Mahdi Sharif-Alhoseini; Vafa Rahimi-Movaghar

    2014-01-01

    Objective:We evaluated a new hypothesis of acetaminophen therapy to reduce the necessity of imaging in patients with probable traumatic cervical spine injury.Methods:Patients with acute blunt trauma to the neck and just posterior midline cervical tenderness received acetaminophen (15 mg/kg) intravenously after cervical spine immobilization.Then,all the patients underwent plain radiography and computerized tomography of the cervical spine.The outcome measure was the presence of traumatic cervical spine injury.Sixty minutes after acetaminophen infusion,posterior midline cervical tendemess was reassessed.Results:Of 1 309 patients,41 had traumatic cervical spine injuries based on imaging.Sixty minutes after infusion,posterior midline cervical tenderness was eliminated in 1 041 patients,none of whom had abnormal imaging.Conclusion:Patients with cervical spine trauma do not need imaging if posterior midline cervical tendemess is eliminated after acetaminophen infusion.This analgesia could be considered as a diagnostic and therapeutic intervention.

  9. Developmental biomechanics of the human cervical spine.

    Science.gov (United States)

    Nuckley, David J; Linders, David R; Ching, Randal P

    2013-04-01

    Head and neck injuries, the leading cause of death for children in the U.S., are difficult to diagnose, treat, and prevent because of a critical void in our understanding of the biomechanical response of the immature cervical spine. The objective of this study was to investigate the functional and failure biomechanics of the cervical spine across multiple axes of loading throughout maturation. A correlational study design was used to examine the relationships governing spinal maturation and biomechanical flexibility curves and tolerance data using a cadaver human in vitro model. Eleven human cadaver cervical spines from across the developmental spectrum (2-28 years) were dissected into segments (C1-C2, C3-C5, and C6-C7) for biomechanical testing. Non-destructive flexibility tests were performed in tension, compression, flexion, extension, lateral bending, and axial rotation. After measuring their intact biomechanical responses, each segment group was failed in different modes to measure the tissue tolerance in tension (C1-C2), compression (C3-C5), and extension (C5-C6). Classical injury patterns were observed in all of the specimens tested. Both the functional (pmechanics exhibited significant relationships with age. Nonlinear flexibility curves described the functional response of the cervical spine throughout maturation and elucidated age, spinal level, and mode of loading specificity. These data support our understanding of the child cervical spine from a developmental perspective and facilitate the generation of injury prevention or management schema for the mitigation of child spine injuries and their deleterious effects. PMID:23415075

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

    International Nuclear Information System (INIS)

    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.)

  11. Cervical spine response in frontal crash.

    Science.gov (United States)

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

    2011-11-01

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

  12. 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.

  13. Thickening of spine ligamentum flavum and facet tropism

    Directory of Open Access Journals (Sweden)

    Paulo Roberto Appolonio

    2014-03-01

    Full Text Available OBJECTIVE: This study investigated the thickening of the ligamentum flavum (LF and its correlation with facet tropism and its severity at different levels of the spine. METHOD: This retrospective study was performed with patients with chronic back pain consecutively admitted to a specialized spinal surgery service between January 2012 and January 2013. All patients underwent magnetic resonance imaging (MRI to measure the thickness of the LF and facet tropism severity (severe, moderate or absent according to the spine levels (L3 -L4, L4-L5, L5-S1. The association between the thickness of LF and facet tropism was analyzed. RESULTS: During the study period, 98 consecutive patients were enrolled with a mean age of 53.6 years, most women (59.2%. There was no significant difference between the thicknesses of the ligament and the presence of tropism in different spinal levels (p > 0.05. The thickness of LF was significantly associated with the severity of tropism only in L5-S1 level (p < 0.03. CONCLUSIONS: Our results show that there is a positive relationship between severe facet tropism and increased thickness of the LF in the L5-S1 level.

  14. Is posterior fusion necessary with laminectomy in the cervical spine?

    OpenAIRE

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

    2012-01-01

    Background: Cervical decompressive laminectomy is a common procedure for addressing multilevel cervical spine pathology. The most common reasons for performing simultaneous posterior cervical fusion include the prevention of progressive postlaminectomy kyphotic deformity or other types of instability which can contribute to late neurological deterioration. Methods: The medical literature (Pub Med with MeSH) concerning cervical laminectomy, posterior cervical fusion, and complications of lamin...

  15. Lateral Mass Fixation in Subaxial Cervical Spine: Anatomic Review

    OpenAIRE

    Mohamed, Elrahmany; Ihab, Zidan; Moaz, Anwar; Ayman, Nabawi; Haitham, Abo-elw

    2012-01-01

    Introduction The cervical spine is a highly mobile segment of the spinal column, liable to a variety of diseases and susceptible to trauma. It is a complex region where many vital structures lie in close proximity. Lateral mass screw fixation has become the method of choice in stabilizing subaxial cervical spine among other posterior cervical fixation techniques whenever the posterior elements are absent or compromised. Objective This study examined cervical specimens of cadavers and cervical...

  16. Therapeutic strategy for traumatic instability of subaxial cervical spine

    Institute of Scientific and Technical Information of China (English)

    CAO Peng; LIANG Yu; GONG Yao-cheng; ZHENG Tao; ZHANG Xin-kai; WU Wen-jian

    2008-01-01

    Background A simple, safe and effective therapeutic strategy for traumatic instability of the subaxial cervical spine, as well as its prognostic assessment, is still controversial.Methods The therapeutic options for 83 patients of traumatic instability of the subaxial cervical spine, whose average age was 35 years, were determined, according to the Allen-Ferguson classification, general health and concomitant traumatic conditions, neurological function, position of compression materials, concomitant traumatic disc herniation/damage, concomitant locked-facet dislocation, the involved numbers and position, and the patients' economic conditions. An anterior, posterior or combination approach was used to decompress and reconstruct the cervical spine. No operations with an anterior-posterior-anterior approach were performed.Results The average follow-up was three years and nine months. Distraction-flexion and compression-flexion were the most frequent injury subtypes. There were 46, 28 and 9 cases of anterior, posterior and combination operations, respectively. The average score of the Japanese Orthopaedics Association, visual analog scale and American Spinal Cord Injury Association (ASIA) motor index improved from 11.2, 7.8 and 53.5, respectively, before operation, to 15.3, 2.6 and 67.8, respectively, at final follow-up. For incomplete spinal cord injury (SCI), the average ASIA neurological function scale was improved by 1-2 levels. Patients with complete SCI had no neurological recovery, but recovery of nerve root function occurred to different extents. After surgery, radiological parameters improved to different extents. Fusion was achieved in all patients and 12 developed complications.Conclusions The best surgical strategy should be determined by the type of subaxial cervical injury, patients' general health, local pathological anatomy and neurological function.

  17. Posterior approach to the degenerative cervical spine

    OpenAIRE

    Yonenobu, Kazuo; Oda, Takenori

    2003-01-01

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

  18. Pharyngocutaneous fistula after anterior cervical spine surgery

    OpenAIRE

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

    2009-01-01

    Pharyngocutaneous fistulae are rare complications of anterior spine surgery occurring in less than 0.1% of all anterior surgery cases. We report a case of a 19 year old female who sustained a C6 burst fracture with complete quadriplegia. She was treated urgently with a C6 corpectomy with anterior cage and plating followed by posterior cervical stabilization at another institution. Post operatively she developed a pharyngocutaneous fistula that failed to heal despite several attempts of closu...

  19. Uremic tumoral calcinosis in the cervical spine: case report.

    Science.gov (United States)

    Fatehi, Mostafa; Ahuja, Christopher S; Wang, Shelly; Ginsberg, Howard J

    2016-07-01

    Tumoral calcinosis is an uncommon condition characterized by the calcification of periarticular soft tissue. In uremic patients the disease is secondary to metabolic disturbances in predisposed patients. The authors report the case of a 73-year-old woman who presented with a new painful cervical mass while undergoing continuous ambulatory peritoneal dialysis for long-standing end-stage renal disease (ESRD). A CT scan of the neck showed a lobulated, calcified mass in the left paraspinal soft tissue at C2-3. This mass affected the facet joint and also extended into the neural foramen but did not cause any neurological compromise. Due to the patient's significant medical comorbidities, resection was deferred and the patient was followed in the clinic. Subsequent repeat imaging has shown a significant decrease in the size of the mass. In the context of ESRD, a diagnosis of uremic tumoral calcinosis (UTC) was made. The authors conducted a search of the PubMed and EMBASE databases and identified 7 previously reported cases of UTC of the cervical spine. They present a summary of these cases and discuss the etiology, diagnosis, and management of the condition. Although the metabolic disturbances seen in patients undergoing dialysis can lead to tumoral calcinosis, most reported cases involve large joints such as the shoulder or the hip; however, the spine can also be affected and should be considered in the differential diagnosis of patients with uremia as it can mimic aggressive bone-forming neoplasms. PMID:26943247

  20. Candida albicans osteomyelitis of the cervical spine

    Energy Technology Data Exchange (ETDEWEB)

    Cha, Jang-Gyu; Hong, Hyun-Sook [Soonchunhyang University Bucheon Hospital, Department of Radiology, Bucheon-Si, Gyeonggi-Do (Korea); Koh, Yoon-Woo [Soonchunhyang University Bucheon Hospital, Department of Otolaryngology - Head and Neck Surgery, Bucheon-Si, Gyeonggi-Do (Korea); Kim, Hee-Kyung [Soonchunhyang University Bucheon Hospital, Department of Pathology, Bucheon-Si, Gyeonggi-Do (Korea); Park, Jung-Mi [Soonchunhyang University Bucheon Hospital, Department of Nuclear Medicine, Bucheon-Si, Gyeonggi-Do (Korea)

    2008-04-15

    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.)

  1. Candida albicans osteomyelitis of the cervical spine

    International Nuclear Information System (INIS)

    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. Operative stabilization of the cervical spine in cases of metastases

    International Nuclear Information System (INIS)

    Because of intraspinal space requirement or instability of the cervical spine, metastases may lead to a compression of the spinal cord and/or the nerve roots. Early decompression and stabilization prevents unavoidable tetraparesis. In most cases quality of life can be maintained. The indication and methodology of cervical spine stabilization as well as the results of treatment in 18 patients are demonstrated. (orig.)

  3. Rugby injuries of the upper cervical spine. Case reports.

    Science.gov (United States)

    Scher, A T

    1983-09-17

    Fractures and dislocations of the upper cervical spine (atlas and axis) differ markedly from those of the lower cervical spine (C3 - C7) because of the unique anatomy and function of these two vertebrae. Case reports of 4 rugby players who sustained serious injuries of the upper cervical spine are presented. The role of the high tackle in causing these injuries is described and the association of head and upper cervical spinal trauma is emphasized. The radiological management of the player with suspected injury is outlined. PMID:6623223

  4. Hough Forest-based Corner Detection for Cervical Spine Radiographs

    OpenAIRE

    Al-Arif, S. M.; Asad, M; Knapp, K.; Gundry, M.; Slabaugh, G. G.

    2015-01-01

    The cervical spine (neck region) is highly sensitive to trauma related injuries, which must be analysed carefully by emergency physicians. In this work, we propose a Hough Forest-based corner detection method for cervical spine radiographs, as a first step towards a computer-aided diagnostic tool. We propose a novel patch-based model based on two-stage supervised learning (classification and regression) to estimate the corners of cervical vertebral bodies. Our method is evaluated using 106 ce...

  5. Complications of the anterior approach to the cervical spine

    OpenAIRE

    Marcelo Lemos Vieira da Cunha; Francisco Alves de Araújo Júnior; Cássio Czottis Grapiglia; Denildo César Amaral Veríssimo; Roberta Rehder; Samir Ale Bark; Luis Alencar Biurrum Borba

    2014-01-01

    OBJECTIVE: To evaluate the complications of anterior approach to the cervical spine in patients who underwent cervical arthrodesis with instrumentation. METHODS: Prospective and descriptive study was conducted from January 2009 to April 2010. All patients who underwent arthrodesis of the cervical spine by anterior approach were included, regardless the diagnosis. Access was made by the anterior approach on the right side. We evaluated the number of operated levels (1, 2 or 3 levels) and,...

  6. Delayed surgical treatment for a traumatic bilateral cervical facet joint dislocation using a posterior-anterior approach: a case report

    Directory of Open Access Journals (Sweden)

    Shimada Takashi

    2013-01-01

    Full Text Available Abstract Introduction There have been few reports of patients with bilateral cervical facet dislocations that remain untreated for eight weeks or more. We report the case of a 76-year-old man with an old bilateral cervical facet joint dislocation fracture that was treated by posterior-anterior reduction and fixation. Case presentation A 76-year-old Asian man was involved in a road traffic accident. He presented with neck pain and arm pain on his right side, but motor weakness and paralysis were not observed. He was treated conservatively; however, instability and spondylolisthesis at the C5 to C6 joint increased eight weeks after the injury. We performed a posterior-anterior reduction and fixation. After surgery, bony union was achieved, and his neck pain and arm pain disappeared. Conclusion We recommend reduction and fixation surgery if a patient has an old bilateral facet joint dislocation fracture in the cervical spine.

  7. 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 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. PMID:27190732

  8. Non-Contiguous Spinal Injury in Cervical Spinal Trauma: Evaluation with Cervical Spine MRI

    OpenAIRE

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

    2004-01-01

    Objective 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. Materials and Methods 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, hyp...

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

    International Nuclear Information System (INIS)

    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

  10. 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.

  11. Clinical implications of alignment of upper and lower cervical spine

    Directory of Open Access Journals (Sweden)

    Sherekar S

    2006-01-01

    Full Text Available Aims and Objectives: The alignment of upper and lower cervical spine is presumed to be closely interrelated and the knowledge of this is mandatory when performing occipito-cervical and upper cervical fusions. The aim of this study was to establish standard values for upper and lower cervical spine alignment in the Indian population. Materials and Methods: Five hundred eighteen asymptomatic volunteers (261 males and 257 females between 12 and 80 years of age underwent lateral radiography with their neck in the neutral position. Angles for occipital to 2nd cervical (Oc-C2, 1st to 2nd cervical (C1-C2 and sagittal alignment of 2nd to 7th cervical vertebrae (C2-C7 were measured. Statistical analyses were performed using a statistical package SPSS 10 for windows and the students ′t′ test. Results: The mean Oc-C2, C1-C2 and C2--C7 angles were 14.66 + 9.5°, 25.6 + 7.9° and 16.8 + 12.7° in male, while same angles in female were 15.59 + 8.26°, 26.9 + 6.8° and 9.11 + 10.4° respectively. Weak statistically significant negative correlation was observed between the measured angles of the upper (Oc-C2 and C1-C2 and lower (C2-C7 cervical spines, which means if the lordosis of the occiput and upper cervical spine increases (if the Oc-C2 angle increases, the alignment of lower cervical spine becomes kyphotic and vice versa. This negative correlation was stronger between the Oc-C2 and C2-C7 angles than between the C1-C2 and C2-C7 angles. Conclusions: Relationship between alignment of the upper and the lower cervical spine should be taken into consideration when performing cervical fusion.

  12. Rheumatoid arthritis: Radiological changes in the cervical spine

    International Nuclear Information System (INIS)

    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. Biometric X-ray-function diagnosis of the cervical spine

    International Nuclear Information System (INIS)

    Subject of this study was the investigation of functional disorders of the cervical spine and their possible causal relation with the symptoms and signs of pathological cervical images. In order to approach this investigation with objectively measurable time criteria, functional X-ray diagnostics results to be the appropriate method. From the results obtained in individual and statistical group examinations as well as in examinations of the longitudinal section the conclusion is drawn that a functional disorder of the cervical spine may provoke a cervical syndrome. (APR)

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

    Directory of Open Access Journals (Sweden)

    Sun-Ren Sheng

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

  15. Subaxial Cervical Spine Trauma: Evaluation and Surgical Decision-Making

    OpenAIRE

    Joaquim, Andrei F.; Patel, Alpesh A.

    2013-01-01

    Study Design Literature review. Objective To discuss the evaluation and management of subaxial cervical spine trauma (C3–7). Methods A literature review of the main imaging modalities, classification systems, and nonsurgical and surgical treatment performed. Results Computed tomography and reconstructions allow for accurate radiologic identification of subaxial cervical spine trauma in most cases. Magnetic resonance imaging can be utilized to evaluate the stabilizing discoligamentous complex,...

  16. The 100 Most Influential Articles in Cervical Spine Surgery

    OpenAIRE

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

    2015-01-01

    Study Design Literature review. Objective To identify and analyze the top 100 cited articles in cervical spine surgery. Methods The Thomson Reuters Web of Knowledge was searched for citations of all articles relevant to cervical spine surgery. The number of citations, authorship, year of publication, journal of publication, country of publication, and institution were recorded for each article. Results The most cited article was the classic from 1991 by Vernon and Mior that described the Neck...

  17. Complications of Anterior and Posterior Cervical Spine Surgery

    OpenAIRE

    Cheung, Jason Pui Yin; Luk, Keith Dip-Kei

    2016-01-01

    Cervical spine surgery performed for the correct indications yields good results. However, surgeons need to be mindful of the many possible pitfalls. Complications may occur starting from the anaesthestic procedure and patient positioning to dura exposure and instrumentation. This review examines specific complications related to anterior and posterior cervical spine surgery, discusses their causes and considers methods to prevent or treat them. In general, avoiding complications is best achi...

  18. MRI of cervical spine injuries complicating ankylosing spondylitis

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  19. The Langerhans' cell histiocytosis (eosinophilic granuloma) of the cervical spine: a rare diagnosis of cervical pain.

    Science.gov (United States)

    Simanski, C; Bouillon, B; Brockmann, M; Tiling, T

    2004-05-01

    We present the case of a 44-year-old man who complained of cervical pain. He was treated with physiotherapy and analgetics. Because of persistent pain, computed tomography (CT) scan and MRI were performed. They revealed an osteolytic destruction of the fourth cervical vertebra. The patient was treated surgically for removal of the tumor and stabilization of his cervical spine. Histology of the osteolytic material led to the diagnosis of an eosinophilic granuloma of the cervical spine. This case report describes the incidence, clinical significance, background and therapy of an eosinophilic granuloma of the spine. PMID:15120180

  20. Desmoid type fibromatosis in the facet joint of lumbar spine: Case report and review of literature

    Energy Technology Data Exchange (ETDEWEB)

    Kim, So Jung; Ha, Doo Hoe; Lee, Sang Min; Kang, Hae Youn [CHA Bundang Medical Center, CHA University, Seongnam (Korea, Republic of)

    2013-10-15

    Desmoid type fibromatosis is a benign fibroblastic tumor arising from the fascia or musculoaponeurosis. It may occur in various locations, but most commonly in the shoulder girdle and neck; to our knowledge, there has been no reported case originating from a facet joint of the spine. We report CT and MR imaging findings of a desmoid type fibromatosis, involving the facet joint of the L3-4 spine with bone involvement.

  1. Desmoid type fibromatosis in the facet joint of lumbar spine: Case report and review of literature

    International Nuclear Information System (INIS)

    Desmoid type fibromatosis is a benign fibroblastic tumor arising from the fascia or musculoaponeurosis. It may occur in various locations, but most commonly in the shoulder girdle and neck; to our knowledge, there has been no reported case originating from a facet joint of the spine. We report CT and MR imaging findings of a desmoid type fibromatosis, involving the facet joint of the L3-4 spine with bone involvement.

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

    Directory of Open Access Journals (Sweden)

    Farzanah Ismail

    2013-06-01

    Full Text Available Aim: It is not uncommon for vertebral artery injury to occur when there are fractures through the transverse foraminae of the first to the sixth vertebral bodies. Other important risk factors for vertebral artery injury include facet joint dislocations and fractures of the first to the third cervical vertebral bodies. The aim of this study was to determine the pattern and prevalence of vertebral artery injury on CT angiography (CTA in patients with cervical spine fractures.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.

  3. Biphasic synovial sarcoma in the cervical spine: Case report

    OpenAIRE

    Foreman Stephen M; Stahl Michael J

    2011-01-01

    Abstract Synovial sarcoma is a rare malignant neoplasm of soft tissue that typically arising near large joints of the upper and lower extremities in young adult males. Only 3% of these neoplasms have been found to arise in the head and neck region. To our knowledge, there are limited reports in the literature of this neoplasm in the cervical spine. A case of biphasic synovial sarcoma of the cervical spine is reviewed. A 29 year-old male presented with pain on the left side of the cervical spi...

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

    Science.gov (United States)

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

    2016-02-01

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

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

    Science.gov (United States)

    Morin, Michael; Langevin, Pierre; Fait, Philippe

    2016-01-01

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

  6. Dynamic sagittal flexibility coefficients of the human cervical spine.

    Science.gov (United States)

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

    2007-07-01

    The goal of the present study was to determine the dynamic sagittal flexibility coefficients, including coupling coefficients, throughout the human cervical spine using rear impacts. A biofidelic whole cervical spine model (n=6) with muscle force replication and surrogate head was rear impacted at 5 g peak horizontal accelerations of the T1 vertebra within a bench-top mini-sled. The dynamic main and coupling sagittal flexibility coefficients were calculated at each spinal level, head/C1 to C7/T1. The average flexibility coefficients were statistically compared (p<0.05) throughout the cervical spine. To validate the coefficients, the average computed displacement peaks, obtained using the average flexibility matrices and the measured load vectors, were statistically compared to the measured displacement peaks. The computed and measured displacement peaks showed good overall agreement, thus validating the computed flexibility coefficients. These peaks could not be statistically differentiated, with the exception of extension rotation at head/C1 and posterior shear translation at C7/T1. Head/C1 was significantly more flexible than all other spinal levels. The cervical spine was generally more flexible in posterior shear, as compared to axial compression. The coupling coefficients indicated that extension moment caused coupled posterior shear translation while posterior shear force caused coupled extension rotation. The present results may be used towards the designs of anthropometric test dummies and mathematical models that better simulate the cervical spine response during dynamic loading. PMID:17140545

  7. 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.

  8. 78 FR 65451 - Agency Information Collection (Neck (Cervical Spine) Conditions Disability Benefits Questionnaire...

    Science.gov (United States)

    2013-10-31

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

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

    International Nuclear Information System (INIS)

    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

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

    Science.gov (United States)

    Dabke, Harshad V.

    2014-01-01

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

  11. Risk factors for vertebral artery injuries in cervical spine trauma

    Directory of Open Access Journals (Sweden)

    Nanjundappa S. Harshavardhana

    2014-10-01

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

  12. Analysis of cervical spine function in healthy persons

    International Nuclear Information System (INIS)

    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.)

  13. Maintenance of graft compression in the adult cervical spine

    OpenAIRE

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

    2006-01-01

    It is generally advised that the graft inserted in adult cervical spine should be pre-loaded with a compressive force or that the screws are inserted in a divergent orientation, in order to maximise compression and the chance of graft incorporation (Truumees et al. in Spine 28:1097–1102, 2003). However, there is little evidence that a compressive force is maintained once the force applicator has been removed, or that the divergent screws enhance compression. This study compared the maintenanc...

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

    OpenAIRE

    Harshavardhana, Nanjundappa S.; Harshad V. Dabke

    2014-01-01

    Blunt cerebrovascular injuries (i.e. involvement of carotid and vertebral arteries) are increasingly being recognized in setting of cervical spine trauma/fractures and are associated with high incidence of stroke/morbidity and mortality. The incidence of vertebral artery injuries (VAI) is more common than previously thought and regular screening is seldom performed. However there exists no screening criteria and conflicting reports exists between spine and trauma literature. Many clinicians d...

  15. Risk factors for vertebral artery injuries in cervical spine trauma

    OpenAIRE

    Harshavardhana, Nanjundappa S.; Harshad V. Dabke

    2014-01-01

    Blunt cerebrovascular injuries (i.e. involvement of carotid and vertebral arteries) are increasingly being recognized in setting of cervical spine trauma/fractures and are associated with high incidence of stroke/morbidity and mortality. The incidence of vertebral artery injuries (VAI) is more common than previously thought and regular screening is seldom performed. However there exists no screening criteria and conflicting reports exists between spine and trauma literature. Many clinicians d...

  16. Cervical spine trauma: Radiologic manifestations and imaging algorithms

    International Nuclear Information System (INIS)

    Cervical spine trauma is very critical injury that is incurred most frequently in automobile accidents, mining incidents, and war. Injuries of the cervical spine produce neurologic damage in approximately 40% of cases, whereas injuries of the thoracolumbar junction produce neurologic damage in 4% and injuries of the thoracic spine do so in 10%. Radiology has a fundamental role in the recognition and follow-up of patients. Radiologists should be quite familiar with the imaging algorithms and various radiologic manifestations of cervical spine injuries. In this paper, techniques of examining severely injured patients as well as those with slight or questionable injuries are demonstrated. Indications and limitations of various diagnostic procedures (plain film radiography, tomography, CT, and MR imaging) are discussed. A systematic plan for the study of the cervical spine with an emphasis on joints, bones, ligaments and soft tissues (JO-B-LI-ST) is introduced. Mechanisms of injury and the stability or instability of the injuries are presented. Plain radiography as well as other imaging modalities are used to demonstrate the most important forms of injuries at various levels. Follow-up of some of the treated cases is shown. The late complications of spinal cord damage in closed injuries and open wounds (urinary stones, myositis, ossificans, contractures, fractures, disuse atrophy, and bone infections) are presented at the end

  17. 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).

  18. Modern posterior screw techniques in the pediatric cervical spine

    OpenAIRE

    Hedequist, Daniel J

    2014-01-01

    Treatment of children with cervical spine disorders requiring fusion is a challenging endeavor for a variety of reasons. The size of the patients, the corresponding abnormal bony anatomy, the inherent ligamentous laxity of children, and the relative rarity of the disorders all play a part in difficulty of treatment. The benefits of modern posterior cervical instrumentation in children, defined as rigid screw-rod systems, have been shown to be many including: improved arthrodesis rates, dimini...

  19. THE EFFECT OF WEARING HEADSCARVES ON CERVICAL SPINE PROPRIOCEPTION

    OpenAIRE

    Samiah F. Alqabbani; Eric G. Johnson; Daher, Noha S.; Shilpa B. Gaikwad; SukrutDeshpande

    2016-01-01

    Background: Proprioception plays an important role in sensorimotor control of posture and movement. Impairments in cervical proprioception have been demonstrated in subjects with whiplash-associated disorder, patients with age-related degeneration, and patients with articular diseases or spondylosis. The joint position error test is widely used to measure head repositioning accuracy. Objective: The purpose of this pilot study was to compare cervical spine joint position error in females w...

  20. Vertebral locking lesion following cervical spine fracture in ankylosing spondylitis.

    Science.gov (United States)

    Kuroiwa, Tomoyuki; Yoshii, Toshitaka; Sakaki, Kyohei; Inose, Hiroyuki; Tomizawa, Shoji; Kato, Tsuyoshi; Kawabata, Shigenori; Shinomiya, Kenichi; Okawa, Atsushi

    2012-06-01

    Spine fractures in patients with ankylosing spondylitis frequently extend to all 3 columns, which can lead to displacement and deformity with severe instability. Cervical spine fractures occasionally cause severe kyphotic deformities, such as chin-on-chest deformities. In such cases, the patients typically exhibit a chronic progression of hyperkyphosis after the traumatic event. This article describes a unique case of ankylosing spondylitis associated with an acute chin-on-chest deformity following a spine fracture due to a vertebral locking lesion.A 60-year-old man fell while walking and sustained a compression fracture of the C6 vertebra. Two weeks later, the patient acutely developed an inability to raise his head, difficulties with chewing and swallowing, and a horizontal gaze. Radiographs demonstrated a severe kyphosis in the cervical spine with a locking lesion between the anterior wall of the C5 and C6 vertebrae. The patient also presented with neurological impairment in his hands. Because the anterior approach to the spine was anatomically impossible, halo traction was initially applied under a close observation of neurological symptoms. Three days after halo traction, release of the vertebral locking lesion and realignment of the spine were seen. The patient subsequently underwent spinal fusion using a combined anterior-posterior approach.Postoperatively, neurological dysfunction improved, and solid fusion was confirmed at 6 months. In cases of acute kyphotic deformity following cervical spine fracture in ankylosing spondylitis patients, halo traction followed by circumferential spine fusion is a safe and effective approach for improving the alignment and stability of the spine. PMID:22691645

  1. 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.

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

    International Nuclear Information System (INIS)

    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

  3. A validated classification for external immobilization of the cervical spine.

    Science.gov (United States)

    Holla, Micha; Huisman, Joske M R; Hosman, Allard J F

    2013-10-01

    Study Design Interobserver and intraobserver reliability study. Objective The aim of this study is to validate a new classification system of external cervical spine immobilization devices by measuring the interobserver and intraobserver agreement. Methods A classification system, with five main categories, based on the anatomical regions on which the device supports, was created. A total of 28 independent observers classified 50 photographs of different devices, designed to immobilize the cervical spine according to the new proposed classification system. At least 2 weeks later, the same devices were classified again in a new random order. Before and after the classification, all the participants answered questions about the usefulness of the proposed classification. Results The mean interobserver and intraobserver agreement Fleiss' kappa was 0.88 and 0.91, respectively. Both are, according to the interpretation described by Landis and Koch, "almost perfect." A majority of the participators answered that they needed a classification (89%) and considered the classification to be clear (96%). All the participants considered the classification to be useful in clinical practice. Conclusion This study showed that the new classification of external cervical spine immobilizers, based on anatomical support areas, has an excellent interobserver and intraobserver agreement. Furthermore, the study participants considered the proposed classification to be clear and useful in clinical practice. As the majority of patients with cervical spine injuries are treated with external immobilization devices, this new classification system can improve the closed treatment of cervical spine injuries in daily clinical practice. Furthermore, it makes reproducible comparisons between groups possible, which are essential for further evolution of evidence-based spine care. PMID:24436704

  4. 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

  5. Hemorrhagic Facet Cyst in the Lumbar Spine Causing Contralateral Leg Symptoms: A Case Report

    OpenAIRE

    Utsunomiya, Risa; Sakai, Toshinori; Wada, Keizo; Sairyo, Koichi; Kosaka, Hirofumi; Katoh, Shinsuke; Yasui, Natsuo

    2011-01-01

    Here we present a case of hemorrhagic lumbar facet cyst presenting with progressive radiculopathy only on the contralateral side. If a patient has previous back pain or neuropathy for several months and then suddenly deteriorates, hemorrhagic facet cyst of the lumbar spine should be part of the differential diagnosis. However, as in the present case, we should be aware that there is a possibility of a contralateral lesion.

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

    OpenAIRE

    Claudio Silveri; Juan Manuel Velasco; Asdrúbal Silveri

    2014-01-01

    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.

  7. Cervical facet dislocation adjacent to the fused motion segment

    Directory of Open Access Journals (Sweden)

    Kunio Yokoyama

    2016-01-01

    Full Text Available This study reports on a case that forces re-examination of merits and demerits of anterior cervical fusion. A 79-year-old male was brought to the emergency room (ER of our hospital after he fell and struck the occipital region of his head following excessive alcohol consumption. Four years prior, he had undergone anterior cervical discectomy and fusion of C5/6 and a magnetic resonance imaging (MRI performed 3 years after this surgery indicated that he was suffering from degeneration of C6/7 intervertebral discs. After arriving at the ER, he presented motor impairment at level C7 and lower of manual muscle testing grade 1 as well as moderate loss of physical sensation from the trunk and peripheries of both upper limbs to the peripheries of both lower limbs (Frankel B. Cervical computed tomography (CT indicated anterior dislocation of C6/7, and MRI indicated severe spinal cord edema. We performed manipulative reduction of C6/7 with the patient under general anesthesia. Next, we performed laminectomy on C5-T1 and posterior fusion on C6/7. Postoperative CT indicated that cervical alignment had improved, and MRI indicated that the spinal cord edema observed prior to surgery had been mitigated. Three months after surgery, motor function and sensory impairment of the lower limbs had improved, and the patient was ambulatory upon discharge from the hospital (Frankel D. In the present case, although C5 and 6 were rigidly fused, degeneration of the C6/7 intervertebral disc occurred and stability was compromised. As a result, even slight trauma placed a severe dynamic burden on the facet joint of C6/7, which led to dislocation.

  8. Cervical facet dislocation adjacent to the fused motion segment.

    Science.gov (United States)

    Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Tanaka, Hidekazu; Ito, Yutaka; Kuroiwa, Toshihiko

    2016-01-01

    This study reports on a case that forces re-examination of merits and demerits of anterior cervical fusion. A 79-year-old male was brought to the emergency room (ER) of our hospital after he fell and struck the occipital region of his head following excessive alcohol consumption. Four years prior, he had undergone anterior cervical discectomy and fusion of C5/6 and a magnetic resonance imaging (MRI) performed 3 years after this surgery indicated that he was suffering from degeneration of C6/7 intervertebral discs. After arriving at the ER, he presented motor impairment at level C7 and lower of manual muscle testing grade 1 as well as moderate loss of physical sensation from the trunk and peripheries of both upper limbs to the peripheries of both lower limbs (Frankel B). Cervical computed tomography (CT) indicated anterior dislocation of C6/7, and MRI indicated severe spinal cord edema. We performed manipulative reduction of C6/7 with the patient under general anesthesia. Next, we performed laminectomy on C5-T1 and posterior fusion on C6/7. Postoperative CT indicated that cervical alignment had improved, and MRI indicated that the spinal cord edema observed prior to surgery had been mitigated. Three months after surgery, motor function and sensory impairment of the lower limbs had improved, and the patient was ambulatory upon discharge from the hospital (Frankel D). In the present case, although C5 and 6 were rigidly fused, degeneration of the C6/7 intervertebral disc occurred and stability was compromised. As a result, even slight trauma placed a severe dynamic burden on the facet joint of C6/7, which led to dislocation. PMID:26933361

  9. Cervical facet dislocation adjacent to the fused motion segment

    Science.gov (United States)

    Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Tanaka, Hidekazu; Ito, Yutaka; Kuroiwa, Toshihiko

    2016-01-01

    This study reports on a case that forces re-examination of merits and demerits of anterior cervical fusion. A 79-year-old male was brought to the emergency room (ER) of our hospital after he fell and struck the occipital region of his head following excessive alcohol consumption. Four years prior, he had undergone anterior cervical discectomy and fusion of C5/6 and a magnetic resonance imaging (MRI) performed 3 years after this surgery indicated that he was suffering from degeneration of C6/7 intervertebral discs. After arriving at the ER, he presented motor impairment at level C7 and lower of manual muscle testing grade 1 as well as moderate loss of physical sensation from the trunk and peripheries of both upper limbs to the peripheries of both lower limbs (Frankel B). Cervical computed tomography (CT) indicated anterior dislocation of C6/7, and MRI indicated severe spinal cord edema. We performed manipulative reduction of C6/7 with the patient under general anesthesia. Next, we performed laminectomy on C5-T1 and posterior fusion on C6/7. Postoperative CT indicated that cervical alignment had improved, and MRI indicated that the spinal cord edema observed prior to surgery had been mitigated. Three months after surgery, motor function and sensory impairment of the lower limbs had improved, and the patient was ambulatory upon discharge from the hospital (Frankel D). In the present case, although C5 and 6 were rigidly fused, degeneration of the C6/7 intervertebral disc occurred and stability was compromised. As a result, even slight trauma placed a severe dynamic burden on the facet joint of C6/7, which led to dislocation. PMID:26933361

  10. Assessment of ultrasound as a diagnostic modality for detecting potentially unstable cervical spine fractures in pediatric severe traumatic brain injury: A feasibility study

    Directory of Open Access Journals (Sweden)

    Deepak Agrawal

    2015-01-01

    Full Text Available Background: Early cervical spine clearance is extremely important in unconscious trauma patients and may be difficult to achieve in emergency setting. Objectives: The aim of this study was to assess the feasibility of standard portable ultrasound in detecting potentially unstable cervical spine injuries in severe traumatic brain injured (TBI patients during initial resuscitation. Materials and Methods: This retro-prospective pilot study carried out over 1-month period (June-July 2013 after approval from the institutional ethics committee. Initially, the technique of cervical ultrasound was standardized by the authors and tested on ten admitted patients of cervical spine injury. To assess feasibility in the emergency setting, three hemodynamically stable pediatric patients (≦18 years with isolated severe head injury (Glasgow coma scale ≤8 coming to emergency department underwent an ultrasound examination. Results: The best window for the cervical spine was through the anterior triangle using the linear array probe (6-13 MHz. In the ten patients with documented cervical spine injury, bilateral facet dislocation at C5-C6 was seen in 4 patients and at C6-C7 was seen in 3 patients. C5 burst fracture was present in one and cervical vertebra (C2 anterolisthesis was seen in one patient. Cervical ultrasound could easily detect fracture lines, canal compromise and ligamental injury in all cases. Ultrasound examination of the cervical spine was possible in the emergency setting, even in unstable patients and could be done without moving the neck. Conclusions: Cervical ultrasound may be a useful tool for detecting potentially unstable cervical spine injury in TBI patients, especially those who are hemodynamically unstable.

  11. Biphasic synovial sarcoma in the cervical spine: Case report

    Directory of Open Access Journals (Sweden)

    Foreman Stephen M

    2011-05-01

    Full Text Available Abstract Synovial sarcoma is a rare malignant neoplasm of soft tissue that typically arising near large joints of the upper and lower extremities in young adult males. Only 3% of these neoplasms have been found to arise in the head and neck region. To our knowledge, there are limited reports in the literature of this neoplasm in the cervical spine. A case of biphasic synovial sarcoma of the cervical spine is reviewed. A 29 year-old male presented with pain on the left side of the cervical spine. Physical examination revealed a global loss of cervical motion and large, palpable mass in the left paravertebral area. The long-delayed Magnetic Resonance (MR scan revealed a soft tissue mass measuring 8.3 centimeters (cm × 5.7 cm that was surgically removed. A malignant biphasic synovial sarcoma was diagnosed on pathologic examination. The clinical and imaging findings of an atypically located synovial sarcoma are reviewed. This case report emphasizes the consequences of a limited differential diagnosis, prolonged treatment and the failure to perform timely diagnostic imaging in the presence of a paraspinal mass.

  12. Percutaneous vertebroplasty for multiple myeloma of the cervical spine

    Energy Technology Data Exchange (ETDEWEB)

    Mont' Alverne, Francisco [Universite Paris VI, Department of Neuroradiology, Groupe Hospitalier Pitie-Salpetriere, Paris Cedex 13 (France); Sao Paulo University, Department of Radiology, Hospital das Clinicas, Sao Paulo, S.P. (Brazil); Vallee, Jean-Noel; Guillevin, Remy; Cormier, Evelyne; Jean, Betty; Rose, Michelle; Chiras, Jacques [Universite Paris VI, Department of Neuroradiology, Groupe Hospitalier Pitie-Salpetriere, Paris Cedex 13 (France); Caldas, Jose Guilherme [Sao Paulo University, Department of Radiology, Hospital das Clinicas, Sao Paulo, S.P. (Brazil)

    2009-04-15

    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.)

  13. X-Ray Exam: Cervical Spine

    Science.gov (United States)

    ... find the cause of symptoms such as neck, shoulder, upper back, or arm pain, as well as tingling, numbness, or weakness in the arm or hand. It can detect fractures in the cervical vertebrae or dislocation of the joints between the vertebrae. It's commonly ...

  14. Complications of the anterior approach to the cervical spine

    Directory of Open Access Journals (Sweden)

    Marcelo Lemos Vieira da Cunha

    2014-09-01

    Full Text Available OBJECTIVE: To evaluate the complications of anterior approach to the cervical spine in patients who underwent cervical arthrodesis with instrumentation. METHODS: Prospective and descriptive study was conducted from January 2009 to April 2010. All patients who underwent arthrodesis of the cervical spine by anterior approach were included, regardless the diagnosis. Access was made by the anterior approach on the right side. We evaluated the number of operated levels (1, 2 or 3 levels and, the type of procedure performed: discectomy and placement of cage and plate (D+C+P, discectomy with placement of a cage (D+C or corpectomy with placement of cage and plate (C+C+P. All complications related to surgical approach were reported. RESULTS: We studied 34 patients, 70% male. The average age was 50 years and mean follow-up was 8 months. Eighteen percent of patients had complications, distributed as follows: dysphasia (33% and dysphonic (67%. Among patients who developed complications, most underwent to D+C+P (83% and no complications were found in patients where no cervical plate was used. Regarding levels, both complications were identified in patients operated to one or two levels. However, in patients operated on three levels, only dysphonia was identified. CONCLUSION: The most frequent complication was dysphonia. Patients who presented more complications were those undergoing discectomy and fusion with cage and anterior cervical plate. All cases of dysphonia were in this group. The number of accessible levels does not seem to have affected the incidence of complications.

  15. 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.

  16. Magnetic resonance tomography for trauma of the cervical spine

    International Nuclear Information System (INIS)

    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.)

  17. [Magnetic resonance tomography in injuries of the cervical spine].

    Science.gov (United States)

    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. PMID:3025951

  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. Classification of acute subaxial cervical spine injury

    OpenAIRE

    2012-01-01

    Abstract Study Design Literature review Objective The aim of this thesis is to compare the main classification systems available for classifying acute subaxial cervical spinal injury and compare their relative strengths and weaknesses, especially in their ability to guide treatment and predict prognosis. Methods A PICO question was formulated and used to select search terms. The search terms were used to search the online database Pubmed/Medline for English language revi...

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

    OpenAIRE

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

    2013-01-01

    We present a case report to remind surgeons of this unusual complication that can occur in any surgery, even posterior cervical spine surgery under general anesthesia and discuss its causes, treatment methods, and the follow-up results in the literature. The peripheral Tapia's syndrome is a rare complication of anesthetic airway management. Main symptoms are hoarseness of voice and difficulty of tongue movement. Tapia's syndrome after endotracheal general anesthesia is believed to be due to p...

  1. A Validated Classification for External Immobilization of the Cervical Spine

    OpenAIRE

    Holla, Micha; Huisman, Joske M. R.; Hosman, Allard J. F.

    2013-01-01

    Study Design Interobserver and intraobserver reliability study. Objective The aim of this study is to validate a new classification system of external cervical spine immobilization devices by measuring the interobserver and intraobserver agreement. Methods A classification system, with five main categories, based on the anatomical regions on which the device supports, was created. A total of 28 independent observers classified 50 photographs of different devices, designed to immobilize the ce...

  2. 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.

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

    Science.gov (United States)

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

    1998-01-01

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

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

    Science.gov (United States)

    Schmidt, G

    1989-07-01

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

  5. 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.

  6. Imaging of acute cervical spine trauma: when to obtain which modality.

    Science.gov (United States)

    Ulbrich, Erika J; Carrino, John A; Sturzenegger, Matthias; Farshad, Mazda

    2013-09-01

    The current knowledge and evidence around the merits of different imaging modalities for the evaluation of cervical spine injuries are reviewed. The National Emergency X-Radiography Use Study, Canadian Cervical Spine rule, and American College of Radiology appropriateness criteria are reviewed and summarized. The advantages and disadvantages of available imaging modalities for selected cervical spine injury patterns are also illuminated to simplify the decision making on when to use which modality. PMID:24101178

  7. Anterior Cervical Discectomy and Fusion Alters Whole-Spine Sagittal Alignment

    OpenAIRE

    Kim, Jang Hoon; Park, Jeong Yoon; Yi, Seong; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

    2015-01-01

    Purpose Anterior cervical discectomy and fusion (ACDF) has become a common spine procedure, however, there have been no previous studies on whole spine alignment changes after cervical fusion. Our purpose in this study was to determine whole spine sagittal alignment and pelvic alignment changes after ACDF. Materials and Methods Forty-eight patients who had undergone ACDF from January 2011 to December 2012 were enrolled in this study. Cervical lordosis, thoracic kyphosis, lumbar lordosis, sagi...

  8. [Clinical and technical assessment of the cervical spine].

    Science.gov (United States)

    Dvorak, J

    1996-11-01

    In analysis of the cervical and cervicobrachial syndrome with or without signs of compression of the nerve root or spinal cord, functional assessment of the cervical spine is of great importance. Comparisons between actively performed and passively induced motion can be verified by using standardized computer-assisted assessment allowing precise documentation of the range of motion and coupled motion. The age-related normal values should be considered. The neurological assessment includes not only the cranial nerves and upper extremities but also lower extremities to avoid overlooking the signs of cervical myelopathy. In patients with compression of nerve roots or the spinal cord neurophysiology might be helpful in identifying or verifying compression. In patients with suspected myelopathy sensory evoked potentials will allow assessment of the function of the ascending spinal pathways and motor evoked potentials, assessment of the function of the descending cortical spinal pathways. PMID:8999404

  9. Cervical Spine Alignment and Motion in the Acute Management of Potential Catastrophic Cervical Spine Injuries in Sport

    Institute of Scientific and Technical Information of China (English)

    Erik E Swartz

    2008-01-01

    @@ The incidence of spinal cord injury in the United States is estimated to be 11,000 new cases each year[1].Sport participation constitutes the fourth most common cause[1](approximately 8. 7%) of these injuries overall but is the second most common cause for those under the age of 30[2]. The majority of all cervical spine injuries since 2000 have occurred in individuals between the ages of 16 and 30[1].

  10. Anterior retropharyngeal approach to the cervical spine.

    Directory of Open Access Journals (Sweden)

    Behari S

    2001-10-01

    Full Text Available The anterior retropharyngeal approach (ARPA accesses anteriorly situated lesions from the clivus to C3, in patients with a short neck, Klippel Feil anomaly or those in whom the C2-3 and C3-4 disc spaces are situated higher in relation to the hyoid bone and the angle of mandible where it is difficult to approach this region using the conventional anterior approach, due to the superomedial obliquity of the trajectory. The ARPA avoids the potentially contaminated oropharyngeal cavity providing for a simultaneous arthrodesis and instrumentation during the primary surgical procedure. Experience of five patients with high cervical extradural compression, who underwent surgery using this approach between 1994 and 1999, is presented. The surgical procedures included excision of ossified posterior longitudinal ligament (n=2; excision of prolapsed disc and osteophytes (n=2; and excision of a vertebral body neoplasm (n=1. Following the procedure, vertebral arthrodesis was achieved using an iliac graft in all the patients. Only one patient with vertebral body neoplasm required an additional anterior cervical plating procedure for stabilisation the construct. The complications included transient respiratory insufficiency and neurological deterioration in two patients; and, pharyngeal fistula and donor site infection in one patient.

  11. 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. PMID:26378358

  12. 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.)

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

    International Nuclear Information System (INIS)

    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.)

  14. Evaluation of Facet Joint Arthrosis in Stenotic and Normal Lumbar Spines with MRI

    OpenAIRE

    Ebru Ozan

    2013-01-01

    Aim: To reveal the prevalence of lumbar facet joint arthrosis in normal and stenotic lumbar spines with magnetic resonance imaging. Material and Method: Study group consisted of 30 patients with complaints and findings of lower back pain, neurologic claudicatio and lumbar spinal stenosis detected at L3-4, L4-5 and/or L5-S1 with magnetic resonance imaging (cross section area of the dural sac

  15. Evaluation of Facet Joint Arthrosis in Stenotic and Normal Lumbar Spines with MRI

    Directory of Open Access Journals (Sweden)

    Ebru Ozan

    2013-10-01

    Full Text Available Aim: To reveal the prevalence of lumbar facet joint arthrosis in normal and stenotic lumbar spines with magnetic resonance imaging. Material and Method: Study group consisted of 30 patients with complaints and findings of lower back pain, neurologic claudicatio and lumbar spinal stenosis detected at L3-4, L4-5 and/or L5-S1 with magnetic resonance imaging (cross section area of the dural sac

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

    International Nuclear Information System (INIS)

    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.)

  17. 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.

  18. 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

    2016-01-01

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

  19. Cervical Spine Stenosis Measures in Normal Subjects.

    Science.gov (United States)

    Tierney, Ryan T; Maldjian, Catherine; Mattacola, Carl G; Straub, Stephen J; Sitler, Michael R

    2002-06-01

    OBJECTIVE: To compare 2 methods of determining cervical spinal stenosis (Torg ratio, space available for the cord [SAC]); determine which of the components of the Torg ratio and the SAC account for more of the variability in the measures; and present standardized SAC values for normal subjects using magnetic resonance imaging (MRI). DESIGN AND SETTING: The research design consisted of a posttest-only, comparison-group design. The independent variable was method of measurement (Torg ratio and SAC). The dependent variables were Torg ratio and SAC scores. SUBJECTS: Fourteen men (age = 24.4 +/- 2.5 years, height = 181.0 +/- 5.8 cm, weight = 90 +/- 13.5 kg) participated in this study. The C3 to C7 vertebrae were examined in each subject (n = 70). MEASUREMENTS: The Torg ratio was determined by dividing the sagittal spinal-canal diameter by the corresponding sagittal vertebral-body diameter. The SAC was determined by subtracting the sagittal spinal-cord diameter from the corresponding sagittal spinal-canal diameter. The Torg ratio and SAC were measured in millimeters. RESULTS: The SAC ranged from 2.5 to 10.4 mm and was greatest at C7 in 71% (10 of 14) of the subjects. The SAC was least at C3 or C5 in 71% (10 of 14) of the subjects. A Pearson product moment correlation revealed a significant relationship between the Torg ratio and SAC (r =.53, P SAC than the spinal cord (r (2) =.23). CONCLUSIONS: The SAC measure relies more on the spinal canal compared with the Torg ratio and, therefore, may be a more effective indicator of spinal stenosis. This is relevant clinically because neurologic injury related to stenosis is a function of the spinal canal and the spinal cord (not the vertebral body). Further research must be done, however, to validate the SAC measure. PMID:12937434

  20. Langerhans cell histiocytosis of the cervical spine in an adult: a case report.

    Science.gov (United States)

    Sayhan, Salih; Altinel, Deniz; Erguden, Cenk; Kizmazoglu, Ceren; Guray, Merih; Acar, Umit

    2010-07-01

    We present a case of a 47-year-old-woman with a complaint of cervical pain with paresthetic appearance on her left arm. She was treated with analgetics. Further radiological evaluation because of the persistent pain revealed an osteolytic destruction of the fourth cervical vertebra. The patient underwent anterior cervical corpectomy with total excision of the tumor. Stabilization of the cervical spine was performed. Histology confirmed the diagnosis of Langerhans cell histiocytosis (LCH) of the cervical spine. This case report presents the histopathological evaluation, diagnostic work-up and the treatment procedures because of rarity of cervical spinal LCH cases in the literature. PMID:20669118

  1. 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.

  2. A Mathematical Model of the Cervical Spine Movement

    Science.gov (United States)

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

    2011-09-01

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

  3. Computed tomography (CT) of traumatic injuries of the cervical spine

    International Nuclear Information System (INIS)

    32 patients with traumatic injuries of the cervical spine were investigated by CT. All patients were initially examined by plain films. CT was definitely superior to conventional radiology in compressive fractures of vertebral bodies. In flexion-extension injuries CT was useful showing fractures of the posterior elements in great detail. Conventional tomography was superior to CT in patients with complex dislocations of vertebral bodies. In the absence of fracture CT failed to detect disruptions of ligaments, which were readily shown by functional examination. (orig.)

  4. Tomographic imaging of the cervical spine of horses

    International Nuclear Information System (INIS)

    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)

  5. Paraplegia by Acute Cervical Disc Protrusion after Lumbar Spine Surgery.

    Directory of Open Access Journals (Sweden)

    Sheng-Huan Chen

    2005-04-01

    Full Text Available Non-traumatic paraplegia caused by herniation of the cervical intervertebral disc is anuncommon postoperative complication. A patient with claudication and radiculopathy wasscheduled for lumbar laminectomy due to spinal stenosis. Postoperatively, numbness belowT6 was found in his both legs of the patient. MRI showed a protruded intervertebral discbetween C6 and C7. Despite urgent disectomy, the patient's lower extremities remained paralyzedwithout significant improvement for 3 months. Loss of muscle support during generalanesthesia, excessive neck extension during endotracheal intubation and positioning, as wellas bucking and agitation are believed as triggering factors for the protrusion of the cervicaldisc. We suggest that a complete history taking and physical examination be accomplishedin patients scheduled for lumbar spine surgery in order to exclude coexisting cervical spinedisorders. In addition, skillful endotracheal intubation and careful neck positioning aremandatory for patients receiving surgery in the prone position.

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

    OpenAIRE

    Lakshmanan, Palaniappan; Jones, Alwyn; Howes, John; Lyons, Kathleen

    2004-01-01

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

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

    OpenAIRE

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

    2002-01-01

    Objective: Immediate rescue breathing, or cardiopulmonary resuscitation, may be necessary for the cervical spine-injured football player without removal of the helmet. The purpose of our study was to compare 2 pocket-mask insertion techniques with a face-mask rotation technique to determine which allowed the quickest initiation of rescue breathing with the least cervical spine motion.

  8. Internal fixation on the lower cervical spine – biomechanics and clinical practice of procedures and implants

    OpenAIRE

    Ulrich, Chr.; Arand, M.; Nothwang, J.

    2001-01-01

    The decision to opt for a particular internal fixation procedure of a traumatized unstable lower cervical spine should be based on analysis and implementation of scientific and clinical data on the biomechanics of the intact, the unstable and the implant-fixed spine. The following recommendations for surgical stabilization of the lower cervical spine seem, therefore, to be justified. Firstly, the surgical procedure should be to bring about decompression, realignment, and stability. Secondly, ...

  9. Laryngeal dislocation after ventral fusion of the cervical spine

    Directory of Open Access Journals (Sweden)

    Jenny Krauel

    2013-01-01

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

  10. In vivo flexion/extension of the normal cervical spine.

    Science.gov (United States)

    Dvorak, J; Panjabi, M M; Novotny, J E; Antinnes, J A

    1991-11-01

    Twenty-two women (age range 25-49 years, average 30.9 years) and twenty-two men (age range 23-42 years, average 31.6 years), all healthy and asymptomatic, underwent passive flexion/extension examinations of the cervical spine. Functional x-rays were taken and analyzed using a computer-assisted method that quantified intervertebral rotations, translations, and locations of the centers of rotation for each level C1-C2-C6-C7. The aim of the study was to establish values for these parameters for a normal population as related to age and gender. In the process, a statistically significant difference was found in the average value of rotation between male and female groups at the C5-C6 level. A new parameter, the ratio between translation and rotation, was also established and may prove useful for clinical diagnoses. This parameter has a smaller error associated with it than do pure translations and may aid the clinician by helping to account for the large variation in rotatory ranges of motion within the population. This translation/rotation ratio indicated highly significant differences in the lower segments of the cervical spine between gender groups. PMID:1919845

  11. The Incidence of Infection after Posterior Cervical Spine Surgery: A 10 Year Review

    OpenAIRE

    Barnes, Matt; Liew, Sue

    2012-01-01

    Background The incidence of infection after posterior cervical spine surgery ranges from 0 to 18%. Higher rates have been reported after posterior procedures compared with anterior procedures, but these studies have been for small series. We report on our rate of surgical site infection (SSI) after posterior cervical spine surgery and the risk factors that influence these infections. Methods We retrospectively reviewed the records of 90 consecutive patients who underwent posterior cervical sp...

  12. Percutaneous vertebroplasty for metastatic lesions of the cervical spine

    International Nuclear Information System (INIS)

    Objective: To assess the safety and effectiveness of percutaneous vertebroplasty (PVP) performed via three different routes for the treatment of osteolytic metastatic lesions of the cervical spine. Methods: A total of 36 patients with osteolytic cervical metastases (57 cervical vertebrae involved) received the treatment of the PVP. The clinical data were retrospectively analyzed. The WHO standards and visual analogue scale (VAS) were assessed before and after the operation, and the application of three operative accesses (anterolateral approach, lateral approach and anterolateral approach through disc space) was discussed. Results: The puncturing accesses used in three groups were anterolateral approach, lateral approach and anterolateral approach through disc space. The whole procedure, including puncturing and injection of bone cement, was successfully accomplished for all diseased cervical vertebral bodies. All patients were followed up for three months. Of 32 patients who had complete clinical data, complete remission (CR) was obtained in 11, partial remission (PR) in 20, mild remission (MR) in one and no remission (NR) in zero. The clinical effectiveness (CR + PR) was 97%. The VAS scores before operation as well as 24 hours, one week and 3 months after the operation were separately determined, and four groups of data were obtained. Statistically significant difference in VAS scores existed between each other of the above four data groups (P<0.05). A little bone cement leakage was observed in 17 vertebral bodies (29.82%), however, no serious clinical complications occurred. Conclusion: Percutaneous vertebroplasty via anterolateral approach is a safe and effective technique for the treatment of osteolytic metastases located at lower cervical vertebrae (C4-C7). While in treating metastatic lesions invaded the vertebra of C1, PVP via lateral approach should be employed. For C2 and C3 vertebral involvement, PVP via anterolateral approach through disc space should

  13. Imaging diagnosis of cervical spine and spinal cord injuries in children

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To provide the experience in imaging diagnosis of cervical spine and spinal cord injuries in children.Methods: Imaging data of cervical spine and spinal cord injuries in 62 children were retrospectively reviewed.The routine radiography including the lateral,anteroposterior and open-mouth odontoid views were performed in all the patients. Tomography was available for 25 patients, and flexion-extension lateral views for 28patients, CT scanning for 21 patients, MRI for 26 patients.Results: Of these patients, 46 patients were identified with injuries of upper cervical spine (9 with atlantal arch fracture, seven with axial fracture, 21 with odontoid fracture, 1 with atlantal arch fracture combining with odontoid fracture, and 1 with atlantal transverse ligament disruption); 7 patients sustained injuries of lower cervical spine (3 fractures of vertebral body, 2 dislocations and 6fracture-dislocations ); 2 patients had multiple noncontiguous cervical injuries; and 3 had cervical spinal cord injury without radiographic abnormalities (SCIWORA).Conclusions: Imaging assessment is of great importance in the diagnosis of cervical spine and spinal cord injuries in children. Whenever cervical spine and spinal cord injuries are suspected for children patients, and the three-views should be routinely indicated. MRI should be routinely performed in all children with cervical SCIWORA.

  14. Langerhans cell histiocytosis of the cervical spine: case report of an unusual location

    International Nuclear Information System (INIS)

    An unusual location for Langerhans cell histiocytosis of the cervical spine is presented. The osteolytic lesion, instead of being located in the vertebral body, was visualised in the left lateral mass of the fifth cervical vertebra, extending into the vertebral body and through the interapophyseal joint into the lateral mass of the fourth cervical vertebra. (orig.)

  15. Langerhans cell histiocytosis of the cervical spine: case report of an unusual location

    Energy Technology Data Exchange (ETDEWEB)

    Geusens, E.; Brys, P.; Ghekiere, J.; Baert, A.L. [Department of Radiology, University Hospital Gasthuisberg KU Leuven (Belgium); Samson, I. [Department of Orthopedic Surgery, University Hospitals, Leuven (Belgium); Sciot, R. [Department of Pathology II, University Hospitals, Leuven (Belgium); Brock, P. [Department of Pediatrics, University Hospitals, Leuven (Belgium)

    1998-09-01

    An unusual location for Langerhans cell histiocytosis of the cervical spine is presented. The osteolytic lesion, instead of being located in the vertebral body, was visualised in the left lateral mass of the fifth cervical vertebra, extending into the vertebral body and through the interapophyseal joint into the lateral mass of the fourth cervical vertebra. (orig.) With 3 figs., 7 refs.

  16. Langerhans cell histiocytosis of the cervical spine: case report of an unusual location.

    Science.gov (United States)

    Geusens, E; Brys, P; Ghekiere, J; Samson, I; Sciot, R; Brock, P; Baert, A L

    1998-01-01

    An unusual location for Langerhans cell histiocytosis of the cervical spine is presented. The osteolytic lesion, instead of being located in the vertebral body, was visualised in the left lateral mass of the fifth cervical vertebra, extending into the vertebral body and through the interapophyseal joint into the lateral mass of the fourth cervical vertebra. PMID:9724427

  17. CT evaluation of the pattern of odontoid fractures in the elderly--relationship to upper cervical spine osteoarthritis.

    Science.gov (United States)

    Lakshmanan, Palaniappan; Jones, Alwyn; Howes, John; Lyons, Kathleen

    2005-02-01

    Odontoid fractures are common in the elderly following minor falls. Almost all of them have osteoarthritis of the cervical spine below the axis vertebra. As a result, there is increased stress on the spared upper cervical spine, resulting in a higher incidence of injuries. As movement in the upper cervical spine involves participation of five joints, degeneration in any one particular joint may affect the biomechanics of loading of the upper cervical spine. We aimed to analyse the relationship of odontoid fractures to the pattern of upper cervical spine osteoarthritis in the elderly. We studied the CT-scan images of the cervical spine in 23 patients who were over the age of 70 years and had odontoid fractures. In each patient, the type of odontoid fracture and the characteristics of the degenerative changes in each joint were analysed. Twenty-one of 23 patients had Type-II odontoid fractures. The incidence of significant atlanto-odontoid degeneration in these individuals was very high (90.48%), with relative sparing of the lateral atlantoaxial joints. Osteoporosis was found in 13 of 23 patients at the dens-body junction and in seven of 23 patients at the odontoid process and body of the axis. With ageing, progressively more severe degenerative changes develop in the atlanto-odontoid joint. These eventually obliterate the joint space and fix the odontoid to the anterior arch of the atlas. In contrast, the lateral atlantoaxial joints are hardly affected by osteoarthritis. Thus, ultimately, atlantoaxial movements including atlantoaxial rotation are markedly limited by osteoarthritis of the atlanto-odontoid joint. However, there is still potential for movement in the lateral atlantoaxial joints, as they remain relatively free of degenerative change. The vulnerability of the atlantoaxial segment is further increased by markedly limited rotation below the axis vertebra due to severe facet-joint degeneration. As a consequence, a relatively low-energy trauma to the lateral

  18. Catastrophic cervical spine injuries in the collision sport athlete, part 2: principles of emergency care.

    Science.gov (United States)

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

    2004-01-01

    Catastrophic cervical spine injuries can lead to devastating consequences for the collision athlete. Improved understanding of these injuries can lead to identification of risk factors, early diagnosis, and effective on-field management. This article is the second in a 2-part series. The first part, published in the June 2004 issue, reviewed the current concepts regarding the epidemiology, functional anatomy, and diagnostic considerations relevant to cervical spine trauma in collision sports. In this article, the principles of on-field emergency care of the spine-injured athlete are reviewed. The authors discuss the need for effective pre-event planning, on-field evaluation and management of cervical spine injuries, and the transition of care from the playing field to the emergency room. The protocol for equipment removal, when necessary, is also reviewed. An organized, rapid approach to the management of cervical spine-injured collision athletes can help to optimize the outcomes of these catastrophic injuries. PMID:15494346

  19. 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.

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

    Science.gov (United States)

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

    2002-01-01

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

  1. Comparative experimental biomechanical study of different types of stabilization methods of the lower cervical spine.

    Science.gov (United States)

    Kalff, R; Ulrich, C; Claes, L; Wilke, H J; Grote, W

    1992-01-01

    In a comparative experimental biodynamic study using thirty-two human cervical spines of cadavers the primary stabilization effect of different types of spondylodesis was examined. Whereas in flexion stress all methods showed a sufficient stability, the rotation tests proved, that in case of a dorsal instability of the lower cervical spine, posterior interlaminar wiring or anterior plate stabilization showed no reliable stabilization effect. However, the compression clamps by ROOSEN and TRAUSCHEL as well as the hook-plates by MAGERL are suitable dorsal stabilization methods with excellent rotation stability. In case of dorsal instability of the lower cervical spine a posterior spondylodesis is necessary and sufficient. PMID:1480272

  2. 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.

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

    Science.gov (United States)

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

    2006-08-01

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

  4. Biomechanical analysis of plate stabilization on cervical part of spine

    Directory of Open Access Journals (Sweden)

    M. Kiel

    2009-07-01

    Full Text Available Purpose: The main aim of the work was determination of biomechanical analysis of cervical spine – stabilizer system made of stainless steel (Cr-Ni-Mo and Ti-6Al-4V alloy.Design/methodology/approach: To define biomechanical characteristic of the system the finite elements method (FEM was applied. Geometric model of part of spine C5-C7 and stabilizer were discretized by SOLID95 element. Appropriate boundary conditions imitating phenomena in real system with appropriate accuracy were established.Findings: The result of biomechanical analysis was calculation of displacements and stresses in the vertebras and the stabilizer in a function of the applied loading: 50-300 N for the stabilizer made of stainless steel (Cr-Ni-Mo and Ti-6Al-4V alloy.Research limitations/implications: The result of biomechanical analysis for plate stabilizer obtained by FEM can be use to determine a construction features of the stabilizer, and to select mechanical properties of metallic biomaterial and estimation of stabilization quality. The calculation of displacements for part C5-C7 show that the proposed type of stabilizer enables correct stabilization used to clinical apply.Practical implications: The results of biomechanical analysis showed correct mechanical properties used to made the plate stabilizer.Originality/value: The obtained numerical results should be verified in “in vitro” tests.

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

    Science.gov (United States)

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

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

  6. THE EFFECT OF WEARING HEADSCARVES ON CERVICAL SPINE PROPRIOCEPTION

    Directory of Open Access Journals (Sweden)

    Samiah F. Alqabbani

    2016-04-01

    Full Text Available Background: Proprioception plays an important role in sensorimotor control of posture and movement. Impairments in cervical proprioception have been demonstrated in subjects with whiplash-associated disorder, patients with age-related degeneration, and patients with articular diseases or spondylosis. The joint position error test is widely used to measure head repositioning accuracy. Objective: The purpose of this pilot study was to compare cervical spine joint position error in females who routinely wear headscarves to females that do not wear headscarves. Methods: Twelve females with mean age 27.5±4.0 years were divided into two groups: females who routinely wear headscarves (n=6, and females who never wear headscarves (n=6. Joint position error was measured using a head-mounted laser while subjects were seated. The tasks involved relocating the head to neutral after flexion, extension, right rotation, and left rotation. A total of six trials were done for each direction. Results: The joint position error was higher in females wearing headscarves compared to females who do not wear them in the cumulative joint position error score (8.2±1.0 vs. 4.4±1.0, p=0.06 as well as during head rotation to the right (9.3±1.6 vs. 3.1±1.6, p=0.06. Conclusion: Wearing headscarves may increase the cervical joint position error and can negatively impact postural control. However, further studies are needed to confirm this finding.

  7. Cervical facet dislocation adjacent to the fused motion segment

    OpenAIRE

    Kunio Yokoyama; Masahiro Kawanishi; Makoto Yamada; Hidekazu Tanaka; Yutaka Ito; Toshihiko Kuroiwa

    2016-01-01

    This study reports on a case that forces re-examination of merits and demerits of anterior cervical fusion. A 79-year-old male was brought to the emergency room (ER) of our hospital after he fell and struck the occipital region of his head following excessive alcohol consumption. Four years prior, he had undergone anterior cervical discectomy and fusion of C5/6 and a magnetic resonance imaging (MRI) performed 3 years after this surgery indicated that he was suffering from degeneration of C6/7...

  8. 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.

  9. Ganglion cyst of the cervical spine presenting with Brown-Sequard syndrome.

    Science.gov (United States)

    Cheng, Wen-Yu; Shen, Chiung-Chyi; Wen, Mei-Chin

    2006-12-01

    Ganglion cysts of the spine are uncommon. They occur mostly in the dorsolateral trunk and arise with the greatest frequency in the lumbar spine. However, they are rarely symptomatic. We report a rare case of a patient with a ganglion cyst of the lower cervical spine presenting with acute Brown-Sequard syndrome. The patient had no history of trauma. Magnetic resonance imaging of the cervical spine showed a cystic lesion connecting to the synovial joint C6-7 and compressing the posterior aspect of the spinal cord. The patient underwent emergent C6-7 laminectomy with total removal of the cyst. Neurological function recovered completely 4 months after operation. Ganglion cysts should be considered in the differential diagnosis of an extradural mass of the cervical spine. Magnetic resonance imaging provides a rapid and correct diagnosis, and laminectomy with removal of the cyst results in good neurological recovery. PMID:17113987

  10. Lumbar Facet Joint Arthritis Is Associated with More Coronal Orientation of the Facet Joints at the Upper Lumbar Spine

    International Nuclear Information System (INIS)

    We retrospectively analyzed CT scans of 620 individuals, who presented to our traumatology department between 2008 and 2010. Facet joint (FJ) arthritis was present in 308 (49.7%) individuals with a mean grade of 1. It was seen in 27% of individuals ≤40 years and in 75% of individuals ≥41 years ( Ρ <0.0001) as well as in 52% of females and 49% of males ( Ρ=0.61). Mean FJ orientation was 30.4° at L2/3, 38.7° at L3/4, 47° at L4/5, and 47.3° at L5/S1. FJ arthritis was significantly associated with more coronal (increased degree) FJ orientation at L2/3 (Ρ=0.03) with a cutoff point at ≥32°. FJs were more coronally oriented (48.8°) in individuals ≤40 years and more sagittally oriented (45.6°) in individuals ≥41 years at L5/S1 (Ρ=0.01). Mean FJ asymmetry was 4.89° at L2/3, 6.01° at L3/4, 6.67° at L4/5, and 7.27° at L5/S1, without a significant difference for FJ arthritis. FJ arthritis is common, increases with age, and affects both genders equally. More coronally oriented FJs (≥32°) in the upper lumbar spine may be an individual risk factor for development of FJ arthritis.

  11. 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)

  12. A case of dialysis-related amyloidosis of the hip and cervical spine: imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Gyung Kyu; Kang, Ik Won; Min, Seon Jung; Cho, Seong Whi; Kim, Seok Woo; Jang, Woo Young [Hallym University College of Medicine, Chuncheon (Korea, Republic of); Lee, Seon Joo [Inje University College of Medicine, Seoul (Korea, Republic of); Suh, Kyung Jin [Dankook University College of Medicine, Busan Paik Hospital, Busan (Korea, Republic of)

    2006-05-15

    Dialysis-related amyloidosis is a complication of long-term hemodialysis and it is characterized by the accumulation of {beta} 2-microglobulin in the osteoarticular structures. We describe here the imaging findings of a case of dialysis-related amyloidosis involving the hip and cervical spine in a 62-year-old woman who received long-term dialysis. We focus here on the CT and MR imaging findings of the cervical spine and we include a review of the relevant literatures.

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

    OpenAIRE

    Skaf, Ghassan S.; Sabbagh, Amira S.; Hadi, Usamah

    2006-01-01

    Anterior surgery to the upper cervical spine, although rare, several successful approaches were described in the literature. To avoid the risks and limitations of transoral approach, the anterior retropharyngeal approach was developed. In this study, we describe our experience with anterior retropharyngeal approach to the upper cervical spine and discuss the significance of resecting the submandibular gland. From July 2001 to July 2004, we performed six anterior prevascular retropharyngeal ap...

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

    OpenAIRE

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

    2013-01-01

    Background: Truview laryngoscope provides an indirect view of the glottis and will cause less cervical spine movement since a ventral lifting force will not be required to visualize the glottis compared to Macintosh laryngoscope. Materials and Methods: A randomized crossover study to assess the degree of movement of cervical spine during endotracheal intubation with Truview laryngoscope was conducted in 25 adult ASA-I patients. After a standard anesthetic technique laryngoscopy was perfor...

  15. Misdiagnosed bilateral C5-C6 dislocation causing cervical spine instability: a case report

    OpenAIRE

    Gelalis, Ioannis D.; Christoforou, Georgios; Arnaoutoglou, Christina M.; Politis, Angelos N.; Manoudis, Gregory; Xenakis, Theodoros A

    2009-01-01

    Introduction The diagnosis of cervical spine injuries remains a significant problem in many blunt trauma patients. Correct and early diagnosis of these injuries is imperative as delayed or missed diagnoses result in increased morbidity and mortality. Case presentation A 57-year-old Caucasian woman presented with a misdiagnosed bilateral C5-C6 dislocation one month after a fall and head injury, without clearance of the cervical spine in her previous visits to two physicians and having already ...

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

    Science.gov (United States)

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

    2004-11-01

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

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

    OpenAIRE

    Narayanan, Mohan; Serban, Daniel; Tender, Gabriel C.

    2013-01-01

    Introduction Carcinoid tumors are neuroendocrine neoplasms derived from the enterochromaffin cells. Central nervous system involvement is rare and has been reported either as metastases to the brain and spine or primary tumors involving the sacrococcygeal spine. We report the first case of a primary carcinoid tumor of the cervical spine. Case presentation A 50-year-old African-American woman presented with a 4-month history of numbness, paresthesias, and mild left-hand weakness. Magnetic reso...

  18. CT-guided percutaneous biopsy of the cervical spine: a series of 12 cases

    International Nuclear Information System (INIS)

    Twelve patients underwent biopsy of cervical vertebral bodies under CT guidance. An accurate diagnosis was obtained in 11. No complications were observed, except for a transitory recurrent laryngeal nerve palsy. Technical problems of the cervical spine biopsy are discussed and the utility of bone biopsy with a coaxial trephine system is emphasized. (orig.)

  19. Sub-axial cervical spine injuries: Modified Stellerman′s algorithm

    Directory of Open Access Journals (Sweden)

    Arjun Shetty

    2011-01-01

    Conclusion: We feel that on table decompression and reduction followed by anterior stabilization can be used as the initial surgical approach to manage most types of cervical injuries. In rotation/translational cases where reduction cannot be achieved, monitored cervical traction on the decompressed spine can safely achieve reduction and hence avoid the need for a posterior facetectomy in a large percentage of cases.

  20. Characteristic MRI and MR Myelography Findings for the Facet Cyst Hematoma at T12-L1 Spine: A Case Report

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    Chung, Seung Eun [Dept of Diagnostic Radiology, Wooridul Spine Hospital, Seoul (Korea, Republic of); Lee, Sang Ho [Dept. of Neurosurgery, Wooridul Spine Hospital, Seoul (Korea, Republic of); Kim, Tae Hong [Dept. of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of); Choi, Gun [Dept. of Neurosurgery, Seoul Wooridul Hospital, Seoul (Korea, Republic of); Paeng, Sung Suk [Dept of Radiology, Wooridul Spine Hospital, Seoul (Korea, Republic of)

    2011-05-15

    A facet cyst is a very rare condition in the thoracolumbar spine and more so, hemorrhage into a cyst is extremely rare. We present a case of a facet cyst hematoma in the T12-L1 spine. A 69-year-old woman complained of chronic back pain with right lower extremity pain, and weakness for 3 years. MRI and MR myelography showed an extradural mass at the T12-L1 level with heterogeneous signal intensity on both T1-and T2-weighted images, which was continuous to the right T12-L1 facet joint. The neighboring facet joint showed severe degeneration on the CT scan. The mass a was simple hematoma covered with a thin fibrous membrane and connected with facet joint macroscopically and microscopically. The pathogenesis of the facet cyst hematoma is not clear but it can compress nerve roots or dura mater and cause radiculopathy or cauda equina syndrome. Surgical removal should be recommended for symptomatic relief.

  1. High-resolution CT of the cervical spine

    International Nuclear Information System (INIS)

    1. High-resolution CT of a slice 1.5 mm thick is capable of demonstrating the protrusion of a cartilaginous disc on non-contrast studies. As the central disc is often associated with partial calcification, it is easily demonstrated, but this thin-section CT is indispensable for demonstrating a lateral disc. We can easily find a vacuum phenomenon of the cervical spine when the neck is hyperextended. It is important to take and to compare CTs with the patient's neck flexed and with the patient's neck extended. 2. A protruded disc is more clearly visualized by intravenous contrast agents, because the epidural plexus and granulation tissue around the disc are contrast-enhanced. Within 6 months after laminectomy, the tissue surrounding dural canal is contrast-enhanced, and it is easy to recognize the enlargement of the dural canal. It is useful that these methods can be done on outpatients. 3. As metrizamide myelo-CT can help the diagnosis of myelography, it is better for it to be done routinely after metrizamide myelography. By 1.5 mm-thick-slice CT, we can demonstrate various intraspinal structures, for example, an anterior median fissure, a posterior root, and an anterior root. It is also very useful for a postoperative check. We can conveniently use it to ascertain the relationship between the spinal cord and a vertebral body or between the nerve root and the vertebral arch. (author)

  2. Novel Intraoperative Technique to Visualize the Lower Cervical Spine: A Case Series.

    Science.gov (United States)

    Rauck, Ryan; Stammen, Kari; Yu, Elizabeth; Khan, Safdar N

    2016-02-01

    Visualization of the lower cervical spine with a lateral radiograph poses a challenge secondary to encroachment of the shoulders. Applying traction to the arms or taping the shoulders down provides adequate visualization in most patients, but imaging the mid- to lower cervical levels presents a significant challenge in patients with stout necks. We present a variation of the lateral radiograph that is 30º oblique from horizontal and 30º cephalad from neutral and used in a series of patients with stout necks that require anterior instrumentation of the lower cervical spine. We reviewed intraoperative images of 2 patients who underwent anterior cervical spine surgery at our institution, and assessed type of procedure, body mass index, and outcome scores. Our variation provided improved visualization relative to a lateral view and was used intraoperatively to confirm correct-level hardware placement in both patients. PMID:26866322

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

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    Peterson Cynthia K

    2004-06-01

    Full Text Available Abstract Background Although the effectiveness of manipulative therapy for treating back and neck pain has been demonstrated, the validity of many of the procedures used to detect joint dysfunction has not been confirmed. Practitioners of manual medicine frequently employ motion palpation as a diagnostic tool, despite conflicting evidence regarding its utility and reliability. The introduction of various spinal models with artificially introduced 'fixations' as an attempt to introduce a 'gold standard' has met with frustration and frequent mechanical failure. Because direct comparison against a 'gold standard' allows the validity, specificity and sensitivity of a test to be calculated, the identification of a realistic 'gold standard' against which motion palpation can be evaluated is essential. The objective of this study was to introduce a new, realistic, 'gold standard', the congenital block vertebra (CBV to assess the validity of motion palpation in detecting a true fixation. Methods Twenty fourth year chiropractic students examined the cervical spines of three subjects with single level congenital block vertebrae, using two commonly employed motion palpation tests. The examiners, who were blinded to the presence of congenital block vertebrae, were asked to identify the most hypomobile segment(s. The congenital block segments included two subjects with fusion at the C2–3 level and one with fusion at C5-6. Exclusion criteria included subjects who were frankly symptomatic, had moderate or severe degenerative changes in their cervical spines, or displayed signs of cervical instability. Spinal levels were marked on the subject's skin overlying the facet joints from C1 to C7 bilaterally and the motion segments were then marked alphabetically with 'A' corresponding to C1-2. Kappa coefficients (K were calculated to determine the validity of motion palpation to detect the congenitally fused segments as the 'most hypomobile' segments. Sensitivity

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

    Science.gov (United States)

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

    2012-03-01

    Previous epidemiological studies of rollover crashes have focused primarily on serious and fatal injuries in general, while rollover crash testing has focused almost exclusively on cervical spine injury. The purpose of this study was to examine and compare the risk factors for cervical spine, head, serious, and fatal injury in real world rollover crashes. Rollover crashes from 1995-2008 in the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) were investigated. A large data set of 6015 raw cases (2.5 million weighted) was generated. Nonparametric univariate analyses, univariate logistic regression, and multivariate logistic regression were conducted. Complete or partial ejection, a lack of seatbelt use, a greater number of roof inversions, and older occupant age significantly increased the risk of all types of injuries studied (phead, and cervical spine injury (pinjury in general. Higher BMI was associated with an increased risk of fatal, serious, and cervical spine injury (phead injury. Greater roof crush was associated with a higher rate of fatal and cervical spine injury (poccupant height, and occupant gender had inconsistent and generally non-significant effects on injury. This study demonstrates both common and unique risk factors for different types of injuries in rollover crashes. PMID:22269486

  5. Quantitative morphometric analysis of the lumbar vertebral facets and evaluation of feasibility of lumbar spinal nerve root and spinal canal decompression using the Goel intraarticular facetal spacer distraction technique: A lumbar/cervical facet comparison

    Directory of Open Access Journals (Sweden)

    Savni R Satoskar

    2014-01-01

    Full Text Available Objective : The authors evaluate the anatomic subtleties of lumbar facets and assess the feasibility and effectiveness of use of ′Goel facet spacer′ in the treatment of degenerative spinal canal stenosis. Materials and Methods : Twenty-five lumbar vertebral cadaveric dried bones were used for the purpose. A number of morphometric parameters were evaluated both before and after the introduction of Goel facet spacers within the confines of the facet joint. Results : The spacers achieved distraction of facets that was more pronounced in the vertical perspective. Introduction of spacers on both sides resulted in an increase in the intervertebral foraminal height and a circumferential increase in the spinal canal dimensions. Additionally, there was an increase in the disc space or intervertebral body height. The lumbar facets are more vertically and anteroposteriorly oriented when compared to cervical facets that are obliquely and transversely oriented. Conclusions : Understanding the anatomical peculiarities of the lumbar and cervical facets can lead to an optimum utilization of the potential of Goel facet distraction arthrodesis technique in the treatment of spinal degenerative canal stenosis.

  6. EVALUATION OF THE RESULTS OF CERVICAL SPINE & SPINAL CORD TRAUMA IN CHILDREN

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    G.R. Bahadorkhan

    2009-01-01

    Full Text Available Objectives Major differences exist in the anatomy and biomechanics of the growing spine that causes failure patterns different from those in adults. Spinal injury in the pediatric patient is a main concern because timely diagnosis and appropriate treatment can prevent further neurologic damage and deformity and potentiate recovery. We conducted a retrospective clinical study of 137 cases (93 boys, 44 girls of pediatric cervical spine injuries, managed over fifteen years, to present data from a large series of pediatric patients with cervical spine injuries from a single regional trauma center. The aim was to assess and analyze complications, etiology, pathogenesis, site of injuries and age difference of cervical spine and spinal cord injury in a pediatric age group and compare the findings with current literature.Materials & Methods One hundred and thirty seven children with cervical spine injuries, seen over twelve years, were divided into two age groups: 54 patients were in group one (0-9 years and 83 patients were in group two (10 – 17 years . We managed them according to status at presentation and type of injury. Forty seven patients were managed surgically and ninety nonsurgically (52 wore a halo brace and 38 wore different hard collars and braces. T-test and Chi squares were used to analyze differences between groups ResultsThe most common cause of injury was motor vehicle accidents(MVA. Our younger patients (Group 1 had sustained more neurological injuries than the older ones (Group 2, 77% vs.48%.; upper cervical spine was the most common site involved in 76%, while 43% suffered head injuries. In group two, 88% of children two sustained fractures or fracture/ subluxations; also in this group, subluxation, and fracture/subluxation was present in 10 and 25% of children respectively. The most common radiological findings were vertebral fractures (38%. Solid fusions were demonstrated in all patients at late follow–up review (mean 6 years

  7. Langerhans cell histiocytosis of the cervical spine: a single institution experience in four patients.

    Science.gov (United States)

    Tan, Grace; Samson, Ignace; De Wever, Ivo; Goffin, Jan; Demaerel, Philippe; Van Gool, Stefaan W

    2004-03-01

    When Langerhans cell histiocytosis (LCH) occurs at critical sites, such as in the cervical spine, there is a substantial risk for morbidity. Therefore, reports on clinical experiences with those patients remain important. We summarize the history of four patients with unifocal LCH at the cervical spine. All four patients received a biopsy to prove the histopathological diagnosis of LCH by demonstration of CD1a+cells. They were treated with oral prednisolone. All patients recovered completely and kept a normal function of the cervical spine. No reactivation of the disease occurred with an observation time of 3.4-7.3 years. This report contributes to the clinical experience for the treatment of LCH at critical sites. PMID:15076592

  8. Increased pelvic incidence may lead to arthritis and sagittal orientation of the facet joints at the lower lumbar spine

    OpenAIRE

    Jentzsch, Thorsten; Geiger, James; Bouaicha, Samy; Slankamenac, Ksenija; Nguyen-Kim, Thi Dan; Werner, Clément M. L.

    2013-01-01

    BACKGROUND: Correct sagittal alignment with a balanced pelvis and spine is crucial in the management of spinal disorders. The pelvic incidence (PI) describes the sagittal pelvic alignment and is position-independent. It has barely been investigated on CT scans. Furthermore, no studies have focused on the association between PI and facet joint (FJ) arthritis and orientation. Therefore, our goal was to clarify the remaining issues about PI in regard to (1) physiologic values, (2) age, (3) gende...

  9. Correlation of Ordered Cervical Spine X-rays in Emergency Department with NEXUS and Canadian C-Spine Rules; a Clinical Audit

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    Hamid Kariman

    2015-10-01

    Full Text Available Introduction: Evaluation of cervical spine injuries makes up a major part of trauma patient assessments. Based on the existing sources, more than 98% of the cervical spine X-rays show no positive findings. Therefore, the present clinical audit aimed to evaluate the correlation of ordered cervical spine X-rays in multiple trauma patients with NEXUS and Canadian c-spine clinical decision rules. Methods: The present clinical audit, evaluated the correlation of cervical spine imaging orders in multiple trauma patients presented to the emergency department, with NEXUS and Canadian c-spine rules. Initially, in a pilot study, the mentioned correlation was evaluated, and afterwards the results of this phase was analyzed. Since the correlation was low, an educational training was planned for all the physicians in charge. Finally, the calculated correlations for before and after training were compared using SPSS version 21. Results: Before and after training, cervical spine X-ray was ordered for 98 (62.82% and 85 (54.48% patients, respectively. Accuracy of cervical spine X-ray orders, based on the standard clinical decision rules, increased from 100 (64.1% cases before training, to 143 (91.7% cases after training (p < 0.001. Area under the receiver operating characteristic (ROC curve regarding the correlation also raised from 52 (95% confidence interval (CI: 43 – 61 to 92 (95% CI: 87 – 97. Conclusion: Teaching NEXUS and Canadian c-spine clinical decision rules plays a significant role in improving the correlation of cervical spine X-ray orders in multiple trauma patients with the existing standards.

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

    Science.gov (United States)

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

    2016-06-01

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

  11. Cost and effectiveness of cervical spine evaluation with and without oblique views

    International Nuclear Information System (INIS)

    This paper investigates the impact of oblique views of the cervical spine in trauma patients on cost and accuracy of interpretation. Six radiologists interpreted 76 trauma-related cervical spine studies with and without oblique views. Radiologists knew that studies were obtained from emergency department patients seen in May 1989. All studies yielded normal findings. Among 311 interpretations made with oblique views, 37 were false- positive. Among 333 interpretations without oblique views, 61 were false-positive. Among readings obtained without oblique views, readers requested no additional studies in 71.8%; with oblique views, readers requested no additional studies in 88.1%

  12. [FUNCTIONAL STATE OF STATOKINETIC SYSTEM AND CERVICAL SPINE IN EDENTULOUS PATIENTS WITH CONCOMITANT SOMATIC PATHOLOGY].

    Science.gov (United States)

    Ovsiannikov, K A; Veretenko, E A; Iordanishvili, A K

    2015-01-01

    This study was aimed to evaluate the functional state of statokinetic system and cervical spine in edentulous patients with concomitant somatic pathology before and three months after prosthetic dental treatment. Thirty seven edentulous patients underwent comprehensive examination including computer-assisted stabilometry. Stabilometric recordings were performed using stabilometric platform "Stabilan-01" (manufactured by special design office "Ritm", Taganrog) by means of special tests. According to the data of computer-assisted stabilometry prosthetic dental treatment leads to improvement of the functional state of statokinetic system and cervical spine in patients with concomitant somatic pathology. PMID:26390624

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

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    Yushi Ueki

    2014-01-01

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

  14. Cervical spine arthrodesis in rheumatoid arthritis: a long-term follow-up.

    OpenAIRE

    Krieg, J. C.; Clark, C. R.; Goetz, D. D.

    1993-01-01

    Forty-one patients with rheumatoid arthritis involving the cervical spine had a posterior cervical arthrodesis. They were followed for a minimum period of seven years. The diagnoses prior to surgery included cranial settling, atlantoaxial subluxation, subaxial subluxation, and any combination of these three. All patients had posterior arthrodesis, with or without methylmethacrylate, and iliac crest autogenous bone graft. In addition, one patient had an anterior vertebrectomy, and two had tran...

  15. The use of disharmonic motion curves in problems of the cervical spine

    OpenAIRE

    Feipel, V.; Rondelet, B; LePallec, J. P.; Dewitte, O; Rooze, M.

    1999-01-01

    Cervical spine motion was investigated by three-dimensional electrogoniometry in 257 asymptomatic volunteers and in 32 patients with cervical disc hernia or whiplash syndrome. Maximal ranges of main and coupled motions were considered. Motion curves were analysed qualitatively and using fitting of sixth degree polynomials. Motion ranges obtained were in agreement with previous observations. Significant differences between patients and volunteers concerned several primary and coupled component...

  16. Effect of playing basketball on the posture of cervical spine in healthy collegiate students

    OpenAIRE

    Singla, Deepika; Veqar, Zubia

    2015-01-01

    Objective: To assess and compare the cervical posture of collegiate students and collegiate basketball players.Procedure: Craniovertebral angle and Sagittal head tilt were measured using photogrammetric method in 15 collegiate students and 15 collegiate basketball players.Results: Significant differences were not found between two groups for any of the two angles at p<0.05.Conclusions: Playing basketball does not place any significant impact on the posture of cervical spine of collegiate s...

  17. Subject-Specific Inverse Dynamics of the Head and Cervical Spine During in Vivo Dynamic Flexion-Extension

    OpenAIRE

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

    2013-01-01

    The effects of degeneration and surgery on cervical spine mechanics are commonly evaluated through in vitro testing and finite element models derived from these tests. The objectives of the current study were to estimate the load applied to the C2 vertebra during in vivo functional flexion-extension and to evaluate the effects of anterior cervical arthrodesis on spine kinetics. Spine and head kinematics from 16 subjects (six arthrodesis patients and ten asymptomatic controls) were determined ...

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

    OpenAIRE

    Lebl, Darren R.

    2013-01-01

    The advent of recombinant DNA technology has substantially increased the intra-operative utilization of biologic augmentation in spine surgery over the past several years after the Food and Drug Administration approval of the bone morphogenetic protein (BMP) class of molecules for indications in the lumbar spine. Much less is known about the potential benefits and risks of the “off-label” use of BMP in the cervical spine. The history and relevant literature pertaining to the use of the “off-l...

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

    OpenAIRE

    Rainer O. Seidl; Niedeggen, Andreas; Todt, Ingo; Westhofen, Martin; Ernst, Arne

    2006-01-01

    A report of our experiences involving the treatment six male patients with a new method of closing perforations in the pharynx and upper esophagus, following surgery of the cervical spine region. Perforation of the pharynx and upper esophagus are rare complications following cervical spine surgery. The grave consequences of these complications necessitate in most cases immediate surgical therapy. In most cases, the first step involves the removal of the cervical plate and screws. The defect w...

  20. Pediatric Upper Cervical Spine Giant Cell Tumor: Case Report

    OpenAIRE

    Alfawareh, Mohammad D.; Shah, Irfanullah D.; Orief, Tamer I.; Halawani, Mohammad M.; Attia, Walid I.; Almusrea, Khaled N.

    2014-01-01

    Study Design Case report. Objective The purpose of this work is to report the case of a giant cell tumor involving the second cervical vertebra in a pediatric patient. Surgical management included a combined posterior and anterior cervical approach. There has been no recurrence in 2 years of follow-up. Case Report A 13-year-old girl presented with scoliosis with incidentally lytic lesion involving the second cervical vertebra. The radiologic investigations and biopsy result indicated a giant ...

  1. Thoracic spine pain

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    Aleksey Ivanovich Isaikin

    2013-03-01

    Full Text Available Thoracic spine pain, or thoracalgia, is one of the common reasons for seeking for medical advice. The epidemiology and semiotics of pain in the thoracic spine unlike in those in the cervical and lumbar spine have not been inadequately studied. The causes of thoracic spine pain are varied: diseases of the cardiovascular, gastrointestinal, pulmonary, and renal systems, injuries to the musculoskeletal structures of the cervical and thoracic portions, which require a thorough differential diagnosis. Facet, costotransverse, and costovertebral joint injuries and myofascial syndrome are the most common causes of musculoskeletal (nonspecific pain in the thoracic spine. True radicular pain is rarely encountered. Traditionally, treatment for thoracalgia includes a combination of non-drug and drug therapies. The cyclooxygenase 2 inhibitor meloxicam (movalis may be the drug of choice in the treatment of musculoskeletal pain.

  2. Evolving standards of practice for cervical spine imaging in trauma: a retrospective review

    International Nuclear Information System (INIS)

    Full text: Recently published works on radiology and emergency medicine suggest an increasing role for primary CT imaging of the cervical spine (C-spine) in trauma, rather than plain X-rays. This observational retrospective study of 406 patients was undertaken to examine current practice in a metropolitan teaching hospital setting and to define factors affecting the use of primary imaging for suspected C-spine fracture. This study supports the increasing recognition of the limited accuracy and adequacy of plain films, especially among the more severely injured patients. It is suggested that intubated patients, patients with severe trauma or patients with Glasgow Coma Scale <13 have CT as a primary screening examination for suspected C-spine fracture rather than X-ray. Patients having head CT for suspected intracranial injury may also benefit from included C-spine CT. The increasing usage of primary CT will increase overall imaging costs and resource utilization

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

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    Neerja Bhardwaj

    2013-01-01

    Full Text Available Background: Truview laryngoscope provides an indirect view of the glottis and will cause less cervical spine movement since a ventral lifting force will not be required to visualize the glottis compared to Macintosh laryngoscope. Materials and Methods: A randomized crossover study to assess the degree of movement of cervical spine during endotracheal intubation with Truview laryngoscope was conducted in 25 adult ASA-I patients. After a standard anesthetic technique laryngoscopy was performed twice in each patient using in turn both the Macintosh and Truview laryngoscopes. A baseline radiograph with the head and neck in a neutral position was followed by a second radiograph taken during each laryngoscopy. An experienced radiologist analyzed and measured the cervical movement. Results: Significant cervical spine movement occurred at all segments when compared to the baseline with both the Macintosh and Truview laryngoscopes (P < 0.001. However, the movement was significantly less with Truview compared to the Macintosh laryngoscope at C 0 -C 1 (21%; P = 0.005 and C 1 -C 2 levels (32%; P = 0.009. The atlantooccipital distance (AOD traversed while using Truview laryngoscope was significantly less than with Macintosh blade (26%; P = 0.001. Truview blade produced a better laryngoscopic view (P = 0.005 than Macintosh blade, but had a longer time to laryngoscopy (P = 0.04. Conclusion: Truview laryngoscope produced a better laryngoscopic view of glottis as compared with Macintosh laryngoscopy. It also produced significantly less cervical spine movement at C 0 -C 1 and C 1 -C 2 levels than with Macintosh laryngoscope in patients without cervical spine injury and without manual in-line stabilization (MILS. Further studies are warranted with Truview laryngoscope using MILS.

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

    Science.gov (United States)

    Leven, Dante

    2016-01-01

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

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

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

    OpenAIRE

    Hitzemann, Martin

    2003-01-01

    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.

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

    International Nuclear Information System (INIS)

    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 106 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

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

    International Nuclear Information System (INIS)

    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)

  9. Cognitive deficits in patients after soft tissue injury of the cervical spine.

    Science.gov (United States)

    Radanov, B P; Dvorák, J; Valach, L

    1992-02-01

    Fifty-one patients suffering from soft tissue injury of the cervical spine underwent clinical and psychometric examination. Clinical interview evaluated subjective complaints and formal testing of self-estimated cognitive impairment, divided attention, and speed of information processing. Results indicated at least two different syndromes: 1) the "cervicoencephalic syndrome," characterized by headache, fatigue, dizziness, poor concentration, disturbed accommodation, and impaired adaptation to light intensity; and 2) the "lower cervical spine syndrome," which is accompanied by cervical and cervicobrachial pain. When comparing patients with either of these two syndromes, those suffering from cervicoencephalic syndrome had significantly poorer results when tested for divided attention. Speed of information processing was reduced to a comparable extent in both syndromes. These findings were not related to the length of the post-traumatic interval. Reduced processing of working memory is assumed, which may account for more global cognitive problems as well as secondary neurotic reaction. PMID:1553581

  10. 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.

  11. 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.

  12. Lumbar Facet Joint Arthritis Is Associated with More Coronal Orientation of the Facet Joints at the Upper Lumbar Spine

    OpenAIRE

    Thorsten Jentzsch; James Geiger; Zimmermann, Stefan M.; Ksenija Slankamenac; Thi Dan Linh Nguyen-Kim; Clément M. L. Werner

    2013-01-01

    We retrospectively analyzed CT scans of 620 individuals, who presented to our traumatology department between 2008 and 2010. Facet joint (FJ) arthritis was present in 308 (49.7%) individuals with a mean grade of 1. It was seen in 27% of individuals ≤40 years and in 75% of individuals ≥41 years (P < 0.0001) as well as in 52% of females and 49% of males (P = 0.61). Mean FJ orientation was 30.4° at L2/3, 38.7° at L3/4, 47° at L4/5, and 47.3° at L5/S1. FJ arthritis was significantly associated wi...

  13. Lumbar facet joint arthritis is associated with more coronal orientation of the facet joints at the upper lumbar spine

    OpenAIRE

    Jentzsch, Thorsten; Geiger, James; Zimmermann, Stefan M.; Slankamenac, Ksenija; Nguyen-Kim, Thi Dan Linh; Werner, Clément M. L.

    2013-01-01

    We retrospectively analyzed CT scans of 620 individuals, who presented to our traumatology department between 2008 and 2010. Facet joint (FJ) arthritis was present in 308 (49.7%) individuals with a mean grade of 1. It was seen in 27% of individuals ≤40 years and in 75% of individuals ≥41 years (P < 0.0001) as well as in 52% of females and 49% of males (P = 0.61). Mean FJ orientation was 30.4° at L2/3, 38.7° at L3/4, 47° at L4/5, and 47.3° at L5/S1. FJ arthritis was significantly associated wi...

  14. The possibility of the radiological and ultrasonographic examination of the facet joints of the equine thoracic and lumbar spine

    International Nuclear Information System (INIS)

    The facet joints of the equine thoracic and lumbar spine were examined by radiology and ultrasonography in 31 and 20 standing horses, respectively. The employed methods were evaluated. The left and right joints of 15/31 standing horses were comparatively x-rayed with both 20o ventral oblique and 30o dorsal oblique techniques. The independent evaluation of the ensuing films by four experienced veterinary surgeons yielded a significantly better assessment of the tested parameters in the 20o ventral oblique technique. It was possible to depict the facet joints of the right and left sides between the caudal margin of the scapula and the diaphragm with the pulmonary field as background rich in contrast. In 20 horses, the facet joints were examined from Th10 to L6 in longitudinal and sagittal planes. A linear-array ultrasound probe with a frequency of 7,5 MHz and a convex ultrasound probe with a frequency of 3,5 MHz were used. Depending on the nutritional state, the soft tissue structures could be evaluated. The evaluation of the facet joints themselves was very limited. (author)

  15. 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

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

    International Nuclear Information System (INIS)

    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

  17. Intradural tumor and concomitant disc herniation of cervical spine

    Directory of Open Access Journals (Sweden)

    Mihir R Bapat

    2011-01-01

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

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

    Science.gov (United States)

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

    2016-05-01

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

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

    Kordecki, Michael; Smith, Danny; Hoogenboom, Barb

    2011-06-01

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

  1. 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.

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

    OpenAIRE

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

    2012-01-01

    Cervical spine immobilization is an essential component of the ATLS® system. Inadequate training in the management of trauma calls and failure of early recognition can have disastrous consequences. Pre-hospital personnel are routinely involved more in the assessment and stabilization of patients in comparison to other health care professionals. This case study and review highlights the importance of early recognition, assessment and correct stabilization of cervical spine injuries both in the...

  3. The Use of Bone Morphogenetic Protein in Pediatric Cervical Spine Fusion Surgery: Case Reports and Review of the Literature

    OpenAIRE

    Molinari, Robert W.; Molinari, Christine

    2015-01-01

    Study Design Case report. Objective There is a paucity of literature describing the use of bone graft substitutes to achieve fusion in the pediatric cervical spine. The outcomes and complications involving the off-label use of bone morphogenetic protein (BMP)-2 in the pediatric cervical spine are not clearly defined. The purpose of this article is to report successful fusion without complications in two pediatric patients who had instrumented occipitocervical fusion using low-dose BMP-2. Meth...

  4. Comparison of Modic Changes in the Lumbar and Cervical Spine, in 3167 Patients with and without Spinal Pain

    OpenAIRE

    Sheng-yun, Li; Letu, Suyou; JIAN, CHEN; Mamuti, Maiwulanjiang; Jun-Hui, Liu; Zhi, Shan; Chong-yan, Wang; Shunwu, Fan; Zhao, Fengdong

    2014-01-01

    Background Context There are few comparisons of Modic changes (MCs) in the lumbar and cervical spine. Purpose Compare the prevalence of MCs in the lumbar and cervical spine, and determine how MC prevalence depends on spinal pain, age, disc degeneration, spinal level, and the presence or absence of kyphosis. Study Design Retrospective clinical survey. Materials and Methods Magnetic resonance images (MRIs) were compared from five patient groups: 1. 1223 patients with low-back pain/radiculopathy...

  5. Embolic brain infarction related to posttraumatic occlusion of vertebral artery resulting from cervical spine injury: a case report

    OpenAIRE

    Nakao, Yaoki; Terai, Hiroshi

    2014-01-01

    Introduction The frequency of vertebrobasilar ischemia in patients with cervical spine trauma had been regarded as low in many published papers. However, some case reports have described cervical spine injury associated with blunt vertebral artery injury. Many aspects of the management of vertebral artery injuries still remain controversial, including the screening criteria, the diagnostic modality, and the optimal treatment for various lesions. The case of a patient who had a brain infarctio...

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

    OpenAIRE

    Kordecki, Michael; Smith, Danny; Hoogenboom, Barb

    2011-01-01

    Since the inception of the term Sports Medicine Athletic Trainers, Sports Physical Therapists, Paramedics, and Emergency Room Physicians have faced a number of challenges when it comes to providing care to an equipment laden athlete suspected of having a cervical spine or serious head injury. The same equipment that is designed to protect the player may significantly impede the medical team when it comes to diagnosing and treating cervical spine and head injuries. Incorrectly removing the hel...

  7. Laminar hook instrumentation in the cervical spine. An experimental study on the relation of hooks to the spinal cord

    OpenAIRE

    Fagerström, T.; Hedlund, R.; Bancel, P.; Robert, R; Dupas, B.

    2001-01-01

    Several anterior and posterior methods are today available for stabilization of the cervical spine. Factors such as level and degree of instability, method of decompression, bone quality, length of fixation and safety factors influence the choice of method for a particular patient. The use of laminar hooks in the cervical spine has been restricted by fear of cord compression with the potential of tetraplegia. The aim of the present study was to assess the safety and determine the anatomical r...

  8. Utility of CT angiography in cervical spine trauma: analysis of radiation and cost

    Directory of Open Access Journals (Sweden)

    Waqas Shuaib

    2014-12-01

    Full Text Available Purpose: Vertebral artery injuries (VAIs can be seen in cervical injuries. This investigation was conducted to assess the impact of head and neck computed tomography (CT angiography (CTA on planning treatment of vertebral artery injuries, if these tests were ordered appropriately, and to estimate cost and associated exposure to radiation and contrast material. Methods: This retrospective review included all patients who underwent CT of the cervical spine and CTA of the head and neck from March 2011 to October 2012 at a single institution. Patients were divided into two groups, those with and those without cervical spine fracture appreciated on CT of the cervical spine. The frequency of vascular injury on CTA in those with a cervical fracture was assessed. The frequency of vascular injury treatment and modifications owed to a positive CTA of head and neck were also assessed. A study was considered appropriate if it was ordered in accordance with the modified Denver Screening criteria. Effective radiation dose (mSv was calculated by multiplying dose length product (DLP from the scanner with the standard conversion coefficient (k (k = 0.0021 mSv/mGy x cm.Results: In the 387 CTAs of head and neck, a cervical injury was recorded in 128 patients. Twenty CTA scans were correctly ordered for non-spinal indications, and 19 were ordered off protocol. CTA was found positive in 1 patient for whom the imaging was off protocol and 1 for whom the clinical indication was non-cervical. There were 19 positive CTA cases of head and neck, none of which underwent surgical intervention. CTA was positive in 13 of 48 patients who had suffered a C2 fracture; this accounted for 13 of the 19 positive CTA studies (p < 0.01. Estimated fee for CTA was $3783, and radiation exposure was 4 mSv with a standard deviation (±1.3. Conclusion: CTA of head and neck ordered off an institutional imaging protocol has a low probability of being positive. Adherence to protocols for CTA of

  9. 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.

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

    International Nuclear Information System (INIS)

    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

  11. 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

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

    Science.gov (United States)

    Bühring, M

    1984-01-01

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

  13. Diagnosis of instability of the upper cervical spine by functional computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Dvorak, J.; Hayek, J.

    1986-11-01

    The evaluation by means of functional X-rays, of rotatory instability of the upper cervical spine as a result traumatic or inflammatory destruction of the ligamentous apparatus, is unsatisfactory. Functional CT of the upper cervical spine allows measurement of the segmental rotatory movements. 9 healthy juveniles and 30 patients were examined after neck injury via functional CT's. A rotation between occiput and atlas greater than 9/sup 0/, between atlas and axis over 50/sup 0/, the left-right difference at the level C0/C1 greater than 6/sup 0/ and at the level C1/C2 over 10.5/sup 0/ point to a suspicion of hypermobility or instability.

  14. Cervical spine cord compression by eosinophilic granuloma. Case report.

    Science.gov (United States)

    Duarte-Silva, E B; Noujaim J el-K; Carnevale, F

    1999-06-01

    Eosinophilic granuloma is a term reserved for the most often and benign form of disorder known as Langerhans cells histiocytosis. It is a disease of children and adolescents that very rarely affects adults, representing the localized form of a pathological proliferation of histiocytes in bones, like skull and long bones. Vertebral involvement is uncommon, approximately 8% of the cases, being the cervical localization the least affected. Moreover, the involvement of the spinal cord and roots remains a rare occurrence. Only five cases characterized by signs of cervical spinal cord compression have been reported. We report the sixth case in a 42-year-old-man who evolved with resolution of symptoms, and has remained asymptomatic after treatment. The clinical, radiological and histological features and, also, the value, in selected cases, of surgical treatment followed by low-dose radiation therapy is discussed. A review of the pertinent literature is also presented. PMID:10450361

  15. MANAGEMENT OF CEREBROSPINAL FLUID LEAKAGE FOLLOWING CERVICAL SPINE SURGERY

    Institute of Scientific and Technical Information of China (English)

    Ye Tian; Ke-yi Yu; Yi-peng Wang; Jun Qian; Gui-xing Qiu

    2008-01-01

    Objective To investigate the management and outcome of cerebrospinal fluid leakage (CSFL) after cervical surgery. Methods Medical records of 642 patients who underwent cervical surgery between December 1999 and December 2005 at our hospital were retrospectively reviewed. Five patients complicated by CSFL after surgery were enrolled, of which 4 cases were complicated after ossified posterior longitudinal ligament or posterior vertebral osteophyte resection directly injuring the dura, and 1 case after posterior cervical double-door laminoplasty with out observed dural injury during surgery. Of the 5 CSFL cases, 4 cases occurred at 1-3 days after operation and 1 case at 9 days after operation. All 5 postoperative CSFL cases were treated through wound drainage removal, wound sutures, prophylactic antibiotics, and continuous subarachnoid drainage in the elevated head position.Results All 5 CSFL cases experienced leakage cessation within 1-3 days and wound healing within 4-8 days, and subarachnoid drainage lasted 11-16 days with an average volume of 320 mL (range, 150-410 mL). Four cases experienced headache, nausea and vomiting, 1 case suffered from somnolence and hyponatremia, and symptoms subsided after symptomatic treatment and intravenous fluid administration. All patients were followed up for an average of 32 months (range, 22-50 months). No occurrence of cerebrospinal fluid cyst or wound infection was observed. CSFL produced no significant negative effects upon neuromuscular function recovery.Conclusion Continuous subarachnoid cavity drainage in combination with elevated head position is a simple and safe non-surgical method in treatment of CSFL following cervical surgery.

  16. Factors influencing surgical outcome after anterior stabilization of the cervical spine with heterogeneous material

    OpenAIRE

    Petridis, Athanasios K.; Sabrina Sechting; Michael Budde; Alexandros Doukas; Homajoun Maslehaty; Hubertus Maximilian Mehdorn

    2012-01-01

    Intervertebral fusion through an anterior approach with polymethylacrylate is a well-established neurosurgical technique in the treatment of cervical spine degeneration. However, questions still remain concerning the post-surgical outcome. Factors influencing surgical outcome that could help to predict which patients need further post-surgical treatment and what to expect after surgery are the subject of numerous studies. In the present study, we retrospectively collected data from patients w...

  17. 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.

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Shen, W.C. [Department of Radiology, and School of Medicine, China Medical College, China Medical College Hospital, Taiwan (Taiwan); Chiou, T.L. [Department of Neurosurgery, China Medical College Hospital, No. 2 Yuh-Der Road, 407 Taichung, Taiwan (Taiwan); Lin, T.Y. [Department of Pathology, China Medical College Hospital, Taichung (Taiwan)

    2000-01-01

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

  20. Primary bony non-Hodgkin lymphoma of the cervical spine: a case report

    OpenAIRE

    Sedrak Mark F; Smith Zachary A; Khoo Larry T

    2010-01-01

    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, parasth...

  1. Central Cord Syndrome Due to Diffuse Idiopathic Skeletal Hyperostosis of the Cervical Spine

    OpenAIRE

    Aydan KURTARAN; Selcen ÖZDEMİR; Barın SELÇUK; Özge YILDIRIM; İbrahim DEĞİRMENCİ; Müfit AKYÜZ

    2012-01-01

    Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic skeletal disease of unknown etiology characterized by ligamentous ossification of the anterolateral spine and the extraspinal ligaments. In generally, it has been reported to be associated with diabetes mellitus and obesity. The most common symptoms of cervical DISH are compression of the trachea and esophagus, however, neurological deficits are rare. In this article, we present an 85-year-old male patient who had non-traumatic cen...

  2. National Trends in Outpatient Surgical Treatment of Degenerative Cervical Spine Disease

    OpenAIRE

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

    2014-01-01

    Study Design Retrospective population-based observational study. Objective To assess the growth of cervical spine surgery performed in an outpatient setting. Methods A retrospective study was conducted using the United States Healthcare Cost and Utilization Project's State Inpatient and Ambulatory Surgery Databases for California, New York, Florida, and Maryland from 2005 to 2009. Current Procedural Terminology, fourth revision (CPT-4) and International Classification of Diseases, ninth revis...

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

    International Nuclear Information System (INIS)

    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)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    International Nuclear Information System (INIS)

    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

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

    Science.gov (United States)

    Scher, A T

    1998-01-01

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

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

    International Nuclear Information System (INIS)

    Purpose: With 54o 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

  8. Comparative effectiveness of McCoy laryngoscope and CMAC® videolaryngoscope in simulated cervical spine injuries

    Science.gov (United States)

    Jain, Divya; Bala, Indu; Gandhi, Komal

    2016-01-01

    Background: Videolaryngoscopes are increasingly being used in potentially difficult airway. McCoy laryngoscope provides definitive advantage over conventional laryngoscopes in cervical spine patients. The aim of this study was to compare the performance of the CMAC® videolaryngoscope with the McCoy Laryngoscope in patients with a cervical collar. Material and Methods: Sample size of at least 22 patients in each group was calculated using Intubation Difficulty Scale (IDS) score as the primary outcome. 60 American Society of Anesthesiologists I and II patients requiring tracheal intubation for elective surgery were randomly allocated into the McCoy group (n = 30) and the CMAC® videolaryngoscope group (n = 30). Anesthesia was induced with fentanyl 2 mcg/kg, propofol 2-3 mg/kg and rocuronium 0.6 mg/kg. A rigid collar was applied to immobilize the cervical spine. Comparative data on the IDS scale, Cormack-Lehane (CL) laryngoscopic view, time taken for glottis visualization, time taken to pass endotracheal tube, total time to intubate, number of optimizing maneuvers and hemodynamic variables were recorded in the two groups. Results: IDS score was significantly less in the CMAC® group compared to the McCoy group (median [interquartile range (IQR)], 1 [0-1] vs. 4 [3-6], P laryngoscope, 29 (96.7%) patients in the CMAC® group had Modified CL Grade I compared with 16 (53.3%) patients in McCoy group. The hemodynamic variables, number of optimizing maneuvers and incidence of side effects were comparable in the two groups. Conclusion: CMAC® videolaryngoscope forms an effective tool for the airway management of cervical spine patients with a cervical collar. PMID:27006543

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

    Science.gov (United States)

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

    2009-01-01

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

  10. 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.

  11. Unilateral ossified ligamentum flavum in the high cervical spine causing myelopathy

    Directory of Open Access Journals (Sweden)

    Singhal Udit

    2009-01-01

    Full Text Available High cervical ossified ligamentum flavum (OLF is rare and may cause progressive quadriparesis and respiratory failure . Our two patients had unilateral OLF between C1 and C4 levels. MR showed a unilateral, triangular bony excrescence with low signal and a central, intermediate or high signal on all pulse sequences due to bone marrow within. There was Type I thecal compression (partial deficit of contrast media ring. The first patient had a linear and nodular OLF with calcification within tectorial membrane, C2-3 fusion and unilateral C2-facetal hypertrophy; and the second patient, a lateral, linear OLF with loss of lordosis and C3-6 spondylotic changes. A decompressive laminectomy using "posterior floating and enbloc resection" brought significant relief in myelopathy. Histopathology showed mature bony trabeculae, bone marrow and ligament tissue. The coexisting mobile cervical vertebral segment above and congenitally fused or spondylotic rigid segment below the level of LF may have led to abnormal strain patterns within resulting in its unilateral ossification. In dealing with cervical OLF, carefully preserving facets during laminectomy or laminoplasty helps in maintaining normal cervical spinal curvature.

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

    International Nuclear Information System (INIS)

    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.)

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

    Directory of Open Access Journals (Sweden)

    Naveen Eipe

    2013-01-01

    Full Text Available We report the perioperative course of a patient with long standing ankylosing spondylitis with severe dysphagia due to large anterior cervical syndesmophytes at the level of the epiglottis. He was scheduled to undergo anterior cervical decompression and the surgical approach possibly precluded an elective pre-operative tracheostomy. We performed a modified awake fibreoptic nasal intubation through a split nasopharyngeal airway while adequate oxygenation was ensured through a modified nasal trumpet inserted in the other nares. We discuss the role of nasal intubations and the use of both the modified nasopharyngeal airways we used to facilitate tracheal intubation. This modified nasal fibreoptic intubation technique could find the application in other patients with cervical spine abnormalities and in other anticipated difficult airways.

  14. Symptomatic ossification of the posterior longitudinal ligament of the cervical spine: pictorial essay

    International Nuclear Information System (INIS)

    Symptomatic ossification of the posterior longitudinal ligament (OPLL) of the cervical spine is a rare but well documented condition. It is the causative factor in up to 5% of cases presenting with cervical radiculopathy or myelopathy. Computed tomography is the modality of choice in showing the distinctive characteristics and extent of the disease. Magnetic resonance imaging (MRI) is sensitive in detecting cord compression and its attendant complications. Cervical OPLL commonly affects those of middle and advanced age, and the condition is noted to be particularly common in Japanese, although other racial groups are also affected. A 'mushroom' or 'hill' shape on axial CT typifies OPLL. A sharp radiolucent line separating the posterior vertebral margin from the superficial component of the ossified ligament is a characteristic feature. Copyright (1999) Blackwell Science Pty Ltd

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

    International Nuclear Information System (INIS)

    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.)

  16. Treatments for primary aneurysmal bone cysts of the cervical spine: experience of 14 cases

    Institute of Scientific and Technical Information of China (English)

    Wang Chao; Liu Xiaoguang; Jiang Liang; Yang Shaomin; Wei Feng; Wu Fengliang; Liu Zhongjun

    2014-01-01

    Background Aneurysmal bone cyst (ABC) is a benign lesion with the potential to be locally aggressive.The optimal treatment of cervical spine lesions remains controversial.This retrospective study was designed to evaluate the different treatments for primary ABCs of the cervical spine.Methods This series included eight men and six women diagnosed between 2002 and 2012.A retrospective review of the hospital charts,operating room reports,office charts,and radiographs was performed.The data collected included patient age,sex,radiological features,pathology,treatment method,outcomes,and complications from biopsies and treatments.The mean age at diagnosis was 17.5 years old with a range of 6-35 years.All patients had experienced local pain for a mean of 7.3 months (range,0.5-18.0 months),and three patients had neurological deficits (one with radiculopathy and two with myelopathy).The Frankel classification before treatment was E in 12 cases,D in one case,and C in one case.Results Four patients received radiotherapy alone.Ten patients underwent surgery,including five total spondyiectomies,two local resections,and three curettages.Three patients received preoperative selective arterial embolization,and four received adjuvant radiotherapy.The mean follow-up time was 44.5 months (range 12-96 months),and no recurrence was identified.Three patients with neurological deficits achieved complete recovery,as noted at the final follow-up examination.One patient received radiotherapy without appropriate immobilization as prescribed and developed C1-C2 subluxation with severe spinal cord compression but without myelopathy.He refused further treatment.Conclusions The results can be achieved by different treatments (surgical resection/curettage,selective arterial embolization,and radiotherapy) for ABC of the cervical spine.Reconstruction of stability is also important for the treatment of cervical ABC.

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

    International Nuclear Information System (INIS)

    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, P2=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. (2

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

    Science.gov (United States)

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

    2015-12-01

    Animal models have historically provided an appropriate benchmark for understanding human pathology, treatment, and healing, but few animals are known to naturally develop intervertebral disc degeneration. The study of degenerative disc disease and its treatment would greatly benefit from a more comprehensive, and comparable animal model. Alpacas have recently been presented as a potential large animal model of intervertebral disc degeneration due to similarities in spinal posture, disc size, biomechanical flexibility, and natural disc pathology. This research further investigated alpacas by determining the prevalence of intervertebral disc degeneration among an aging alpaca population. Twenty healthy female alpacas comprised two age subgroups (5 young: 2-6 years; and 15 older: 10+ years) and were rated according to the Pfirrmann-grade for degeneration of the cervical intervertebral discs. Incidence rates of degeneration showed strong correlations with age and spinal level: younger alpacas were nearly immune to developing disc degeneration, and in older animals, disc degeneration had an increased incidence rate and severity at lower cervical levels. Advanced disc degeneration was present in at least one of the cervical intervertebral discs of 47% of the older alpacas, and it was most common at the two lowest cervical intervertebral discs. The prevalence of intervertebral disc degeneration encourages further investigation and application of the lower cervical spine of alpacas and similar camelids as a large animal model of intervertebral disc degeneration. PMID:26135031

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

    Science.gov (United States)

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

    1997-01-01

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

  20. MRI of the cervical spine with 3D gradient echo sequence at 3 T: initial experience

    International Nuclear Information System (INIS)

    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

  1. C5 Nerve root palsies following cervical spine surgery: A review

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2015-01-01

    Full Text Available Background: Cervical C5 nerve root palsies may occur in between 0% and 30% of routine anterior or posterior cervical spine operations. They are largely attributed to traction injuries/increased cord migration following anterior/posterior decompressions. Of interest, almost all studies cite spontaneous resolution of these deficits without surgery with 3-24 postoperative months. Methods: Different studies cite various frequencies for C5 root palsies following anterior or posterior cervical spine surgery. In their combined anterior/posterior series involving C4-C5 level  decompressions, Libelski et al. cited up to a 12% incidence of C5 palsies. In Gu et al. series, C5 root palsies occurred in 3.1% of double-door laminoplasty, 4.5% of open-door laminoplasty, and 11.3% of laminectomy. Miller et al. observed an intermediate 6.9% frequency of C5 palsies followed by posterior cervical decompressions and fusions (PCDF. Results: Gu et al. also identified multiple risk factors for developing C5 palsies following posterior surgery; male gender, ossification of the posterior longitudinal ligament (OPLL, narrower foramina, laminectomy, and marked dorsal spinal cord drift. Miller et al. also identified an average $1918 increased cost for physical/occupational therapy for patients with C5 palsies. Conclusions: The incidence of C5 root deficits for anterior/posterior cervical surgery at C4-C5 was 12% in one series, and ranged up to 11.3% for laminectomies, while others cited 0-30%. Although identification of preoperative risk factors for C5 root deficits may help educate patients regarding these risks, there is no clear method for their avoidance at this time.

  2. Hyperlordosis is associated with facet joint pathology at the lower lumbar spine

    OpenAIRE

    Jentzsch, Thorsten; Geiger, James; König, Matthias A; Werner, Clément M. L.

    2013-01-01

    STUDY DESIGN:: A retrospective study. OBJECTIVE:: Our study opted to clarify the remaining issues of lumbar lordosis (LL) in regard to (1) its physiologic values, (2) age, (3) gender, (4) facet joint (FJ) arthritis and orientation using CT scans. SUMMARYOF BACKGROUND DATA:: Recent studies have questioned whether LL really decreases with age, but study sample sizes have been rather small and mostly been based on X-rays. Since hyperlordosis increases the load transferred through the FJs, ...

  3. Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine.

    Science.gov (United States)

    An, Howard S; Al-Shihabi, Laith; Kurd, Mark

    2014-07-01

    Although classically associated with patients of East Asian origin, ossification of the posterior longitudinal ligament (OPLL) may cause myelopathy in patients of any ethnic origin. Degeneration of the PLL is followed by endochondral ossification, resulting in spinal cord compression. Specific genetic polymorphisms and medical comorbidities have been implicated in the development of OPLL. Patients should be evaluated with a full history and neurologic examination, along with cervical radiographs. Advanced imaging with CT and MRI allows three-dimensional evaluation of OPLL. Minimally symptomatic patients can be treated nonsurgically, but patients with myelopathy or severe stenosis are best treated with surgical decompression. OPLL can be treated via an anterior (ie, corpectomy and fusion) or posterior (ie, laminectomy and fusion or laminoplasty) approach, or both. The optimal approach is dictated by the classification and extent of OPLL, cervical spine sagittal alignment, severity of stenosis, and history of previous surgery. Anterior surgery is associated with superior outcomes when OPLL occupies >50% to 60% of the canal, despite increased technical difficulty and higher complication rates. Posterior surgery is technically easier and allows decompression of the entire cervical spine, but patients may experience late deterioration because of disease progression. PMID:24966248

  4. Significance and cost-effectiveness of somatosensory evoked potential monitoring in cervical spine surgery

    Directory of Open Access Journals (Sweden)

    Ayoub Chakib

    2010-01-01

    Full Text Available Background : Intraoperative somatosensory evoked potential (SSEP monitoring during cervical spine surgery is not a universally accepted standard of care. Our retrospective study evaluated the efficacy and cost-effectiveness of intraoperative SSEP in a single surgeon′s practice. Materials and Methods : Intraoperative SSEP monitoring was performed on 210 consecutive patients who had cervical spine surgery: anterior cervical approach 140 and posterior approach 70. They were screened for degradation or loss of SSEP data. A cost analysis included annual medical costs for health and human services, durable goods and expendable commodities. Results : Temporary loss of the electrical wave during cauterization resolved upon discontinuation of the cautery. We had no loss of cortical wave with preservation of the popliteal potential. A drop in the amplitude of the cortical wave was observed in three patients. This drop was resolved after hemodynamic stabilization in the first patient, readjusting the bone graft in the second patient, and interrupting the surgery in the third patient. The additional cost for SSEP monitoring was $835 per case and the total cost of the surgery was $13,835 per case. By spending $31,546 per year on SSEP, our institution is saving a total cost ranging from $64,074 to $102,192 per patient injured per year. Conclusion : Intraoperative SSEP monitoring is a reliable and cost-effective method for preventing postoperative neurological deficit by the early detection of vascular or mechanical compromise, and the immediate alteration of the anesthetic or surgical technique.

  5. Evaluation in the use of bismuth shielding on cervical spine CT scan using a male phantom

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    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)

  6. Evaluation in the use of bismuth shielding on cervical spine CT scan using a male phantom

    International Nuclear Information System (INIS)

    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)

  7. Injuries of the upper cervical spine: A series of 28 cases

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    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.

  8. Management of neglected cervical spine dislocation: a study of six cases

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    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

  9. MR imaging of the neural foramina of the cervical spine

    International Nuclear Information System (INIS)

    Purpose: To assess whether a single three-dimensional double-echo steady state (3D-DESS) sequence can produce equivalent results when compared to a 3D free induction with steady precession (3D-FISP) sequence for the evaluation of the neural foraminal diameter and structures. Material and Methods: Five phantoms were imaged on CT with 3-mm axial slices followed by reformatted axial 3D-DESS and 3D-FISP sequences. In addition, 3D-DESS and 3D-FISP sequences of 20 healthy subjects were compared with regard to image quality, differentiation between vertebrae and discs, differentiation between discs and neural foramina, and differentiation between vertebrae and neural foramina. Results: Compared with CT, 3D-DESS and 3D-FISP sequences consistently underestimated the diameters of the neural foramina. The mean difference values for the 3D-DESS was 12.8%, compared to 9.5% for the 3D-FISP sequence. Concerning the in vivo studies, the 3D-DESS sequence was superior but not statistical significant to the 3D-FISP sequence with regard to image quality, differentiation between vertebrae and discs, differentiation between discs and neural foramina, and identification of the nerve roots. Conclusion: The 3D-DESS sequence is moderately accurate in the evaluation of the neural foraminal size. Compared to the 3D-FISP sequence, the 3D-DESS sequence is compatible concerning the image quality, differentiation between the cervical vertebrae and discs, and between the discs and neural foramina

  10. Histological, magnetic resonance imaging, and discographic findings on cervical disc degeneration in cadaver spines. A comparative study

    International Nuclear Information System (INIS)

    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)

  11. Osteoradionecrosis of the upper cervical spine: MR imaging following radiotherapy for nasopharyngeal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    King, Ann D. [Department of Diagnostic Radiology and Organ Imaging, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong (China)], E-mail: king2015@cuhk.edu.hk; Griffith, James F.; Abrigo, Jill M. [Department of Diagnostic Radiology and Organ Imaging, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong (China); Leung Singfai [Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong (China); Yau Fungkwai [Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong (China); Tse, Gary M.K. [Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong (China); Ahuja, Anil T. [Department of Diagnostic Radiology and Organ Imaging, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong (China)

    2010-03-15

    Purpose: To document the MRI appearances of radiation-induced abnormalities in the cervical spine following treatment for nasopharyngeal carcinoma (NPC). Methods: Patients with radiation-induced abnormalities in the upper cervical spine were identified from a retrospective analysis of reports from patients undergoing MRI follow-up. Imaging and clinical records of these patients were reviewed. Symmetrical distribution of abnormalities at C1 (anterior arch {+-} adjacent aspect of the lateral masses) and C2 (dens {+-} body especially with a characteristic horizontal rim of marrow preservation above the inferior endplate) were considered typical for osteoradionecrosis (ORN). Results: Abnormalities of C1/2 were identified in 9/884 (1%) patients. The MRI distribution of abnormalities was typical for ORN in four and atypical in five patients. Abnormal soft tissue was present in the atlantoaxial joint in eight patients, forming a florid mass in six. This soft tissue was in direct continuity with the posterior nasopharyngeal wall ulceration via the retropharyngeal region. The final clinical diagnosis was ORN in eight, five of whom had clinical factors which suggested infection could have played a contributory role, and osteomyelitis in one patient. All patients had undergone additional radiotherapy treatment comprising of brachytherapy (7), stereotactic radiotherapy (1) or radiotherapy boost (2) and three had undergone nasopharyngectomy. Conclusion: ORN of the upper cervical spine following radiotherapy for NPC is more common than previously suspected and is seen in patients with additional treatment, especially brachytherapy. MRI features are often atypical and a contributory role of infection in the development of some cases of ORN is postulated.

  12. Neurophysiological evaluation of patients with degenerative diseases of the cervical spine

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    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.

  13. Epidemiology and risk factors of cervical spine injury during heating season in the patients with cervical trauma: a cross-sectional study.

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    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.

  14. Persisting upper cervical pain as sole symptom by unstable fractures in the cervical spine

    DEFF Research Database (Denmark)

    Saksø, Henrik; Foldager, Casper Bindzus; Bünger, Cody

    2015-01-01

    fractures can be difficult to diagnose because of lack of symptoms. Two case stories describe neck pain as the only symptom to severe and unstable cervical fracture and highlight the importance of an accurate history, thorough physical examination and relevant radiological investigation....

  15. Granuloma eosinofílico de coluna cervical: relato de caso Eosinophilic granuloma of the cervical spine: case report

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    Manoel Baldoino Leal Filho

    2003-03-01

    Full Text Available Granuloma eosinofílico (GE é condição benigna de proliferação histiocitária localizada ou multifocal. A ocorrência de lesões na coluna cervical pode variar entre 1,5% e 20% dos casos de GE. Relatamos caso de menina de sete anos de idade e história de cervicalgia há cerca de um mês, torcicolo persistente e postura viciosa do pescoço, com desvio cefálico para esquerda. A tomografia computadorizada revelou lesão expansiva, osteodestrutiva ao nível da hemilâmina esquerda de C2, com invasão do canal raquiano e do plano muscular a este nível. A paciente foi submetida a laminectomia cervical com retirada da lesão com pós-operatório favorável, e melhora da sintomatologia. Foi feita quimioterapia com prednisona, vinblastina e etoposide. Após seis meses, o protocolo foi mantido e associado a metotrexate. A paciente segue sem recidiva há 36 meses.Eosinophilic granuloma (EG is a benign condition of histocytes proliferation localized or multifocal. It is presents in the cervical spine in 1.5%-20% of the cases of EG. We report the case of a seven-year-old girl that presented with a one month history of cervical pain, persistent wryneck and vicious posture of the neck. A computerized tomography was performed and confirmed the presence of spreading lesion, ostheodestructive to the level of the left laminae of C2, with invasion of the spine and the muscular tissue. A laminectomy was underwent for removal of the lesion. The patient had a good post-operative recovery with improvement of the symptoms. Chemotherapy with prednisone, vinblastine and ethoposide was administred. After six months, this protocol was repeated associaded to methotrexate.The patient improved and had no new symptoms in a follow-up of 36 months.

  16. 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)

    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)

  17. 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.

  18. Solitary juvenile xanthogranuloma of the cervical spine in a child: A case report and review of literature

    Science.gov (United States)

    Bhaisora, Kamlesh Singh; Jaiswal, Awadhesh Kumar; Mehrotra, Anant; Sahu, Rabi Narayan; Srivastava, Arun; Jaiswal, Sushila; Behari, Sanjay

    2015-01-01

    The authors present a case of 15 years male child who presented with neck pain and progressive ascending quadriparesis. Magnetic resonance imaging showed lytic mass involving C5 and C6 vertebra with soft tissue extension. Surgical excision of mass done using anterior cervical approach. Postoperatively, patient showed improvement in spasticity and power. Histopathological examination of mass was suggestive of juvenile xanthogranuloma (JXG). At 6 months follow–up, patient was improving without any evidence of recurrence. Only 12 cases of JXG of spine have been reported till date including only four cases involving the cervical spine and among these four cases only two were of pediatric age group. PMID:25767592

  19. Lift-up laminoplasty for myelopathy caused by ossification of the posterior longitudinal ligament of the cervical spine

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    Takami T

    2004-01-01

    Full Text Available Background and Aims: We have utilized lift-up laminoplasty to treat patients with myelopathy caused by ossification of the posterior longitudinal ligament (OPLL of the cervical spine. The preliminary surgical outcome with computer-assisted morphological assessment is presented. Material and Methods: The surgical technique of lift-up laminoplasty includes standard posterior exposure of the cervical spine, en-bloc laminectomy, and expansion of the cervical canal by lift-up of the laminae with custom-designed hydroxyapatite laminar spacers and stabilization of the laminae using titanium miniplates. From 1998 to 2003, 10 consecutive patients with cervical myelopathy secondary to OPLL have been treated with this method and comprehensively evaluated. Care was taken to tailor the treatment to individual patients by using different sizes of spacers to adjust the degree of expansion depending on the amount of stenosis of the cervical spine. The degree of expansion of the cervical canal was altered by design, based on the preoperative imaging simulation. Results: Preliminary surgical outcome, evaluated at 6 months after surgery, revealed a significant improvement of neurological function. Image analysis revealed that the cervical canals were significantly expanded, with a mean reduction of 13.1% in the stenosis ratio. Lift-up laminoplasty was effective in the treatment of patients with myelopathy secondary to cervical OPLL, and the amount of expansion could be individually adjusted at the discretion of the surgeon. Conclusion: Although analysis with a larger population and a longer follow-up period needs to be undertaken, our method of lift-up laminoplasty appears to be a viable choice among standard posterior cervical approaches for cervical OPLL.

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

    Science.gov (United States)

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

    2005-04-01

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

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

    OpenAIRE

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

    2005-01-01

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

  2. The Use of Bone Morphogenetic Protein in Pediatric Cervical Spine Fusion Surgery: Case Reports and Review of the Literature.

    Science.gov (United States)

    Molinari, Robert W; Molinari, Christine

    2016-02-01

    Study Design Case report. Objective There is a paucity of literature describing the use of bone graft substitutes to achieve fusion in the pediatric cervical spine. The outcomes and complications involving the off-label use of bone morphogenetic protein (BMP)-2 in the pediatric cervical spine are not clearly defined. The purpose of this article is to report successful fusion without complications in two pediatric patients who had instrumented occipitocervical fusion using low-dose BMP-2. Methods A retrospective review of the medical records was performed, and the patients were followed for 5 years. Two patients under 10 years of age with upper cervical instability were treated with occipitocervical instrumented fusion using rigid occipitocervical fixation techniques along with conventionally available low-dose BMP-2. A Medline and PubMed literature search was conducted using the terms "bone morphogenetic protein," "BMP," "rh-BMP2," "bone graft substitutes," and "pediatric cervical spine." Results Solid occipitocervical fusion was achieved in both pediatric patients. There were no reported perioperative or follow-up complications. At 5-year follow-up, radiographs in both patients showed successful occipital cervical fusion without evidence of instrumentation failure or changes in the occipitocervical alignment. To date, there are few published reports on this topic. Complications and the appropriate dosage application in the pediatric posterior cervical spine remain unknown. Conclusions We describe two pediatric patients with upper cervical instability who achieved successful occipital cervical fusion without complication using off-label BMP-2. This report underscores the potential for BMP-2 to achieve successful arthrodesis of the posterior occipitocervical junction in pediatric patients. Use should be judicious as complications and long-term outcomes of pediatric BMP-2 use remain undefined in the existing literature. PMID:26835215

  3. Outpatient cervical and lumbar spine surgery is feasible and safe: A consecutive single center series of 1449 patients

    OpenAIRE

    Helseth, Øystein; Lied, Bjarne Lidvar; Halvorsen, Charlotte Marie; Ekseth, Kåre; Helseth, Eirik

    2015-01-01

    BACKGROUND: There is an increasing demand for surgery of degenerative spinal disease. Limited healthcare resources draw attention to the need for cost-effective treatments. Outpatient surgery, when safe and feasible, is more cost effective than inpatient surgery. OBJECTIVE: To study types and rates of complications after outpatient lumbar and cervical spine decompressions. METHODS: Complications were recorded prospectively in 1449 (1073 lumbar, 376 cervical) outpatients undergoing micro...

  4. 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.

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

    Science.gov (United States)

    Torg, J S; Vegso, J J; O'Neill, M J; Sennett, B

    1990-01-01

    Epidemiologic, pathologic, biomechanical, and cinematographic data on head and neck injuries occurring in tackle football have been compiled since 1971 by the National Football Head and Neck Injury Registry. Preliminary analysis performed in 1975 indicated that the majority of serious cervical spine football injuries were caused by axial loading. Based on this observation, the National Collegiate Athletic Association (NCAA) and National Federation of High School Athletic Associations (NFHSAA) implemented rule changes banning "spearing" and the use of the top of the helmet as the initial point of contact in striking an opponent during a tackle or block. Between 1976 and 1987, as a result of these rule changes, the Registry has documented a dramatic decrease in both the total number of cervical spine injuries and those resulting in quadriplegia at both the high school and college level. It is suggested that development and implementation of similar preventative measures based on clearly defined injury mechanisms would decrease injury rates in diving, rugby, ice hockey, trampolining, wrestling, and other high-risk sports as well. PMID:2301692

  6. Cervical spine degenerative changes (narrowed intervertebral disc spaces and osteophytes) in coal miners

    International Nuclear Information System (INIS)

    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)

  7. Fast spin echo vs conventional spin echo in cervical spine imaging

    International Nuclear Information System (INIS)

    The major attraction of fast-spin-echo (FSE) imaging is reduced acquisition time; however, careful review of the literature reveals many weaknesses: phase-encoded blurring, truncation artefact, bright fat signal, reduced magnetic susceptibility and increased motion artefact. Our aim was a prospective, blinded comparison of FSE and conventional spin echo (CSE) in the cervical spine. Both sequences were performed in 43 patients (19 males and 24 females; mean age 45 years, range 15-66 years). Twenty-eight patients were studied at 1.5 T and 15 at 0.5 T. Typical sequence parameters were: at 1.5 T, TR/TE 2000/90 CSE and 3000/120 FSE, and at 0.5 T, 2200/80 CSE and 2800/120 FSE. Time saved on the FSE was used to increase the matrix and the number of acquisitions. Two neuroradiologists evaluated the images for pathology, artefacts, disc signal intensity, thecal sac compression and image quality. Ten patients had cord lesions; 2 (20%) were missed on CSE. In 4 of 10 patients with moderate/severe thecal sac compression, the degree of stenosis was apparently exaggerated on CSE. The mean degree of confidence for the CSE sequences was 1.8 and for the FSE 1.1, where 1 is optimal. For cervical spine imaging, FSE should be preferred to CSE. (orig.). With 3 figs

  8. 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.

  9. 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.

  10. 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.

  11. Management of neglected cervical spine dislocation: a study of six cases

    Institute of Scientific and Technical Information of China (English)

    Vijay Goni; Nirmal Raj Gopinathan; Vibhu Krishnan; Rajesh Kumar; Avinash Kumar

    2013-01-01

    Objective:To report a case series of six neglected cervical spine dislocations without neurological deficit,which were managed operatively.Methods:The study was conducted fromAugust 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 C5-C6 subluxation developed neurological deficit with sensory loss below C6 level and motor power of 2/5 in the lower limb and 3/5 in the upper limb below C6 level.Conclusion:There is no role of skull traction in neglected distractive flexion injuries to cervical spine delayed for more than 3 weeks.Posterior followed by anterior approach 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 stabilization is recommended,as there is a risk of deterioration in neurological status.

  12. Systematic review of flexion/extension radiography of the cervical spine in trauma patients

    International Nuclear Information System (INIS)

    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

  13. 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...

  14. [Surgical treatment after cervical spine and spinal cord injuries of the C3-C7 level].

    Science.gov (United States)

    Kopczyński, Stefan; Derenda, Marek; Kowalina, Ireneusz; Siwiecki, Tomasz

    2002-01-01

    The authors report the methods and results of the treatment of 83 patients with lower cervical spine (C3-C7) injuries, who were treated in the Neurosurgery Department in Elblag in a period of 11 years. Lesions ranged from fractures mainly of vertebral C5 and C6 bodies, and dislocations--mostly at levels C4-C5 and C5-C6. Most lesions were the consequence of a headlong jump into water (38.5%) and traffic accidents (29%). In admission sensory disturbances (38.5%) and tetraplegia or paresis of the upper limbs with paralysis of lower limbs (together 44.6%) were most frequently observed. The state of the patients was evaluated according to the ASIA-Frankel's scale. 148 surgical procedures were carried out. Decompression and autogenic and/or plate stabilization--from the anterior approach using Caspar's system and Crutchfield's traction--were the preferred methods. The post-surgical follow up extends from 9 years to 3 months. The most satisfying result was the improvement observed in the patients from groups A and B according to ASIA-Frankel's scale. Among 36 such patients, the medullary functions of 17 patients improved. 14 patients died from 5 days to 3 months after surgery. The authors also present an overview of contemporary management of lower cervical spine injuries. The emphasis is placed on the importance of factors making the treatment of spine and spinal cord injuries more difficult and delaying the beginning of early and efficient surgery. PMID:12418133

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

    Science.gov (United States)

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

    2016-01-01

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

  16. 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.

  17. 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.

  18. Therapeutic swimming in a special medical group of female students, who have osteochondrosis of the cervical spine.

    Directory of Open Access Journals (Sweden)

    Balamutova N.M.

    2011-06-01

    Full Text Available It was developed a method of therapeutic and recreational swimming in a special medical group of female students, who have osteochondrosis of the cervical spine. In the experiment took part 40 students. The experiment used teacher observation, miotonometriya, methods of mathematical statistics. It was established that the intended method of therapeutic swimming is more efficient than the usual recreational swimming.

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

    International Nuclear Information System (INIS)

    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)

  20. Partial tetraplegic syndrome as a complication of a mobilizing/manipulating procedure of the cervical spine in a man with Forestier's disease: a case report

    Directory of Open Access Journals (Sweden)

    Exadaktylos Aristomenis K

    2011-10-01

    Full Text Available Abstract Introduction Even if performed by qualified physical therapists, spinal manipulation and mobilization can cause adverse events. This holds true particularly for the cervical spine. In light of the substantial risks, the benefits of cervical spine manipulation may be outweighed by the possibility of further injury. Case presentation We present the case of a 56-year-old Caucasian man with Forestier's disease who went to see a physiotherapist to relieve his aching neck while on a holiday trip. Following the procedure, he was transferred to a local hospital with a partial tetraplegic syndrome due to a cervical 6/7 luxation fracture. Reportedly, the physiotherapist took neither a detailed history, nor adequate diagnostic measures. Conclusions This case highlights the potentially dangerous complications associated with cervical spine mobilization/manipulation. If guidelines concerning cervical spine mobilization and manipulation practices had been followed, this adverse event could have been avoided.

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

    Science.gov (United States)

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

    2016-09-01

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

  2. [Whiplash injury of the cervical spine--on the role of pre-existing degenerative diseases].

    Science.gov (United States)

    Meenen, N M; Katzer, A; Dihlmann, S W; Held, S; Fyfe, I; Jungbluth, K H

    1994-06-01

    Radiological investigations contribute little in differentiating the problems of patients with whiplash injuries. Nevertheless the more prolonged cases of whiplash injuries must not be attributed to preexisting degenerative disease, despite radiologically-proven medicolegal opinion. In this study, 60 patients who were seen for whiplash injuries in the Department for Trauma and Reconstructive Surgery at the University Hospital Hamburg-Eppendorf for clinical and radiological evaluation, an average of 5.7 years post injury, were divided into two groups (n = 30) depending on radiologically-proven preexisting degenerative changes of the cervical spine. On average the patients with degenerative changes were 11.2 years older than those with healthy vertebral columns and also demonstrated an increase in acute symptoms in the lower cervical spine (cervicobrachial syndrome). The chronicity of individual symptoms such as neck-pain, dizziness, nausea and psychological illness was also observed in both groups. Problems such as paresthesias as well as pain in the shoulder-arm-area appeared to increase in subsequent check-ups, irrespective of the earlier degenerative changes. Patients with typical posterior headaches recovered faster when they had radiologically normal spines. Presenting late, there was a significant accumulation of patients with pre-existing degenerative changes complaining merely of tinnitus. The earlier changes in any individual motion segment do not determine the clinical course of whiplash injuries, but merely represent an area of increased vulnerability to trauma. On the other hand, trauma has not been proven to influence the development or aggravation of degenerative changes in normal or diseased spines. We are not able to differentiate the posttraumatic course from the natural history of the degenerative process, either clinically or radiologically. Considering the involvement of sensitive neurological structures the classical objective organic diagnosis

  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

    In the evaluation of children younger than 3 years with intracranial hemorrhage it can be difficult to determine whether the cause of hemorrhage was traumatic, and if so, whether abusive head trauma (AHT) is a possibility. Cervical spine MRI is not a routine part of the nationally recommended imaging workup for children with suspected abusive head trauma. There is increasing evidence that spinal injuries are found at autopsy or MRI in abused children. However the prevalence of cervical spine injuries in children evaluated for abusive head trauma is unknown. We sought to determine both the incidence and the spectrum of cervical spine and brain injuries in children being evaluated for possible abusive head trauma. We also examined the relationship between cervical and brain MRI findings and selected study outcome categories. This study is a 3-year retrospective review of children evaluated for abusive head trauma. Inclusion criteria were: children with head trauma seen at our institution between 2008 and 2010, age younger than 36 months, availability of diagnostic-quality brain and cervical spine MRI, and child abuse team involvement because abusive head trauma was a possibility. A child abuse pediatrician and pediatric radiologists, all with board certification, were involved in data collection, image interpretation and data analysis. Statistical analysis was performed using Stata v12.1. The study included 74 children (43 boys, 31 girls) with a mean age of 164 days (range, 20-679 days). Study outcomes were categorized as: n = 26 children with accidental head trauma, n = 38 with abusive head trauma (n = 18 presumptive AHT, n = 20 suspicious for AHT), and n = 10 with undefined head trauma. We found cervical spine injuries in 27/74 (36%) children. Most cervical spine injuries were ligamentous injuries. One child had intrathecal spinal blood and two had spinal cord edema; all three of these children had ligamentous injury. MRI signs of cervical injury did not show a

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

    International Nuclear Information System (INIS)

    In the evaluation of children younger than 3 years with intracranial hemorrhage it can be difficult to determine whether the cause of hemorrhage was traumatic, and if so, whether abusive head trauma (AHT) is a possibility. Cervical spine MRI is not a routine part of the nationally recommended imaging workup for children with suspected abusive head trauma. There is increasing evidence that spinal injuries are found at autopsy or MRI in abused children. However the prevalence of cervical spine injuries in children evaluated for abusive head trauma is unknown. We sought to determine both the incidence and the spectrum of cervical spine and brain injuries in children being evaluated for possible abusive head trauma. We also examined the relationship between cervical and brain MRI findings and selected study outcome categories. This study is a 3-year retrospective review of children evaluated for abusive head trauma. Inclusion criteria were: children with head trauma seen at our institution between 2008 and 2010, age younger than 36 months, availability of diagnostic-quality brain and cervical spine MRI, and child abuse team involvement because abusive head trauma was a possibility. A child abuse pediatrician and pediatric radiologists, all with board certification, were involved in data collection, image interpretation and data analysis. Statistical analysis was performed using Stata v12.1. The study included 74 children (43 boys, 31 girls) with a mean age of 164 days (range, 20-679 days). Study outcomes were categorized as: n = 26 children with accidental head trauma, n = 38 with abusive head trauma (n = 18 presumptive AHT, n = 20 suspicious for AHT), and n = 10 with undefined head trauma. We found cervical spine injuries in 27/74 (36%) children. Most cervical spine injuries were ligamentous injuries. One child had intrathecal spinal blood and two had spinal cord edema; all three of these children had ligamentous injury. MRI signs of cervical injury did not show a

  5. Fibular allograft and anterior plating for dislocations/fractures of the cervical spine

    Directory of Open Access Journals (Sweden)

    Ramnarain A

    2008-01-01

    Full Text Available Background: Subaxial cervical spine dislocations are common and often present with neurological deficit. Posterior spinal fusion has been the gold standard in the past. Pain and neck stiffness are often the presenting features and may be due to failure of fixation and extension of fusion mass. Anterior spinal fusion which is relatively atraumatic is thus favored using autogenous grafts and cages with anterior plate fixation. We evaluated fresh frozen fibular allografts and anterior plate fixation for anterior fusion in cervical trauma. Materials and Methods: Sixty consecutive patients with single-level dislocations or fracture dislocations of the subaxial cervical spine were recruited in this prospective study following a motor vehicle accident. There were 38 males and 22 females. The mean age at presentation was 34 years (range 19-67 years. The levels involved were C5/6 ( n = 36, C4/5 ( n = 15, C6/7 ( n = 7 and C3/4 ( n = 2. There were 38 unifacet dislocations with nine posterior element fractures and 22 were bifacet dislocations. Twenty-two patients had neurological deficit. Co-morbidities included hypertension ( n = 6, non-insulin-dependent diabetes mellitus ( n = 2 and asthma ( n = 1. All patients were initially managed on skull traction. Following reduction further imaging included Computerized Tomography and Magnetic Resonance Imaging. Patients underwent anterior surgery (discectomy, fibular allograft and plating. All patients were immobilized in a Philadelphia collar for eight weeks (range 7-12 weeks. Eight patients were lost to follow-up within a year. Follow-up clinical and radiological examinations were performed six-weekly for three months and subsequently at three-monthly intervals for 12 months. Pain was analyzed using the visual analogue scale (VAS. The mean follow-up was 19 months (range 14-39 months. Results: Eight lost to followup, hence 52 patients were considered for final evaluation. The neurological recovery was 1.1 Frankel

  6. Degenerative diseases of the cervical spine: comparison of a multiecho data image combination sequence with a magnetisation transfer saturation pulse and cervical myelography and CT

    Energy Technology Data Exchange (ETDEWEB)

    Dorenbeck, U. [Department of Neuroradiology, University Hospital of the Saarland, 66421, Homburg (Germany); Department of Diagnostic Radiology, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93042, Regensburg (Germany); Schreyer, A.G.; Held, P.; Feuerbach, S.; Seitz, J. [Department of Diagnostic Radiology, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93042, Regensburg (Germany); Schlaier, J. [Department of Neurosurgery, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93042, Regensburg (Germany)

    2004-04-01

    Assessing degenerative disease in the cervical spine remains a challenge. There is much controversy about imaging the cervical spine using MRI. Our aim in this prospective study was to compare a T2*-weighted 2D spoiled gradient-echo multiecho sequence (MEDIC) with a magnetisation transfer saturation pulse with cervical myelography and postmyelographic CT. Using an assessment scale we looked at the vertebral bodies, intervertebral discs, neural foramina, anterior and posterior nerve roots, grey matter, ligamenta flava, oedema in the spinal cord and stenosis of the spinal canal. We also evaluated postmyelography CT and the MEDIC sequence for assessing narrowing of the neural foramina in a cadaver cervical spine. We examined 67 disc levels in 18 patients, showing 18 disc prolapses and 21 osteophytes narrowing the spinal canal or the neural foramina. All MRI studies showed these abnormalities findings equally well. Postmyelography CT was significantly better for showing the bony structures and the anterior and posterior nerve roots. The MEDIC sequence provided excellent demonstration of soft-tissue structures such as the intervertebral disc and ligamentum flavum. No statistical differences between the imaging modalities were found in the assessment of narrowing of the neural foramina or the extent of spinal stenosis. The cadaver measurements showed no overestimation of abnormalities using the MEDIC sequence. (orig.)

  7. Degenerative diseases of the cervical spine: comparison of a multiecho data image combination sequence with a magnetisation transfer saturation pulse and cervical myelography and CT

    International Nuclear Information System (INIS)

    Assessing degenerative disease in the cervical spine remains a challenge. There is much controversy about imaging the cervical spine using MRI. Our aim in this prospective study was to compare a T2*-weighted 2D spoiled gradient-echo multiecho sequence (MEDIC) with a magnetisation transfer saturation pulse with cervical myelography and postmyelographic CT. Using an assessment scale we looked at the vertebral bodies, intervertebral discs, neural foramina, anterior and posterior nerve roots, grey matter, ligamenta flava, oedema in the spinal cord and stenosis of the spinal canal. We also evaluated postmyelography CT and the MEDIC sequence for assessing narrowing of the neural foramina in a cadaver cervical spine. We examined 67 disc levels in 18 patients, showing 18 disc prolapses and 21 osteophytes narrowing the spinal canal or the neural foramina. All MRI studies showed these abnormalities findings equally well. Postmyelography CT was significantly better for showing the bony structures and the anterior and posterior nerve roots. The MEDIC sequence provided excellent demonstration of soft-tissue structures such as the intervertebral disc and ligamentum flavum. No statistical differences between the imaging modalities were found in the assessment of narrowing of the neural foramina or the extent of spinal stenosis. The cadaver measurements showed no overestimation of abnormalities using the MEDIC sequence. (orig.)

  8. Tratamento das luxações traumáticas da coluna cervical por meio da abordagem anterior Treatment of traumatic dislocations of the cervical spine through anterior approach

    Directory of Open Access Journals (Sweden)

    Helton L. A. Defino

    2007-01-01

    Full Text Available Foram estudados 20 pacientes portadores de luxação traumática uni ou bifacetária da coluna cervical tratados pela artrodese e fixação anterior. Os pacientes foram avaliados por meio de parâmetros clínicos, radiológicos e funcionais. Os pacientes foram seguidos por um período que variou de 1 a 14 anos. A consolidação radiológica da artrodese foi observada em todos os pacientes e 1 paciente apresentou soltura tardia de um dos parafusos. A angulação no plano sagital do segmento vertebral lesado apresentou alteração no período pré-operatório, sendo obtido redução no pós-operatório imediato e manutenção da mesma após um ano do tratamento cirúrgico. A avaliação clínica e funcional de acordo com o SF-36 e escala de dor e trabalho de Denis demonstrou bons resultados clínicos sendo as principais queixas pós-operatórias decorrentes do grau da lesão neurológica. O hematoma da ferida operatória, que necessitou de drenagem cirúrgica foi a única complicação observada em um paciente. A realização da artrodese e fixação anterior para o tratamento das luxações traumáticas uni ou bifacetárias da coluna cervical apresentou bons resultados clínicos, radiológicos, funcionais e baixo índice de complicações, justificando nossa preferência por esse método de tratamento para esse tipo de lesão da coluna cervical.Twenty patients presenting with single-or bi-faceted traumatic dislocation of the cervical spine treated by means of arthrodesis and anterior fixation have been studied. Patients were assessed by clinical, X-ray, and functional parameters. The patients were followed up during a period ranging from 1 to 14 years. Union of the arthrodesis, as evidenced by X-ray, was noticed in all patients, with one patient presenting with late loosening of one of the screws. Angulations at sagittal plane of the injured vertebral segment showed a change preoperatively, with reduction being achieved at the early postoperative

  9. [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. PMID:980212

  10. 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).

  11. [Disorders of the cervical spine and the upper extremities and occupations].

    Science.gov (United States)

    Krapac, L

    1989-12-01

    A chronological review of damage to the spine and upper extremities associated with work was carried out in a sample of 120 retired disabled workers. Examination of risk factors for cervicobrachial syndrome (CBS) showed that the forced, bent position of the body at work contributed significantly to the frequency of the disease, particularly in women (70.0% against 38% in controls P less than 0.01). The lifting of heavy loads was also frequently observed in women with CBS (12% compared to 6% in the control group (P less than 0.05). Repeated movements during work were claimed by 52.9% of the males and 80% of the females with CBS and by only 41.4% of the males and 50% of the females without it (P less than 0.01). The heaviest load lifted by subjects with CBS at work exceeded significantly that of control subjects. It is considered that there is a causal link between excessive burden and the occurrence of CBS in women. For early diagnosis of CBS, tiredness, pain in the cervical spine, reduced strength in the hands and poor ability to endure manual work are signs to be looked for. Early recognition of disease, improved working conditions and recreation can help prevent the disease or slow down its progress. PMID:2637664

  12. 360 degree decompresion and stabilisation of the C6-C7 cervical spine luxation - case study.

    Science.gov (United States)

    Chrzanowski, Robert; Godlewski, Bartosz; Klauz, Grzegorz; Janeczko, Łukasz

    2012-01-01

    We present the operative technique employed in a young man with cervical spine luxation at the level of C6-C7 with clinical signs of damage to the spinal cord at the level of C5. In order to achieve an optimal therapeutic effect (decompression of neural structures and spinal stabilisation) during one surgical procedure, the positioning of the patient was changed twice during the procedure. Considering the positioning of the patient at the beginning of the procedure, the body position was changed by 360 degrees. The first part of the procedure was performed from an anterior approach with the patient in the supine position. It involved a C6-C7 discectomy and removal of the upper surface of the body of C7, which was protruding into the vertebral canal and compressing the spinal cord. Intraoperative inspection showed that a posterior approach was necessary to reduce the luxation. Therefore, for the second part of the operation, the patient was turned by 180 degrees and placed in the prone position. For the last (third) part of the surgical procedure, the patient was again turned by 180 degrees and placed in the supine position in order to insert an anterior spine fixator. We believe that a procedure utilising different surgical approaches and different positioning of the patient in order to achieve optimal therapeutic effect may be used in selected cases in everyday clinical practice. PMID:23382285

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

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    Hu, Yangqiu; Haynor, David R.

    2004-05-01

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

  14. Prospective Validation of Modified NEXUS Cervical Spine Injury Criteria in Low-risk Elderly Fall Patients

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    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.

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

    Science.gov (United States)

    2014-01-01

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

  16. Association between cervical spine and skull-base fractures and blunt cerebrovascular injury

    International Nuclear Information System (INIS)

    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.)

  17. Association between cervical spine and skull-base fractures and blunt cerebrovascular injury

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    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.)

  18. Vertebral artery injury associated with cervical spine fracture-dislocation. Prevention of distal embolism using coil embolization

    International Nuclear Information System (INIS)

    This study investigated the efficacy of coil embolization of the injured vertebral artery associated with fracture-dislocation of the cervical spine for the prevention of embolic stroke. Between 2001 and 2010, 27 patients underwent reduction of the dislocation fracture of the cervical spine. In 4 cases, preoperative MRI revealed disappearance of the flow-void signal of the unilateral vertebral artery in the foramen transversarium, and we performed further investigation of the injury of the vertebral artery with digital subtraction angiography. In all 4 cases, digital subtraction angiography revealed occlusion of the unilateral vertebral artery. After conviction of the existence of colateral cerebral blood flow from the contra-lateral vertebral arteries or external carotid arteries, we embolized the proximal part of the occluded vertebral arteries in endovascular procedures with detachable coils for the prevention of the embolic stroke associated with orthopedical procedures. All patients underwent reduction of the cervical dislocation after coil embolization, and the operations were performed uneventfully. During the follow-up period (66.8 months on the average), there were no episodes of vertebrobasilar infarction. Perioperative and postoperative antiplatelet or anticoagulant therapies were not necessary. Dislocation fracture of the cervical spine is frequently associated with injuries of vertebral artery, and the management of the risk for cerebral infarction remains controversial. Preoperative embolization of the injured vertebral artery can be an effective procedure in preventing the embolic stroke caused by orthopedical procedures. (author)

  19. Chordomas of the upper cervical spine: clinical characteristics and surgical management of a series of 21 patients

    Institute of Scientific and Technical Information of China (English)

    Zhou Hua; Jiang Liang; Wei Feng; Yu Miao; Wu Fengliang; Liu Xiaoguang; Liu Zhongjun

    2014-01-01

    Background Chordomas of the upper cervical spine are rare and present unique surgical challenge.This study aimed to describe the clinical characteristics and surgical management of patients with chordomas of the upper cervical spine.Methods Twenty-one patients with chordomas of the upper cervical spine who were treated in Peking University Third Hospital from January 1999 to October 2012 were retrospectively analyzed.Survival was calculated by the Kaplan-Meier method and was compared between groups using the log-rank test.Results The postoperative diagnosis was classical chordoma in 20 cases and chondroid chordoma in one case.The mean operative time was 9.5 hours (range 6-17 hours),and the mean blood loss was 2 812 ml (range 700-4 800 ml).There were two postoperative deaths.Unilateral vertebral artery ligation was performed in six patients,cervical nerve roots were cut in six patients,and the external branch of the superior laryngeal nerve was repaired after being cut in one case.Two patients developed postoperative velopharyngeal incompetence,and loosening of the occipitocervical screws was observed in one patient.The recurrence rate was 66.7% (10/15) after a mean follow-up period of 46.8 months (range 14-150 months).The 5-and 10-year overall survival rates were (39.8±13.1)% and (31.9±12.7)%,respectively.There was a significant difference in survival rate between patients who underwent surgery and those who did not.Conclusion In spite of the high rates of recurrence and complications after surgical treatment of chordomas of the upper cervical spine,intralesional resection combined with adjuvant radiotherapy remains the optimal treatment to prolong survival.

  20. SELECTION OF SURGICAL APPROACH TO TREAT TRAUMATIC INSTABILITY OF SUBAXIAL CERVICAL SPINE

    Institute of Scientific and Technical Information of China (English)

    CAO Peng; LIANG Yu; GONG Yao-cheng; ZHENG Tao; ZHANG Xing-kai; WU Wen-jian

    2008-01-01

    Objective To evaluate the clinical outcomes of surgical therapy in treating traumatic instability of subaxial cervical spine through either anterior or posterior approach. Methods according to the allen-Fergurson's classification, we retrospectively studied 42 cases of traumatic instability of subaxial cervical spine through either anterior or posterior surgical reconstruction. Patients requiring approach for either reduction or decompression were not included.Results The average follow-up interval was 3 years and 2 months. The anterior and posterior reconstructions were 24 and 18 cases, respectively. Before operation, the average scores of JOA and VAS were: 12.1 and 6.9 for anterior group, and 12.3 and 7.2 for posterior group. At the final assement, the scores of JOA and VAS improved to 16.0 and 2.2 for anterior group, and 15.7 and 2.6 for posterior group. The average ASIA motor scores of anterior and posterior group improved to 68.2 and 65.5 at the final follow-up from 58.4 and 59.7 before operation, respectively. The ASIA grade (A-E) was converted to a numeric score. The average scores before operation in the anterior and posterior group were 3.3 and 3.4, and increased to 3.8 and 3.7 at the final follow-up. After operation, there were different extent improvements of average radiological parameter, such as Cobb angle, vertebral body translation and disc height ratio. The average operation time and blood losing were 122 min and 125 mL for anterior group, and 153 min and 287 mL for posterior group. Fusion was achieved in all patients and 4 and 2 complications occurred at the anterior or posterior group.Conclusion The results showed that there were no obvious difference in parameters, such as neurological assements, functional grades, fusion rate, operation time and blood losing, between anterior and posterior group, except the virtues of anterior group in reconstruction and maintaining physiologic cervical lordosis and intervertrbal disc height occurred.

  1. The effect of ergonomics in dentistry on the occurrence of pain in the cervical neck region of the spine

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    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.

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

    Science.gov (United States)

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

    2013-03-01

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

  3. 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)

    Objective: To explore a safe and effective method for placing the cervical pedicle screws. Methods: There were ten adult cadaver specimens of cervica spine (C1-C7) 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 C2-C7 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)

  4. 颈椎有限元模型的应用进展%Application progress of finite element model in cervical spine

    Institute of Scientific and Technical Information of China (English)

    周毅强; 张建新; 林蔚莘

    2014-01-01

    有限元分析法(FEA)是一种在生物力学领域广泛应用的研究方法.近年来,颈椎有限元模型已被广泛应用于研究颈椎损伤、颈椎退变及模拟各种颈椎手术,已日趋完善.回顾了颈椎有限元模型的发展,介绍了颈椎有限元建模与分析在颈椎损伤、人工椎间盘置换、椎间植骨融合、颈椎退变及颈椎失稳等方面的应用进展,展望了未来的发展趋势.%Finite element analysis (FEA) is broadly used in biomechanics.Being widely used in clinical studies on cervical spine injury,cervical degeneration and stimulating a variety of cervical spine surgeries,cervical finite element model is becoming more and more accurate in recent years.This paper aims to review the development of cervical finite element model,to introduce the application progress of the modeling and analysis in cervical spine injury,cervical disc arthroplasty,cervical interbody fusion,cervical degeneration and cervical instability,and to prospect the foreground of cervical finite element model in future.

  5. 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.

  6. CAN A SPECIFIC NECK STRENGTHENING PROGRAM DECREASE CERVICAL SPINE INJURIES IN A MEN'S PROFESSIONAL RUGBY UNION TEAM? A RETROSPECTIVE ANALYSIS

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    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

  7. Informative value of radiological findings recorded from cervical spine with reference to clinical symptoms in patients with cervical syndrome. Aussagewert roentgenologischer Befunde an der Halswirbelsaeule in bezug zur klinischen Symptomatik bei Patienten mit Zervikalsyndrom

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    Loreck, D.; Kuehn, A. (Humboldt-Univ., Berlin (Germany). Inst. fuer Roentgendiagnostik); Conradi, E. (Humboldt Univ., Berlin (Germany). Poliklinik fuer Physiotherapie)

    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.).

  8. Risk factors for cervical spine injury among patients with traumatic brain injury

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    Tomoko Fujii

    2013-01-01

    Full Text Available Background: Diagnosis of cervical spine injury (CSI is difficult in patients with an altered level of consciousness as a result of a traumatic brain injury (TBI. Patients with TBI and older adults are at increased risk for CSI. This study examined the various risk factors for CSI among trauma patients with TBI and whether adults who were older (≥55 years were at higher risk for CSI when they sustained a fall-related TBI. Materials and Methods: Data used was the 2007 National Trauma Data Bank (NTDB, National Sample Project (NSP for adults who sustained a TBI. This dataset contains 2007 admission records from 82 level I and II trauma centers. Logistic regression was used to identify potential risk factors for CSI and to test for interaction between age and injury mechanism. Additional model variables included gender, race, Glasgow Coma Score, multiple severe injuries, hypotension and respiratory distress. Results: An analysis of the NTDB NSP identified 187,709 adults with TBI, of which 16,078 were diagnosed with a concomitant CSI. In motor vehicle traffic injuries, the older age group had significantly higher odds of CSI (odds ratio [OR] = 1.26 [1.15-1.39]. In fall-related injuries the older age group did not have a higher odds of CSI compared to the younger age group. Skull/face fracture, other spine fracture/dislocation, upper limb injury, thorax injury, and hypotension were significantly associated with CSI. Pelvic injuries had an inverse association with CSI (OR = 0.60 [0.54-0.67]. Black had significantly higher odds of CSI compared to Whites (OR = 1.25 [1.07-1.46]. Conclusion: The identification of associated injuries and factors may assist physicians in evaluating CSI in patients with TBI.

  9. 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.)

  10. 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)

    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.)

  11. Estudo anatômico do trajeto da artéria vertebral na coluna cervical inferior humana Anatomical study of the vertebral artery path in human lower cervical spine

    Directory of Open Access Journals (Sweden)

    Ben Hur Junitiro Kajimoto

    2007-01-01

    Full Text Available O aumento da utilização de novas técnicas e materiais de síntese para o tratamento cirúrgico de afecções da coluna cervical baixa foi acompanhado da crescente preocupação em relação às complicações que podem ocorrer. A técnica de fixação transpedicular, amplamente utilizada para os outros níveis da coluna vertebral, quando realizada na coluna cervical, apesar de conferir maior estabilidade quando comparada a outras técnicas, pode cursar com complicações graves como lesão da artéria vertebral, lesão de raiz nervosa, além de lesão da articulação facetária. A vértebra C7, no entanto, é considerada mais segura para a realização de tal procedimento, já que, na grande maioria das pessoas, segundo os estudos anatômicos disponíveis, esta não possui a artéria vertebral dentro de seu forame transverso, pois este vaso irá penetrar tal estrutura apenas na vértebra C6. Como hoje existem apenas estudos de imagem para avaliação do trajeto desta artéria e suas variações anatômicas, realizamos este estudo anatômico dissecando 40 artérias vertebrais de cadáveres para avaliar a incidência das variações anatômicas. Encontramos 3 casos onde a artéria vertebral penetrou o forame transverso já em C7 (7,5%, o que aumentaria o risco de uma técnica transpedicular neste nível. O restante das peças anatômicas possuíam anatomia habitual.The increasing use of new techniques and materials for surgical treatment of lower cervical spine conditions has come along with an increasing concern regarding potential complications that might occur. The transpedicular fixation technique, frequently used in other spine levels, is used on the cervical spine, while providing more stability than other techniques, it may cause serious complications such as vertebral artery injury, nervous root injury, or facet joint injuries. However, the C7 vertebra is considered safer for performing this procedure, since, in the vast majority of

  12. The ossification pattern in paediatric occipito-cervical spine: is it possible to estimate real age?

    International Nuclear Information System (INIS)

    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

  13. A knowledge-based approach to soft tissue reconstruction of the cervical spine.

    Science.gov (United States)

    Seifert, Sascha; Wachter, Irina; Schmelzle, Gottfried; Dillmann, Rüdiger

    2009-04-01

    For surgical planning in spine surgery, the segmentation of anatomical structures is a prerequisite. Past efforts focussed on the segmentation of vertebrae from tomographic data, but soft tissue structures have, for the most part, been neglected. Only sparse research work has been done for the spinal cord and the trachea. However, as far as the author is aware, there is no work on segmenting intervertebral discs. Therefore, a totally automatic reconstruction algorithm for the most relevant cervical structures is presented. It is implemented as a straightforward process, using anatomical knowledge which is, in concept, transferrable to other tissues of the human body. No seed points are required since the discs, as initial landmarks, are located via an object recognition approach. The spinal musculature is reconstructed by surface analysis on already segmented vertebrae, thus it can be taken into account in a biomechanical simulation. The segmentation results of our approach showed 91% accordance with expert segmentations and the computation time is less than 1 min on a standard PC. Since the presented system follows some general concepts this approach may also be considered as a step towards full body segmentation of the human. PMID:19272999

  14. Gd-DTPA-enhanced Three-dimensional MR imaging of degenerative disease of the cervical spine

    International Nuclear Information System (INIS)

    This paper assesses cervical spine three-dimensional (3D) MR imaging with Gd-DTPA, with the hypothesis that an enhanced 3D sequence with reconstructions would suffice for the evaluation of degenerative disease. Sixty patients were examined with (1) T1-weighted spin-echo and axial 2D gradient-echo low-flip-angle images representing the standard examination; and (2) one of two different enhanced 3D gradient-echo techniques: 30 patients with 3D fast low-angle shot (FLASH) imaging (TR 40/TE 7, 40 degrees flip angle, 64 2-mm sagittal partitions, one excitation, 10:67 minutes) and 30 with 3D Turbo FLASH imaging (MP RAGE) (7/5, 10 degrees, 128 1.5-mm partitions, one excitation, 6:07 minutes). 3D studies were reconstructed at 45 degrees obliquities for foramina, and axially. Standard and 3D studies were evaluated independently by two neuroradiologists for the location and size of extradural disease

  15. Colliculus atlantis: an insufficiently considered anatomic structure in open-mouth radiography of the cervical spine

    International Nuclear Information System (INIS)

    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.)

  16. 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.)

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

    Science.gov (United States)

    Oostveen, J.; van de Laar, M. A F J; Geelen, J.; de Graaff, R.

    1999-01-01

    OBJECTIVE—To report the efficacy of conservative treatment with cervical traction and immobilisation with a Halo vest, in two consecutive rheumatoid arthritis patients with progressive cervical myelopathy caused by subaxial subluxation.
METHODS—Description of neurological symptoms and signs and findings in plain radiography (PR) and magnetic resonance imaging (MRI) of the cervical spine before and after treatment of the subaxial subluxation by traction and immobilisation with a Halo vest during four months.
RESULTS—During four months of traction and immobilisation neurological examination showed a considerable improvement of the signs and symptoms of cervical myelopathy. Afterwards PR and MRI of the cervical spine showed reduction of the subaxial subluxation. Eventually firm stabilisation was obtained in both patients without surgery of the cervical spine.
CONCLUSION—Cervical traction and immobilisation with a Halo vest can be considered as an independent conservative treatment in rheumatoid arthritis patients with cervical myelopathy caused by subaxial subluxation.

 Keywords: rheumatoid arthrits; rheumatoid subaxial subluxation PMID:10343530

  18. Surgical option of lower cervical spine fracture and dislocation%下颈椎骨折脱位的治疗术式选择

    Institute of Scientific and Technical Information of China (English)

    王雷; 柳超; 田纪伟

    2013-01-01

    Objectives:To explore the surgical option and clinical efficacy of lower cervical spine fracture and dislocation.Methods:A total of 32 patients including 23 males and 9 females with a mean age of 56.4 years (ranging from 28 to 78) with lower cervical spine fracture and dislocation and treated surgically from January 2007 to October 2012 was analyzed retrospectively.22 patients suffered from neurological deficit.Based on Frankel system,5 cases were grade A,9 were grade B,6 were grade C,and 2 were grade D before surgery.Surgical approaches were determined based on the type of fracture,herniated disc,spinal cord compression,facet joint locking and cervical spine injury degree.Anterior surgery was performed on 21 cases with vertebral fractures but no facet joint locking(anterior cervical discectomy or corpectomy and fusion).Posterior treatment was performed on 4 cases with facet joint locking but no significant vertebral fractures,and MRI finding of no significant pressure or flexion distraction fracture combined with bilateral facet fractures.Combined posterior and anterior approach was performed in 7 cases with vertebral fractures and disc injury associated with facet joint locking or lamina fractures,with the fracture fragments penetrating into the spinal canal.During follow-up,the neurofunction,bony fusion and spine stability were reviewed.Results:All patients underwent surgery safely without severe complications such as tracheal and esophageal injury,4 patients were found complicated with spinal cord injury and cerebrospinal fluid leakage during operation and the wound heal after corresponsive intervention.Postoperatively,all patients were immobilized in a hard collar for 3 months.The average follow-up time was 18.5 months(range,6-24 months).1-2 degree of neurofunction recovery was achieved in all cases except 1 case with Frankel B.X ray verified the proper position of the screws after operation.Fusion achieved in all cases within 6 months(mean 4.5 months

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

    International Nuclear Information System (INIS)

    Sixty-three consecutive patients with RA and subjective symptoms, especially neck or occipital pain, and/or clinical objective signs consistent with a compromised cervical cord were included in this study. The patients were prospectively assigned to one of three classes on the basis of their neurologic status. Lateral cervical spine radiographs and sagittal Tl-weighted and gradient echo images were performed. The qualitative MR features evaluated were erosion of the dens and atlas, brain stem compression, subarachnoid space encroachment, pannus around the dens, appearance of the fat body caudal to the clivus, and the signal intensity of the pannus. The quantitative imaging parameters were the cervicomedullary angle and the distance of the dens to the line of McRae. Damage documented with radiographs and MR imaging in patients with RA is often severe, even in those without neurologic signs (class 1). None of the abnormalities confined to the atlantoaxial level correlated significantly with neurologic classification. Subarachnoid space encroachment anywhere in the entire cervical spine did correlate significantly with neurologic classification. (orig./MG)

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

    Science.gov (United States)

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

    2013-01-01

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

  1. Kinematic MRI of the cervical spine in patients with degenerative disease; Kinematische MRT bei degenerativen Halswirbelsaeulenveraenderungen

    Energy Technology Data Exchange (ETDEWEB)

    Muhle, C. [Klinik fuer Radiologische Diagnostik, Christian-Albrechts-Universitaet, Kiel (Germany); Wiskirchen, J. [Klinik fuer Radiologische Diagnostik, Christian-Albrechts-Universitaet, Kiel (Germany); Brinkmann, G. [Klinik fuer Radiologische Diagnostik, Christian-Albrechts-Universitaet, Kiel (Germany); Falliner, A. [Klinik fuer Orthopaedie, Christian-Albrechts-Universitaet, Kiel (Germany); Weinert, D. [Klinik fuer Neurochirurgie, Christian-Albrechts-Universitaet, Kiel (Germany); Reuter, M. [Klinik fuer Radiologische Diagnostik, Christian-Albrechts-Universitaet, Kiel (Germany); Heller, M. [Klinik fuer Radiologische Diagnostik, Christian-Albrechts-Universitaet, Kiel (Germany)

    1995-08-01

    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{sub 2}{sup `} 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) [Deutsch] Bei 23 Probanden und 23 Patienten mit degenerativen Veraenderungen der Halswirbelsaeule erfolgte nach Abschluss der statischen MRT-Untersuchung die Funktionsuntersuchung der Halswirbelsaeule von maximal 50 Anteflexion bis maximal 30 Retroflexion in bis zu 9 unterschiedlichen Flexionsstellungen. In jeder Flexionsstellung wurden sagittale Aufnahmen in T{sub 2}{sup `}-gewichteten Gradienten-Echo-Sequenzen angefertigt. In der Probandengruppe konnten bei max. Anteflexion (50 ) eine physiologische Verschmaelerung des ventralen Subarachnoidalraumes von ca. 50% gegenueber der horizontalen Ausgangstellung (0 ) und eine Erweiterung des ventralen Subarachnoidalraumes von ca. 10% waehrend max. Retroflexion (30 ) festgestellt werden. Die Funktionsuntersuchungen zeigten bei 5 Patienten (22%) in Anteflexion und bei 15 Patienten (65%) in Retroflexion eine zunehmende Spinalkanalstenose bzw. Myelonkompression durch dorsale osteophytaere Randanbauten. Gegenueber der Ausgangsstellung war bei nur 3 Patienten (13%) eine Befundkonstanz zu beobachten. (orig./MG)

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

    Science.gov (United States)

    Tatsuzaki, H; Urie, M M

    1991-08-01

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

  3. Quantitative morphometric analysis of the lumbar vertebral facets and evaluation of feasibility of lumbar spinal nerve root and spinal canal decompression using the Goel intraarticular facetal spacer distraction technique: A lumbar/cervical facet comparison

    OpenAIRE

    Savni R Satoskar; Aimee A Goel; Mehta, Pooja H.; Atul Goel

    2014-01-01

    Objective : The authors evaluate the anatomic subtleties of lumbar facets and assess the feasibility and effectiveness of use of ′Goel facet spacer′ in the treatment of degenerative spinal canal stenosis. Materials and Methods : Twenty-five lumbar vertebral cadaveric dried bones were used for the purpose. A number of morphometric parameters were evaluated both before and after the introduction of Goel facet spacers within the confines of the facet joint. Results : The spacers achieved distrac...

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-07-18

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

  6. Signal intensity loss of the intervertebral discs in the cervical spine of young patients on fluid sensitive sequences

    Energy Technology Data Exchange (ETDEWEB)

    Bruin, F. de; Horst, S. ter; Bloem, J.L.; Reijnierse, M. [Leiden University Medical Center, Department of Radiology, C2-S, Albinusdreef 2, PO box 9600, Leiden (Netherlands); Berg, R. van den; Hooge, M. de; Gaalen, F. van; Heijde, D. van der [Leiden University Medical Center, Department of Rheumatology, Leiden (Netherlands); Fagerli, K.M. [Diakonhjemmet Hospital, Department of Rheumatology, Oslo (Norway); Landewe, R. [Amsterdam Medical Center, Department of Rheumatology, Amsterdam (Netherlands); Oosterhout, M. van [Groene Hartziekenhuis, Department of Rheumatology, Gouda (Netherlands)

    2016-03-15

    To evaluate the signal intensity (SI) of the intervertebral discs of the cervical spine on magnetic resonance (MR) fluid sensitive sequences, and correlate this to secondary signs of degeneration on MR and radiographs as well as to age. A total of 265 patients aged ≥16 with back pain (≥3-months, <2-year, onset <45-years) from the SPondyloArthritis Caught Early (SPACE) cohort were included. Sagittal 1.5 T MR images and lateral radiographs of the cervical spine were independently evaluated by two readers for: SI of the intervertebral discs using a grading system based of Pfirrmann (grade 1 normal/bright SI; 2 inhomogeneous/bright SI; 3 inhomogeneous/mildly decreased SI; 4 inhomogeneous/markedly decreased SI; 5 signal void), disc herniation and Modic changes (MRI) and disc space narrowing, osteophytes and sclerosis (radiograph). Readers were blinded for clinical information. Descriptive statistics were used for characteristics and prevalence of findings, and regression analysis was used for age and grades. Of 265 patients (36 % male, mean age 30), 221 (83 %) patients had 1 to 6 discs (median 4) with decreased SI. Of 1,590 discs, 737 (46 %) were grade 1; 711 (45 %) grade 2; 133 (8 %) grade 3; 8 (1 %) grade 4 and 1 (0 %) grade 5. Secondary signs of degeneration were rare and seen predominantly in C5-C7 and appear to be related to signal loss grade 3 and 4. Low signal intensity of intervertebral discs in absence of secondary degenerative signs in the cervical spine on fluid sensitive MR images might be pre-existing and part of the natural course. (orig.)

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

    OpenAIRE

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

    2013-01-01

    Background It has been found that significantly different clinical outcomes occur in trauma patients with different mechanisms of injury. Ground level falls (GLF) are usually considered “minor trauma” with less injury occurred in general. However, it is not uncommon that geriatric trauma patients sustain cervical spine (C-spine) fractures with other associated injuries due to GLF or less. The aim of this study is to determine the injury patterns and the roles of clinical risk factors in these...

  8. Severe Facet Joint Arthrosis Caused C7/T1 Myelopathy: A Case Report

    OpenAIRE

    Eiji Itoi; Takeshi Hoshikawa; Hiroshi Ozawa; Toshimi Aizawa; Takashi Kusakabe

    2009-01-01

    Cervical myelopathy is caused by degenerative processes of the spine including intervertebral disc herniation and posterior spur usually developing at C3/4 to C5/6. C7/T1 single level myelopathy is very rare because of the anatomical characteristics. Facet joint arthrosis can be a cause of cervical myelopathy but only a few cases have been reported. The authors report an extremely rare case of C7/T1 myelopathy caused by facet joint arthrosis. A 58-year-old male presented with hand and gait cl...

  9. Cervical degenerative intraspinal cyst: a case report and literature review involving 132 cases

    OpenAIRE

    Machino, Masaaki; YUKAWA, YASUTSUGU; ITO, KEIGO; KATO, FUMIHIKO

    2012-01-01

    Intraspinal and extradural cysts in the cervical spine are rare disorders that may cause myelopathy or radiculopathy. A synovial cyst or ganglion derived from the facet joint and that from a ligamentum flavum have been reported. We report a surgical case of degenerative intraspinal cyst, causing cervical myelopathy. MRI of a case revealed cystic lesion at C4–5. Spinal cord was compressed by cyst and symptoms of myelopathy were also observed. The patient with cervical spinal canal stenosis und...

  10. Metric and morphological study of the upper cervical spine from the Sima de los Huesos site (Sierra de Atapuerca, Burgos, Spain)

    OpenAIRE

    Gómez Olivencia, Asier; Carretero, José Miguel; Arsuaga, Juan Luis; Rodríguez García, Laura; García González, Rebeca; Martínez Mendizábal, Ignacio

    2007-01-01

    In this article, the upper cervical spine remains recovered from the Sima de los Huesos (SH) middle Pleistocene site in the Sierra de Atapuerca (Burgos, Spain) are described and analyzed. To date, this site has yielded more than 5000 human fossils belonging to a minimum of 28 individuals of the species Homo heidelbergensis. At least eleven individuals are represented by the upper cervical (C1 and C2) specimens: six adults and five subadults, one of which could represent an adolescent...

  11. Surgical Management of Solitary Nerve Sheath Tumors of the Cervical Spine: A Retrospective Case Analysis Based on Tumor Location and Extension

    OpenAIRE

    Abe, Junya; Takami, Toshihiro; NAITO, Kentaro; Yamagata, Toru; Arima, Hironori; Ohata, Kenji

    2014-01-01

    Complete resection of spinal nerve sheath tumors (NSTs) does not always result in significant neurological deficit. The purpose of this retrospective case analysis was to discuss the optimal surgical strategy for spinal NST of the cervical spine. Twenty-four patients who underwent surgery for solitary cervical NST over the past decade were included in this retrospective study. Patients with neurofibromatosis or schwannomatosis were excluded. Seventeen of the 24 cases (70.8%) showed extradural...

  12. Percutaneous vertebroplasty for eosinophilic granuloma of the cervical spine in a child

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Hua-Qiao; Li, Ming-Hua; Wu, Chun-Gen; Gu, Yi-Feng; Zhang, He; Fang, Chun [Shanghai Sixth People' s Hospital affiliated to Shanghai Jiao Tong University, Department of Radiology, Shanghai (China)

    2007-10-15

    We report a case of eosinophilic granuloma at the fourth cervical vertebra in a 10-year-old girl presenting with a 1-month history of cervical pain and stiffness. This lesion was histologically diagnosed by needle biopsy and then treated by percutaneous vertebroplasty. After the procedure, the cervical pain and stiffness resolved rapidly. The height of the vertebral body remained stable without further collapse over a 6-month follow-up period. (orig.)

  13. Effects of Neonatal Enzyme Replacement Therapy and Simvastatin Treatment on Cervical Spine Disease in Mucopolysaccharidosis I Dogs

    Science.gov (United States)

    Chiaro, Joseph A; O’Donnell, Patricia; Shore, Eileen M; Malhotra, Neil R; Ponder, Katherine P; Haskins, Mark E; Smith, Lachlan J

    2014-01-01

    Mucopolysaccharidosis I (MPS I) is a lysosomal storage disease characterized by deficient α-L-iduronidase activity, leading to the accumulation of poorly degraded glycosaminoglycans (GAGs). Children with MPS I exhibit high incidence of spine disease, including accelerated disc degeneration and vertebral dysplasia, which in turn lead to spinal cord compression and kypho-scoliosis. In this study we investigated the efficacy of neonatal enzyme replacement therapy (ERT), alone or in combination with oral simvastatin (ERT+SIM) for attenuating cervical spine disease progression in MPS I, using a canine model. Four groups were studied: normal controls; MPS I untreated; MPS I ERT treated; and MPS I ERT+SIM treated. Animals were euthanized at one year-of-age. Intervertebral disc condition and spinal cord compression were evaluated from MRIs and plain radiographs, vertebral bone condition and odontoid hypoplasia were evaluated using microcomputed tomography, and epiphyseal cartilage to bone conversion was evaluated histologically. Untreated MPS I animals exhibited more advanced disc degeneration and more severe spinal cord compression than normal animals. Both treatment groups resulted in partial preservation of disc condition and cord compression, with ERT+SIM not significantly better than ERT alone. Untreated MPS I animals had significantly lower vertebral trabecular bone volume and mineral density, while ERT treatment resulted in partial preservation of these properties. ERT+SIM treatment demonstrated similar, but not greater, efficacy. Both treatment groups partially normalized endochondral ossification in the vertebral epiphyses (as indicated by absence of persistent growth plate cartilage), and odontoid process size and morphology. These results indicate that ERT begun from a very early age attenuates the severity of cervical spine disease in MPS I, particularly for the vertebral bone and odontoid process, and that additional treatment with simvastatin does not

  14. Laryngoscope and a new tracheal tube assist lightwand intubation in difficult airways due to unstable cervical spine.

    Directory of Open Access Journals (Sweden)

    Cai-neng Wu

    Full Text Available The WEI Jet Endotracheal Tube (WEI JET is a new tracheal tube that facilitates both oxygenation and ventilation during the process of intubation and assists tracheal intubation in patients with difficult airway. We evaluated the effectiveness and usefulness of the WEI JET in combination with lightwand under direct laryngoscopy in difficult tracheal intubation due to unstable cervical spine.Ninety patients with unstable cervical spine disorders (ASA I-III with general anaesthesia were included and randomly assigned to three groups, based on the device used for intubation: lightwand only, lightwand under direct laryngoscopy, lightwand with WEI JET under direct laryngoscopy.No statistically significant differences were detected among three groups with respect to demographic characteristics and C/L grade. There were statistically significant differences between three groups for overall intubation success rate (p = 0.015 and first attempt success rate (p = 0.000. The intubation time was significantly longer in the WEI group (110.8±18.3 s than in the LW group (63.3±27.5 s, p = 0.000 and DL group (66.7±29.4 s, p = 0.000, but the lowest SpO2 in WEI group was significantly higher than other two groups (p<0.01. The WEI JET significantly reduced successful tracheal intubation attempts compared to the LW group (p = 0.043. The severity of sore throat was similar in three groups (p = 0.185.The combined use of WEI JET under direct laryngoscopy helps to assist tracheal intubation and improves oxygenation during intubation in patients with difficult airway secondary to unstable spine disorders.Chinese Clinical Trial Registry ChiCTR-TRC-14005141.

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

    Science.gov (United States)

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

    2016-03-01

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

  16. Palliative Surgery in Treating Painful Metastases of the Upper Cervical Spine: Case Report and Review of the Literature.

    Science.gov (United States)

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

    2016-05-01

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

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

    Science.gov (United States)

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

    2003-01-01

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

  18. Cervical spondylosis

    Science.gov (United States)

    ... Past neck injury (often several years before) Past spine surgery Ruptured or slipped disk Severe arthritis Small fractures ... Kshettry VR. Cervical spondylosis. In: Benzel EC, ed. Spine Surgery . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap ...

  19. Laminoplasty for Cervical Myelopathy

    OpenAIRE

    Ito, Manabu; Nagahama, Ken

    2012-01-01

    This article reviews cervical laminoplasty. The origin of cervical laminoplasty dates back to cervical laminectomy performed in Japan ~50 years ago. To overcome poor surgical outcomes of cervical laminectomy, many Japanese orthopedic spine surgeons devoted their lives to developing better posterior decompression procedures for the cervical spine. Thanks to the development of a high-speed surgical burr, posterior decompression procedures for the cervical spine showed vast improvement from the ...

  20. Image quality in the anteroposterior cervical spine radiograph: Comparison between moving, stationary and non-grid techniques in a lamb neck

    Energy Technology Data Exchange (ETDEWEB)

    Keating, Michelle [School of Health and Social Care, Faculty of Health and Life Sciences, University of the West of England, Stapleton, Bristol BS16 1DD (United Kingdom); Grange, Stuart, E-mail: Stuart2.Grange@uwe.ac.u [School of Health and Social Care, Faculty of Health and Life Sciences, University of the West of England, Stapleton, Bristol BS16 1DD (United Kingdom)

    2011-05-15

    Background: Cervical spine radiography is a commonly employed examination for degenerative disease and trauma in the cervical spine. Traditionally, the anteroposterior projection is undertaken with the use of an anti-scatter grid. Some practitioners appear to have rejected this practice in favour of a non-grid technique, possibly because of the dose saving it affords. It is necessary to determine if image quality in the cervical spine is significantly degraded and whether the omission of the grid is justified. Method: Using a slaughtered lamb neck as a model of the human neck triplicate radiographs were obtained using a non-grid, a stationary grid and a moving grid technique. Entrance surface dose and dose area product was measured for these techniques. Image quality in terms of contrast, sharpness and overall acceptability was evaluated by 9 independent and blinded observers. Results: A significant reduction in measured dose was observed when the non-grid technique was compared to stationary or moving grid techniques. A statistically significant reduction in image contrast, sharpness and acceptability was also seen in the non-grid compared to grid techniques. Conclusion: These results show evidence of significantly greater image quality in the presence of either a moving or stationary grid in the lamb model. As such they support the continued use of scatter rejection methods such as the anti-scatter grid in AP radiography of the human cervical spine, to optimise radiographic image quality in this critical structure.

  1. Straightened cervical lordosis causes stress concentration: a finite element model study

    International Nuclear Information System (INIS)

    In this study, we propose a finite element analysis of the complete cervical spine with straightened and normal physiological curvature by using a specially designed modelling system. An accurate finite element model is established to recommend plausible approaches to treatment of cervical spondylosis through the finite element analysis results. There are few reports of biomechanics influence of the straightened cervical curve. It is difficult to measure internal responses of cervical spine directly. However, the finite element method has been reported to have the capability to quantify both external and internal responses to mechanical loading, such as the strain and stress distribution of spinal components. We choose a subject with a straightened cervical spine from whom to collect the CT scan data, which formed the basis of the finite element analysis. By using a specially designed modelling system, a high quality finite element model of the complete cervical spine with straightened curvature was generated, which was then mapped to reconstruct a normal physiological curvature model by a volumetric mesh deformation method based on discrete differential properties. Then, the same boundary conditions were applied to do a comparison. The result demonstrated that the active movement range of straightened cervical spine decreased by 24–33 %, but the stress increased by 5–95 %. The stress was concentrated at the facet joint cartilage, uncovertebral joint and the disk. The results suggest that cervical lordosis may have a direct impact on cervical spondylosis treatment. These results may be useful for clinical treatment of cervical spondylosis with straightened curvature.

  2. 上颈椎融合对颈椎活动度的影响%The impact of the upper cervical spine fusion on cervical range of motion

    Institute of Scientific and Technical Information of China (English)

    袁伟; 朱悦; 崔璀

    2012-01-01

    目的 探讨上颈椎融合对颈椎活动功能的影响,并评估颈椎活动度测量仪(cervical range of motion device,CROM)的可靠性.方法 我科于2010年7月至2011年10月对收治的14例上颈椎疾病患者使用CROM仪测量,其中5例为颈枕融合,2例寰枢椎融合,7例采用Halo架非融合治疗后2个月及6个月左右颈椎前屈、后伸、左右侧弯、左右旋转主动活动度,并与15例健康志愿者颈椎活动度进行比较,分析术后颈椎活动度丢失情况;使用CROM仪重复测量健康志愿者颈椎活动度并采用组间相关系数(intraclass correlation coefficients,ICC)来评价CROM仪的测量者内可靠性.结果 术后6个月随访时颈椎活动度六个方向中的三个方向:颈椎前屈、左旋转及右旋转,融合组与非融合组相比有显著降低(P<0.05),与正常组相比则在六个方向均有显著性差异(P<0.05).融合组中颈枕融合较寰枢椎融合在颈椎前屈、左右旋转活动上有显著性降低(P<0.05),术后第6个月随访各组颈椎活动度较3个月随访时均有一定程度的增加.CROM仪测量颈椎六个方向的活动度测量者内ICC均在0.91以上,有较高的可靠性.结论 上颈椎融合使颈椎活动范围显著性减小,对颈椎前屈、旋转功能影响最大.此外,CROM仪是一种可靠的颈椎活动度测量工具.%Objective To investigate the impact of the upper cervical spine fusion on cervical range of motion (CROM) and to evaluate the reliability of the CROM device. Methods From July 2010 to October 2011, 14 patients with upper cervical disease were adopted by our department and treated with cervical spine fusion or non-fusion, among whom there were 5 cases of cervicooccipital fusion, 2 cases of atlantoaxial fusion and 7 cases of Halo-vest treatment. The cervical flexion, backward extension, left and right lateral bending and rotation of all patients were measured by the CROM device about 2 months and 6 months after surgery

  3. Prospective Validation of Modified NEXUS Cervical Spine Injury Criteria in Low-risk Elderly Fall Patients

    OpenAIRE

    John Tran; Donald Jeanmonod; Darin Agresti; Khalief Hamden; Jeanmonod, Rebecca K.

    2016-01-01

    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 ...

  4. Chronic whiplash-associated disorder and traumatic cerebrospinal fluid leak. Analysis of cases with radioisotope cisternography, epidural blood patch, and cervical facet joint blocks

    International Nuclear Information System (INIS)

    This paper describes RI cisternographic (RIC) examinations of whiplash-associated disorder (WAD) and results of their treatment with nerve block and epidural blood patch (EBP) conducted in authors' facilities. Subjects were 40 chronic (av. symptomatic period of 3.1 y) WAD patients (av. age 34 y) with traffic (28 cases), sports (7) and falling (5) causes with complication of suspicious cerebrospinal fluid (CSF) leak. RIC was done 2.5-24 hr after injection of 37 MBq of 111In-diethylenetriamine pentaacetic acid (DTPA) in the medullary space through epidural puncturing needle. Positive finding of clear leak or early accumulation of RI in the bladder was seen in 21 cases and negative, in 19. Positive patients had significantly higher rates of headache, abnormal vision and fatigue than negative ones. EBP was conducted through X-ray to all positive patients and to negative ones with strongly suspicious leak complication (7 cases), which resulted in improvement of symptoms like headache and vision in the former, but no improvement in the latter cases. Repeated RIC of the patients with poor improvement in the former was suggested effective for judgment of repetition of EBP treatment. Cervical facet joint blocks were found effective in cases with posterior cervical pain. Symptoms in WAD accompanying headache should be differentially diagnosed whether it is derived from posttraumatic CSF leak or from pain due to cervical facet arthritis. (R.T.)

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

    OpenAIRE

    Jawahar, Ajay; Nunley, Pierce

    2012-01-01

    Anterior cervical discectomy and arthrodesis has come to represent standard of care for patients with persistent radicular and/or myelopathic symptoms that have failed to improve with conservative treatments. One potential complication of the procedure is the accelerated degeneration of the vertebrae and the intervertebral discs adjacent to the level fused and the effects of fusion on those levels. The concern that fusion may be a contributing factor to accelerated adjacent segment degenerati...

  6. Accessory articulation of elongated anterior transverse process: a rare anatomical variant of the cervical spine depicted with CT and post-processing techniques.

    Science.gov (United States)

    Bilreiro, C; Saraiva, J; Duarte Silva, L; Brito, J; Grande, P

    2016-03-01

    There are several described anatomical variants of the cervical spine, ranging from common to extremely rare, which may have different clinical implications. We present the case of an extremely rare anatomical variant of the cervical spine, in a symptomatic patient, consisting of a unilateral accessory articulation between the 5th and 6th cervical vertebrae, due to elongated anterior transverse processes. Our search found only three cases in the English literature describing similar findings to the case here reported. Our case is, to our knowledge, the first report of this anatomical variant imaged with computed tomography including post-processing images (volume rendering technology and multiplanar reformations), which contribute greatly to a better understanding and depiction of the anatomical variant. PMID:26251024

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

    Directory of Open Access Journals (Sweden)

    Neerja Bharti

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jiju Joseph

    2012-01-01

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

  9. Imaging skeletal anatomy of injured cervical spine specimens: comparison of single-slice vs multi-slice helical CT

    International Nuclear Information System (INIS)

    Our objective was to compare a single-slice CT (SS-CT) scanner with a multi-slice CT (MS-CT) scanner in the depiction of osseous anatomic structures and fractures of the upper cervical spine. Two cervical spine specimens with artificial trauma were scanned with a SS-CT scanner (HighSpeed, CT/i, GE, Milwaukee, Wis.) by using various collimations (1, 3, 5 mm) and pitch factors (1, 1.5, 2, 3) and a four-slice helical CT scanner (LightSpeed, QX/i, GE, Milwaukee, Wis.) by using various table speeds ranging from 3.75 to 15 mm/rotation for a pitch of 0.75 and from 7.5 to 30 mm/rotation for a pitch of 1.5. Images were reconstructed with an interval of 1 mm. Sagittal and coronal multiplanar reconstructions of the primary and reconstructed data set were performed. For MS-CT a tube current resulting in equivalent image noise as with SS-CT was used. All images were judged by two observers using a 4-point scale. The best image quality for SS-CT was achieved with the smallest slice thickness (1 mm) and a pitch smaller than 2 resulting in a table speed of up to 2 mm per gantry rotation (4 points). A reduction of the slice thickness rather than of the table speed proved to be beneficial at MS-CT. Therefore, the optimal scan protocol in MS-CT included a slice thickness of 1.25 mm with a table speed of 7.5 mm/360 using a pitch of 1.5 (4 points), resulting in a faster scan time than when a pitch of 0.75 (4 points) was used. This study indicates that MS-CT could provide equivalent image quality at approximately four times the volume coverage speed of SS-CT. (orig.)

  10. Evaluation of injuries of the upper cervical spine in a postmortem study with digital radiography, CT and MRI

    International Nuclear Information System (INIS)

    Purpose: To compare digital X-ray, CT, and MRI in the evaluation of ligamentous and osseous lesions in upper cervical spine specimens after artificial craniocervical injury with the findings of macroscopic preparation. Materials and Methods: A rotation trauma of defined severity was applied to 19 human corpses. After dissection of the neck specimens, digital X-ray (DIMA Soft P41, Feinfocus), conventional and helical CT (CTi, High Speed, GE, collimation 1 mm; pitch 1.0), and MRI were performed from the skull base to C3. The findings were correlated with the macroscopic results of preparation. MR (Magnetom Vision, Siemens) imaging was obtained with a 1.5 T system using 2D- and 3D-sequences. Results: Preparation revealed 6 fractures of the vertebral bodies, 5 fractures of the dens axis, 1 fracture of the arcus anterior of the atlas, 4 osseous flakes at the occipital condylus, and 6 lesions of the alar ligaments. Digital radiography showed all fractures and 4 osseous flakes at the occipital condylus. With conventional and helical CT, all fractures and all ruptured alar ligaments could be detected. 2D MRI depicted 9 of the fractures and 3D MRI showed fractures. With 2D MRI, 2 of the 4 osseous flakes at the condylus could be detected and with 3D MRI one occipital condylus fracture could be depicted. Ligamentous injuries were visualized by 2D MRI in 2 of 6 cases and by 3 D MRI inone case. Conclusions: In post-mortem studies, CT was superior to MRI in the visualization of osseous and ligamentous injuries after trauma of the upper cervical spine. However, these results are not transferable to patients with rotation injury in general. (orig.)

  11. Reconstruction of the cervical spine with two osteocutaneous fibular flap after radiotherapy and resection of osteoclastoma

    DEFF Research Database (Denmark)

    Kaltoft, Britta; Kruse, Anders; Jensen, Lisa Toft;

    2012-01-01

    to C3. Two months later, rupture of the pharyngeal wall was noted with exposure of the anterior cage. A few days later, the posterior scar ruptured. The anterior cage was removed and the pharyngeal wall was sutured. Revision of the posterior wound was performed, leaving the implants in place. To...... secure stability of the spine, the patient was treated with a HALO. Once again, the pharyngeal wall ruptured. Reconstruction of the posterior pharyngeal wall and the anterior column of the spine was performed with an osteocutaneous fibular flap from the skull base to C3. Five months later, a computed...

  12. Radiological evaluation of the cervical spinal trauma

    International Nuclear Information System (INIS)

    Acute injuries of the cervical spine are the most common causes of severe disability following trauma, yet the diagnosis of these injuries are often delayed and the treatment, inadequate. Traumatic injuries of the cervical spine are diagnosed by radiological examinations. And complete evaluations of bony structures and soft tissue changes on conventional radiograms are very important for determining the therapeutic plans and prognoses of the injuries patients. During the period of 5 years from June 1976 to May 1981, the radiological and clinical evaluation had been made on 38 patients suffered from acute cervical spinal injuries which were confirmed by the radiological examinations. The results were as follows. 1. Age distribution of total 38 patients was broad ranging from 19 years to 72 years. 2. The most common cause of injury was traffic accident, next fall down, other accident respectively. 3. Levels of the cervical spinal injuries were as follows: Upper cervical spine in 15.8%, lower cervical spine in 84.2%, and the most common injuries level was C 5. Most of the lower cervical spinal injuries were located in the vertebral body and spinous process. 4. Anatomical sites of the cervical spinal injuries were as follows; vertebral body in 55.5%, spinous process in 23.7%, neural arch in 15.8%, and locked facet in 18.4%, etc. 5. Most of the patients with severe mental changes were injuries in upper cervical spine rather than lower. And most of the patients with quadriplegia or paraplegia were shown marked disruption of spinal canal

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

    Science.gov (United States)

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

    2016-01-01

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

  14. Surgical management of solitary nerve sheath tumors of the cervical spine: a retrospective case analysis based on tumor location and extension.

    Science.gov (United States)

    Abe, Junya; Takami, Toshihiro; Naito, Kentaro; Yamagata, Toru; Arima, Hironori; Ohata, Kenji

    2014-01-01

    Complete resection of spinal nerve sheath tumors (NSTs) does not always result in significant neurological deficit. The purpose of this retrospective case analysis was to discuss the optimal surgical strategy for spinal NST of the cervical spine. Twenty-four patients who underwent surgery for solitary cervical NST over the past decade were included in this retrospective study. Patients with neurofibromatosis or schwannomatosis were excluded. Seventeen of the 24 cases (70.8%) showed extradural dumbbell extension, most frequently at the C1 or C2 vertebral level. Neurological condition was assessed using the modified McCormick functional schema and sensory pain scale. Total removal of the tumor was achieved in 20 of 24 cases (83.3%). Staged surgery using combined anterior and posterior approaches was applied for 2 of 17 cases with extradural dumbbell extension. Tumor involvement with nerve root fibers critical for upper extremity function (C5-C8) was recognized in 6 of 24 cases (25.0%), with complete resection in all 6 cases. Final assessment of neurological function revealed satisfactory or acceptable recovery in all 6 patients. Spinal NSTs with extradural dumbbell extension are a common condition in the cervical spine. Complete removal of spinal NST of the cervical spine may carry a risk of permanent neurological deficit, but such sequelae appeared to be the exception in the present case analysis. A radical and safe surgical strategy, including staged surgery combining anterior and posterior approaches, should be tailored to the individual case. PMID:25367583

  15. Mechanisms of titanium release from posterior cervical spine plates in a canine model based on computational and biocompatibility studies

    Energy Technology Data Exchange (ETDEWEB)

    Villarraga, M.L. [Exponent, Inc., Philadelphia, PA (United States); Tulane Univ., New Orleans, LA (United States). Dept. of Biomedical Engineering; Anderson, R.C.; Hart, R.T.; Bundy, K.J. [Tulane Univ., New Orleans, LA (United States). Dept. of Biomedical Engineering; Dinh, D.H. [Talane Univ., New Orleans, LA (United States). Dept. of Neurological Surgery

    2001-07-01

    The use of Ti-6Al-4V in spinal implants has increased due to its advantageous mechanical properties, biocompatibility, corrosion resistance, and MRI compatibility. The release of metal ions or particulates, which results from mechanical loads imposed on the implant, affects the biocompatibility of spinal implants, potentially influencing performance. In this study, the titanium release from posterior cervical spine plates was examined using a computational and experimental approach in the canine model. The in vivo titanium release from plates implanted in four canines at the C4-C5 level was determined using atomic emission spectroscopy techniques. The highest titanium levels (>100 ppm dry weight) were found in tissue samples closest to the screw-plate interfaces. The retrieved implants showed the highest amounts of surface damage at the screw-plate interfaces. The histological evaluation of tissues showed a normal fibrous response with the presence of titanium particulates. A three-dimensional finite element model of the canine cervical spine (C3 to C6), plate, and screws was developed and validated. This model included contact definitions at the screw-plate interfaces and at the plate-bone interfaces and simulated an average physiologically loaded canine neck. The simulations predicted that the highest values of all the mechanical parameters evaluated were at the screw-plate interfaces. Based on the simulation, fretting, wear, spalling, and stress-enhanced ion release were identified as candidate metal release mechanisms. A conceptual model was proposed describing likely metal release mechanisms taking place in a plate-screw type implant in the spine. The highest areas of titanium concentration are at the screw-plate interfaces, and the areas of low titanium concentration are at the central portion of the plate. The majority of the titanium detected at the high areas is proposed to be released by fretting and wear at the screw-plate interfaces, and, at the center

  16. 上颈椎损伤的诊治进展%Advances in the Diagnosis and Treatment of Upper Cervical Spine Injury

    Institute of Scientific and Technical Information of China (English)

    李柳炳; 顾俊; 董启榕; 沈光思; 陆政峰; 秦建忠; 陈礼(综述); 沈忆新(审校)

    2015-01-01

    位于上颈椎管内的脊髓是中枢神经系统中重要及脆弱的部分。由于其包含神经、血管结构,上颈椎骨性结构的完整性对生存和功能至关重要。由于上颈椎特殊的解剖位置及较大的活动范围,其易遭受不同方向的暴力。上颈椎损伤主要是指寰枢椎及其附属结构由于受到暴力导致骨折、韧带撕裂、脱位等。该文将介绍上颈椎各种常见的损伤类型、治疗原则、手术方式以及研究进展,为临床处理各型上颈椎损伤提供参考。%The spinal cord in upper cervical canal is an essential and vulnerable component of the cen-tral nervous system.The integrity of the upper cervical spine is essential for the survival and function ,because of the neurovascular structures contained in it.Due to its specific anatomical location,large range of rotation, upper cervical spine easily suffers from violence of different directions.The upper cervical spine injuries mainly refer to the fractures,torn ligaments,dislocation of atlantoaxial vertebrae and its accessory structures caused by violence.Here is to make a review of various common types of upper cervical spine injuries,as well as their treatment principles,surgical approaches and research progress,in order to provide reference for clini-cal treatment.

  17. Granuloma eosinofílico de coluna cervical: relato de caso Eosinophilic granuloma of the cervical spine: case report

    OpenAIRE

    Manoel Baldoino Leal Filho; Aline de Almeida Xavier Aguiar; Bruno Ribeiro de Almeida; Karoline da Silva Dantas; Marcelo Adriano da Cunha e Silva Vieira; Ricardo Keyson Paiva de Morais

    2003-01-01

    Granuloma eosinofílico (GE) é condição benigna de proliferação histiocitária localizada ou multifocal. A ocorrência de lesões na coluna cervical pode variar entre 1,5% e 20% dos casos de GE. Relatamos caso de menina de sete anos de idade e história de cervicalgia há cerca de um mês, torcicolo persistente e postura viciosa do pescoço, com desvio cefálico para esquerda. A tomografia computadorizada revelou lesão expansiva, osteodestrutiva ao nível da hemilâmina esquerda de C2, com invasão do ca...

  18. Diffuse idiopathic skeletal hyperostosis of cervical spine - An unusual cause of difficult flexible fiber optic intubation

    Directory of Open Access Journals (Sweden)

    Baxi Vaibhavi

    2010-01-01

    Full Text Available This is a report of anterior osteophytes on the cervical vertebra resulting in distortion of the airway and leading to difficulty during intubation. The osteophytes associated with the syndrome of diffuse idiopathic skeletal hyperostosis were at the C2-3 and C6-7, T1 level and resulted in anterior displacement of the pharynx and the trachea respectively.

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

    Directory of Open Access Journals (Sweden)

    Forrest Lianne

    2010-10-01

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

  20. Internal jugular phlebectasia as an incidental finding in cervical spine surgery

    Directory of Open Access Journals (Sweden)

    Thulasiraman V

    2010-01-01

    Full Text Available Idiopathic internal jugular phlebectasia, occurs either unilaterally or bilaterally affecting the internal jugular vein is a rare congenital variation often diagnosed during childhood. It usually presents with a benign swelling over the lateral side of neck on the affected side, seen on exertion. A-30-year old male was operated for anterior cervical dissectomy from right lateral approach and was diagnosed per-operatively as internal jugular phlebectasia.The surgery was abandoned at this stage on the advice of cardiothoracic surgeon to investigate the patient for the secondary etiological factors for internal jugular vein dilatation. The patient was reassured without any active intervention for the phlebectasia and cervical dissectomy was performed in the second surgery through the lateral approach from left side. This case is presented in view of rarity and suggested that during preoperative workup the nearby structures like carotid sheath should be evaluated by magnetic resonance imaging to avoid such per-operative surprises.

  1. The effects of cervical joint manipulation, based on passive motion analysis, on cervical lordosis, forward head posture, and cervical ROM in university students with abnormal posture of the cervical spine

    OpenAIRE

    Gong, Wontae

    2015-01-01

    [Purpose] The aim of this study was to determine the effect of cervical posture manipulation, based on passive motion analysis (MBPMA) and general mobilization, on cervical lordosis, forward head posture (FHP), and cervical ROM in university students with problems in cervical posture and range of motion (ROM). [Subjects] The Subjects were 40 university students in their 20s who displayed problems in cervical posture and ROM; they were divided into an MBPMA group (n=20) and a mobilization grou...

  2. Unilateral ossified ligamentum flavum in the high cervical spine causing myelopathy

    OpenAIRE

    Singhal Udit; Jain Manoj; Jaiswal Awadhesh; Behari Sanjay

    2009-01-01

    High cervical ossified ligamentum flavum (OLF) is rare and may cause progressive quadriparesis and respiratory failure . Our two patients had unilateral OLF between C1 and C4 levels. MR showed a unilateral, triangular bony excrescence with low signal and a central, intermediate or high signal on all pulse sequences due to bone marrow within. There was Type I thecal compression (partial deficit of contrast media ring). The first patient had a linear and nodular OLF with calcification within t...

  3. Cervical surgery for ossification of the posterior longitudinal ligament: One spine surgeon′s perspective

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2014-01-01

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

  4. Melanotic Schwannoma of the Cervical Spine Progressing With Pulmonary Metastasis: Case Report

    OpenAIRE

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

    2013-01-01

    Melanotic schwannoma (MS) is an unusual variant of nerve sheath neoplasm. Only 10% of these tumors will undergo malignant degeneration, with exceedingly rare reported metastasis. We present a 32-year-old woman with a 6-month history of cervical pain and left arm progressive weakness. Neurological examination showed a left upper limb radicular pain, with pyramidal syndrome at C5 level. The magnetic resonance imaging (MRI) study highlighted an intradural extramedullary heterogeneous mass along ...

  5. 下颈椎骨折脱位并小关节绞锁的外科治疗方法探讨%Surgical treatment for lower cervical fracture and dislocation combined with locked facet

    Institute of Scientific and Technical Information of China (English)

    王锋; 龙耀武; 赵晓东; 陈光福; 袁智锐; 付美奇

    2013-01-01

    目的 对高能量损伤致下颈椎骨折脱位关节突绞锁并脊髓损伤的患者实施同期前后联合手术,探讨该方法的可行性及其疗效.方法 对13例下颈椎骨折脱位伴小关节突绞锁实施前、后路或前后联合手术.新鲜脱位并绞锁者采用同期后路小关节突部分切除复位,全椎板切除减压,间盘切除自体髂骨植骨内固定;椎体骨折并脱位或病程超过两周的陈旧性颈椎脱位并绞锁者采用同期后路关节突切除复位,前路椎体次全切减压,钛网植骨融合内固定.结果术后X线片显示13例颈椎骨折脱位均恢复了正常序列,无神经功能恶化.本组11例获得了13~29个月随访,平均为16.8月,术后大部分患者(11/13)神经功能改良ASIA分级上升.住院时间平均19天.结论对严重下颈椎骨折脱位伴小关节突绞锁患者行同期前后联合手术是安全可行的,是治疗颈椎骨折脱位合并小关节绞锁的理想方法.%Objective To investiagate the clinical feasibility and effects of the treatment for fracture dislocation with articular process interlocking in lower cervical spine caused by high-energy trauma by one-stage operation with combined anterior and posterior approaches. Methods Thirteen patients with fracture-dislocation and articular process interlocking in lower cervical spine underwent operation by combined anterior and posterior approaches. Reducion with partial resection of articular process laminectomy, disectomy and fusion with internal fixation were performed in patients with fresh dislocation and facet locking. Reduction with partial resection of articular process, anterior cervical corpectomy, fusion with titanium cage and internal fixation were performed in patients with vertebral fracture and dislocation or those who were in jured more than two weeks. Results After operation, the neural function of all cases not aggrauated, and joint interlocking and dislocation were all released and reduced. Eleven

  6. Tracheal intubation in patients with cervical spine immobilization: A comparison of McGrath® video laryngoscope and Truview EVO2® laryngoscope

    OpenAIRE

    Ruchi Bhola; Swaran Bhalla; Radha Gupta; Ishwar Singh; Sunil Kumar

    2014-01-01

    Background and Aims: Literature suggests that glottic view is better when using McGrath® Video laryngoscope and Truview® in comparison with McIntosh blade. The purpose of this study was to evaluate the effectiveness of McGrath Video laryngoscope in comparison with Truview laryngoscope for tracheal intubation in patients with simulated cervical spine injury using manual in-line stabilisation. Methods: This prospective randomised study was undertaken in operation theatre of a tertiary referral ...

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

    Directory of Open Access Journals (Sweden)

    Zhang C

    2014-03-01

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

  8. Airway Management with Cervical Spine Immobilisation: A Comparison between the Macintosh Laryngoscope, Truview Evo2, and Totaltrack VLM Used by Novices—A Manikin Study

    Science.gov (United States)

    Gaszyński, Tomasz

    2016-01-01

    Airway management in patients with suspected cervical spine injury plays an important role in the pathway of care of trauma patients. The aim of this study was to evaluate three different airway devices during intubation of a patient with reduced cervical spine mobility. Forty students of the third year of emergency medicine studies participated in the study (F = 26, M = 14). The time required to obtain a view of the entry to the larynx and successful ventilation time were recorded. Cormack-Lehane laryngoscopic view and damage to the incisors were also assessed. All three airway devices were used by each student (a novice) and they were randomly chosen. The mean time required to obtain the entry-to-the-larynx view was the shortest for the Macintosh laryngoscope 13.4 s (±2.14). Truview Evo2 had the shortest successful ventilation time 35.7 s (±9.27). The best view of the entry to the larynx was obtained by the Totaltrack VLM device. The Truview Evo2 and Totaltrack VLM may be an alternative to the classic Macintosh laryngoscope for intubation of trauma patients with suspected injury to the cervical spine. The use of new devices enables achieving better laryngoscopic view as well as minimising incisor damage during intubation. PMID:27034926

  9. The pattern of skeletal anomalies in the cervical spine, hands and feet in patients with Saethre-Chotzen syndrome and Muenke-type mutation

    Energy Technology Data Exchange (ETDEWEB)

    Trusen, Andreas; Beissert, Matthias; Darge, Kassa [Department of Paediatric Radiology, Institute of Radiodiagnostics, University of Wuerzburg, Josef-Schneider-Str. 2, 97080 Wuerzburg (Germany); Collmann, Hartmut [Department of Paediatric Neurosurgery, University of Wuerzburg, Wuerzburg (Germany)

    2003-03-01

    Saethre-Chotzen syndrome (SCS) and Muenke-type mutation (MTM) are complex syndromes with craniosynostosis and skeletal anomalies including syndactyly, carpal and tarsal fusions, and cervical spine abnormalities. In this study, we analysed radiographs of the cervical spine, hands and feet of a large patient population with genetically proven SCS and MTM. The aim was to describe the pattern of skeletal anomalies and to determine whether specific features are present that could help differentiate between the two entities. Radiographs of 43 patients (23 males, 20 females) with SCS (n=35) or MTM (n=8) were evaluated. The median age was 8 years (range 1 month-36 years). All radiographs were reviewed by two radiologists. In the hands and feet, a variety of anomalies such as brachyphalangy, clinodactyly, partial syndactyly, partial carpal or tarsal fusion, and cone-shaped epiphyses were noted. Duplicated distal phalanx of the hallux (n=12/35) and triangular deformity of the epiphysis of the distal phalanx of the hallux (n=10/35) were detected in SCS only; calcaneo-cuboid fusion (n=2/35) was detected in MTM only. In the cervical spine, fusion of vertebral bodies and/or the posterior elements occurred only in patients with SCS. Pathognomonic signs for SCS are the triangular shape of the epiphysis and duplicated distal phalanx of the hallux. Calcaneo-cuboid fusion was detected in MTM only. These signs may be helpful in the differentiation of SCS from MTM. (orig.)

  10. The pattern of skeletal anomalies in the cervical spine, hands and feet in patients with Saethre-Chotzen syndrome and Muenke-type mutation

    International Nuclear Information System (INIS)

    Saethre-Chotzen syndrome (SCS) and Muenke-type mutation (MTM) are complex syndromes with craniosynostosis and skeletal anomalies including syndactyly, carpal and tarsal fusions, and cervical spine abnormalities. In this study, we analysed radiographs of the cervical spine, hands and feet of a large patient population with genetically proven SCS and MTM. The aim was to describe the pattern of skeletal anomalies and to determine whether specific features are present that could help differentiate between the two entities. Radiographs of 43 patients (23 males, 20 females) with SCS (n=35) or MTM (n=8) were evaluated. The median age was 8 years (range 1 month-36 years). All radiographs were reviewed by two radiologists. In the hands and feet, a variety of anomalies such as brachyphalangy, clinodactyly, partial syndactyly, partial carpal or tarsal fusion, and cone-shaped epiphyses were noted. Duplicated distal phalanx of the hallux (n=12/35) and triangular deformity of the epiphysis of the distal phalanx of the hallux (n=10/35) were detected in SCS only; calcaneo-cuboid fusion (n=2/35) was detected in MTM only. In the cervical spine, fusion of vertebral bodies and/or the posterior elements occurred only in patients with SCS. Pathognomonic signs for SCS are the triangular shape of the epiphysis and duplicated distal phalanx of the hallux. Calcaneo-cuboid fusion was detected in MTM only. These signs may be helpful in the differentiation of SCS from MTM. (orig.)

  11. [Symptomatic Langerhans-cell-histiocytosis of the cervical spine in a child: case report].

    Science.gov (United States)

    Schroers, C; Donauer, E; Laudan, M; Herbst, E W; Barz, H

    2000-01-01

    We report on a six year old female presented with a painful torticollis and a hemidysaesthesia caused by destruction of the third cervical vertebra and a paravertebral soft-tissue mass. At diagnostic routine finally a biopsy gives the diagnosis of Langerhans cell histiocytosis. In a second open approach the destructed vertebral body was replaced by a precisely adjusted autologous bone interponate and the patient was maintained in halo vest immobilisation. The outcome is described and an overview of the current literature is given. PMID:10916784

  12. Corrective surgery for deformity of the upper cervical spine due to ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Bin Lin

    2014-01-01

    Full Text Available Rotational and flexion deformity of C1-C2 due to ankylosing spondylitis is rare. We did surgical correction in one such case by lateral release, resection of the posterior arch of C1 and mobilization of the vertebral arteries, wedge osteotomy of the lateral masses of C1 and internal fixation under general anesthesia. There were no vascular and neurological complications during the surgery. After operation the atlantoaxial rotational deformity was corrected and the normal cervical lordosis was restored. At 1 year followup his visual field and feeding became normal and internal fixation was stable.

  13. Posterior cervical spine arthrodesis with laminar screws. A report of two cases

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Sugimoto,Yoshihisa

    2007-04-01

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

  15. BLADE sequences in transverse T2-weighted MR imaging of the cervical spine. Cut-off for artefacts?

    Energy Technology Data Exchange (ETDEWEB)

    Finkenzeller, T. [Hospital Nuremberg Sued (Germany). Inst. of Radiology and Neuroradiology; Wendl, C.M.; Stroszczynski, C.; Fellner, C. [University Hospital Regensburg (Germany). Inst. of Radiology; Lenhart, S. [Klinikum Weiden (Germany). Radiology and Neuroradiology; Schuierer, G. [Center of Neuroradiology, Regensburg (Germany). Inst. of Neuroradiology

    2015-02-15

    The BLADE (PROPELLER) technique reduces artefacts in imaging of the cervical spine in sagittal orientation, but till now failed to do so in axial orientation, because here it increased through plane CSF-flow artefacts, which spoiled the benefit of BLADE artefact reduction 'in plane'. The aim of this study was to compare a BLADE sequence with optimised measurement parameters in axial orientation to T2-TSE. Both sequences were compared in 58 patients with 31 discal, 16 bony and 11 spinal cord lesions. Image sharpness, reliability of spinal cord depiction, CSF flow artefacts and lesion detection were evaluated by 3 independent observers. Additionally the observers were asked which sequence they would prefer for diagnostic workup. Statistical evaluations were performed using sign and {sub X}2 test. BLADE was significantly superior concerning image sharpness, spinal cord depiction and overall lesion detection. BLADE was rated better for most pathologies, for bony lesions the differences compared with TSE were statistically significant. Regarding CSF-flow artefacts both sequences showed no difference. All readers preferred BLADE in side by side reading. An optimised axial T2 BLADE sequence decreases the problems of increased through plane CSF-flow artefacts in this orientation. By reducing various other artefacts it yields better image quality and has the potential to reduce the number of non-diagnostic examinations especially in uncooperative patients.

  16. BLADE sequences in transverse T2-weighted MR imaging of the cervical spine. Cut-off for artefacts?

    International Nuclear Information System (INIS)

    The BLADE (PROPELLER) technique reduces artefacts in imaging of the cervical spine in sagittal orientation, but till now failed to do so in axial orientation, because here it increased through plane CSF-flow artefacts, which spoiled the benefit of BLADE artefact reduction 'in plane'. The aim of this study was to compare a BLADE sequence with optimised measurement parameters in axial orientation to T2-TSE. Both sequences were compared in 58 patients with 31 discal, 16 bony and 11 spinal cord lesions. Image sharpness, reliability of spinal cord depiction, CSF flow artefacts and lesion detection were evaluated by 3 independent observers. Additionally the observers were asked which sequence they would prefer for diagnostic workup. Statistical evaluations were performed using sign and X2 test. BLADE was significantly superior concerning image sharpness, spinal cord depiction and overall lesion detection. BLADE was rated better for most pathologies, for bony lesions the differences compared with TSE were statistically significant. Regarding CSF-flow artefacts both sequences showed no difference. All readers preferred BLADE in side by side reading. An optimised axial T2 BLADE sequence decreases the problems of increased through plane CSF-flow artefacts in this orientation. By reducing various other artefacts it yields better image quality and has the potential to reduce the number of non-diagnostic examinations especially in uncooperative patients.

  17. Traumatic Cervical Cord Transection without Facet Dislocations-A Proposal of Combined Hyperflexion-Hyperextension Mechanism: A Case Report

    OpenAIRE

    Cha, Yoo-Hyun; Cho, Tai-Hyoung; Suh, Jung-Keun

    2010-01-01

    A patient is presented with a cervical spinal cord transection which occurred after a motor vehicle accident in which the air bag deployed and the seat belt was not in use. The patient had complete quadriplegia below the C5 level and his imaging study showed cervical cord transection at the level of the C5/6 disc space with C5, C6 vertebral bodies and laminar fractures. He underwent a C5 laminectomy and a C4-7 posterior fusion with lateral mass screw fixation. Previous reports have described ...

  18. 单节段双节段颈椎融合术后颈椎活动度的观察%Motion changes of cervical range after one or two-level cervical spine fusion

    Institute of Scientific and Technical Information of China (English)

    赵信; 徐宏光; 郑权; 方振; 赵泉来; 王弘; 刘平

    2015-01-01

    目的:探讨单节段及双节段颈椎融合手术对颈椎活动度的影响。方法:选取2010年6月~2012年6月在皖南医学院附属弋矶山医院脊柱外科行颈椎前路减压融合术的43例颈椎病患者,其中单节段融合29例,双节段融合14例。根据症状及X线片评价手术的有效率及融合节段的融合率。使用颈椎活动度测量仪( cervical range of motion device ,CROM)测量患者术前及术后随访24个月时颈椎前屈、后伸、左右侧弯、左右旋转6个方向的活动度。结果:从患者主诉分析,所有患者临床症状均得到缓解,通过X线评价融合节段融合率为100%。与术前相比单节段融合术后患者颈椎左右侧弯方向活动度无明显差异(P>0.05),而在前屈、后伸及左右旋转方向的活动度均较术前明显减低(P<0.05)。行双节段融合手术后患者颈椎在6个方向的活动度较术前均明显减低( P<0.05)。对两种不同融合术后患者颈椎活动度的差异进行统计学分析后发现双节段融合患者术后颈椎活动度在6个方向均较单节段融合患者降低( P<0.05)。结论:颈椎融合手术能够降低患者颈椎的活动度,与单节段融合相比双节段融合术后颈椎活动度的降低更为明显。%Objective:To observe the impact of one or two-level and double-level cervical spine fusion on the rang of cervical motion .Methods:Forty-three patients undergone cervical spine fusion in our department between June of 2010 and 2012 were included,among whom 29 received single-level fusion,and 14,two-level fusion.The curative effects and fusion rate of spine were evaluated by presented symptoms and X-ray findings.The cervical flexion,backward extension,left and right lateral bending,left and right rotation of the cervical vertebrae were measured by the cervical range of motion device(CROM) in all patients before operation and post-operative 24-month follow

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

    OpenAIRE

    Chanplakorn, Pongsthorn; Kraiwattanapong, Chaiwat; Aroonjarattham, Kitti; Leelapattana, Pittavat; Keorochana, Gun; Jaovisidha, Suphaneewan; Wajanavisit, Wiwat

    2014-01-01

    Background Cervical pedicle screw (CPS) insertion is a technically demanding procedure. The quantitative understanding of cervical pedicle morphology, especially the narrowest part of cervical pedicle or isthmus, would minimize the risk of catastrophic damage to surrounding neurovascular structures and improve surgical outcome. The aim of this study was to investigate morphology and quantify cortical thickness of the cervical isthmus by using Multi-detector Computerized Tomography (MD-CT) sca...

  20. Cervical spine degenerative diseases: An evaluation of clinical and imaging features in surgical decisions

    International Nuclear Information System (INIS)

    In clinically severe cervical spondylosis, imaging plays a vital role in surgical decisions. A prime factor is acquired canal stenosis with cord compression. To validate this concept, the clinical and imaging features of 20 patients with spondylitic myelopathy and 24 with radiculopathy were retrospectively reviewed. All had computed tomographic myelography (CTM) as part of their clinical work-up. The patients' clinical severity was graded as mild, moderate and severe; the age, length of illness and a history of eventual surgery or otherwise were recorded. At the level of maximum compression the following parameters were obtained from the axial CTM images: surface area and ratio of the anteroposterior to the transverse diameter of the cord; subarachnoid space and vertebral canal areas. Data were statistically analysed. A significant association exists between surgery and increasing severity of symptoms (P=0.04), and advancing age (P=0.01). These associations hold true for myelopathy and radiculopathy. A strong association is present between surgery and the surface area of the cord (P=0.01), being applicable to myelopathy only. The other parameters show no association with surgical decisions. It is concluded that with myelopathy a narrow cord area at the level of maximum compression, and moderate-severe functional impairment are indicators for surgical intervention. (authors)

  1. Cervical Spine Disc Deformation During In Vivo Three-Dimensional Head Movements.

    Science.gov (United States)

    Anderst, William; Donaldson, William; Lee, Joon; Kang, James

    2016-05-01

    Although substantial research demonstrates that intervertebral disc cells respond to mechanical signals, little research has been done to characterize the in vivo mechanical environment in the disc tissue. The objective of this study was to estimate cervical disc strain during three-dimensional head movements. Twenty-nine young healthy adults performed full range of motion flexion/extension, lateral bending, and axial rotation of the head within a biplane radiography system. Three-dimensional vertebral kinematics were determined using a validated model-based tracking technique. A computational model used these kinematics to estimate subject-specific intervertebral disc deformation (C3-4 to C6-7). Peak compression, distraction and shear strains were calculated for each movement, disc level, and disc region. Peak compression strain and peak shear strain were highest during flexion/extension (mean ± 95% confidence interval) (32 ± 3 and 86 ± 8%, respectively), while peak distraction strain was highest during lateral bending (57 ± 5%). Peak compression strain occurred at C4-5 (33 ± 4%), while peak distraction and shear strain occurred at C3-4 (54 ± 8 and 83 ± 11%, respectively). Peak compression, distraction, and shear strains all occurred in the posterior-lateral annulus (48 ± 4, 80 ± 8, and 109 ± 12%, respectively). These peak strain values may serve as boundary conditions for in vitro loading paradigms that aim to assess the biologic response to physiologic disc deformations. PMID:26271522

  2. Do experienced physiotherapists apply equal magnitude of force during a grade I central pa on the cervical spine?

    Directory of Open Access Journals (Sweden)

    M. Conradie

    2004-02-01

    Full Text Available Background and purpose: Physiotherapists frequently use central posterior-anterior (PA joint mobilization techniques for assessing and managing spinal disorders. Manual examination findings provide the basis for the selection of treatment techniques. From the literature it is evident that the level of reliability varies when physiotherapists perform different mobilization techniques. Repeatability of mobilization techniques is important for better physiotherapy management. The aim of the study was to determine whether experienced physiotherapists apply equal magnitude of force during a grade I central PA mobilisation technique on the cervical spine. Another aim was to determine the variation in the magnitude of forceapplied by each individual physiotherapist. Subjects: Sample of convenience, consisting of sixteen (n=16 selected qualified physiotherapists with experience inOrthopaedic Manual Therapy.Methods: A grade I central PA was performed on the Flexiforce TM sensors positioned on C6 of the same asymptomatic model to measure the applied magnitude of force. Two separate measurements, each lasting 30-seconds, were obtained.Results: The average maximum peak force applied by the majority of physiotherapists (87.5% was between 10.95gand 72g. The difference in the forces applied for the two measurements ranged between 0.64g and 24.4g. The BlandAltman scatterplot determined the mean of the difference between measurement one and two, calculated for the group, was zero. When comparing the two measurements, little variation was noted in the forces applied, as well as the coefficient of variation for each physiotherapist.Conclusion and Discussion: Current results demonstrated good intra-therapist and moderate to good inter-therapist repeatability. Further research is required to generalize results.

  3. Biomechanical stability of a bioabsorbable self-retaining polylactic acid/nano-sized β-tricalcium phosphate cervical spine interbody fusion device in single-level anterior cervical discectomy and fusion sheep models

    Directory of Open Access Journals (Sweden)

    Cao L

    2012-11-01

    Full Text Available Lu Cao,1 Ping-Guo Duan,1 Xi-Lei Li,1 Feng-Lai Yuan,3 Ming-Dong Zhao,2 Wu Che,1 Hui-Ren Wang,1 Jian Dong11Department of Orthopedic Surgery, Zhongshan Hospital, State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai, China; 2Department of Orthopedic Surgery, Jinshan Hospital, Fudan University, Shanghai, China; 3Affiliated Third Hospital of Nantong University, Wuxi, ChinaPurpose: The aim of this study was to investigate the biomechanical stability provided by a novel, polylactic acid/nano-sized, β-tricalcium phosphate, bioabsorbable, self-retaining cervical fusion cage (BCFC.Methods: Quasistatic nonconstraining torques (maximum 1.5 NM induced flexion, extension, lateral bending (±1.5 NM, and axial rotation (±1.5 NM on 32 sheep cervical spines (C2–C5. The motion segment C3–C4 was first tested intact; the following groups were tested after complete discectomy: autologous tricortical iliac crest bone graft, Medtronic–Wego polyetheretherketone (PEEK cage, Solis PEEK cage, and BCFC. The autologous bone graft group was tested with an anterior plate. The mean range of motion (ROM was calculated from the load-displacement curves.Results: BCFC significantly decreased ROM in lateral bending and axial rotation compared to other implants, and no significant difference in ROM between two types of PEEK cages and BCFC could be observed in flexion and extension. Anterior cervical plate (ACP significantly decreased ROM in flexion and extension, but no significant difference in ROM between BCFC and bone graft plus ACP could be determined in lateral bending and axial rotation.Conclusion: The BCFC device showed better stability to autologous tricortical iliac crest bone graft and PEEK cages in single-level anterior cervical discectomy and fusion models and thus may be a potential alternative to the current PEEK cages.Keywords: biomechanics, cervical spine, cages, bioabsorbable, sheep

  4. Tracheal intubation in patients with cervical spine immobilization: A comparison of McGrath ® video laryngoscope and Truview EVO2 ® laryngoscope

    Directory of Open Access Journals (Sweden)

    Ruchi Bhola

    2014-01-01

    Full Text Available Background and Aims: Literature suggests that glottic view is better when using McGrath® Video laryngoscope and Truview® in comparison with McIntosh blade. The purpose of this study was to evaluate the effectiveness of McGrath Video laryngoscope in comparison with Truview laryngoscope for tracheal intubation in patients with simulated cervical spine injury using manual in-line stabilisation. Methods: This prospective randomised study was undertaken in operation theatre of a tertiary referral centre after approval from the Institutional Review Board. A total of 100 consenting patients presenting for elective surgery requiring tracheal intubation were randomly assigned to undergo intubation using McGrath® Video laryngoscope (n = 50 or Truview® (n = 50 laryngoscope. In all patients, we applied manual-in-line stabilisation of the cervical spine throughout the airway management. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. Demographic data, airway assessment and haemodynamics were compared using the Chi-square test. A P < 0.05 was considered significant. Results: The time to successful intubation was less with McGrath video laryngoscope when compared to Truview (30.02 s vs. 38.72 s. However, there was no significant difference between laryngoscopic views obtained in both groups. The number of second intubation attempts required and incidence of complications were negligible with both devices. Success rate of intubation with both devices was 100%. Intubation with McGrath Video laryngoscope caused lesser alterations in haemodynamics. Conclusions: Both laryngoscopes are reliable in case of simulated cervical spine injury using manual-in-line stabilisation with 100% success rate and good glottic view.

  5. SU-E-I-51: Use of Blade Sequences in Cervical Spine MR Imaging for Eliminating Motion, Truncation and Flow Artifacts

    Energy Technology Data Exchange (ETDEWEB)

    Mavroidis, P [University of Texas Health Science Center, UTHSCSA, San Antonio, TX (United States); Lavdas, E; Kostopoulos, S; Ninos, C; Strikou, A; Glotsos, D; Vlachopoulou, A; Oikonomou, G [Technological Education Institute of Athens, Athens, Athens (Greece); Economopoulos, N [General University Hospital ATTIKON, Athens, Athens (Greece); Roka, V [Health Center of Farkadona, Trikala (Greece); Sakkas, G [Center for Research and Technology of Thessaly, Trikala (Greece); Tsagkalis, A; Batsikas, G [IASO Thessalias Hospital, Larissa (Greece); Statkahis, S [Cancer Therapy and Research Center, San Antonio, TX (United States); Papanikolaou, N [University of Texas HSC SA, San Antonio, TX (United States)

    2014-06-01

    Purpose: To assess the efficacy of the BLADE technique to eliminate motion, truncation, flow and other artifacts in Cervical Spine MRI compared to the conventional technique. To study the ability of the examined sequences to reduce the indetention and wrap artifacts, which have been reported in BLADE sagittal sequences. Methods: Forty consecutive subjects, who had been routinely scanned for cervical spine examination using four different image acquisition techniques, were analyzed. More specifically, the following pairs of sequences were compared: a) T2 TSE SAG vs. T2 TSE SAG BLADE and b) T2 TIRM SAG vs. T2 TIRM SAG BLADE. A quantitative analysis was performed using the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and relative contrast (ReCon) measures. A qualitative analysis was also performed by two radiologists, who graded seven image characteristics on a 5-point scale (0:non-visualization; 1:poor; 2:average; 3:good; 4:excellent). The observers also evaluated the presence of image artifacts (motion, truncation, flow, indentation). Results: Based on the findings of the quantitative analysis, the ReCON values of the CSF (cerebrospinal fluid)/SC (spinal cord) between TIRM SAG and TIRM SAG BLADE were found to present statistical significant differences (p<0.001). Regarding motion and truncation artifacts, the T2 TSE SAG BLADE was superior compared to the T2 TSE SAG and the T2 TIRM SAG BLADE was superior compared to the T2 TIRM SAG. Regarding flow artifacts, T2 TIRM SAG BLADE eliminated more artifacts compared to the T2 TIRM SAG. Conclusion: The use of BLADE sequences in cervical spine MR examinations appears to be capable of potentially eliminating motion, pulsatile flow and trancation artifacts. Furthermore, BLADE sequences are proposed to be used in the standard examination protocols based on the fact that a significantly improved image quality could be achieved.

  6. Comparison of the conventional CMAC and the D-blade CMAC with the direct laryngoscopes in simulated cervical spine injury-a manikin study

    Directory of Open Access Journals (Sweden)

    Divya Jain

    2014-07-01

    Full Text Available BACKGROUND: CMAC videolaryngoscope has recently been introduced for videoscope guided intubation. The aim of our study was to compare and evaluate the efficacy of the conventional blade and the angulated D blade of the CMAC videolaryngoscope with the direct laryngoscopes in simulated cervical spine injury patients on the airway manikin. MATERIALS AND METHODS: Following power analysis, 33 resident doctors were enrolled to perform endotracheal intubation using all the 4 different laryngoscopes namely the Macintosh laryngoscope, McCoy laryngoscope, conventional CMAC videolaryngoscope and the D blade of the CMAC videolaryngoscopes on the airway manikin in simulated cervical spine injury. The demographic variables of the resident doctors were recorded. The outcomes measured included vocal cord visualization (Cormack-Lehane grading, time taken to intubate, number of attempts for successful intubation and optimizing maneuvers required. RESULTS: The use of indirect videolaryngoscopes resulted in better glottic visualization in comparison to the direct laryngoscopes (CL-I in 20/33 (60.6% in the Macintosh group, 24/33 (72.7% in McCoy group, 30/33 in (90.9% in Vlc group and 32/33 (96.9% in Vld group. The time taken to intubate averaged to 15.54 ± 2.6 in Macintosh group, 18.90 ± 4.47 in McCoy group, 20.21 ± 7.9 in Vlc group and 27.42 ± 9.09 in Vld group. The 1st attempt intubation success rate was 84.8% (Macintosh, 72.7% (McCoy, 90.9% (Vlc and, 78.7% (Vld. CONCLUSIONS: The overall performance of the conventional CMAC blade proved to be the best when compared with the D-blade CMAC, Macintosh blade and the McCoy blade for intubation in simulated cervical spine patients by anesthesia residents.

  7. Adaptation of proton total dose with respect to dosimetric parameters within the frame of treatment of skull base or upper cervical spine chordomas

    International Nuclear Information System (INIS)

    The authors report the study of the feasibility of a photon-proton irradiation protocol with a dose adaptation with respect to dosimetric factors for patients suffering form a skull base and upper cervical spine chordoma. Sixty patients have been treated between May 2006 and June 2008 with a combination of high energy photons and protons. As five tumours have locally relapsed and one at distance, the authors comment the local control rates, the number of attained cranial nerves, the value of the macroscopic tumour volume, the survival rate without relapse in terms of multifactorial of uni-factorial analysis. Short communication

  8. [Unstable traumatic lesions of the lower cervical spine without neurologic deficiency. Our experience at the Fondation Jeanne Ebori in Libreville (Gabon)].

    Science.gov (United States)

    Loembe, P M; Chouteau, Y; Bouger, D

    1991-04-01

    23 cases of unstable traumatic lesions of the lower cervical spine, without neurologic complication, were treated over a period of eight years. These cases consisted of eight dislocations, five subluxations, nine fracture-dislocations and one "tear drop" or fracture of the vertebral body. Six cases were treated conservatively and fifteen operatively. Two patients died in skeletal traction while awaiting surgical intervention. The surgical approaches were anterior (6 cases), posterior (8 cases) and combined (1 case). There was one case of transitory neurologic deficit immediately after surgery. One case required re-intervention. Overall they obtained satisfactory osteoligamentary consolidation. PMID:2055985

  9. 颈椎前路手术20例并发症治疗分析%Treatment for Surgical Complications of Anterior Cervical Spine

    Institute of Scientific and Technical Information of China (English)

    郑军; 杨效宁; 曹雷

    2011-01-01

    Objective To investigate the reasons of and prevention for surgical complications of anterior cervical spine. Methods The clinical data of 20 patients with surgical complications in 201 patients who underwent anterior cervical surgery from May 2000 to May 2009 were analyzed retrospectively. Results The patients with complications were followed up for 3 months to 10 years with an average of 5. 5 years. The rate of 11 patients with short-term complications was 15%, and the rate of nine patients with long-term complications was 4. 48%. Conclusion The key of a successful surgery for anterior cervical spine inludes full realization of type of cervical spinal cord injury, careful evaluation of the patient's general condition, skilled operation, and good post-operative care.%目的 探讨颈椎手术并发症原因及预防措施,以提高手术成功率.方法 对2000年5月-2009年5月实施颈椎前路手术的脊髓型颈椎病患者201例中20例发生并发症患者的临床资料及随访情况进行回顾性分析.结果 20例并发症患者获得随访时间3个月~10年,平均5.5年.近期并发症11例,发生率5.47%;远期并发症9例,发生率4.48%.结果 充分认识脊髓的损伤类型,仔细评估患者的全身情况,熟练的手术操作,良好的术后护理是手术成功的关键.

  10. Early complications of cervical spine surgery in 96 patients%颈椎手术96例早期并发症分析

    Institute of Scientific and Technical Information of China (English)

    储建军; 王涛; 裴少保; 李键; 李定滨; 王之兵

    2014-01-01

    Objective To evaluate the early complications of cervical spine surgery .Methods We retro-spectively analyzed 96 cervical spine surgery patients in our department ,including 56 cervical spondylotic myelopathy , 21 cervical fracture and/or dislocation ,11 cervical spine tumor ,5 atlantoaxial dislocation ,3 Chiari malformation .By analyzing causes of complications ,the countermeasures were developed .Results 27 patients had complications .The major complications were:death in 1 case,incision hematoma in 2 cases,incision infection in 4 cases,spine cord inju-ry or nerve root injury in 3 cases,cerebrospinal fluid leakage in 3 cases,superior laryngeal nerve and recurrent laryn-geal nerve injury in 4 cases,pulmonary infection in 5 cases,urinary tract infection in 4 cases.There were no esophage-al fistula and vertebral artery injury in these patients .The incidence rate in anterior ,posterior,anterior combined with posterior surgery was 24.6%(14/57),36.8%(7/19),40.0%(6/15) respectively.Conclusion Cervical spine surgery is likely to get early complications .Adequate preoperative preparation and improving operative techniques , timely and correctly handle the complications could reduce complications and improve cure rate .%目的:分析颈椎手术早期并发症的发生原因及处理方法。方法回顾性分析96例颈椎手术患者的临床资料,其中脊髓型颈椎病56、颈椎骨折脱位21例、颈椎肿瘤11例、寰枢椎脱位5例、Chiari 畸形3例;颈椎前路手术57例、后路手术24例,前后联合手术15例,分析早期并发症发生率、发生原因及其对策。结果96例颈椎手术中27例出现并发症,发生率为29.2%,其中死亡1例,切口血肿2例,切口感染4例,脊髓或神经损伤3例,脑脊液瘘3例,喉返神经损伤2例,喉上神经损伤2例,肺部感染5例,尿路感染4例,无食管瘘及椎动脉损伤病例。前路手术并发症发生率24.6%(14/57),后路手

  11. Advances in neurobiological mechanism of cervical facet joint pain%颈椎小关节源性疼痛机制的神经生物学研究进展

    Institute of Scientific and Technical Information of China (English)

    唐峰

    2015-01-01

    Diseases of cervical facet joint is a common source of chronic neck pain.Clinically,the accuracy and stability of the diagnosis of cervical facet joint-induced pain is often been concerned,whereas the pathophysiology and pain mechanism,especially the related neurobiological information were still not recognized adequately.In this paper,researches in pain from cervical facet joint,which is a integrated reaction regulated and maintained by all kinds of inflammatory factors and neurotransmitters,were reviewed from the aspect of cytological level of pain induction: the innervation and the distribution of pain receptors of cervical facet joint were introduced,irreversible neuropathological changes of cervical facet joint after chronic injuries were discussed which involved neuron activation,inflammatory cytokines release and changes of neuronal phenotype,at the same time,neurotransmitters and peptides involved in starting and sustaining the facet joint pain were emphasized which including the following three categories: pain neurotransmitters,stress-related proteins and local inflammatory factors,as well as spinal glutamate.%颈椎小关节疾病是颈部慢性疼痛的常见来源,临床上较为关注其诊断的精确性和稳定性,而对病理生理及疼痛机制,特别是相关神经生物学研究缺乏足够的认识.该文从疼痛产生的细胞学水平层面对颈椎小关节源性疼痛这一由多种炎性因子及神经递质参与调节及维持的综合反应进行综述:介绍颈椎小关节神经支配及其疼痛感受器的分布情况,阐述慢性损伤后小关节发生的不可逆的神经病理变化(包括神经元激活、炎性因子释放和神经元免疫表型改变等),并重点介绍其中参与疼痛启动与维持的疼痛传入递质、应激相关蛋白和局部炎性因子、脊髓谷氨酸等三大类神经递质和肽类.

  12. Spine surgery - discharge

    Science.gov (United States)

    ... Vertebral interbody fusion - discharge; Posterior spinal fusion - discharge; Arthrodesis - discharge; Anterior spinal fusion - discharge; Spine surgery - spinal fusion - discharge Images Spinal surgery -- cervical - series References Agrawal BM, Zeidman SM, Rhines L, ...

  13. Analysis of amelioration of neurological function on cervical degeneration disease after treatment with cervical spine locking plate%颈椎带锁钢板内固定术对颈椎退变性疾病神经功能改善的分析

    Institute of Scientific and Technical Information of China (English)

    赖志军; 谢惠缄; 谢唏衷; 肖建如

    2002-01-01

    Objective To discuss the clinical effect of treatment with anterior decompression, bone graft and cervical locking plate fixation for cervical degeneration disease.Method 23 patients with cervical spondylotic myelopathy and cervical ossification of the posterior longitudinal ligament have undergone the treatment of anterior cervical spine locking plate fusion.Neurological signs and symptoms were evaluated before and after surgery, and mean follow up time was 11.3 months.Result In all cases,radiography demonstrated a solid bony fusion.Additional general complications include a large wound hematoma in one and hoarseness in one.All patients' neurological function were improved.Conclusion The clinical effect of treatment with anterior decompression, bone graft and cervical locking plate fixation for cervical degeneration disease is satisfactory.

  14. Cervical neural foramina: Correlation of microtomy and CT anatomy

    International Nuclear Information System (INIS)

    The CT appearance of the cervical neural foramina and contents is described in detail. Nineteen cervical spine specimens were studied with CT and corresponding cryomicrotomy in direct axial, sagittal, coronal, and oblique planes. Both ventra and dorsal nerve roots can be identified in the foramen's lower portion at or below the disk level. The dorsal nerve roots and ganglion contact the superior facet. The ventral nerve roots contact the uncinate process and bottom of the neural foramen. The ventral nerve roots, dorsal nerve roots and ganglion, and vertebral artery are resolved with current high-resolution CT

  15. 颈椎前路内固定术后中远期食管并发症%Delayed esophageal complications after anterior cervical spine surgery

    Institute of Scientific and Technical Information of China (English)

    高瑞; 杨立利; 陈华江; 王新伟; 袁文

    2012-01-01

    Objective To investigate incidence,diagnosis and treatment strategy of delayed esophageal complications after anterior cervical spine surgery.Methods The clinical data of 2316 patients who had undergone anterior cervical spine surgery from January 2001 to December 2011 were analyzed.The delayed esophageal complications were defined as esophageal perforation,esophago-tracheal fistula,esophago-cutaneous fistula,diverticulum of esophagus,esophagopleural fistula and esophageal stenosis that occurred 2 weeks after spine surgery.Results Delayed esophageal complications occurred in 4 patients,and the incidence was 0.17%.Esophageal perforation occurred in 2 patients; the incidence was 0.09%.Case 1 was a 31-year-old man who was found to have esophageal diverticulum and perforation 7 years after anterior cervical spine surgery.Then he underwent removal of implant,excision of diverticulum,and repair of esophagus with sternohyoid muscle flap and omohyoid muscle flap.Case 2 was a 46-year-old man who was found to have esophageal diverticulum 3 years after cervical spine surgery.He also underwent removal of implant,excision of diverticulum,and repair of esophagus with sternohyoid muscle flap and omohyoid muscle flap.Case 3 was a 58-year-old woman who was found to have esophageal diverticulum 5 years after cervical spine surgery.She underwent removal of implant,excision of diverticulum,and repair of esophagus with sternocleidomastoid muscle flap.Case 4 was a 56-year-old woman who was found to have esophageal perforation 3 years after cervical spine surgery.She underwent removal of implant and repair of esophagus with sternocleidomastoid muscle flap.All 4 patients recovered after operation.Conclusion The incidence of delayed esophageal complications after anterior cervical spine surgery is low,and the diagnosis is difficult.X-ray,digestive tract radiography,and gastrointestinal endoscopy are the main diagnostic tools.Surgical treatment is the main and effective management

  16. Cervical spine CT scan

    Science.gov (United States)

    ... the benefits of the test. Some people have allergies to contrast dye. Let your provider know if you have ... injected contrast dye. The most common type of contrast given into a ... an iodine allergy is given this type of contrast, nausea or ...

  17. Artrodese na coluna cervical utilizando SICAP como substituto de enxerto ósseo Artrodesis en la columna cervical utilizando SICAP como sustituto de injerto óseo Cervical spine fusion utilizing silicated calcium phosphate bone graft substitute (SICAP

    Directory of Open Access Journals (Sweden)

    Juliano Fratezi

    2011-01-01

    resembling natural bone. METHODS: 19 patients who underwent cervical spine fusion were retrospective

  18. Yoga and disc degenerative disease in cervical and lumbar spine: an MR imaging-based case control study

    OpenAIRE

    Jeng, Chin-Ming; Cheng, Tzu-Chieh; Kung, Ching-Huei; Hsu, Hue-Chen

    2010-01-01

    The objective of the current study was to find out whether yoga practice was beneficial to the spine by comparing degenerative disc disease in the spines of long-time yoga practitioners and non-yoga practicing controls, using an objective measurement tool, magnetic resonance imaging. This matched case–control study comprised 18 yoga instructors with teaching experience of more than 10 years and 18 non-yoga practicing asymptomatic individuals randomly selected from a health checkup database. A...

  19. A modification to the Gill-Thomas-Cosman (GTC) head frame for stereotactic radiosurgery of head and neck and cervical spine sites

    International Nuclear Information System (INIS)

    PURPOSE/OBJECTIVE: Fractionated Stereotactic Radiosurgery (FSR) is used primarily to treat intracranial lesions. Many tumors which arise at or inferior to the base of skull and about the cervical spine area were not amenable to radiosurgery. Presented is a modification to the GTC head frame which permits stereotactic radiosurgery to be directed at head and neck tumors with accurate reproducible precision. MATERIALS AND METHODS: The original GTC head frame has two fixation points; an anterior individualized dental impression and a posterior occipital plate with a mold contoured to the occipital pertuberance. The height of the occipital plate is adjustable in its vertical plane. However, the position of the dental piece is fixed and, therefore, limits treatment to regions superior. Treatment of head and neck and cervical spine tumors has been accomplished with a modification of the dental apparatus. Presented is our new device; a bracket extension which attaches to the dental piece and allows the head frame to be lowered to multiple desired positions. The occipital plate is elevated accordingly to support the occipital pertuberance. The depth helmet is also modified for quality assurance. A Rando phantom was used to test the accuracy and reproducibility of the new equipment. Bracket extensions lowering the head frame by 3 cm and 8 cm, respectively, were tested for accuracy of relocation on the Rando Phantom. Each extension was tested 20 times and for each individual test 18 depth helmet positions were obtained. RESULTS: The standard deviation of the modified head frame for each depth helmet measurement ranged from 0.05 to 0.35mm (mean 0.20) as compared to the standard deviation for the original GTC head frame which was 0.13 to 0.34mm (mean 0.24). The new device maintains the accuracy and reproducibility of the original GTC head frame. CONCLUSION: The GTC relocatable head frame for FSR has been modified to treat tumors of the head and neck and cervical spine sites

  20. Magnetic resonance imaging analysis of the upper cervical spine extensor musculature in an asymptomatic cohort: an index of fat within muscle

    Energy Technology Data Exchange (ETDEWEB)

    Elliott, J.M. [Division of Physiotherapy, University of Queensland, Brisbane, QLD (Australia)]. E-mail: jimelliott@plbb.net; Galloway, G.J. [Center for Magnetic Resonance, University of Queensland, Brisbane, QLD (Australia); Jull, G.A. [Division of Physiotherapy, University of Queensland, Brisbane, QLD (Australia); Noteboom, J.T. [Department of Physical Therapy, Regis University, Denver, CO, USA (United States); Centeno, C.J. [Centeno Clinic, Westminster, CO, USA (United States); Gibbon, W.W. [Department of Radiology, School of Medicine, University of Queensland, Brisbane, QLD (Australia)

    2005-03-01

    AIM: To establish a simple method to quantify muscle/fat constituents in cervical muscles of asymptomatic women using magnetic resonance imaging (MRI), and to determine whether there is an age effect within a defined age range. MATERIALS AND METHODS: MRI of the upper cervical spine was performed for 42 asymptomatic women aged 18-45 years. The muscle and fat signal intensities on axial spin echo T1-weighted images were quantitatively classified by taking a ratio of the pixel intensity profiles of muscle against those of intermuscular fat for the rectus capitis posterior major and minor and inferior obliquus capitis muscles bilaterally. Inter- and intra-examiner agreement was scrutinized. RESULTS: The average relative values of fat within the upper cervical musculature compared with intermuscular fat indicated that there were only slight variations in indices between the three sets of muscles. There was no significant correlation between age and fat indices. There were significant differences for the relative fat within the muscle compared with intermuscular fat and body mass index for the right rectus capitis posterior major and right and left inferior obliquus capitis muscles (p=0.032). Intraclass correlation coefficients for intraobserver agreement ranged from 0.94 to 0.98. Inter-rater agreement of the measurements ranged from 0.75 to 0.97. CONCLUSION: A quantitative measure of muscle/fat constituents has been developed, and results of this study indicate that relative fatty infiltration is not a feature of age in the upper cervical extensor muscles of women aged 18-45 years.

  1. Magnetic resonance imaging analysis of the upper cervical spine extensor musculature in an asymptomatic cohort: an index of fat within muscle

    International Nuclear Information System (INIS)

    AIM: To establish a simple method to quantify muscle/fat constituents in cervical muscles of asymptomatic women using magnetic resonance imaging (MRI), and to determine whether there is an age effect within a defined age range. MATERIALS AND METHODS: MRI of the upper cervical spine was performed for 42 asymptomatic women aged 18-45 years. The muscle and fat signal intensities on axial spin echo T1-weighted images were quantitatively classified by taking a ratio of the pixel intensity profiles of muscle against those of intermuscular fat for the rectus capitis posterior major and minor and inferior obliquus capitis muscles bilaterally. Inter- and intra-examiner agreement was scrutinized. RESULTS: The average relative values of fat within the upper cervical musculature compared with intermuscular fat indicated that there were only slight variations in indices between the three sets of muscles. There was no significant correlation between age and fat indices. There were significant differences for the relative fat within the muscle compared with intermuscular fat and body mass index for the right rectus capitis posterior major and right and left inferior obliquus capitis muscles (p=0.032). Intraclass correlation coefficients for intraobserver agreement ranged from 0.94 to 0.98. Inter-rater agreement of the measurements ranged from 0.75 to 0.97. CONCLUSION: A quantitative measure of muscle/fat constituents has been developed, and results of this study indicate that relative fatty infiltration is not a feature of age in the upper cervical extensor muscles of women aged 18-45 years

  2. 治疗颈椎单侧小关节骨折的几种内固定方式的比较%The Comparison of Several Fixation Methods which were Used to Treat Cervical Unilateral Facet Fracture

    Institute of Scientific and Technical Information of China (English)

    孙泉; 邱玉金; 赵思顺

    2013-01-01

      目的通过比较多种颈椎内固定方式以寻找颈椎后路治疗颈椎单侧小关节骨折的标准的手术方式。方法对6具新鲜的人体颈椎标本(C3~T1)的C3椎体从0Nm到2.0Nm以0.5Nm的增量进行运动。每个标本顺次进行以下8步处理:①完整状态;②C5/6平面不稳定;③C5~6双侧侧块内固定;④不稳定的右侧C5侧块骨折;⑤C5~6单侧侧块内固定;⑥辅以棘突间缆线的C5~6单侧侧块内固定;⑦C4~6双侧侧块内固定;⑧C5~6 ACDF。结果相对于完整状态,平均活动范围C5~6双侧侧块内固定减少到33.3%,C5~6单侧侧块内固定上升到113.6%,辅以棘突间缆线的C5~6单侧侧块内固定减少到90.3%,C4~6双侧侧块内固定减少到44.2%,ACDF减少到66.9%.结论辅以棘突间缆线的单侧侧块内固定应该被视为颈椎后路手术的方式之一。%Objective To find a gild standard dorsal approach by comparing several fixation methods .Meth-ods Six fresh human cervical spine specimens (C3 ~T1) were tested by applying pure moments to the C 3 vertebral body in increments of 0.5 Nm from 0 Nm to 2.0 Nm.Each specimen was tested in the following 8 conditions:①intact;②after destabilization via injury to the C5~6 facet;③with bilateral C5~6 lateral mass screws and rods;④after further destabilization by creating a right unilateral lateral mass fracture of C 5;⑤with unilateral left C5~6 lateral mass screws and rod;⑥with unilateral C5~6 lateral mass screws and rod supplemented with an interspinous cable;⑦with a bilateral multilevel dorsal construct C4~6;and⑧after a C5~6 anterior cervical discectomy and fusion (ACDF) procedure with a polyetheretherketone graft and plate .Results Relative to the normal,the range of C5~6 motion in each construct was:33.3%in the bilateral C5~6 lateral mass construct,113.6%in the unilateral C5~6 lateral mass construct,90.3%in the unilateral lateral mass

  3. Follow-up radiographs of the cervical spine after anterior fusion with titanium intervertebral disc; Roentgen-Verlaufsuntersuchung der Halswirbelsaeule nach anteriorer Fusion mit Titaninterponaten

    Energy Technology Data Exchange (ETDEWEB)

    Biederer, J.; Hutzelmann, A.; Heller, M. [Kiel Univ. (Germany). Klinik fuer Diagnostische Radiologie; Rama, B. [Paracelsus Klinik, Osnabrueck (Germany). Klinik fuer Neurochirurgie

    1999-08-01

    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.) [German] Ziel: An Patienten mit zervikalen Kompressionssyndromen wurden Stellung und Funktion der Halswirbelsaeule nach Diskektomie und Fusion mit einem neuartigen Titaninterponat untersucht. Patienten und Methoden: Bei 37 Patienten (42 Segmente) wurden praeoperativ sowie 4 Tage, 6 Wochen und 7 Monate postoperativ mit seitlichen Uebersichts- und Funktionsaufnahmen Stellung und Mobilitaet der HWS beurteilt. Erfasst wurden Lageveraenderungen des Titaninterponates und die Reaktion der angrenzenden Wirbelkoerperabschlussplatten. Ergebnisse: Das Titaninterponat bewirkte postoperativ eine

  4. Single-stage Anterior and Posterior Fusion Surgery for Correction of Cervical Kyphotic Deformity Using Intervertebral Cages and Cervical Lateral Mass Screws: Postoperative Changes in Total Spine Sagittal Alignment in Three Cases with a Minimum Follow-up of Five Years.

    Science.gov (United States)

    Ogihara, Satoshi; Kunogi, Junichi

    2015-01-01

    The surgical treatment of cervical kyphotic deformity remains challenging. As a surgical method that is safer and avoids major complications, the authors present a procedure of single-stage anterior and posterior fusion to correct cervical kyphosis using anterior interbody fusion cages without plating, as illustrated by three consecutive cases. Case 1 was a 78-year-old woman who presented with a dropped head caused by degeneration of her cervical spine. Case 2 was a 54-year-old woman with athetoid cerebral palsy. She presented with cervical myelopathy and cervical kyphosis. Case 3 was a 71-year-old woman with cervical kyphotic deformity following a laminectomy. All three patients underwent anterior release and interbody fusion with cages and posterior fusion with cervical lateral mass screw (LMS) fixation. Postoperative radiographs showed that correction of kyphosis was 39° in case 1, 43° in case 2, and 39° in case 3. In all three cases, improvement of symptoms was established without major perioperative complications, solid fusion was achieved, and no loss of correction was observed at a minimum follow-up of 61 months. We also report that preoperative total spine sagittal malalignment was improved after corrective surgery for cervical kyphosis and was maintained at the latest follow-up in all three cases. The combination of anterior fusion cages and LMS is considered a safe and effective procedure in cases of severe cervical kyphotic deformity. Preoperative total spine sagittal malalignment improved, accompanied by correction of cervical kyphosis, and was maintained at last follow-up in all three cases. PMID:26119893

  5. Disc degeneration of cervical spine on MRI in patients with lumbar disc herniation: comparison study with asymptomatic volunteers

    OpenAIRE

    Okada, Eijiro; Matsumoto, Morio; Fujiwara, Hirokazu; Toyama, Yoshiaki

    2010-01-01

    An association between progression of cervical disc degeneration and that of lumbar disc degeneration has been considered to exist. To date, however, this association has not yet been adequately studied. Age-related changes in the cervical intervertebral discs were evaluated by magnetic resonance imaging (MRI) in patients with lumbar disc herniation, and compared with the MRI findings of healthy volunteers without lower back pain. The purpose of this study was to clarify whether the prevalenc...

  6. Discover人工颈椎间盘置换治疗颈椎间盘退变性疾病的临床疗效%Outcome of discover cervical artificial disc replacement for degenerativedisc disease of the cervical spine

    Institute of Scientific and Technical Information of China (English)

    何智勇; 李开南; 聂海; 母建松; 兰海

    2012-01-01

    Objective To estimate the clinical effects on Discover cervical artificial disc replacement for degenerative disc disease of the cervical spine. Methods A total of 20 patients with cervical disc degeneration, whose pain is not relieved adequately with six weeks of conservative care and daily activities become difficult, were chosed in this study between January 2007 and August 2011. The clinical outcomes were assessed using neck disable index (NDI) and visual analogue scale ( VAS) and Odora scale before surgery and 1、6、12、24 months after surgery. Imageological examination included X ray, cervical CT scanning and MR imaging. Results There are 26 levels in 20 patients performing cervical disc replacement and the follow-up period was 24 months. The NDI, VAS of neck pain, VAS of arm pain were from (23. 82 ±2. 87)、(5.90 ±0. 35)、(5. 91 ±1.63) before sugery to (5. 21 ± 1. 12)、(1. 62 ±0. 87)、(0. 97 ±0. 65) 2 years after sugery. Odom scale were excellent or good in all palienls. The operation time was 60-210 minutes and the estimated blood loss was 70 - 350 milliliter. The motion function of cervical artificial disc implanted was very good with imageology evaluation. The prosthesis moved forward 3 mm in one patient, and another patient had heterotopic ossification 12 months after surgery. Conclusion Discover cervical artificial disc replacement for degenerative disc disease of the cervical spine is safe and effective, however, further study should be conducted to determine the long term outcome.%目的 评价Discover人工颈椎间盘置换治疗颈椎间盘退变性疾病的临床疗效.方法 2007年1月~2011年8月,20例颈椎间盘退变突出经保守治疗无效的患者行人工颈椎间盘置换术.患者术前、术后1、6、12、24个月时使用颈椎功能障碍指数(neck disable index,NDI)、疼痛视觉模拟疼痛量表(visual analogue scale,VAS)进行疗效评估,手术效果采用Odom法评价.影像学检查包括颈椎动力位X

  7. UndertheGrass-rootsHospitalsinCervicalSpineSurgeryClinicalResearch%基层医院开展下颈椎手术的临床研究

    Institute of Scientific and Technical Information of China (English)

    李光荣; 代勇军; 林长生

    2013-01-01

    Objective To study the surgical methods and therapeutic effect of cervical spine fracture dislocation, as a grass-roots hospital to provide appropriate working mode. Methods Retrospective analysis of 56 patients with surgical treatment of cervical spine fracture dislocation, according to the speciifc condition is divided into anterior surgery group, the posterior joint before and after the surgery group and surgery group, the evaluation of patients with postoperative function of spinal cord and vertebral body, observe the related complications. Results All patients were successfully discharged from the hospital, surgery were followed up for 12 months, all patients with cervical spine fracture dislocation after reset satisfaction, no signiifcant complications;three groups of spinal cord function after surgery for patients with preoperative scores were signiifcant difference had statistical signiifcance, no obvious difference between the three groups. Conclusion The patients with cervical spine fracture dislocation, admission line traction reduction, reduction and failure, depending on the speciifc circumstances of anterior, posterior or anterior and joint reduction and internal ifxation, and try to achieve the stability of the reset, restore spinal cord function, conducive to rehabilitation of patients.%目的研究下颈椎骨折脱位的手术方法及疗效,为基层医院提供合适的工作模式。方法回顾性分析我院下颈椎骨折脱位手术治疗的患者56例,按照具体病情分为前路手术组、后路手术组和前后联合手术组,评价术后患者脊髓神经功能及椎体情况,观察相关并发症发生情况。结果所有患者均顺利手术出院,随访12个月,所有患者颈椎骨折脱位后复位都较满意,无显著并发症发生;三组患者术前术后的脊髓功能评分差异均显著均有统计学意义,三组间无明显差异。结论下颈椎骨折脱位患者,入院行颅骨牵引复位术

  8. Occipital Condyle Fracture with Accompanying Meningeal Spinal Cysts as a result of Cervical Spine Injury in 15-Year-Old Girl

    Directory of Open Access Journals (Sweden)

    Łukasz Wiktor

    2015-01-01

    Full Text Available The occipital condyle fracture is rare injury of the craniocervical junction. Meningeal spinal cysts are rare tumors of the spinal cord. Depending on location, these lesions may be classified as extradural and subdural, but extradural spinal cysts are more common. We present the case of a 15-year-old girl who suffered from avulsion occipital condyle fracture treated with use of “halo-vest” system. We established that clinical effect after completed treatment is very good. Control MRI evaluation was performed 12 months after removal of “halo-vest” traction, and clinically silent extradural meningeal spinal cysts were detected at the ventral side of the spinal cord in the cervical segment of the spine. Due to clinically silent course of the disease, we decided to use the conservative treatment. The patient remains under control of our department.

  9. 儿童颈椎外伤的诊断及治疗%The diagnosis and treatment of cervical spine injuries in children

    Institute of Scientific and Technical Information of China (English)

    熊伟; 李锋; 郭风劲; 陈安民

    2008-01-01

    目的 探讨儿童颈椎外伤的临床特点、诊断、治疗方法及难点和要点.方法 回顾性分析我院1995年1月至2005年12月期间治疗的儿童颈椎外伤病例的临床资料,同时检索分析国内外关于儿童颈椎外伤的文献.结果 11例患儿纳入本研究,其中男8例,女3例;平均年龄(12.1±4.0)岁;受伤机制包括坠落伤(3例),运动伤(3例),车祸伤(2例),直接暴力伤(2例),因娱乐致伤(1例).受伤部位分布为C1-34例,C4-77例.4例合并神经系统症状,其中1例为无骨折脱位型脊髓损伤.4例接受手术治疗,7例行保守治疗.结论 儿童颈椎外伤相对少见,其在临床表现、影像学检查及治疗方法上均存在与年龄相关的特点.熟悉这些特点对儿童颈椎外伤患儿的诊断及治疗至关重要.%Objective To review our experience in diagnosis and treatment of pediatric cervical spine injuries. Methods From January 1995 to December 2005, 11 patients including 8 boys and 3 girls were recruited in this study. Their mean age was 12. 14 years, ranged from 5 to 17 years. The causes for injury included falls (3 cases), sports related injuries (3 cases), traffic accidents (2 cases), direct hit injuries (2 bcases), and entertainment related injuries (1 case). All patients underwent neurological and radiological examinations. The treatments were carried out according to the results of such examinations. Results The injury sites were C1-3 in 4 patients and C4-7 in 7 patients. Neurological function was evaluated according to Frankel score: 1 case of Frankel A, 1 case of Frankel B, 2 cases of Frankel C and 7 cases of Frankel E. One of the 11 patients was affected by spinal cord injury without radiographic abnormality. Seven patients were cured by conservative treatments. The other 4 patients underwent operations, 2 were anterior decompression and fusion operations and the other 2 were posterior approach operations. Among the 2 cases with posterior approach, 1 was

  10. A COMPARISON OF McC OY LARYNGOSCOPE AND MCGRATH VIDEO LARYNGOSCOPES FOR TRACHEAL INTUBATION IN PATIENTS WITH IMMOBILIZED CERVICAL SPINE

    Directory of Open Access Journals (Sweden)

    Annapurna Sarma

    2015-08-01

    Full Text Available INTRODUCTION : Expert airway management is the most essential requirement of an anesthesiologist . Difficult and failed intubation is the leading causes of anesthetic related morbidity and mortality. AIM OF STUDY: The purpose of this study was to compare the effectiveness of McCoy laryngoscope and McGrath video laryngoscope in tracheal intubation in patients using Manual in - line stabilization (MILS for cervical spine injury. MATERIALS AND METHODS : This study was condu cted in King George Hospital , Visakhapatnam, Andhra Pradesh on 60 patients aged 20 – 70, of American Society of Anesthesiologists physical status I – III, posted for elective surgery for cervical spine injury under general anesthesia. The patients were assigne d to two groups. One group was named as MC where McCoy laryngoscope was used, other group named as MG, where McGrath video laryngoscope was used for laryngoscopy during tracheal intubation . Two groups were compared on the basis of demogr aphic data, airway examination, comparison of visualization of vocal cords with McC oy laryngoscope and video laryngoscope and comparison of laryngoscope time. RESULTS: There was no significant difference between male and female sex. Most of the patients falls into Mallampati score I (60%, followed by score II and III (25 and 14% respectively. Statistically highly significant improvement in laryngoscope view was noted with video laryngoscope than with McCoy laryngoscope with Chi - square value=49.52; DF= 10; p - value=0.000(highl y significant. Statistically highly significant difference was seen in effective laryngoscopy time of McCoy and Video laryngoscope. CONCLUSION: We conclude McGrath video laryngoscope is superior to McCoy laryngoscope in terms of providing better intubatin g conditions in patients requiring MILS, though there is a little prolongation of effective laryngoscope time .

  11. The applied Anatomy research of Anterolateral approach to the cervical spine%颈前外侧入路的应用解剖学研究

    Institute of Scientific and Technical Information of China (English)

    顾红林; 张烽; 金国华

    2011-01-01

    Objective To provide basis of the applied anatomy basis for the anterolateral approach to cervical spine. Methods Ten cadavers were dissected, observed and measured through mimicing the right anterolateml approach to the cervical spine. Results The common carotid artery bifurcation was mostly found at the level of C4 (70%). The facial vein drained into the internal jugular vein mostly at the level of C3/4 (70%). Cervical sympathetic trunk was located posteromedial to carotid sheath and just anterior to the longus muscles. It extended longitudinally from the longus capitis to the longus colli over the muscles and under the prevertebral fascia. The average distance between the cervical sympathetic trunk and medial border of the longus colli muscle at C6 was (14.5±4.8) mm. The average diameter of the cervical sympathetic trunk at C6 was (2.6±1.2)mm. Superior ganglion of cervical sympathetic trunk in all dissections was located at the level of C2 vertebra. The length and width of the superior cervical ganglion were (ll.9±2.5)mm and (7.4±4.2)mm,respectively. Forty percent of the middle ganglion was at the C5 level, and 60% was at C6 level,; The the length and width of the middle cervical ganglion were (8.9±5.9)mm and ( 5.1 ±3.2)mm. All of the vertebral artery arteries entered the transverse foramen of C6. The height and width of C5 uncinate process was were smallest but had the greatest distance from the medial edge of the uncinate process to the anterior tubercle (P<0.05). Conclusions Choosing anterolateral approach to the cervical spine approach could reach the lesion directly,causing less damage to the anterolateral transverse processes. This technique also allows through decompression, and preservation of cervical motion and spinal stability to the full extent.%目的 为颈前外侧入路手术提供应用解剖学基础.方法 对10具标本模拟右侧颈前外侧入路进行解剖观测.结果 颈总动脉的分叉在C4水平为70%.丽静脉70%

  12. Surgical treatment strategy for cervical spine fracture%颈椎骨折手术入路的选择策略

    Institute of Scientific and Technical Information of China (English)

    桑宏勋; 雷伟; 陈志文; 吴子祥; 王林; 樊勇; 马真胜; 裴国献

    2009-01-01

    Objective To review anterior approach, posterior approach and one-stage combined anterior-posterior approach in surgical treatment of cervical spine fracture in terms of clinical outcomes. Methods From January 2004 to January 2008, 151 patients with cervical spine fractures who had been treated in our department were reviewed. The anterior approach was used for 87 cases in disckectomy, sub-total resection of cervical vertebra and decompression, fusion, and titanium plating; the posterior approach was used for 49 cases in laminectomy of cervical vertebra for decompression, reduction, lateral mass fixation with plate and pedicle screws; the combined anterior-posterior approach was used for 15 cases. By ASIA criteria, the spinal injury was rated as degree A in 51 cases, degree B in 40, degree C in 28, degree D in 24 and degree E in 8. Results All patients were followed up for 6 months to 4 years(average, 12.5 months) . Healing was delayed in 2 cases. Reduction and restoration of the stability of cervical spine were satisfactory, and bone fusion was achieved. All patients had recovery of nerve function, though to different extents. At the last follow-up, the spinal injury was rated, by ASIA scores, as degree A in 30 cases, degree B in 24, degree C in 31, degree D in 40 and degree E in 26. The anterior and posterior surgical approaches had better ASIA scores than combined anterior-posterior approach. Conclusions It is important to choose an appropriate approach according to the type of cervical fracture. The anterior, posterior or combined ante-rior-posterior approach should be chosen mainly according to 2 aspects: the compression site of cervical spinal cord and the residual post-traumatic stability of cervical spine.%目的 回顾性分析前路、后路及前后联合入路手术治疗颈椎骨折的临床效果,为临床颈椎骨折手术入路的选择提供依据. 方法对2004年1月至2008年1月采用前路、后路及前后联合入路

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

    Science.gov (United States)

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

    2016-05-01

    Dystrophic calcinosis in soft tissue occurs in damaged or devitalized tissues in the presence of normal calcium and phosphorous metabolism. It is often noted in subcutaneous tissues in patients with collagen vascular diseases and may involve a relatively localized area or be widespread. A 74-year-old Japanese woman with an overlap of rheumatoid arthritis, Sjögren's syndrome, and systemic sclerosis developed a huge tumor-like mass at the atlanto-axial vertebral joint region that caused severe cervical pain and difficulty in activities of daily living. She also had subcutaneous dystrophic calcification in the soft tissue of the chest wall. Calcinosis associated with systemic sclerosis is a well-recognized phenomenon, but a destructive paraspinal tumor in the cervical spine associated with overlap syndrome is extremely unique. Because calcinosis in spinal locations can be complicated by neurological involvement, patients with progressive symptoms may require surgical intervention. Surgical resection and biological therapy improved this patient's life and activities of daily living. Calcinosis is common in the conditions reviewed here, and different agents have been used for treatment. However, calcinosis management is poorly organized and lacks an accepted classification, systematic studies, and clinical therapeutic trials. The association of calcinosis and collagen vascular diseases is clinically and etiologically important. Although a combination of calcinosis and rheumatoid overlap syndrome is rare, various collagen vascular diseases may occur simultaneously. A perceptive diagnostic approach toward these diseases is critical, and early diagnosis and treatment are needed to prevent dystrophic calcinosis. PMID:24894107

  14. Postoperative cerebrospinal-fluid fistula associated with erosion of the dura. Findings after anterior resection of ossification of the posterior longitudinal ligament in the cervical spine.

    Science.gov (United States)

    Smith, M D; Bolesta, M J; Leventhal, M; Bohlman, H H

    1992-02-01

    Of twenty-two patients who had had anterior decompression of the spinal canal for ossification of the posterior longitudinal ligament and cervical myelopathy, seven had absence of the dura adjacent to the ossified part of the ligament. The spinal cord and nerve-roots were visible through this defect. Although the arachnoid membrane appeared to be intact and watertight in most patients, a cerebrospinal-fluid fistula developed postoperatively in five, and three had a second operation to repair the defect in the dura. On the basis of this experience, we recommend use of autogenous muscle or fascial dural patches, immediate lumbar subarachnoid shunting, and modification of the usual postoperative regimen, such as limitation of mechanical pulmonary ventilation to the shortest time that is safely possible and use of anti-emetic and antitussive medications to protect the remaining coverings of the spinal cord when the dura is found to be absent adjacent to an ossified portion of the posterior longitudinal ligament in the cervical spine. PMID:1541620

  15. Load Rate of Facet Joints at the Adjacent Segment Increased After Fusion

    Institute of Scientific and Technical Information of China (English)

    Hui Li; Bao-Qing Pei; Jin-Cai Yang; Yong Hai; De-Yu Li; Shu-Qin Wu

    2015-01-01

    Background:The cause of the adjacent segment degeneration (ASD) after fusion remains unknown.It is reported that adjacent facet joint stresses increase after anterior cervical discectomy and fusion.This increase of stress rate may lead to tissue injury.Thus far,the load rate of the adjacent segment facet joint after fusion remains unclear.Methods:Six C2-C7 cadaveric spine specimens were loaded under four motion modes:Flexion,extension,rotation,and lateral bending,with a pure moment using a 6° robot arm combined with an optical motion analysis system.The Tecscan pressure test system was used for testing facet joint pressure.Results:The contact mode of the facet joints and distributions of the force center during different motions were recorded.The adjacent segment facet joint forces increased faster after fusion,compared with intact conditions.While the magnitude of pressures increased,there was no difference in distribution modes before and after fusion.No pressures were detected during flexion.The average growth velocity during extension was the fastest and was significantly faster than lateral bending.Conclusions:One of the reasons for cartilage injury was the increasing stress rate of loading.This implies that ASD after fusion may be related to habitual movement before and after fusion.More and faster extension is disadvantageous for the facet joints and should be reduced as much as possible.

  16. Cervical spine surgery in patients with diastrophic dysplasia: Case report with long-term follow-up

    Directory of Open Access Journals (Sweden)

    Barbara Jasiewicz

    2015-01-01

    Full Text Available Cervical kyphosis in diastrophic dysplasia (DTD is a very dangerous deformity which may lead to compression of neural structures resulting in tetraplegia or even. Treatment of this deformity is usually surgical, but no long-term follow-up studies are presented in the literature. Authors present a case of two children with DTD who underwent anterior corpectomy due to severe cervical kyphosis. The kyphotic deformity was corrected and the normal spinal canal width was restored. The effects of the correction remained stable for respectively 6 and 10 years of the follow-up period. The unique follow-up confirms that this type of intervention leads to an effective and long lasting results. Significant cervical kyphosis in patients suffering from DTD may be treated surgically using anterior approach even in young children with a favorable and lasting results.

  17. Surgical approaches for 107 cases of lower cervical spine injuries%手术治疗下颈椎创伤107例

    Institute of Scientific and Technical Information of China (English)

    康照利; 邹三明; 黄笃; 喻亮; 冯华明; 张小舟; 高彪; 王盛; 张宇博

    2012-01-01

    Objective To analyze the outcome of surgical treament for lower spine injuries. Methods The shirty involved 107 patients including 68 patients treated with anterior appoaches, 9 patients treated with posterior approaches , and 30 patients treated with anterior-posterior approaches. Neural function was evaluated by using Frankle classification grades. Results All patients were operated with no early serious complications related to surgery. All 107 patients were followed up for 6-18 months. The graft bone was fused and X-ray films showed normal height of vertebral space and normal sequence of cervical spine affter operation. Except for 2 patients of 9 patients( Frankel A ), other patients got 1-3 grate neural funcion recovery according to Frankle classification. Conclusions Good out-come of treament for lower cervical spine injuries depends on patients selection , correct surgical approach and complications prevention%目的 探讨手术治疗下颈椎创伤的策略.方法 手术治疗下颈椎创伤107例:前路手术68例,后路手术9例,前后联合入路手术30例.评价神经功能Frankel分级情况.结果 患者均顺利完成手术.107例均获随访,时间6~18个月.植骨融合,颈椎序列较好.神经功能恢复情况:除2例高位截瘫患者没有明显恢复外,其余患者的神经功能均.有1~3级恢复.结论 对下颈椎创伤的患者应严格把握手术适应证,选择合适的手术入路,积极预防并发症,采用手术治疗可以取得较好的疗效.

  18. Metric and morphological study of the upper cervical spine from the Sima de los Huesos site (Sierra de Atapuerca, Burgos, Spain).

    Science.gov (United States)

    Gómez-Olivencia, Asier; Carretero, José Miguel; Arsuaga, Juan Luis; Rodríguez-García, Laura; García-González, Rebeca; Martínez, Ignacio

    2007-07-01

    In this article, the upper cervical spine remains recovered from the Sima de los Huesos (SH) middle Pleistocene site in the Sierra de Atapuerca (Burgos, Spain) are described and analyzed. To date, this site has yielded more than 5000 human fossils belonging to a minimum of 28 individuals of the species Homo heidelbergensis. At least eleven individuals are represented by the upper cervical (C1 and C2) specimens: six adults and five subadults, one of which could represent an adolescent individual. The most complete adult vertebrae (three atlases and three axes) are described, measured, and compared with other fossil hominins and modern humans. These six specimens are associated with one another and represent three individuals. In addition, one of these sets of cervical vertebrae is associated with Cranium 5 (Individual XXI) from the site. The metric analysis demonstrates that the Sima de los Huesos atlases and axes are metrically more similar to Neandertals than to our modern human comparative sample. The SH atlases share with Neandertals a sagittally elongated canal. The most remarkable feature of the SH (and Neandertal) axes is that they are craniocaudally low and mediolaterally wide compared to our modern male sample. Morphologically, the SH sample shares with Neandertals a higher frequency of caudally projected anterior atlas arch, which could reflect greater development of the longus colli muscle. In other features, such as the frequency of weakly developed tubercles for the attachment of the transverse ligament of the atlas, the Sima de los Huesos fossils show intermediate frequencies between our modern comparative samples and the Neandertals, which could represent the primitive condition. Our results are consistent with the previous phylogenetic interpretation of H. heidelbergensis as an exclusively European species, ancestral only to H. neanderthalensis. PMID:17467038

  19. Imaging of Herniated Discs of the Cervical Spine: Inter-Modality Differences between 64-Slice Multidetector CT and 1.5-T MRI

    Energy Technology Data Exchange (ETDEWEB)

    Yi, Ji Sook; Cha, Jang Gyu [Dept. of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Han, Jong Kyu [Dept. of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of); Kim, Hyun Joo [Dept. of Radiology, Soonchunhyang University Seoul Hospital, Seoul (Korea, Republic of)

    2015-08-15

    To assess inter-modality variability when evaluating cervical intervertebral disc herniation using 64-slice multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). Three musculoskeletal radiologists independently reviewed cervical spine 1.5-T MRI and 64-slice MDCT data on C2-3 though C6-7 of 51 patients in the context of intervertebral disc herniation. Interobserver and inter-modality agreements were expressed as unweighted kappa values. Weighted kappa statistics were used to assess the extents of agreement in terms of the number of involved segments (NIS) in disc herniation and epicenter measurements collected using MDCT and MRI. The interobserver agreement rates upon evaluation of disc morphology by the three radiologists were in fair to moderate agreement (k = 0.39-0.53 for MDCT images; k = 0.45-0.56 for MRIs). When the disc morphology was categorized into two and four grades, the inter-modality agreement rates were moderate (k-value, 0.59) and substantial (k-value, 0.66), respectively. The inter-modality agreements for evaluations of the NIS (k-value, 0.78) and the epicenter (k-value, 0.79) were substantial. Also, the interobserver agreements for the NIS (CT; k-value, 0.85 and MRI; k-value, 0.88) and epicenter (CT; k-value, 0.74 and MRI; k-value, 0.70) evaluations by two readers were substantial. MDCT tended to underestimate the extent of herniated disc lesions compared with MRI. Multidetector-row computed tomography and MRI showed a moderate-to-substantial degree of inter-modality agreement for the assessment of herniated cervical discs. MDCT images have a tendency to underestimate the anterior/posterior extent of the herniated disc compared with MRI.

  20. Imaging of Herniated Discs of the Cervical Spine: Inter-Modality Differences between 64-Slice Multidetector CT and 1.5-T MRI

    International Nuclear Information System (INIS)

    To assess inter-modality variability when evaluating cervical intervertebral disc herniation using 64-slice multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). Three musculoskeletal radiologists independently reviewed cervical spine 1.5-T MRI and 64-slice MDCT data on C2-3 though C6-7 of 51 patients in the context of intervertebral disc herniation. Interobserver and inter-modality agreements were expressed as unweighted kappa values. Weighted kappa statistics were used to assess the extents of agreement in terms of the number of involved segments (NIS) in disc herniation and epicenter measurements collected using MDCT and MRI. The interobserver agreement rates upon evaluation of disc morphology by the three radiologists were in fair to moderate agreement (k = 0.39-0.53 for MDCT images; k = 0.45-0.56 for MRIs). When the disc morphology was categorized into two and four grades, the inter-modality agreement rates were moderate (k-value, 0.59) and substantial (k-value, 0.66), respectively. The inter-modality agreements for evaluations of the NIS (k-value, 0.78) and the epicenter (k-value, 0.79) were substantial. Also, the interobserver agreements for the NIS (CT; k-value, 0.85 and MRI; k-value, 0.88) and epicenter (CT; k-value, 0.74 and MRI; k-value, 0.70) evaluations by two readers were substantial. MDCT tended to underestimate the extent of herniated disc lesions compared with MRI. Multidetector-row computed tomography and MRI showed a moderate-to-substantial degree of inter-modality agreement for the assessment of herniated cervical discs. MDCT images have a tendency to underestimate the anterior/posterior extent of the herniated disc compared with MRI

  1. Soft tissue artifact evaluation of the cervical spine in motion patterns of flexion and lateral bending: a preliminary study

    Science.gov (United States)

    Wang, Jiajia; Lui, Zhongwen; Ren, Luquan

    2016-01-01

    Background. Soft tissue artifact (STA) is increasingly becoming a focus of research as the skin marker method is widely employed in motion capture technique. At present, medical imaging methods provide reliable ways to investigate the cervical STA. Among these approaches, magnetic resonance imaging (MRI) is a highly preferred tool because of its low radiation. Methods. In the study, the 3D spatial location of vertebral landmarks and corresponding skin markers of the spinous processes of the second (C2), fifth (C5), and sixth (C6) cervical levels during flexion and lateral bending were investigated. A series of static postures were scanned using MRI. Skin deformation was obtained by the Mimics software. Results. Results shows that during flexion, the maximum skin deformation occurs at C6, in the superior–inferior (Z) direction. Upon lateral bending, the maximum skin displacement occurs at C2 level, in the left–right (Y) direction. The result presents variability of soft tissue in the terms of direction and magnitude, which is consistent with the prevailing opinion. Discussion. The results testified variability of cervical STA. Future studies involving large ranges of subject classification, such as age, sex, height, gravity, and etc. should be performed to completely verify the existing hypothesis on human cervical skin deformation. PMID:27069821

  2. Cervical spine disc herniation at C2-C3 level: Study of a Clinical Observation and Literature Review

    Directory of Open Access Journals (Sweden)

    Oka Dominique N'Dri

    2015-12-01

    Full Text Available Cervical C2-C3 herniated disc is rare. It is characterized by its clinical polymorphism. Several surgical approaches have been described for the discectomy of a herniated disc. This work aims at discussing through personal observations and literature review clinical semiology and surgical treatment.

  3. Cervical Synovial Cyst Causing Cervical Radiculomyelopathy: Case Report and Review of the Literature

    OpenAIRE

    Corredor, José A.; Quan, Gerald

    2014-01-01

    Study Design Case report. Objective Synovial cysts in the subaxial cervical spine are rare and are most commonly reported at the cervicothoracic junction. Only six cases of symptomatic C5–C6 synovial cysts have been reported in the literature; the condition is usually treated with decompressive laminectomy. We present a patient with a synovial cyst arising from the C5–C6 facet joint, associated with spondylolisthesis, and causing radiculomyelopathy. The patient was treated with a posterior ex...

  4. Acupoints for cervical spondylosis

    OpenAIRE

    Zhu, Jihe; Arsovska, Blagica; Vasileva, Dance; Petkovska, Sofija; Kozovska, Kristina

    2015-01-01

    Cervical spondylosis is a chronic degenerative condition of the cervical spine that affects the vertebral bodies and intervertebral disks of the neck, as well as the contents of the spinal canal. This is one of the most common degenerative disorders of the spine. The disease can be symptomatic and asymptomatic. Symptoms that are distinctive for cervical spondylosis are: tingling, numbness and weakness in the limbs, lack of coordination, stiff neck, shoulder pain, occipital pain, vertigo, poor...

  5. Lumbar spine superior-level facet joint violations: percutaneous versus open pedicle screw insertion using intraoperative 3-dimensional computer-assisted navigation

    Institute of Scientific and Technical Information of China (English)

    Tian Wei; Xu Yunfeng; Liu Bo; Liu Yajun; He Da; Yuan Qiang; Lang Zhao

    2014-01-01

    Background Percutaneous pedicle screw use has a high rate of cranial facet joint violations (FVs) because of the facet joint being indirectly visualized.Computer-assisted navigation shows the anatomic structures clearly,and may help to lower the rate of FVs during pedicle screw insertion.This study used computed tomography (CT) to evaluate and compare the incidence of FVs between percutaneous and open surgeries employing computer-assisted navigation for the implantation of pedicle screw instrumentation during lumbar fusions.Methods A prospective study,including 142 patients having lumbar and lumbosacral fusion,was conducted between January 2013 and April 2014.All patients had bilateral posterior pedicle screw-rod instrumentation (top-loading screws) implanted by the same group of surgeons; intraoperative 3-dimensional computer navigation was used during the procedures.All patients underwent CT examinations within 6 months postoperation.The CT scans were independently reviewed by three reviewers blinded to the technique used.Results The cohort comprised 68 percutaneous and 74 open cases (136 and 148 superior-level pedicle screw placements,respectively).Overall,superior-level FVs occurred in 20 patients (20/142,14.1%),involving 27 top screws (27/284,9.5%).The percutaneous technique (7.4% of patients,3.7% of top screws) had a significantly lower violation rate than the open procedure (20.3% of patients,14.9% of top screws).The open group also had significantly more serious violations than did the percutaneous group.Both groups had a higher violation rate when the cranial fixation involved the L5.A 1-level open procedure had a higher violation rate than did the 2-and 3-level surgeries.Conclusions With computer-assisted navigation,the placement of top-loading percutaneous screws carries a lower risk of adjacent-FVs than does the open technique; when FVs occur,they tend to be less serious.Performing a single-level open lumbar fusion,or the fusion of the L5-S1

  6. De novo spine surgery as a predictor of additional spine surgery at the same or distant spine regions

    OpenAIRE

    Tolaymat, Abdullah; Abbara, Moataz; Robinson III, Joe Sam; Walid, M Sami; Robinson Jr, Joe Sam

    2011-01-01

    Introduction: Degenerative spine disorders are steadily increasing parallel to the aging of the population with considerable impact on cost and productivity. In this paper we study the prevalence and risk factors for multiple spine surgery and its impact on cost. Methods: Data on 1,153 spine surgery inpatients operated between October 2005 and September 2008 (index spine surgery) in regard to the number of previous spine surgeries and location of surgeries (cervical or lumbar) were retrospect...

  7. What you need to know about ossification of the posterior longitudinal ligament to optimize cervical spine surgery: A review.

    Science.gov (United States)

    Epstein, Nancy E

    2014-01-01

    What are the risks, benefits, alternatives, and pitfalls for operating on cervical ossification of the posterior longitudinal ligament (OPLL)? To successfully diagnose OPLL, it is important to obtain Magnetic Resonance Images (MR). These studies, particularly the T2 weighted images, provide the best soft-tissue documentation of cord/root compression and intrinsic cord abnormalities (e.g. edema vs. myelomalacia) on sagittal, axial, and coronal views. Obtaining Computed Tomographic (CT) scans is also critical as they best demonstrate early OPLL, or hypertrophied posterior longitudinal ligament (HPLL: hypo-isodense with punctate ossification) or classic (frankly ossified) OPLL (hyperdense). Furthermore, CT scans reveal the "single layer" and "double layer" signs indicative of OPLL penetrating the dura. Documenting the full extent of OPLL with both MR and CT dictates whether anterior, posterior, or circumferential surgery is warranted. An adequate cervical lordosis allows for posterior cervical approaches (e.g. lamionplasty, laminectomy/fusion), which may facilitate addressing multiple levels while avoiding the risks of anterior procedures. However, without lordosis and with significant kyphosis, anterior surgery may be indicated. Rarely, this requires single/multilevel anterior cervical diskectomy/fusion (ACDF), as this approach typically fails to address retrovertebral OPLL; single or multilevel corpectomies are usually warranted. In short, successful OPLL surgery relies on careful patient selection (e.g. assess comorbidities), accurate MR/CT documentation of OPLL, and limiting the pros, cons, and complications of these complex procedures by choosing the optimal surgical approach. Performing OPLL surgery requires stringent anesthetic (awake intubation/positioning) and also the following intraoperative monitoring protocols: Somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), and electromyography (EMG). PMID:24843819

  8. What you need to know about ossification of the posterior longitudinal ligament to optimize cervical spine surgery: A review

    OpenAIRE

    Nancy E Epstein

    2014-01-01

    What are the risks, benefits, alternatives, and pitfalls for operating on cervical ossification of the posterior longitudinal ligament (OPLL)? To successfully diagnose OPLL, it is important to obtain Magnetic Resonance Images (MR). These studies, particularly the T2 weighted images, provide the best soft-tissue documentation of cord/root compression and intrinsic cord abnormalities (e.g. edema vs. myelomalacia) on sagittal, axial, and coronal views. Obtaining Computed Tomographic (CT) scans i...

  9. What you need to know about ossification of the posterior longitudinal ligament to optimize cervical spine surgery: A review

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2014-01-01

    Full Text Available What are the risks, benefits, alternatives, and pitfalls for operating on cervical ossification of the posterior longitudinal ligament (OPLL? To successfully diagnose OPLL, it is important to obtain Magnetic Resonance Images (MR. These studies, particularly the T2 weighted images, provide the best soft-tissue documentation of cord/root compression and intrinsic cord abnormalities (e.g. edema vs. myelomalacia on sagittal, axial, and coronal views. Obtaining Computed Tomographic (CT scans is also critical as they best demonstrate early OPLL, or hypertrophied posterior longitudinal ligament (HPLL: hypo-isodense with punctate ossification or classic (frankly ossified OPLL (hyperdense. Furthermore, CT scans reveal the "single layer " and "double layer" signs indicative of OPLL penetrating the dura. Documenting the full extent of OPLL with both MR and CT dictates whether anterior, posterior, or circumferential surgery is warranted. An adequate cervical lordosis allows for posterior cervical approaches (e.g. lamionplasty, laminectomy/fusion, which may facilitate addressing multiple levels while avoiding the risks of anterior procedures. However, without lordosis and with significant kyphosis, anterior surgery may be indicated. Rarely, this requires single/multilevel anterior cervical diskectomy/fusion (ACDF, as this approach typically fails to address retrovertebral OPLL; single or multilevel corpectomies are usually warranted. In short, successful OPLL surgery relies on careful patient selection (e.g. assess comorbidities, accurate MR/CT documentation of OPLL, and limiting the pros, cons, and complications of these complex procedures by choosing the optimal surgical approach. Performing OPLL surgery requires stringent anesthetic (awake intubation/positioning and also the following intraoperative monitoring protocols: Somatosensory evoked potentials (SSEP, motor evoked potentials (MEP, and electromyography (EMG.

  10. Magnetic resonance imaging of the cervical spine: comparison of 2D T2-weighted turbo spin echo, 2D T2*weighted gradient-recalled echo and 3D T2-weighted variable flip-angle turbo spin echo sequences

    International Nuclear Information System (INIS)

    To compare an isotropic three-dimensional (3D) high-resolution T2-weighted (w) MR sequence and its reformations with conventional sequences for imaging of the cervical spine. Fifteen volunteers were examined at 1.5 T using sagittal and axial 3D T2-w, sagittal and axial 2D T2w, and axial 2D T2*w MR sequences. Axial reformations of the sagittal 3D dataset were generated (3D MPR T2w). Signal-to-noise and image homogeneity were evaluated in a phantom and in vivo. Visibility of ten anatomical structures of the cervical spine was evaluated. Artifacts were assessed. For statistical analysis, Cohen's kappa, Wilcoxon matched pairs, and t-testing were utilized. There were no significant differences in homogeneity between the sequences. Sagittal 3D T2w enabled better delineation of nerve roots, neural foramina, and intraforaminal structures compared to sagittal 2D T2w. Axial 3D T2w and axial 3D MPR T2w resulted in superior visibility of most anatomical structures compared to axial 2D T2w and comparable results to 2D T2*w concerning the spinal cord, nerve roots, intraforaminal structures, and fat. Artifacts were most pronounced in axial 2D T2w and axial 3D T2w. Acquisition of a 3D T2w data set is feasible in the cervical spine with superior delineation of anatomical structures compared to 2D sequences. (orig.)

  11. Decreased CSF-flow artefacts in T2 imaging of the cervical spine with periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER/BLADE)

    Energy Technology Data Exchange (ETDEWEB)

    Ragoschke-Schumm, Andreas; Schmidt, Peter; Mayer, Thomas E. [Friedrich-Schiller-University, Department of Neuroradiology, Institute for Diagnostic and Interventional Radiology, University Clinic, Jena (Germany); Schumm, Julia [Friedrich-Schiller-University, Clinic of Internal Medicine I, Jena (Germany); Reimann, Georg; Mentzel, Hans-Joachim; Kaiser, Werner A. [Friedrich-Schiller-University, Institute for Diagnostic and Interventional Radiology, University Clinic, Jena (Germany)

    2011-01-15

    The cervical spine is prone to artefacts in T2 MR-imaging due to patient movements and cerebrospinal fluid flow. The periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER/BLADE) acquisition method was developed to reduce motion artefacts. We sought to determine if T2-BLADE is superior to T2-TSE with conventional k-space reading. Twenty-five patients were examined using a 1.5 T MR-scanner. T2-weighted imaging of the cervical spine in sagittal and axial orientation using conventional or BLADE k-space reading was performed. Spinal cord, subarachnoid space, vertebrae and discs were evaluated by two independent observers using a scale from 0 (non-diagnostic) to 3 (excellent). Interobserver correlation was assessed as Cohen's kappa. Results of Mann-Whitney U test with p < 0.05 were regarded as significant. Furthermore, the investigators were asked for subjective evaluation in consensus. Overall interobserver accuracy of {kappa} = 0.91 was obtained. Comparison of sagittal images showed better values for all investigated structures in T2-BLADE: spinal cord (TSE/BLADE: 1.52/2.04; p < 0.001), subarachnoid space (1.36/2.06; p < 0.001) and vertebrae/discs (1.66/2.86; p < 0.001). Comparison of axial images showed better values in T2-BLADE for spinal cord (1.68/1.86; p = 0.149) and vertebrae/discs (1.0/1.96: p < 0.001) while subarachnoid space was better to be evaluated in conventional T2-TSE (1.94/1.12; p < 0.001). In sagittal orientation, motion- and CSF-flow artefacts were reduced in T2-BLADE. In axial orientation, however, CSF-flow artefacts were pronounced in T2-BLADE. The image quality of the sagittal T2-BLADE sequences was significantly better than the T2-TSE and acquired in less time. In axial orientation, increased CSF-flow artefacts may reduce accuracy of structures in the subarachnoid space. (orig.)

  12. Faceted Search

    CERN Document Server

    Tunkelang, Daniel

    2009-01-01

    We live in an information age that requires us, more than ever, to represent, access, and use information. Over the last several decades, we have developed a modern science and technology for information retrieval, relentlessly pursuing the vision of a "memex" that Vannevar Bush proposed in his seminal article, "As We May Think." Faceted search plays a key role in this program. Faceted search addresses weaknesses of conventional search approaches and has emerged as a foundation for interactive information retrieval. User studies demonstrate that faceted search provides more

  13. Tuina treatment in cervical spondylosis

    OpenAIRE

    Florin Mihai Hinoveanu

    2010-01-01

    Cervical spondylosis is a common, chronic degenerative condition of the cervical spine that affects the vertebral bodies and intervertebral disks of the neck as well as the contents of the spinal canal. Common clinical syndromes associated with cervical spondylosis include cervical pain, cervical radiculopathy and/or mielopathy. This study show the main principles, indication and side effects of tuina in cervical spondylosis´ treatment; tuina is one of the external methods based on the princ...

  14. Operative treatment for cervical fracture and dislocation with blunt unilateral vertebral artery injury

    Institute of Scientific and Technical Information of China (English)

    JIANG Tao; REN Xian-jun; WANG Wei-dong; ZHANG Xia; LI Chang-qing; HAO Yong

    2010-01-01

    Objective: To investigate risks and clinical effects of operative treatment for cervical vertebral fracture and dislocation associated with unilateral vertebral artery injury.Methods: This group consisted of 76 cases of closed cervical spine trauma combined with unilateral vertebral artery injury (23 cases of bilateral facet dislocation, 28 unilateral facet dislocation and 25 fracture). All patients underwent prospective examination of cervical spine MRI and vertebral artery two-dimensional time-of-flight (2D TOF)magnetic resonance angiography (MRA), and anterior cervical decompression. The healthy vertebral artery paths were evaluated before the surgery, and were protected during the surgery according to the anatomical signs.Results: There were no acute or chronic clinical damage symptoms in 76 cases after surgery. No neural damage symptoms were observed in patients with normal neural functions. The neural functions of incomplete paralyzed patients were improved in different grades.Conclusions: Reliable anterior operation can produce good results for cervical fracture and dislocation with unilateral vertebral artery injury. Detecting the course of uninjured vertebral artery before operation and locating the anatomical site during operation are effective to avoid damaging vertebral artery of uninjured side.

  15. The Postoperative Application of Percutanous Dilatational Tracheostomy for Patients with Serious Cervical Spinal Cord Injury Undergoing Anterior or Combined Anterior-posterior Cervical Spine Fixation%经皮扩张气管切开术在重度颈髓损伤颈椎前路或前后路联合手术后人工气道中的应用

    Institute of Scientific and Technical Information of China (English)

    李强; 安卫红; 白宇; 刘飞; 么改琦; 朱曦

    2013-01-01

    Objective To investigate the feasibility of percutanous dilatational tracheostomy on patients undergoing anterior and anterior-posterior cervical spine fixation.Methods A retrospective analysis was done on 17 patients with cervical spinal cord injury who were admitted to ICU of Peking University Third Hospital from January 2012 to March 2013,including 12 cases of anterior and 5 cases of combined anterior-posterior cervical spine fixation.All patients received percutanous dilatational tracheostomy after anterior or anterior-posterior cervical spine fixation.The duration between the percutanous dilatational tracheostomy and the anterior/anterior-posterior cervical spine fixation were 5 to 11 days.Results The procedure of percutanous dilatational tracheostomy was smooth in all 17 cases,with no intraoperative impairment to the vital organs,no postoperative heavy blood loss and no fistula infection.No concurrent anterior and anterior-posterior cervical incision infection occurred.Conclusions Percutanous dilatational tracheostomy is a safe and efficient way of building the artificial airway 5 days after the anterior and anterior-posterior cervical spine fixation.%目的 探讨颈椎前路和颈椎前后路联合颈椎切开复位内固定手术后行经皮扩张气管切开术的安全性. 方法 回顾性分析2012年1月~2013年3月颈脊髓损伤17例,行颈前路(12例)或颈前后路(5例)切开复位内固定手术,术后5 ~11d行经皮扩张气管切开术. 结果 17例经皮扩张气管切开术均过程顺利,无颈前部重要器官损伤、术后局部大量出血、造瘘区域感染、颈前路手术切口及切口深层感染. 结论 颈前路手术5日后行经皮扩张气管切开术是安全高效的建立人工气道的方法.

  16. Utility of coronal oblique slices in cervical spine MRI. Improved detection of the neuroforamina; Nutzen der halbkoronaren Schichtung im MRT der Halswirbelsaeule. Verbesserte Erkennbarkeit von Neuroforamina

    Energy Technology Data Exchange (ETDEWEB)

    Freund, W.; Hoepner, G. [Universitaetskliniken Ulm, Klinik fuer Diagnostische und Interventionelle Radiologie, Ulm (Germany); Klessinger, S. [Nova Clinic Biberach, Neurochirurgie, Biberach (Germany); Universitaetskliniken Ulm, Neurochirurgie, Ulm (Germany); Mueller, M. [Universitaetskliniken Ulm, Klinik fuer Diagnostische und Interventionelle Radiologie, Ulm (Germany); Universitaetskliniken Aachen, Diagnostische und Interventionelle Neuroradiologie, Aachen (Germany); Halatsch, M.E. [Universitaetskliniken Ulm, Neurochirurgie, Ulm (Germany); Weber, F. [Bundeswehrkrankenhaus Ulm, Neurologie, Ulm (Germany); Schmitz, B. [Universitaetskliniken Ulm, Neuroradiologie, Ulm (Germany)

    2015-11-15

    Angulated projections are standard in conventional radiography of the cervical spine, but rarely used in magnetic resonance imaging (MRI). As neuroforaminal pathology plays an important role in the etiology of radicular syndromes and may influence an operative approach, the utility of coronal oblique slices in MRI is explored. In a retrospective setting, 25 consecutive patients with neurologically diagnosed cervical monoradiculopathy were identified. T2-weighted sagittal, coronal oblique, and transversal slice orientations were anonymized. Two radiologists and two neurosurgeons independently assessed the cases. Criteria were site, cause, and grading of the neuroforaminal stenosis and the level of confidence on a 100-point visual analog scale (VAS). We computed interrater agreement, sensitivity, and t tests. Using only one slice orientation, the sensitivity in detecting the relevant neuroforamen was 0.40 for transversal, 0.68 for sagittal, and 0.64 for coronal oblique scans. A combination of the different angulations increased sensitivity and in 4 cases only the coronal oblique scans proved diagnostic. The readers felt significantly more confident in attributing the cause of the pathology on coronal oblique planes (a mean of 72 VAS points, p = 0.0003 vs 58 (sagittal) vs 64 (transversal)). Interrater agreement was significantly better for experienced (kappa 0. 48) than for inexperienced readers (0.32, p = 0.02). Adding coronal oblique planes in cervical spine MRI increases sensitivity and confidence in attributing the cause of neuroforaminal pathology. They are regarded as useful by all the readers. (orig.) [German] Im Gegensatz zur Magnetresonanztomographie (MRT) sind in der konventionellen Roentgendiagnostik der Halswirbelsaeule (HWS) Schraegaufnahmen Standard. Da neuroforaminale Pathologien wichtige Ursachen von radikulaeren Syndromen sind und die Operationstechnik moeglicherweise beeinflussen, wird der Nutzen halbkoronarer Schichten in der MRT untersucht. In

  17. A case report of rod migration into cerebellum through foramen magnum after lateral mass fixation of cervical spine.

    Science.gov (United States)

    Kiran, Belsare; Sharma, Ayush; Prashant, Gedam; Parekh, Aseem

    2016-04-01

    We report on a rare case of connecting rod migration into the posterior cranial fossa after posterior cervical decompression and lateral mass screw fixation. A 55-year-old male patient who was operated on for ossification of posterior longitudinal ligament complained of sudden-onset giddiness followed by loss of consciousness one and half year following surgery. CT scan showed migration of left-sided connecting rod into the right cerebellum through foramen magnum. The patient was operated on for rod removal but he sustained a cardiorespiratory arrest and died on the eighth postoperative day. Autopsy confirmed damage to the right cerebellum due to rod migration. The clinician should be aware that superior rod migration is a rare but potentially disastrous complication. Regular follow-up with radiological evaluation should be done to look for implant loosening, migration, and non-union even in asymptomatic patients. The implant should be subsequently removed after it has served its purpose. PMID:26748502

  18. The impact of spinal cord nerve roots and denticulate ligaments on cerebrospinal fluid dynamics in the cervical spine.

    Directory of Open Access Journals (Sweden)

    Soroush Heidari Pahlavian

    Full Text Available Cerebrospinal fluid (CSF dynamics in the spinal subarachnoid space (SSS have been thought to play an important pathophysiological role in syringomyelia, Chiari I malformation (CM, and a role in intrathecal drug delivery. Yet, the impact that fine anatomical structures, including nerve roots and denticulate ligaments (NRDL, have on SSS CSF dynamics is not clear. In the present study we assessed the impact of NRDL on CSF dynamics in the cervical SSS. The 3D geometry of the cervical SSS was reconstructed based on manual segmentation of MRI images of a healthy volunteer and a patient with CM. Idealized NRDL were designed and added to each of the geometries based on in vivo measurments in the literature and confirmation by a neuroanatomist. CFD simulations were performed for the healthy and patient case with and without NRDL included. Our results showed that the NRDL had an important impact on CSF dynamics in terms of velocity field and flow patterns. However, pressure distribution was not altered greatly although the NRDL cases required a larger pressure gradient to maintain the same flow. Also, the NRDL did not alter CSF dynamics to a great degree in the SSS from the foramen magnum to the C1 level for the healthy subject and CM patient with mild tonsillar herniation (∼ 6 mm. Overall, the NRDL increased fluid mixing phenomena and resulted in a more complex flow field. Comparison of the streamlines of CSF flow revealed that the presence of NRDL lead to the formation of vortical structures and remarkably increased the local mixing of the CSF throughout the SSS.

  19. Parafuso de massa lateral do atlas para fixação da coluna cervical superior: resultados cirúrgicos Tornillos de masa lateral del atlas para la fijación de la columna cervical superior: resultados quirúrgicos Lateral mass screws of the atlas for upper cervical spine fixation: surgical results

    Directory of Open Access Journals (Sweden)

    Enrico Ghizoni

    2011-01-01

    alcanzar la fusión y la estabilidad de la columna cervical, y con el conocimiento de la anatomía y de la técnica quirúrgica es posible obtenerse excelentes resultados.OBJECTIVE: To present the surgical results of a case series of upper cervical spine stabilization with the use of lateral mass screws of the atlas. METHODS: Retrospective review of the surgical results of patients submitted to upper cervical spine stabilization with the use of lateral mass screws of the atlas. RESULTS: Six patients were operated in the period between January 2009 to April 2010, four men and two women. There was no permanent morbidity or mortality in the presented series. The main cause of atlanto-axial instability was trauma and there was just one case of odontoid pathologic fracture from a prostate metastasis. Axis fixation was achieved with the use of three different screw techniques (pars, pedicle and laminar, with equal distribution among the patients. CONCLUSIONS: The use of lateral mass screws of the atlas is an important technique to achieve fusion and stability of the upper cervical spine and with the knowledge of the anatomy and of the surgical technique good results can be achieved.

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

    International Nuclear Information System (INIS)

    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.)

  1. Varicella-Zoster-Mediated Radiculitis Reactivation following Cervical Spine Surgery: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Doniel Drazin

    2013-01-01

    Full Text Available Varicella-zoster virus and herpes simplex virus types 1 and 2 are neurotropic viruses that can be reactivated after a surgical or stressful intervention. Although such cases are uncommon, consequences can be debilitating, and variable treatment responses merit consideration. We describe a 41-year-old male with a history of varicella-mediated skin eruptions, who presented with continuing right arm pain, burning, and numbness in a C6 dermatomal distribution following a C5-6 anterior cervical discectomy and fusion and epidural steroid injections. The operative course was uncomplicated and he was discharged home on postoperative day 1. Approximately ten days after surgery, the patient presented to the emergency department complaining of severe pain in his right upper extremity and a vesicular rash from his elbow to his second digit. He was started on Acyclovir and discharged home. On outpatient follow-up, his rash had resolved though his pain continued. The patient was started on a neuromodulating agent for chronic pain. This case adds to the limited literature regarding this rare complication, brings attention to the symptoms for proper diagnosis and treatment, and emphasizes the importance of prompt antiviral therapy. We suggest adding a neuromodulating agent to prevent long-term sequelae and resolve acute symptoms.

  2. Radiographic evaluation of cervical spine of subjects with temporomandibular joint internal disorder Avaliação radiográfica da coluna cervical de indivíduos com distúrbios internos da articulação temporomandibular

    OpenAIRE

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

    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...

  3. Computed Tomography of the lumbar facet joints

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Mi Ryoung; Kim, Yung Soon; Lee, Joo Hyuk; Jeon, Hae Sang; Kim, Dae Yung [Kang Nam General Hospital, Seoul (Korea, Republic of)

    1989-08-15

    The lumbar facet disease is a frequently overlooked cause of sciatic pain, but the lumbar facet joints are well-recognized source of low back pain and radiating leg pain which can be confused with sciatica due to herniated disc. We measured the angulation of the facet joints on axial spine CT films in 149 cases which contains 41 normal group and 108 abnormal group and studied the relationship between the angulation and degeneration of the facets, the asymmetry of each sided facets and facet degeneration, the asymmetry and disc protrusion, and the asymmetry and annular bulging of the disc. The results were as follows: 1. Facet angulation in abnormal group were more sagittally oriented than the normal group. 2. The angulation of right facet was more sagittally oriented than the left in L4-5 level of abnormal group. 3. Degeneration of facet joints occur asymmetrically, and the more facet joint degenerates, the more it orients sagittally, particularly in L4-5. 4. Asymmetry in facet joint degeneration and unilateral disc protrusion of L5-SI level is greater than the normal gro0008.

  4. Utilización de la radiofrecuencia en el tratamiento de la patología cervical crónica: Estudio retrospectivo Radiofrecuency in the treatment of chronic cervical spine patology: Retrospective study

    Directory of Open Access Journals (Sweden)

    D. Abejón

    2006-01-01

    que se repite la técnica. No se observaron complicaciones derivadas de la técnica o el procedimiento. Conclusiones: La técnica de radiofrecuencia parece ser una técnica segura y prometedora en la patología cervical, dado sus resultados y su falta de efectos secundarios.Objectives: To value the effectiveness and sides effects of conventional radiofrequency (RF and pulsed radiofrequency (PRF in the treatment of the chronic spinal cervical pathology. Material and Methods: It is carried out a retrospective study. The sample composes it 35 patients in those that have been carried out 63 treatments with radiofrequency. The diagnostics were cervical radiculopathy (CR, cervicogenic migraine (CM and spinal cervical facet syndrome (SFC confirmed by means of radiography tests, electromyography and appropriate clinic from January 2000 to October 2004. In all the patients before making the RF is carried out a diagnostic blockade that must reduce to the patients' symptomatology in at least 50% so it is considered positive. It is evaluated, by means of a numeric scale (IN, the intensity of the pain in five moments, the percentage of the patients' improvement is valued according to a scale characteristic of 4 categories, the reduction of the medication is analyzed after applying the technique, the derived complications of the same one, if there was, and the necessity to repeat the procedure and when, if any. The pursuit of the study is carried out during a period of 6 months, and the valuation of the parameters is carried out, to the beginning of the same one (basal, a month, 2 months, at the 3 and the 6 months. They are carried out two analyses, the first of the complete sample and a second analysis in which the different pathologies are studied for separate. The comparison of that of the evolution of the IN along the time in each group (intragroup was carried out with the bilateral analysis of the non parametric variance of Friedman. The test of square Chi is applied to

  5. Facet analysis

    DEFF Research Database (Denmark)

    Hjørland, Birger

    2013-01-01

    The facet-analytic paradigm is probably the most distinct approach to knowledge organization within Library and Information Science, and in many ways it has dominated what has be termed “modern classification theory”. It was mainly developed by S.R. Ranganathan and the British Classification Rese...

  6. [Acceleration injuries of the cervical spine in seat-belted automobile drivers. Determination of the trauma mechanism and severity of injury].

    Science.gov (United States)

    Richter, M; Otte, D; Blauth, M

    1999-05-01

    The analysis of 1,176 whiplash-type neck distortions was sought from a total of 3,838 restrained car driver incident reports. The percentage of these injuries increased from less than 10% in 1985 to over 30% in 1997. These occurred mostly with head-on or with multiple collisions, and only in 15% with pure rear-end collisions. In 23.2%, delta v amounted 10 km/h or less, which corresponds to a very minor crash. The average delta v was the highest in the cases of head-on collisions. Letters were sent to the injured to find out about the duration and type of complaints caused by a cervical spine injury. Of the 138 patients who returned the questionnaires, 121 (88%) indicated that they had or were still suffering from their symptoms. Percentage of various complaints were as follows: pain (74%), tension (6%) and stiffness (5%) in the head (27%), neck (55%) and shoulder (8%). The duration of the complaints was longest after multiple collisions and when the onset of complaints was later than 24 hours after trauma. Women and elderly persons predominated slightly in the group with longer duration of complaints. A correlation between the severity of the accompanying injuries and duration of complaints occurred. Also, with this retrospective study there was considerable difficulties in the lack of adequate follow-up for these patients with less severe injuries. In order to better evaluate this problem, prospective studies are necessary which include documentation of diagnosis, treatment protocols, duration and type of complaints. PMID:10394600

  7. Subject-specific multi-validation of a finite element model of ovine cervical functional spinal units.

    Science.gov (United States)

    Mengoni, Marlène; Vasiljeva, Ksenija; Jones, Alison C; Tarsuslugil, Sami M; Wilcox, Ruth K

    2016-01-25

    The complex motion and geometry of the spine in the cervical region makes it difficult to determine how loads are distributed through adjacent vertebrae or between the zygapophysial (facet) joints and the intervertebral disc. Validated finite element modes can give insight on this distribution. The aim of this contribution was to produce direct validation of subject-specific finite element models of Functional Spinal Units (FSU׳s) of the cervical spine and to evaluate the importance of including fibre directionality in the mechanical description of the annulus fibrosus. Eight specimens of cervical FSU׳s were prepared from five ovine spines and mechanically tested in axial compression monitoring overall load and displacements as well as local facet joints pressure and displacement. Subject-specific finite element models were produced from microCT image data reproducing the experimental setup and measuring global axial force and displacement as well as local facet joints displacement and contact forces. Material models and parameters were taken from the literature, testing isotropic and anisotropic materials for the annulus fibrosus. The validated models showed that adding the direction of the fibres to their non-linear behaviour in the description of the annulus fibrosus improves the predictions at large strain values but not at low strain values. The load transferred through the facet joints was always accurate, irrespective of the annulus material model, while the predicted facet displacement was larger than the measured one but not significantly. This is, to the authors׳ knowledge, the first subject-specific direct validation study on a group of specimens, accounting for inter-subject variability. PMID:26708919

  8. Relationships between radiography of cervical vertebrae and histopathology of the cervical cord in wobbling 19 foals

    International Nuclear Information System (INIS)

    Nineteen wobbling foals (17 males and 2 females) showing lameness of hindlimbs at 6 to 21 months of age were investigated radiographically and histopathologically. Minimum sagittal diameter (MSD), minimum flexion diameter (MFD) and minimum dural sagittal diameter (MDD) were measured on plain radiograms or myelograms taken at neutral and flexed positions as indicators of narrowed vertebral canal. After necropsy, the cervical spines and the spinal cord were examined macroscopically and respectively the relationships between radiographic findings and the corresponding morphological lesions were evaluated. Radiographically, lower values than each minimum reference limits were recorded in 14 foals in MSD, 5 foals in MFD and 6 foals in MDD, respectively. According to the histopathologic examination, the disappearance of axons and myelin sheaths, vacuolated spongy degeneration and appearance of macrophages were recognized symmetrically in the white matter of the cervical cord. These lesions were centrally located at the spinal cord radiographically demonstrated as compressed sites in 12 out of 17 foals examined. Macroscopically, asymmetrical overgrowth of one side of the process, encroachment of articular processes into the intervertebral foramina and proliferation of bone around articular facets were observed in the articular processes of bone specimens in the caudal neck of 6 foals. In conclusion, the equine incoordination might mainly be caused by the cervical stenotic myelopathy resulting from cervical vertebral malformation, and therefore the cervical vertebral radiography, especiallymyelography, is quite very important and effective for the diagnosis of wobbling foals

  9. Risco de tração excessiva nas lesões tipo distração-flexão da coluna cervical baixa Risk of excessive traction on distraction-flexion-type injuries of the low cervical spine

    Directory of Open Access Journals (Sweden)

    Tarcísio Eloy Pessoa de Barros Filho

    2006-01-01

    Full Text Available O estudo em questão visa avaliar a relação entre risco e benefício do uso de tração com halo craniano como alternativa para estabilização nas fraturas-luxações por mecanismo de distração-flexão tipo IV de Allen e Ferguson, considerando a natureza da lesão, seu extenso dano ligamentar e o risco de apresentar distração excessiva e conseqüente lesão da medula espinhal. Para tanto, realizamos uma análise retrospectiva no IOT-HC-FMUSP envolvendo um período de 10 anos, quando 34 casos foram diagnosticados como fratura-luxação por distração-flexão da coluna cervical baixa, sendo 12 deles do tipo IV. Todos foram submetidos à tração esquelética com halo craniano num momento inicial. Durante o controle radiográfico seqüencial, observou-se distração excessiva em sete casos, mesmo com baixo peso inicial (4 kg. Em dois pacientes houve surgimento de nistagmo. Em todos os casos a tração foi retirada e seguiu-se normalização do quadro clínico.This study aims to evaluate the risk/ benefit ratio in the use of traction with cranial halo as an alternative to stabilize fractures-dislocations by Allen & Ferguson's type IV- distraction-flexion mechanism, considering the nature of the injury, its extensive ligament damage and the risk of presenting excessive distraction and resultant spinal cord injury. Thus, we performed a retrospective analysis at IOT-HC-FMUSP comprising a period of 10 years, when 34 cases were diagnosed as fractures-dislocations due to distraction-flexion of the low cervical spine, of which 12 were IV-type. All individuals have been submitted to skeletal traction with cranial halo at an early phase. During sequential X-ray management, an excessive distraction was seen in seven cases, even with initial light weight (4 kg. In two patients, the onset of nistagmus was seen. In all cases, traction was removed, which was followed by stabilization of the clinical picture.

  10. Computed tomography of the cervical spine: comparison of image quality between a standard-dose and a low-dose protocol using filtered back-projection and iterative reconstruction

    International Nuclear Information System (INIS)

    To compare image quality of a standard-dose (SD) and a low-dose (LD) cervical spine CT protocol using filtered back-projection (FBP) and iterative reconstruction (IR). Forty patients investigated by cervical spine CT were prospectively randomised into two groups: SD (120 kVp, 275 mAs) and LD (120 kVp, 150 mAs), both applying automatic tube current modulation. Data were reconstructed using both FBP and sinogram-affirmed IR. Image noise, signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were measured. Two radiologists independently and blindly assessed the following anatomical structures at C3-C4 and C6-C7 levels, using a four-point scale: intervertebral disc, content of neural foramina and dural sac, ligaments, soft tissues and vertebrae. They subsequently rated overall image quality using a ten-point scale. For both protocols and at each disc level, IR significantly decreased image noise and increased SNR and CNR, compared with FBP. SNR and CNR were statistically equivalent in LD-IR and SD-FBP protocols. Regardless of the dose and disc level, the qualitative scores with IR compared with FBP, and with LD-IR compared with SD-FBP, were significantly higher or not statistically different for intervertebral discs, neural foramina and ligaments, while significantly lower or not statistically different for soft tissues and vertebrae. The overall image quality scores were significantly higher with IR compared with FBP, and with LD-IR compared with SD-FBP. LD-IR cervical spine CT provides better image quality for intervertebral discs, neural foramina and ligaments, and worse image quality for soft tissues and vertebrae, compared with SD-FBP, while reducing radiation dose by approximately 40 %. (orig.)

  11. 机械通气在颈椎损伤术后合并呼吸衰竭的临床应用%Clinical application of mechanical ventilation in cervical spine injury surgery with respiratory failure

    Institute of Scientific and Technical Information of China (English)

    崔艳; 王辉

    2012-01-01

    目的 探讨机械通气在颈椎术后合并呼吸衰竭的应用.方法 回顾性分析32例颈椎损伤术后合并呼吸衰竭应用机械通气患者的疗效.结果 26例患者安全度过急性期,2例患者抢救无效死亡,4例患者因经费原因放弃治疗而自动出院.结论 颈椎损伤术后合并呼吸衰竭有效地应用机械通气可使患者顺利度过围术期,提高手术疗效,降低患者病死率,是一种有效的辅助治疗措施.%Objective To investigate the application of mechanical ventilation in cervical spine injury with postoperative respiratory failure.Methods The effects of mechanical ventilation on 32 cases of cervical spine injury with respiratory failure were retrospectively analyzed.Results Twenty-six patients survived the acute period safely,2 patients died,4 patients gave up the treatment due to financial reasons and discharged automatically.Conclusions Effective application of mechanical ventilation in cervical spine injury complicated with postoperative respiratory failure,can make the patients pass through perioperative period,improve operation effectively,reduce the morbidity and mortality.It is an effective adjunctive treatment measure.

  12. The Effect of the PEEK Cage on the Cervical Lordosis in Patients Undergoing Anterior Cervical Discectomy

    OpenAIRE

    Salih Gulsen

    2015-01-01

    BACKGROUND: Loss of cervical lordosis is a significant factor in the development of degeneration of the spine with aging. This degenerative changings of the cervical spine would cause pressure effect on the cervical root and/or medulla spinalis. AIM: Our goal is to understand the effect of the PEEK cage on cervical lordosis in the early postoperative period. Also, to interpret the effects of one- level, two- level, three-level and four- level disc pathologies on cervical lordosis. MAT...

  13. Radiographic evaluation of cervical spine of subjects with temporomandibular joint internal disorder Avaliação radiográfica da coluna cervical de indivíduos com distúrbios internos da articulação temporomandibular

    Directory of Open Access Journals (Sweden)

    Wagner Cesar Munhoz

    2004-12-01

    Full Text Available 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 im ages. 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.Apesar de a etiofisiopatologia dos distúrbios internos (DI da articulação temporomandibular (ATM ser ainda desconhecida, sugere-se que as posturas de cabeça e corpo estariam associadas a seu desencadeamento, desenvolvimento e sua perpetuação. O objetivo deste estudo foi verificar a relação entre alterações radiográficas de coluna cervical e distúrbios internos da ATM. Este estudo avaliou 30 indivíduos com distúrbios da ATM (grupo teste e 20 saudáveis (grupo controle. Os indiv

  14. Unusual facet cyst containing struvite and hydroxyapatite

    Energy Technology Data Exchange (ETDEWEB)

    Grantham, M.; Richmond, B. [Dept. of Musculoskeletal Radiology, Cleveland Clinic Foundation, OH (United States)

    2001-01-01

    This case report describes a patient with severe back pain and radiculopathy. She was found to have a facet cyst within the lumbar spine that appeared to contain calcium on MRI and CT. Upon aspiration the cyst was found to contain calcium ammonium phosphate (struvite) and calcium phosphate (hydroxyapatite). Ammonia production in the presence of urease-producing bacteria is responsible for the production of struvite in the human body. We postulate that there was a prior infection of the facet with urease-producing bacteria, thus accounting for the production of the struvite within the facet cyst. (orig.)

  15. Unusual facet cyst containing struvite and hydroxyapatite

    International Nuclear Information System (INIS)

    This case report describes a patient with severe back pain and radiculopathy. She was found to have a facet cyst within the lumbar spine that appeared to contain calcium on MRI and CT. Upon aspiration the cyst was found to contain calcium ammonium phosphate (struvite) and calcium phosphate (hydroxyapatite). Ammonia production in the presence of urease-producing bacteria is responsible for the production of struvite in the human body. We postulate that there was a prior infection of the facet with urease-producing bacteria, thus accounting for the production of the struvite within the facet cyst. (orig.)

  16. Decompressive cervical laminectomy and lateral mass screw-rod arthrodesis. Surgical analysis and outcome

    Directory of Open Access Journals (Sweden)

    Obaidat Mouness H

    2011-05-01

    Full Text Available Abstract Background This study evaluates the outcome and complications of decompressive cervical Laminectomy and lateral mass screw fixation in 110 cases treated for variable cervical spine pathologies that included; degenerative disease, trauma, neoplasms, metabolic-inflammatory disorders and congenital anomalies. Methods A retrospective review of total 785 lateral mass screws were placed in patients ages 16-68 years (40 females and 70 males. All cases were performed with a polyaxial screw-rod construct and screws were placed by using Anderson-Sekhon trajectory. Most patients had 12-14-mm length and 3.5 mm diameter screws placed for subaxial and 28-30 for C1 lateral mass. Screw location was assessed by post operative plain x-ray and computed tomography can (CT, besides that; the facet joint, nerve root foramen and foramen transversarium violation were also appraised. Results No patients experienced neural or vascular injury as a result of screw position. Only one patient needed screw repositioning. Six patients experienced superficial wound infection. Fifteen patients had pain around the shoulder of C5 distribution that subsided over the time. No patients developed screw pullouts or symptomatic adjacent segment disease within the period of follow up. Conclusion decompressive cervical spine laminectomy and Lateral mass screw stabilization is a technique that can be used for a variety of cervical spine pathologies with safety and efficiency.

  17. 下颈椎骨折伴截瘫患者围手术期护理%Perioperative care for patients with paraplegia and fracture of next cervical spine

    Institute of Scientific and Technical Information of China (English)

    丁传红; 彭瑾; 杨媛

    2011-01-01

    目的 总结下颈椎骨折伴截瘫患者围手术期护理经验.方法 回顾性分析18例围手术期护理下颈椎骨折伴截瘫患者情况.结果 18例患者经围手术期精心护理,减少了术后并发症的发生.结论 围手术期精心护理能使患者主动配合手术并减少术后并发症的发生.%Objective To evaluate and summarize the clinical experience of perioperative care for patients with paraplegia and fracture of next cervical spine. Methods From April 2007 to April 2010, i8 patients with paraplegia and fracture of next cervical spine were cared in perioperative period. Results Postoperation complications of 18 patients were reduced with perioperative care. Conclusion Postoperation complications were reduced with perioperative care which could make patients actively cooperate with surgery.

  18. Posterior atlantoaxial ′facetal′ instability associated with cervical spondylotic disease

    Directory of Open Access Journals (Sweden)

    Atul Goel

    2015-01-01

    Full Text Available Aim: The association of single or multiple level cervical spondylotic disease with atlantoaxial instability is assessed. The implications of identifying and treating atlantoaxial instability in such an association are highlighted. Materials and Methods: The analysis is based on an experience with 11 patients treated during the period June 2013-June 2014. All patients had single or multilevel cervical spondylotic disease. The spinal canal compromise and evidence of cord compression was evident on imaging in the cervical subaxial spine and was related to disc bulges and osteophytic bars. There was no or relatively insignificant compression of the cervicomedullary cord by the odontoid process. There was no evidence of odontoid process-related instability on dynamic imaging. Apart from presence of features of cervical spondylosis, investigations and surgical exploration and direct manual handling of the facets revealed evidence of Type B (posterior atlantoaxial′facetal′ instability in all patients. Our 5-point clinical grading system and Japanese Orthopaedic Association (JOA scores were used to monitor the patients both before and after surgery and at follow-up. Surgery involved both at lantoaxial and subaxial cervical fixation. During the average period of follow-up of 9 months (5-17 months, all patients showed remarkable and gratifying neurological recovery. Conclusion: We conclude that atlantoaxial facetal instability can be ′frequently′ associated with cervical spondylosis and needs surgical stabilization. Our surgical outcome analysis suggests that missing or ignoring the presence of atlantoaxial facetal instability can be an important cause of suboptimal result or failure of surgery for cervical spondylotic myelopathy.

  19. Cervical Synovial Cyst Causing Cervical Radiculomyelopathy: Case Report and Review of the Literature.

    Science.gov (United States)

    Corredor, José A; Quan, Gerald

    2015-08-01

    Study Design Case report. Objective Synovial cysts in the subaxial cervical spine are rare and are most commonly reported at the cervicothoracic junction. Only six cases of symptomatic C5-C6 synovial cysts have been reported in the literature; the condition is usually treated with decompressive laminectomy. We present a patient with a synovial cyst arising from the C5-C6 facet joint, associated with spondylolisthesis, and causing radiculomyelopathy. The patient was treated with a posterior excision of the cyst, decompressive laminectomy, and fusion. Methods A 67-year-old man had vertebral canal stenosis at C5-C6 secondary to a synovial cyst and spondylolisthesis with symptoms and signs of radiculopathy and myelopathy. Surgical management involved C5-C6 posterior decompressive laminectomy and excision of the cyst and C4-C6 instrumented fusion with lateral mass screws and rods. A literature review of symptomatic cervical synovial cysts is presented. Results The imaging studies identified grade I spondylolisthesis and a 3.3 × 4.3-mm extradural lentiform-like mass associated with focal compression of the spinal cord and exiting the C6 nerve root. After the surgery, the patient had an immediate full recovery and was asymptomatic by the 6-month examination. No operative complications were reported. The histologic report confirmed the presence of a synovial cyst. Conclusions C5-C6 is an unusual localization for symptomatic synovial cysts. Similar cases reported in the literature achieved excellent results after cyst excision and decompressive laminectomy. Because spondylolisthesis plus laminectomy are risk factors for segmental instability in the cervical spine, we report a case of a C5-C6 facet synovial cyst successfully treated with posterior laminectomy and C4-C6 fusion. PMID:26225291

  20. Efeito da tração manual sobre o comprimento da coluna cervical em indivíduos assintomáticos: estudo randomizado controlado The effect of manual traction on the length of cervical spine in asymptomatic individuals: a randomized controlled study

    Directory of Open Access Journals (Sweden)

    Roger Burgo de Souza

    2011-03-01

    Full Text Available Os objetivos do estudo foram o de mensurar o comprimento da coluna cervical quando submetida à tração manual, e o de verificar as alterações da cervical após um período de 10 sessões consecutivas. Trata-se de estudo randomizado controlado, no qual 64 participantes foram submetidos a dois procedimentos radiológicos, antes e durante a tração. As distâncias das bordas anteriores e posteriores do corpo vertebral C2 até as do corpo vertebral de C7 foram mensuradas e comparadas. Na primeira etapa as medidas das bordas anteriores foi de 8,40 para 8,50 cm (PTHE Objectives of the study were to measure the length of the cervical spine when submitted to manual traction and to verify changes in the cervical spine after 10 consecutive sessions. In this randomized controlled study 64 participants were submitted to two radiological procedures: one before and another during traction. The distances between the anterior and posterior vertebrae edges of C2 the C7 were measured and compared. In the first stage it was shown that measures of the anterior distance was 8.40 to 8.50 cm (P<0.001 and the posterior was 8.35 to 8.50 cm (P<0.001. For the second stage, subjects were randomized in control group (n=31 and intervention group (n=33 which received ten sessions of cervical traction. After the sessions the anterior and posterior distances of the intervention group increased significantly from 8.40 to 8.90 cm (P<0.001 and 8.40 to 8.65 cm (P<0.001 respectively. After the sessions all participants repeated the same radiological procedures, measurements and comparisons of the vertebral distance. When the groups were compared after the sessions there were statistically significant differences between the anterior and posterior distance of 8.20 and 8.90 cm (P=0.015 and 8.30 and 8.65 (P=0.030 respectively. Therefore the traction increased the length of the cervical spine and after a period of application of this intervention there was significant increase of

  1. Interventional spine procedures

    Energy Technology Data Exchange (ETDEWEB)

    Kelekis, A.D. [Attikon University Hospital, 2nd Radiology Department, University of Athens, Rimini 1, 124 61 Athens (Greece)]. E-mail: akelekis@cc.uoa.gr; Somon, T. [Geneva University Hospital, Department of Radiology, Neuroradiology, 24, Rue Micheli-du-Crest, 1211 Geneva 14 (Switzerland); Yilmaz, H. [Geneva University Hospital, Department of Radiology, Neuroradiology, 24, Rue Micheli-du-Crest, 1211 Geneva 14 (Switzerland); Bize, P. [Geneva University Hospital, Department of Radiology, Neuroradiology, 24, Rue Micheli-du-Crest, 1211 Geneva 14 (Switzerland); Brountzos, E.N. [Attikon University Hospital, 2nd Radiology Department, University of Athens, Rimini 1, 124 61 Athens (Greece); Lovblad, K. [Geneva University Hospital, Department of Radiology, Neuroradiology, 24, Rue Micheli-du-Crest, 1211 Geneva 14 (Switzerland); Ruefenacht, D. [Geneva University Hospital, Department of Radiology, Neuroradiology, 24, Rue Micheli-du-Crest, 1211 Geneva 14 (Switzerland); Martin, J.B. [Clinique Generale Beaulieu 12 chemin Beau Soleil 1206 Geneva (Switzerland)]. E-mail: jbmartin@beaulieu.ch

    2005-09-01

    Minimally invasive techniques for the treatment of some spinal diseases are percutaneous treatments, proposed before classic surgery. By using imaging guidance, one can significantly increase accuracy and decrease complication rates. This review report physiopathology and discusses indications, methods, complications and results of performing these techniques on the spine, including different level (cervical, thoracic, lumbar and sacroiliac) and different kind of treatments (nerve block, disc treatment and bone treatment). Finally the present article also reviews current literature on the controversial issues involved.

  2. Simultaneously Combined Anterior-Posterior Approaches for Subaxial Cervical Circumferential Reconstruction in a Sitting Position.

    Science.gov (United States)

    Han, Yue; Xia, Qun; Hu, Yong-cheng; Zhang, Ji-dong; Lan, Jie; Ma, Xin-long

    2015-11-01

    The purpose of this article is to introduce and analyze the feasibility of simultaneously combined anterior-posterior approaches for subaxial cervical circumferential reconstruction in sitting position. A retrospective case review was performed for above surgery procedure. A 79-year-old man was confirmed subaxial cervical fracture and dislocation with facet locked by radiological examination, and the involved levels were C5-6. According to American Spinal Injury Association (ASIA) classification, the impairment scale was grade B. And the Subaxial Cervical Spine Injury and Severity Score (SLIC) were 9. The patient was restricted in sitting position with traction on a halo in extension to immobilize the head during the operation. A posterior laminectomy and pedicle screws insertion to the involved cervical spine was performed firstly. And then the anterior discectomy and strut graft were accomplished through an anterior cervical approach. The final fixation was finished by clamping the strut graft with pedicle screw system. Total blood loss was 600 ml and the total operating time was 150 min. The patient was followed up for 6 months. The symptom of neck pain improved distinctly and no evidence about implant failure was noted. Neurological status improvement was confirmed and the ASIA scale was improved to grade C. We believed that the simultaneously combined anterior-posterior approach in sitting position was safe and more advantageous for appropriate cases. PMID:26790982

  3. Estudo experimental da influência da altura do enxerto ósseo intersomático na estabilidade da fixação monossegmentar anterior da coluna cervical Experimental study of the impact of intersomatic bone graft height on the stability of anterior monosegmental fixation of the cervical spine

    Directory of Open Access Journals (Sweden)

    Jorge Alfredo Léo

    2008-06-01

    Full Text Available OBJETIVO: Estudar experimentalmente a influência da altura do enxerto ósseo intersomático da coluna cervical na estabilidade mecânica da fixação cervical anterior. MÉTODOS: Foram realizados ensaios mecânicos utilizando a coluna cervical de suínos (C3-C4. Foram formados três grupos experimentais compostos por 20 segmentos da coluna cervical (C3-C4, de acordo com o grau de instabilidade produzido e a fixação do segmento vertebral. Grupo I: retirada do disco intervertebral e colocação de enxerto intersomático. Grupo II: retirada do disco intervertebral, colocação de enxerto intersomático e fixação anterior com placa. Grupo III: retirada do disco intervertebral, secção dos ligamentos posteriores e cápsulas articulares bilateralmente, colocação do enxerto intersomático e fixação anterior com placa. Cada grupo experimental foi dividido em dois subgrupos, de acordo com a altura do enxerto ósseo utilizado (3,0mm ou 6,0mm. Os segmentos vertebrais foram submetidos a ensaios mecânicos de flexão, flexão lateral e torção em máquina universal de ensaio. Os parâmetros analisados foram força máxima (N e o momento (Nm para produzir uma deflexão preestabelecida. RESULTADOS: Não foi observada em todos os grupos experimentais diferença estatística dos valores da força máxima (N e do momento (Nm, entre as diferentes alturas (3,0mm e 6,0mm do enxerto ósseo intersomático. Conclusões: A estabilidade mecânica imediata da artrodese cervical monossegmentar anterior não sofreu influência da altura do enxerto ósseo intersomático nos ensaios de flexão, flexão lateral e torção.OBJECTIVE: To perform an experimental study of the impact of intersomatic bone graft height of the cervical spine on the mechanical stability of anterior cervical fixation. METHODS: Mechanical assays were performed using swine cervical spine (C3-C4. Three experimental groups were formed with 20 cervical spine segments (C3-C4 according to the degree

  4. Imaging fusion (SPECT/CT) in degenerative disease of spine

    International Nuclear Information System (INIS)

    Full text: Objective: To determine the utility of Fusion Imaging SPECT/CT in degenerative pathology of the spine and to establish the impact of the use of fusion imaging in spinal pain due to degenerative changes of the spine. Materials and methods: 44 Patients (M=21, F=23) average age of 63 years and with degenerative pathology of spine were sent to Diagnosis Imaging department in FSFB. Bone scintigraphy (SPECT), CT of spine (cervical: 30%, Lumbar 70%) and fusion imaging were performed in all of them. Bone scintigraphy was carried out in a gamma camera Siemens Diacam double head attached to ESOFT computer. The images were acquired in matrix 128 x 128, 20 seg/imag, 64 images. CT of spine was performed same day or two days after in Helycoidal Siemens somatom emotion CT. The fusion was done in a Dicom workstation in sagital, axial and coronal reconstruction. The findings were evaluated by 2 Nuclear Medicine physicians and 2 radiologists of the staff of FSFB in an independent way. Results: Bone scan (SPECT) and CT of 44 patients were evaluated. CT showed facet joint osteoarthrities in 27 (61.3%) patients, uncovertebral joint arthrosis in 7 (15.9%), bulging disc in 9(20.4%), spinal nucleus lesion in 7(15.9%), osteophytes in 9 (20.4%), spinal foraminal stenosis in 7 (15.9%), spondylolysis/spondylolisthesis in 4 (9%). Bone scan showed facet joint osteoarthrities in 29 (65.9%), uncovertebral joint arthrosis in 4 (9%), osteophytes in 9 (20.4%) and normal 3 (6.8%). The imaging fusion showed coincidence findings (main lesion in CT with high uptake in scintigraphy) in 34 patients (77.2%) and no coincidence in 10 (22.8%). In 15 (34.09%) patients the fusion provided additional information. The analysis of the findings of CT and SPECT showed similar results in most of the cases and the fusion didn't provide additional information but it allowed to confirm the findings but when the findings didn't match where the CT showed several findings and SPECT only one area with high uptake

  5. Adaptation of proton total dose with respect to dosimetric parameters within the frame of treatment of skull base or upper cervical spine chordomas; Adaptation de la dose totale de protons en fonction des parametres dosimetriques dans le cadre du traitement des chordomes de la base du crane et du rachis cervical haut

    Energy Technology Data Exchange (ETDEWEB)

    Hemery, C.G.; Mazeron, J.J.; Feuvret, L. [Groupe hospitalier Pitie-Salpetriere (AP-HP), 75 - Paris (France); Calugaru, V.; Bolle, S.; Habrand, J.L.; Datcharty, J.; Alapetite, C.; Dendale, R.; Feuvret, L. [Institut Curie-Centre de protontherapie d' Orsay, 91 (France); Habrand, J.L.; Datcharty, J. [Institut Gustave-Roussy, 94 - Villejuif (France); Noel, G. [Centre Paul-Strauss, 67 - Strasbourg (France)

    2010-10-15

    The authors report the study of the feasibility of a photon-proton irradiation protocol with a dose adaptation with respect to dosimetric factors for patients suffering form a skull base and upper cervical spine chordoma. Sixty patients have been treated between May 2006 and June 2008 with a combination of high energy photons and protons. As five tumours have locally relapsed and one at distance, the authors comment the local control rates, the number of attained cranial nerves, the value of the macroscopic tumour volume, the survival rate without relapse in terms of multifactorial of uni-factorial analysis. Short communication

  6. Hangman' s Fracture With Unilateral Locked Facet: A Rare Case

    OpenAIRE

    Bakar, Bulent; Tekkok, Ismail Hakki

    2009-01-01

    Objective: The hangman's fracture and traumatic spondylolisthesis of axis are terms used to explain a specific C2 posterior column fracture. Although true mechanism of hangman's fracture is hyperextension and distraction of upper cervical spine with severe cord injury, traumatic axis pedicle fractures are caused by extension and compression of upper cervical spine usually with less probability of cord injury. Herein we describe a case who suffered from C2 bipedicular fractures with left unila...

  7. Diagnosis and treatment of vertebral artery injury in cervical spine surgery%颈椎手术中并发椎动脉损伤的诊断与治疗

    Institute of Scientific and Technical Information of China (English)

    王少波; 孙宇; 刁垠泽; 李迈; 张凤山

    2012-01-01

    目的 探讨颈椎手术中并发椎动脉损伤的发生原因、治疗及预防.方法 回顾性分析2002年10月至2012年4月颈椎手术中并发椎动脉损伤的7例患者资料,男6例,女1例;年龄23~65岁,平均48.9岁;脊髓型颈椎病5例,颈椎外伤合并C4.5半脱位1例,氟骨症致颈椎管狭窄1例.椎动脉损伤均为单侧,左侧4例,右侧3例.分析颈椎手术中并发椎动脉损伤的原因、处理过程及预后.结果 颈椎前路手术4例,其中2例用环钻减压时偏离中线损伤椎动脉,1例切除稚间盘时刮匙过于偏外损伤椎动脉,1例颈椎外伤患者由于C4,5半脱位造成椎动脉迂曲,减压时冲击式咬骨钳损伤椎动脉.颈椎后路手术3例,其中2例为行C4侧块螺钉固定时钻头偏外损伤椎动脉;1例氟骨症致颈椎管狭窄者在切除寰椎后弓时咬骨钳损伤椎动脉,术中出现椎动脉损伤后,迅速填塞压迫止血并关闭伤口,但术后4周发生迟发性出血,采用椎动脉栓塞止血及颈后路血肿清除术治疗.7例患者均未发生脑梗塞,其中2例患者术后出现-过性头晕.结论 椎动脉损伤是颈椎手术的严重并发症,其损伤原因与手术失误、解剖变异等有关;采用直接压迫及椎动脉栓塞治疗效果确切.%Objective To investigate cause,diagnosis,treatment and prevention of vertebral artery injury in cervical spine surgery.Methods Data of 7 patients with vertebral artery injury caused by cervical spine surgery from October 2002 to April 2012 were retrospectively analyzed.There were 6 males and 1 female,aged from 23 to 65 years (average,48.9 years).The reasons of cervical spine surgery were as follows:cervical spondylotic myelopathy (5 cases),traumatic subluxation of C4 and C5 (1 case),and cervical spinal stenosis due to skeletal fluorosis (1 case).All cases had unilateral vertebral artery injury,including 4 cases in the left side and 3 cases in the right side.The cause,treatment and prognosis of

  8. The efficacy of infrared irradiation in treating fat liquefaction of incision after cervical and lumbar spine surgery%红外线治疗颈腰椎术后切口脂肪液化的疗效观察

    Institute of Scientific and Technical Information of China (English)

    王艳; 双峰; 唐家广; 王炎秋

    2011-01-01

    Objective To observe the efficacy and to investigate the effect of infrared irradiation in treating fat liquefaction of incision after cervical and lumbar spine surgery. Methods From August 2008 to September 2010, A total number of 35 patients were included in the research, who had fat liquefaction and incision after cervical and lumbar spine surgeries. The 35 patients were randomly divided into observation group (n=l 8) and comparison group (n=17).Observation group was treated with infrared irradiation once a day for 20 minutes. Healing time of the treatment group was compared with purely dressing-changing group. Results The average healing time of the infrared irradiation group vas 6.17±0.43 days which was significantly shorter than the control group (8.47±0.43 days) (P<0.01). Conclusions Infrared irradiation can obviously promote the healing of fat liquefaction of incision after cervical and lumbar spine surgery and can be regarded as a proper method in treating fat liquefaction of incision.%目的 观察红外线照射治疗对颈腰椎后路术后脂肪液化切口愈合的效果,探讨红外线照射在治疗颈腰椎术后切口脂肪液化中的作用.方法 2008年8月至2010年9月颈腰椎后路术后脂肪液化患者35例,随机分为观察组18例,对照组17例.观察组使用红外线治疗仪照射发生脂肪液化的切口,1次/d,时间为20min.将切口愈合的时间与单纯清洁换药组进行对照.结果 红外线照射治疗组切口愈合时间6.17±0.43d,明显少于对照组8.47±0.43d (P<0.01).结论 红外线照射治疗能明显促进颈腰椎术后脂肪液化切口的愈合,该方法不失为一种治疗颈腰椎术后切口脂肪液化的较好方法.

  9. Development and Clinical Application of Smart Inflatable Nursing Pillow After Cervical Spine Surgery%颈椎术后智能充气护理枕的研制与临床应用

    Institute of Scientific and Technical Information of China (English)

    杜雪莲; 吴惠冰; 黄铭杰

    2014-01-01

    Objective To investigate the application effect of smart inflatable nursing pillow after cervical spine surgery. Methods Sixty patients with cervical spine surgery were randomly divided into experimental group and control group, with 30 cases in each group. Patients in the experimental group used smart inflatable nursing pillow after surgery, while patients in the control group used cotton ring after surgery. The turning satisfaction, degree of comfort, incidence of pressure sores and wound healing situation were observed, and the effect was evaluated by periodic review of X-rays. Results Compared with the control group, the experimental group had higher turning satisfaction and degree of comfort, and lower incidence of pressure sores; all the differences were statistically significant (P <0.05). Conclusions Smart inflatable nursing pillow is easy to operate. It can not only meet the treatment needs of patients with cervical spine surgery, but also increase patients' degree of comfort and reduce the complications and iatrogenic damage.%目的:探讨颈椎术后智能充气护理枕的应用效果。方法将60例颈椎术后患者随机分成试验组和对照组各30例,试验组予使用智能充气护理枕,对照组予使用棉圈,观察两组患者翻身耐受满意度、舒适度、压疮发生率以及伤口愈合情况,并定期复查X光片以了解疗效。结果试验组翻身耐受满意度、舒适度高于对照组,压疮发生率低于对照组,差异均具有统计学意义(P<0.05)。结论智能充气护理枕操作方便,不但能满足颈椎术后患者的治疗需求,且可增加患者的舒适度,同时减少并发症和医源性损害。

  10. 颈椎后路单开门手术对颈椎三维运动及刚性的影响%The effect of the expansive open-door laminoplasty on the three-dimensional motion and stiffness of the cervical spine

    Institute of Scientific and Technical Information of China (English)

    陈维善; 陈其昕; 王性力

    2001-01-01

    Objective To study the effect of the expansive open-door laminoplasty on the three-dimensional motion and stiffness of the cervical spine. Methods 55 cases after open-door laminoplasty of cervical spine due to myelopathy were follow-up for an average of 35.9 months. Cervical axial symptoms, neural functionality (JOA scoring system) and pre- and post-surgery dynamic cervical spine lateral X-ray films were evaluated. The Three-dimensional Motion and Stiffness of the Cervical Spine of Human Body Measuring Equipment was used in 12 post-operative open door laminoplasty cases and 10 pre-operative cases to measure the active and passive range of motion(ROM), load-displacement relationship, stiffness of cervical spine and torque caused by the isometric contraction of the extensors and flexors of the cervical spine. Results The average rate of improvement was 66. 2%. The excellent and good rate was 78.2%. The number of cases with distinct or severe cervical axial symptoms increased after the surgery ( P < 0. O1 ) . The patients who have severe axial symptoms tend to have less curved cervical spine (P < 0. 01 ) . There was no significant statistic difference between the severity of post-surgery cervical axial symptoms and JOA improvement level (P > 0. 05). The active and passive ROM of extension, rotation and lateral bending of cervical spine were decreased after the surgery ( P < 0. 05), and the main affection was on the middle and lower part of the cervical spine. The load-displacement figure of cervical spine can fit into an exponential equation T= b0eb1θ. In each direction, the lateral bending had the strongest stiffness, then the extension and flexion. The stiffness of rotation was the weakest. The stiffness of cervical spine of the post-surgery group was stronger than that of the contrast group. Conclusion The open-door laminoplasty of cervical spine damages the static mechanic balance on the sagittal plane and decreases the ROM and the flexibility of cervical

  11. Anterior cervical plating

    Directory of Open Access Journals (Sweden)

    Gonugunta V

    2005-01-01

    Full Text Available Although anterior cervical instrumentation was initially used in cervical trauma, because of obvious benefits, indications for its use have been expanded over time to degenerative cases as well as tumor and infection of the cervical spine. Along with a threefold increase in incidence of cervical fusion surgery, implant designs have evolved over the last three decades. Observation of graft subsidence and phenomenon of stress shielding led to the development of the new generation dynamic anterior cervical plating systems. Anterior cervical plating does not conclusively improve clinical outcome of the patients, but certainly enhances the efficacy of autograft and allograft fusion and lessens the rate of pseudoarthrosis and kyphosis after multilevel discectomy and fusions. A review of biomechanics, surgical technique, indications, complications and results of various anterior cervical plating systems is presented here to enable clinicians to select the appropriate construct design.

  12. 颈椎前路手术早期并发症防治探讨%The study on prevention and treatment of postoperative complications in early stage of anterior cervical spine surgery

    Institute of Scientific and Technical Information of China (English)

    李强; 陈向阳; 冯虎; 邓斌; 蒋允昌; 乔建恭

    2013-01-01

    目的 回顾分析颈椎前路手术早期常见并发症的发生原因,提出防治策略.方法 对2006-06-2011-08我科开展的416例颈椎前路手术进行回顾性分析.结果 本组共发生早期并发症共29例,总发生率为6.97%.常见并发症为:咽喉部不适吞咽疼痛6例,颈脊髓损伤4例,喉上、喉返神经损伤5例;食管瘘2例;脑脊液漏2例;涎漏2例;气道阻塞3例;髂骨供骨区并发症4例.除喉头水肿、脑脊液漏患者死亡各1例外,其余发生并发症患者均逐渐康复.结论 颈椎前路手术术后早期可能会发生多种并发症,充分的术前准备,熟悉颈前路相关解剖,熟练的手术操作,规范的术后管理,能够减少并发症.%Objective To analyze the causes for early postoperative complications in early stage of cervical surgery by anterior approach and to explore corresponding prevention and treatment measures. Methods A retrospective analysis was performed on 416 cases treated with anterior cervical surgery from June 2006 to August 2011. Results In these cases 29 postoperative complications associated with surgery were found, with an incidence of 6.97%,of which 6 cases were throat pain, 4 cases were aggravated spinal cord injuries,5 cases were laryngeal, recurrent laryngeal nerve injuries,2 cases were esophageal fistula,2 cases were cerebrospinal fluid leakage,2 cases were saliva leakage,3 cases were respiratory tract block,4 cases were complications in the vessels area that supply the iliac bone. One patient with respiratory tract block and one patient cerebrospinal fluid leakage died,but then the rest were recovered gradually. Conclusion Various early postoperative complications may occur in the anterior cervical spine surgery. Adequate preoperative preparation, thorough understanding of anatomy related to the anterior approach,skilled surgical technique and perfect postoperative management may prevent the complications in anterior cervical spine surgery.

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

    OpenAIRE

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

    2011-01-01

    Background: Many studies offer excellent demonstration of the ability of bone morphogenic protein (BMP) to enhance fusion rates in anterior as well as posterior lumbar surgery. Recently, BMP has also been shown to increase arthrodesis rates in anterior cervical surgery, albeit with concomitant increases in complication rates. To date, however, few studies have investigated the safety and efficacy of BMP in cervical surgeries approached posteriorly. Methods: We retrospectively reviewed 204 con...

  14. Spinal surgery -- cervical - series (image)

    Science.gov (United States)

    ... on the vertebral bodies (osteophytes), which compress spinal nerves, trauma, and narrowing (stenosis) of the spinal column around the spinal cord. Symptoms of cervical spine problems include: pain that interferes with daily ...

  15. Anatomia microcirúrgica do nervo laríngeo recorrente: aplicações no acesso cirúrgico anterior à coluna cervical Microsurgical anatomy of the recurrent laryngeal nerve: applications on the anterior approach to the cervical spine

    Directory of Open Access Journals (Sweden)

    Aluízio Arantes

    2004-09-01

    Full Text Available OBJETIVO: Descrever a anatomia do nervo laríngeo recorrente (NLR bilateralmente, correlacionando-a com os prováveis mecanismos de lesão na abordagem cervical anterior. MÉTODO: Foram examinados 12 cadáveres de adultos provenientes do Laboratório de Microcirurgia da Faculdade de Medicina da UFMG. Os dados foram analisados em termos de freqüência, média e desvio-padrão. RESULTADOS: O NLR esquerdo teve comprimento total médio de 9,4 ± 1,6 cm. Penetra na laringe em 36,3% dos casos na altura de C5, 18,2% de C4, 18,2% de C5-C6, 18,2% de C6 e 9,1% de C4-C5. Recorre em 45,4% dos casos na altura de T3, 18,2% de T3-T4, 18,2% de T4 e 18,2% de T5. O NLR direito teve comprimento total médio de 5 ± 0,3 cm. Penetra na laringe em 44,4% dos casos na altura de C5, em 44,4% de C6 e 11,1% de C3-C4. Recorre em 60% dos casos na altura de T1, 30% de C7 e 10% de T2. CONCLUSÃO: O NLR direito encontra-se mais vulnerável a lesões operatórias por dois aspectos diferentes e complementares: trajetória e comprimento. Devido ao fato de apresentar trajetória mais oblíqua e desprotegida, não se relacionando de forma íntima com o sulco traqueoesofágico, existe maior possibilidade de ocorrerem traumas diretos, como a compressão por retratores ou a secção acidental, principalmente nas abordagens envolvendo níveis vertebrais mais baixos. Da mesma forma, o seu menor comprimento favorece o estiramento de suas fibras durante a tração per-operatória.OBJECTIVE: To present an anatomical description of the recurrent laryngeal nerve (RLN on both sides of the larynx as it relates to the possible lesion mechanisms in anterior cervical spine surgery. METHOD: Twelve adult cadavers were examined from the microsurgical laboratory at the School of Medicine at UFMG, MG, Brazil. The data collected were analyzed in terms of frequency, average and standard deviation. RESULTS: The left RLN had a total average length of 9.4 ± 1.6 cm entering the larynx in 36.3% of the

  16. Juxta-facet cysts: MR imaging

    International Nuclear Information System (INIS)

    The term juxta-facet cyst summarizes synovial cysts, arising from degenerated facet joints and ganglion cysts, developing from mucinous degeneration of periarticular connective tissue. Most juxta-facet cysts are observed at the L4/5 level, which generally has the most motion within the lumbar spine. In this retrospective study 31 juxta-facet cysts in 28 patients were detected within 2898 lumbar MRI studies over a 2-year period (frequency 1%). 24 patients complained of back and lower extremity pain, the other 4 patients had unilateral back pain. In 7 cases radicular symptoms were observed, in 6 patients a neurogenic claudication. In 78% of the patients juxta-facet cysts were responsible for clinical symptoms. MRI is the diagnostic imaging technique of choice due to a high sensitivity. The juxta-facet cysts were located extradural, laterally to the thecal sack and adjacent to a degenerated facet joint. In all but one cases the cysts showed a signal intensity equivalent to cerebrospinal fluid. T2-weighted pulse sequences in sagittal orientation were very useful in delineating the hypointense cyst wall. In 1 patient with acute radicular pain MRI demonstrated a subacute hemorrhage within a juxta-facet cyst. Calcifications and gas-filled cysts can be missed with MRI, but will be demonstrated by computed tomography. 45% of the juxta-facet cysts showed an enhancement of the cyst wall after injection of Gd-DTPA. Spontaneous reduction or resolution of the cyst may occur during rest. Injection of corticosteroids into the corresponding facet joint may reduce the inflammatory process and resolve the symptoms in up to 70%. Surgical resection of the cyst is indicated in case of intractable pain and significant neurologic deficit and generally produces good relief from radicular symptoms. (orig.)

  17. Posterior cervical foraminotomy: anatomic study in cadavers

    Directory of Open Access Journals (Sweden)

    Luizio Augusto Arantes Júnior

    2014-03-01

    Full Text Available OBJECTIVE: This study was designed to use different segments of the cervical spine in cadavers to determine how much lateral mass should be resected for adequate foraminal decompression. METHODS: Six cadavers were used. The region of the cervical spine from C1 to the C7-T1 transition was dissected and exposed. The lateral mass of each vertebra was measured bilaterally before the foraminotomy in the following segments: C2-C3, C3-C4, C4-C5, C5-C6 and C6-C7. The procedure was performed with a high-speed drill and through surgical microscopy. Three foraminotomies were performed (F1, F2, F3 in each level. Lateral masses were measured after foraminotomy procedures and compared to the initial measurement, creating a percentage of lateral mass needed for decompression.. The value of the entire surface was defined as 100%. RESULTS: There was a statistical difference between the amounts of the resected lateral mass through each foraminotomy (F1, F2, F3 at the same level. However, there was no statistical significant difference among the different levels. The average percentage of resection of the lateral masses in F2 were 27.7% at C2-C3, 24.8% at C3-C4, 24.4% at C4-C5 and 23.8% and 31.2% at C5-C6 and C6-C7, respectively. In F3, the level that needed greater resection of the lateral masses was C6-C7 level, where the average resection ranged between 41.2% and 47.9%. CONCLUSION: In all segments studied, the removal of approximately 24 to 32% of the facet joint allowed adequate exposure of the foraminal segment, with visualization of the dural sac and the exit of the cervical root.

  18. 儿童颈椎间盘钙化伴髓核疝(附八例报告)%Calcification of Intervertebral Discs in Cervical Spine With Herniation of Nucleus Pulposus in Children

    Institute of Scientific and Technical Information of China (English)

    王舒; 吴秀芬; 朱葆伦; 周坤祥

    1991-01-01

    儿童椎间盘钙化是一种具有较明确的临床症状及X线表现的综合征.病程经过良好,钙化可自然吸收.钙化可见于脊柱任何水平,但好发于颈部.作者报道8例儿童颈椎间盘钙化,6例伴有髓核前疝.结合文献报道,对本病的症状、X线表现等进行讨论.%Eight cases with calcification of intervertebral discs in cervical spine are reported.Among them,six had anterior herniation of the nucleus pulposus.Symptoms disappeared within one to four weeks after cervical traction.The calcification was gradually absorbed,but the adjacent vertebral alterations were still in existence on X-ray film one year later.The etiology,clinical.manifestations and X-ray findings are briefly discussed.

  19. Study Effect of Different Endotracheal Intubation General Anesthesia in High Cervical Spine Fracture With Cervical Spinal Cord Injury%不同气管插管全麻方式应用于高位颈椎骨折伴颈髓损伤的效果研究

    Institute of Scientific and Technical Information of China (English)

    刘卫忠

    2015-01-01

    Objective To investigate the effect of different endotracheal intubation and general anesthesia in high cervical spine fracture with cervical spinal cord injury.Methods 75 patients were randomly divided into three groups, and compared the cervical lfexion degree change, intubation time, the time of the exposure and the success rate of one intubation. Results The three groups of intubation time and glottic exposure time,t he laryngeal mask group intubation time and glottis exposure for the longest time, shikani laryngoscope group was the shortest,P0.05, had no difference statistically significance.Conclusion Shikani laryngoscope in high cervical spine fracture with cervical spinal cord injury of tracheal intubation with intubation laryngeal mask and direct laryngoscope has more advantages.%目的 探讨不同气管插管全麻方式应用于高位颈椎骨折伴颈髓损伤的效果.方法 将75例患者随机分为3组,并比较颈椎屈曲度变化、插管时间、声门显露时间和一次插管成功率.结果 3组插管时间和声门暴露时间比较,插管型喉罩组插管时间和声门暴露时间最长,视可尼喉镜组最短,P<0.05,差异具有统计学意义;在暴露声门时,视可尼喉镜组和插管型喉罩组颈椎屈曲度变化低于直接喉镜组,P<0.05,差异具有统计学意义,气管插入后,视可尼喉镜组颈椎屈曲度变化低于直接喉镜组,P < 0.05,差异具有统计学意义.三种方式在一次插管成功率方面对比,P > 0.05,差异不具有统计学意义.结论 视可尼喉镜在高位颈椎骨折伴颈髓损伤气管插管中较插管性喉罩和直接喉镜有更优势.

  20. Análise radiográfica da coluna cervical em indivíduos assintomáticos submetidos a tração manual Radiographic analysis of the cervical spine in healthy individuals submitted to manual traction

    Directory of Open Access Journals (Sweden)

    Roger Burgo de Souza

    2008-08-01

    Full Text Available OBJETIVO: Avaliar, radiograficamente, o efeito da tração manual sobre o comprimento da coluna cervical. MATERIAIS E MÉTODOS: Cinqüenta e cinco participantes de ambos os gêneros - 12 masculinos (22% e 43 femininos (78% - sem história de distúrbios cervicais contituíram a amostra deste estudo. Eles foram submetidos a dois procedimentos radiológicos, um antes e outro durante a tração manual sustentada por 120 segundos. As distâncias entre as bordas anteriores e posteriores da segunda à sétima vértebras cervicais foram mensuradas e comparadas antes e durante a tração manual. RESULTADOS: A mediana da distância anterior antes da tração foi de 8,40 cm e durante a tração aumentou para 8,50 cm (p=0,002. A mediana da distância posterior antes da tração foi de 8,35 cm e durante a tração aumentou para 8,50 cm (pOBJECTIVE: To evaluate radiographically the effect of manual traction on the length of the cervical spine in healthy individuals. MATERIALS AND METHODS: The sample of the present study included 55 individuals - 12 men (22% and 43 women (78% - with no previous history of cervical disorders, submitted to two radiological procedures previously and during manual traction sustained for 120 seconds. Distances between the anterior and posterior edges from the second to the seventh cervical vertebrae were measured and compared before and during manual traction. RESULTS: The median of pre-traction anterior length was 8.40 cm, increasing to 8.50 cm during the traction (p=0.002; and the median of pre-traction posterior length was 8.35 cm, increasing to 8.50 cm during traction (p<0.001. CONCLUSION: Application of manual traction resulted in a statistically significant increase in the length the cervical spine in healthy individuals.

  1. Surgical Treatment Experience of Cervical Spine Fracture Complicated With Spinal Cord Injury%颈椎骨折伴脊髓损伤的手术治疗体会

    Institute of Scientific and Technical Information of China (English)

    赵光远

    2015-01-01

    目的:对颈椎骨折伴脊髓损伤的手术治疗效果进行分析,并将手术治疗体会进行总结。方法对于2013年9月~2014年6月期间在我院接受手术治疗的35例颈椎骨折脱位伴脊髓损伤患者的手术资料进行回顾性分析,并对手术治疗方法、临床效果以及治疗体会进行分析总结。结果23例患者行颈前路椎间盘及部分椎体切除脊髓减压术,8例患者行后路双开门椎管扩大减压手术,4例患者行一期后、前路手术;本次治疗的总有效率为91.4%,半年后患者的脊髓功能优良率为94.3%。结论对颈椎骨折脱位伴脊髓损伤患者有针对性的选择适宜的手术方式治疗能够取得显著的治疗效果,有利于患者感觉功能、脊髓功能的恢复。%Objective To analyze surgical effect in treatment of cervical spine fracture complicated with spinal cord injury and then summarizes its surgical treatment experience. Methods Selected from 35 patients of cervical spine fracture complicated with spinal cord injury who were treated with surgical treatment in hospital from September 2013 to June 2014 and then summarized surgical treatment approach,its clinical effect and treatment experience. Results There are 23 cases of patients operated with treatment of anterior cervical disc combined with partial corpectomy decompression of spinal cord,and 8 cases of patients treated with posterior double-door vertebra expanded decompression surgery,and 4 cases of patients underwent anterior operation of 1st stage,treatment efficiency rate was up to 91.4% in current,and patients’spinal function excel ence rate was 94.3% after half a year treatment. Conclusion Adopting proper surgical treatment to cure patients of cervical spine fracture complicated with spinal cord injury is conducive to patients’ sense recovery as wel as spinal function recovery.

  2. Análise radiográfica do tratamento cirúrgico da fratura cervical baixa por via posterior Evaluación radiográfica de la fijación posterior de la fractura de la columna cervical baja Radiographic evaluation of the posterior fixation in the subaxial cervical spine injury

    Directory of Open Access Journals (Sweden)

    Nelson Astur Neto

    2012-01-01

    érdida de la reducción, la cifosis segmentaria, la degeneración de nivel adyacente y la pseudoartrosis. RESULTADOS: En comparación con el método de síntesis, 60,8% de los pacientes se sometieron a fijación por cableado interespinoso, 26% a la placa con tornillos de masa lateral y 13% a la barra con tornillos de masa lateral. De los pacientes sometidos a fijación con tornillos, ninguno presentó complicaciones radiográficas y 35,7% de los pacientes sometidos a la fusión con el cableado interespinoso presentaron complicaciones, siendo la cifosis segmentaria la más frecuente. CONCLUSIÓN: Las lesiones de columna cervical sometidas a la fusión con el tornillo de masa lateral presentaron una evolución radiográfica mejor que las de quienesfueron sometidos a fijación con cableado interespinoso, esta última presentó una mayor incidencia de complicaciones en la artrodesis.OBJECTIVE: To perform a radiographic evaluation of the cervical spine injury treated with posterior fixation techniques only. METHODS: From 2000 to 2008, twenty three patients were included in the study, of which 91,3% were men, with a mean age of thirty-four years and four months. The mean follow-up time was 82 months. The type of implant used, the radiographic arthrodesis consolidation, implant failure, lost of reduction, segmental kyphosis and pseudarthrosis were evaluatedin the preoperative period, the immediate postoperative period and after six months of evolution, based on the patients records. RESULTS: When it comes to the type of implant used, there were 60,8% of the patients who underwent interspinous wire fixation, 26% with lateral mass screws and plate and 13% with lateral mass screws and rods. Of the lateral mass screws patients, none had radiographic complications and 35,7% of the interspinous wire patients had complications being the segmental kyphosis the most frequent of them. CONCLUSIONS: The cervical spine injuries that underwent lateral mass screw fixation showed better

  3. Cervical spinal cord compression after thyroidectomy under general anesthesia.

    Science.gov (United States)

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

    2014-02-01

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

  4. Cervical motion segment replacement

    OpenAIRE

    Bryan, Vincent E.

    2002-01-01

    When symptoms bring to light a cervical spine degenerative disc process that requires surgical intervention, a symptom relieving procedure such as decompression, followed by functional restoration, arthroplasty, offers the benefit of prophylaxis of accelerated spondylosis at the operated level. In addition, by altering the biomechanical stress factors at adjacent levels, theoretically it should offer prophylactic benefit at these levels as well. The design requirements for a cervical disc pro...

  5. [The question of radiation exposure of the cervical spine in analgesic roentgen irradiation of therapy-resistant humero-scapular periarthritis associated with local cervical syndrome and/or cervicobrachial syndrome].

    Science.gov (United States)

    Hoenle, R

    1985-08-01

    An improvement is achieved by palliative X-ray irradiation in about 70% out of 47 patients with scapulohumeral periarthritis and local cervical syndrome and/or cervicobrachial syndrome which was hitherto resistant to medicomechanical treatment. Higher rates of success (84%) can be achieved if the patients present an identical symptomatology, but less severe alterations of the vertebral column, even if the vertebral column is not irradiated. In case of severe alterations of the vertebral column, the success of palliative irradiation is diminished, even if the cervical vertebral column is additionally irradiated. PMID:2411026

  6. Effects of the Patients with Cervical Spinal Cord Injury undergoing Tracheal Intubation with Cervical Spine Manual-in-line Immobilizationunder Videolaryngoscopy%可视喉镜下手工中立位气管插管对颈髓损伤患者的影响

    Institute of Scientific and Technical Information of China (English)

    伍元川; 姚爱军; 熊珠取

    2013-01-01

    目的:观察可视喉镜下手工中立位全麻气管插管对颈椎颈髓手术患者术中血流动力学以及术后并发症的影响.方法:选择60例全麻手术患者,随机分为两组,每组30例,即直视喉镜组(对照组),手工中立位可视喉镜组(研究组).对两组患者分别使用直视喉镜、手工中立位可视喉镜进行气管插管,比较两组患者首次插管成功率、围插管期血流动力学及术后24h咽喉部并发症发生率.结果:与直视喉镜组比较,可视喉镜组首次插管成功率明显提高(P <0.05)、围插管期血流动力学波动幅度更小(P <0.05),术后咽喉部并发症发生率降低(P <0.05).结论:与直接喉镜相比,手工中立位可视喉镜可以缩短气管插管的用时,改善围插管期血流动力学波动,减轻咽喉部的损伤.%Objective: To investigate the effects of postoperative laryngopharyngeal complications of the patients with cervical spine surgery undergoing tracheal intubation with cervical spine manual-in-line immobilization under videolaryngoscopy. Method: 60 patients requiring general anesthesia were randomly divided into two groups( n = 30 each ), namely, direct laryngoscopy group ( group A ), videolaryngoscopy group ( group B ). Patients were randomly allocated to intubation with videolaryngoscopy or direct laryngoscopy. The number of intubation attempts, hemodynamic parameters and the incidence of postoperative laryngopharyngeal complications were recorded. Result: Compared with group A, patients' airways were successfully managed on the first attempt in group B ( P<0. 05 ), hemodynamic instability were better during intubation ( P<0. 05 ), and the incidence of postoperative laryngopharyngeal complications decreased ( P<0. 05 ). Conclusion : Compared with direct laryngoscopy, cervical spine manual-in-line immobilization under videolaryngoscopy can improve the speed or ease of intubations and attenuate the laryngopharyngeal injury.

  7. Effect of anterior cervical spine surgery on inflammatory cytokines for cervical spondylotic myelopathy%颈椎前路手术对脊髓型颈椎病患者椎间盘组织中炎性细胞因子的影响

    Institute of Scientific and Technical Information of China (English)

    李翔; 戴志唐; 常新; 戴璐

    2011-01-01

    目的 探讨颈椎前路手术对脊髓型颈椎病(CSM)患者椎间盘组织中炎性细胞因子的影响.方法 35例脊髓型颈椎病患者(CSM组)和30例颈椎外伤患者(对照组)均行颈椎前路手术治疗,观察治疗效果.采用固相分离放射免疫分析法(SPRIA)测定两组颈椎间盘组织中白细胞介素(IL)-6、IL-8、肿瘤坏死因子(TNF)-α水平.结果病程≤6个月组优良率为81.8%,病程>6个月组优良率为38.5%,两组优良率比较差异有统计学意义(P<0.05);CSM患者术前JOA评分为(9.73±2.12)分,术后JOA评分为(14.21±2.52)分,术后JOA评分显著高于术前(P<0.05);CSM组颈椎间盘中IL-6、IL-8、TNF-α水平均显著高于对照组(P<0.05).结论 颈椎前路手术是治疗CSM的一种较有效手术方法;IL-6、IL-8、TNF-α在颈椎间盘退变和CSM发病中起重要作用.%Objective To explore the effect of anterior cervical spine surgery on inflammatory cytokines for cervical spondylotic myelopathy (CSM).Methods Thirty cases of CSM ( CSM group) and 30 cases of cervical trauma (control group) were given the anterior cervical spine surgery.The CID IL-6,IL8 and tumor necrosis factor (TNF)-α levels were detected by solid phase radioimmunoassay.The patients of CSM were followed up for the clinical efficacy and courses of disease were analyzed.Results The excellent rate in course of disease ≤ 6 months group and the course of disease > 6 months group was 81.8% and 38.5% respectively (P < 0.05 ).The preoperative and postoperative JOA scores in patients with CSM were (9.73 ±2.12) and (14.21 ±2.52) respectively (P<0.05).The CID IL-6,IL-8 and TNF-α levels in CSM group were significantly higher than in control group (P < O.05 ).Conclusion The anterior cervical spine surgery is an effective surgical treatment for CSM.The IL-6,IL-8 and TNF-α may play important roles in cervical disc degeneration and CSM.

  8. Endoscopic Facet Debridement for the treatment of facet arthritic pain - a novel new technique

    Directory of Open Access Journals (Sweden)

    Scott M.W. Haufe, Anthony R. Mork

    2010-01-01

    Full Text Available Study design: Retrospective, observational, open label. Objective: We investigated the efficacy of facet debridement for the treatment of facet joint pain. Summary of background data: Facet joint disease, often due to degenerative arthritis, is common cause of chronic back pain. In patients that don't respond to conservative measures, nerve ablation may provide significant improvement. Due to the ability of peripheral nerves to regenerate, ablative techniques of the dorsal nerve roots often provide only temporary relief. In theory, ablation of the nerve end plates in the facet joint capsule should prevent reinnervation. Methods: All patients treated with endoscopic facet debridement at our clinic from 2003-2007 with at least 3 years follow-up were included in the analysis. Primary outcome measure was percent change in facet-related pain as measured by Visual Analog Scale (VAS score at final follow-up visit. Results: A total of 174 people (77 women, 97 men; mean age 64, range 22-89 were included. Location of facet pain was cervical in 45, thoracic in 15, and lumbar in 114 patients. At final follow-up, 77%, 73%, and 68% of patients with cervical, thoracic, or lumbar disease, respectively, showed at least 50% improvement in pain. Mean operating time per joint was 17 minutes (range, 10-42. Mean blood loss was 40 ml (range, 10-100. Complications included suture failure in two patients, requiring reclosure of the incision. No infection or nerve damage beyond what was intended occurred. Conclusions: Our results demonstrate a comparable efficacy of endoscopic facet debridement compared to radiofrequency ablation of the dorsal nerve branch, with durable results. Large scale, randomized trials are warranted to further evaluate the relative efficacy of this surgical treatment in patients with facet joint disease.

  9. 330名大学生颈椎亚健康现状及相关因素的调查分析%Investigation and Analysis of Related Factors of 330 College Students’ Sub-Health Cervical Spine

    Institute of Scientific and Technical Information of China (English)

    王彩鸾; 杨彩梅; 岳剑英; 林次义; 陈松江; 聂晨; 林志萍

    2014-01-01

    目的:了解莆田学院在校大学生颈椎亚健康现状、疲劳程度及抑郁程度,分析其之间的关系。了解大学生日常生活中常见的不良习惯及校内针对颈椎病的相关健康教育现状。为开展健康教育提供依据。方法采用分层整群抽样的方法,随机抽三个院系共6个班级对不良习惯、颈椎亚健康、疲劳程度及抑郁程度进行调查。结果使用 SPSS17.0统计软件进行独立样本 t 检验、秩和检验、二分类条件 Logistic 回归分析。结果颈椎亚健康的同学有105人(占34.7%),非颈椎亚健康的同学有198人(占65.3%)。躯体疲劳、脑力疲劳和抑郁程度与颈椎亚健康的关系均有统计学意义(P<0.05)。有78.2%的同学没有接受过相关的健康教育,有98.3%认为学校开展的相关教育是不够的。结论发生颈椎亚健康的同学不在少数,其中躯体疲劳、脑力疲劳和抑郁程度均是其发生颈椎亚健康的影响因素。学校开展的相关健康教育明显过少。%Objective To get insights into college students’ spine sub-health status, degree of fatigue and depression in Putian U-niversity and analyze the relationships between them. To provide a basis for carrying out health education with knowledge of college students’ common bad habits in daily life and the relevant health campus education related to cervical spondylosis. Methods By using stratified cluster sampling method to randomly pick 6 classes from three departments and conduct the survey of bad habits, cervical sub-health, fatigue and depression degree. And then SPSS17. 0 statistical software was used for independent sample t-test, rank, inspec-tion, binary classification conditional logistic regression analysis. Result The result showed that there were 105 cervical healthy students, which took up 34. 7% of the whole number of students, the rest 198 students (65. 3% ) were not cervical sub-healthy. The relationships between physical

  10. Load and speed effects on the cervical flexion relaxation phenomenon

    OpenAIRE

    Descarreaux Martin; Cantin Vincent; Lafond Danik; Pialasse Jean-Philippe

    2010-01-01

    Abstract Background The flexion relaxation phenomenon (FRP) represents a well-studied neuromuscular response that occurs in the lumbar and cervical spine. However, the cervical spine FRP has not been investigated extensively, and the speed of movement and loading effects remains to be characterized. The objectives of the present study were to evaluate the influence of load and speed on cervical FRP electromyographic (EMG) and kinematic parameters and to assess the measurement of cervical FRP ...

  11. CT anatomy of the spine

    International Nuclear Information System (INIS)

    Effective CT scanning of the spine requires gantry opening greater than 50 cm, spatial resolution of less than 1 mm, contrast resolution of better than 0.5%, and a method for exact localization and selection of cut levels. With a suitable scanner, excellent images of the intervertebral disc, dural sac, spinal cord, facet joints, ligamentum flavum, and epidural veins can be obtained. The purpose of this report is to describe the normal CT appearance of the spinal soft tissues. (orig.)

  12. Management of delayed posttraumatic cervical kyphosis.

    Science.gov (United States)

    Lopez, Alejandro J; Scheer, Justin K; Abode-Iyamah, Kingsley; Smith, Zachary A; Hitchon, Patrick W; Dahdaleh, Nader S

    2016-01-01

    We describe three patients with misdiagnosed unstable fractures of the cervical spine, who were treated conservatively and developed kyphotic deformity, myelopathy, and radiculopathy. All three patients were then managed with closed reductions by crown halo traction, followed by instrumented fusions. Their neurologic function was regained without permanent disability in any patient. Unstable fractures of the cervical spine will progress to catastrophic neurologic injuries without surgical fixation. Posttraumatic kyphosis and the delayed reduction of partially healed fracture dislocations by preoperative traction are not well characterized in the subaxial cervical spine. The complete evaluation of any subaxial cervical spine fracture requires CT scanning to assess for bony fractures, and MRI to assess for ligamentous injury. This allows for assessment of the degree of instability and appropriate management. In patients with delayed posttraumatic cervical kyphosis, preoperative closed reduction provided adequate realignment, facilitating subsequent operative stabilization. PMID:26321304

  13. Association of miR-146a, miR-149, miR-196a2, and miR-499 Polymorphisms with Ossification of the Posterior Longitudinal Ligament of the Cervical Spine

    Science.gov (United States)

    Jeon, Young Joo; Kumar, Hemant; Sohn, Seil; Min, Hyoung Sik; Lee, Jang Bo; Kuh, Sung Uk; Kim, Keung Nyun; Kim, Jung Oh; Kim, Ok Joon; Ropper, Alexander E.; Kim, Nam Keun; Han, In Bo

    2016-01-01

    Background Ossification of the posterior longitudinal ligament (OPLL) of the spine is considered a multifactorial and polygenic disease. We aimed to investigate the association between four single nucleotide polymorphisms (SNPs) of pre-miRNAs [miR-146aC>G (rs2910164), miR-149T>C (rs2292832), miR-196a2T>C (rs11614913), and miR-499A>G (rs3746444)] and the risk of cervical OPLL in the Korean population. Methods The genotypic frequencies of these four SNPs were analyzed in 207 OPLL patients and 200 controls by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay. Findings For four SNPs in pre-miRNAs, no significant differences were found between OPLL patients and controls. However, subgroup analysis based on OPLL subgroup (continuous: continuous type plus mixed type, segmental: segmental and localized type) showed that miR-499GG genotype was associated with an increased risk of segmental type OPLL (adjusted odds ratio = 4.314 with 95% confidence interval: 1.109–16.78). In addition, some allele combinations (C-T-T-G, G-T-T-A, and G-T-C-G of miR-146a/-149/-196a2/-499) and combined genotypes (miR-149TC/miR-196a2TT) were associated with increased OPLL risk, whereas the G-T-T-G and G-C-C-G allele combinations were associated with decreased OPLL risk. Conclusion The results indicate that GG genotype of miR-499 is associated with significantly higher risks of OPLL in the segmental OPLL group. The miR-146a/-149/-196a2/-499 allele combinations may be a genetic risk factor for cervical OPLL in the Korean population. PMID:27454313

  14. Cervical injuries scored according to the Subaxial Injury Classification system: An analysis of the literature

    Directory of Open Access Journals (Sweden)

    Andrei F Joaquim

    2014-01-01

    Full Text Available Introduction: The Subaxial Injury Classification (SLIC system and severity score has been developed to help surgeons in the decision-making process of treatment of subaxial cervical spine injuries. A detailed description of all potential scored injures of the SLIC is lacking. Materials and Methods: We performed a systematic review in the PubMed database from 2007 to 2014 to describe the relationship between the scored injuries in the SLIC and their eventual treatment according to the system score. Results: Patients with an SLIC of 1-3 points (conservative treatment are neurologically intact with the spinous process, laminar or small facet fractures. Patients with compression and burst fractures who are neurologically intact are also treated nonsurgically. Patients with an SLIC of 4 points may have an incomplete spinal cord injury such as a central cord syndrome, compression injuries with incomplete neurologic deficits and burst fractures with complete neurologic deficits. SLIC of 5-10 points includes distraction and rotational injuries, traumatic disc herniation in the setting of a neurological deficit and burst fractures with an incomplete neurologic deficit. Conclusion: The SLIC injury severity score can help su