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Sample records for cervical spine pain

  1. 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

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

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

    2015-01-01

    Upper cervical spine fractures can be caused by very low-energy traumas, and the clinical presentation can vary from mild neck pain to paraplegia and ultimately to death. The most common cause of these fractures is trauma but degenerative and pathologic aetiology is also seen. Upper cervical spin...

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

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    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.

  4. Thoracic spine pain

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    Aleksey Ivanovich Isaikin

    2013-01-01

    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.

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

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

    2004-01-01

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

  7. [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.

  8. [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

  9. The degenerative cervical spine.

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    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

  10. Cervical spine chordoma

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    Díez-González L

    2012-03-01

    Full Text Available Chordomas are neoplasms that arise from notochord embryonic remnants, been the sacrococcygeal spine the main site of involvement; the cervical spine site is uncommon and it account for less than 10% of chordomas. Because of their slow growth, the diagnosis is delayed until they reach a large size, despite which they are locally aggressive tumours due to their relation to critical neurovascular structures and present a high rate of local recurrence. Radical surgery is the elective treatment and proton radiotherapy is used when residual tumour tissue and recurrences.Because of the uncommonness of this pathology, we report a case of a patient with cervical chordoma.

  11. Hemangiopericytoma of the cervical spine

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    Raghvendra V Ramdasi

    2014-01-01

    Full Text Available A 28-year-old male presented with neck pain and dysesthesias in the right upper limb. On examination, he had a firm, well-defined midline posterior cervical mass discernible on palpation at the mid-cervical level. He had no neurological deficit. Neuroradiology revealed a variegated enhancing cervical mass is arising from C3 lamina. The mass extended into the right extradural space eroding the C3 lamina and posteriorly into the intermuscular plane. The tumor was excised totally. Histopathology of the tumor showed features of hemangiopericytoma (HPC. The patient underwent postoperative radiotherapy. Primary osseous spinal HPC are rare malignant extra-axial tumors that tend to recur and metastasize. Only two cases of primary osseous HPC have been reported earlier to involve the cervical spine. The clinical presentation and management of the present case with a review of the literature is presented.

  12. [Pediatric orthopedic cervical spine problems].

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    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

  13. Unusual cervical spine epidural abscess.

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    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

  14. 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...

  15. Imaging of cervical spine injuries of childhood

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

    2007-06-15

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

  16. Cervical spine in Treacher Collins syndrome.

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

    2012-05-01

    Treacher Collins syndrome is a congenital syndrome with characteristic craniofacial malformations, which are well described in the literature. However, the presence of cervical spine dysmorphology in this syndrome has been minimally described. This study reviews cervical spine radiographs of 40 patients with Treacher Collins syndrome. In this sample, 7 of 40 patients displayed cervical spine anomalies, with 3 of these patients displaying multiple cervical spine anomalies. The patterns of spinal anomalies were variable, suggesting that the underlying genetic mutation has variable expressivity in cervical spine development as it does elsewhere in the craniofacial skeleton.

  17. Cervical Spine Instrumentation in Children.

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    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

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

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    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

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

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

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    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

  2. Traumatic cervical spine fractures in the adult.

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    Copley, Phillip; Tilliridou, Vicky; Jamjoom, Aimun

    2016-09-01

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

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

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    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.

  4. Cervical Spine Axial Rotation Goniometer Design

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    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. Percutaneous vertebroplasty for multiple myeloma of the cervical spine

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    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.)

  6. Cervical spine injuries in rugby players.

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    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. Cervical spine and crystal-associated diseases: imaging findings

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

    2006-02-01

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

  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. 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...

  12. 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...

  13. Posterior approach to the degenerative cervical spine

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    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...

  14. 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...

  15. 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 ...

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

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

    2010-11-01

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

  17. 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.)

  18. 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.)

  19. 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.

  20. 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...

  1. 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,...

  2. How to image patients with spine pain

    International Nuclear Information System (INIS)

    Highlights: • Imaging plays and important role for the evaluation of patients with spine pain. • MRI is the best method to evaluateintraspinal lesions, soft tissue and ligaments. • CT of the spine is useful to evaluate bony structures. - Abstract: Different radiological methods play an important role in the work-up of patients complaining of spine pain. Depending on the symptoms and the suspected underlying etiology different methods are selected. In the following presentation we briefly present the different radiological and magnetic resonance tomography methods that are at hand, give some guidance in which method to use, and present the typical imaging findings in some of the most common conditions that presents with spine pain

  3. How to image patients with spine pain

    Energy Technology Data Exchange (ETDEWEB)

    Siemund, R. [Department of Diagnostic Radiology, Institution of Clinical Sciences Lund, Lund Univeristy, Lund (Sweden); Thurnher, M. [Department of Diagnostic Radiology, Institution of Clinical Sciences Lund, Lund Univeristy, Lund (Sweden); Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna (Austria); Sundgren, P.C., E-mail: Pia.sundgren@med.lu.se [Department of Diagnostic Radiology, Institution of Clinical Sciences Lund, Lund Univeristy, Lund (Sweden)

    2015-05-15

    Highlights: • Imaging plays and important role for the evaluation of patients with spine pain. • MRI is the best method to evaluateintraspinal lesions, soft tissue and ligaments. • CT of the spine is useful to evaluate bony structures. - Abstract: Different radiological methods play an important role in the work-up of patients complaining of spine pain. Depending on the symptoms and the suspected underlying etiology different methods are selected. In the following presentation we briefly present the different radiological and magnetic resonance tomography methods that are at hand, give some guidance in which method to use, and present the typical imaging findings in some of the most common conditions that presents with spine pain.

  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.

  5. Vertebroplasty for Spine Fracture Pain

    Science.gov (United States)

    ... make the bone stronger. Sometimes, patients may need surgery to secure the spine using a bone graft or an internal metal ... bone is safe. Patients with tumors on the spine may be at slightly higher risk of complications. You should always discuss the risks of any ...

  6. 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

  7. 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.

  8. Successful Treatment of Severe Sympathetically Maintained Pain Following Anterior Spine Surgery

    OpenAIRE

    Woo, Jae Hee; Park, Hahck Soo

    2014-01-01

    Sympathetic dysfunction is one of the possible complications of anterior spine surgery; however, it has been underestimated as a cause of complications. We report two successful experiences of treating severe dysesthetic pain occurring after anterior spine surgery, by performing a sympathetic block. The first patient experienced a burning and stabbing pain in the contralateral upper extremity of approach side used in anterior cervical discectomy and fusion, and underwent a stellate ganglion b...

  9. 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.

  10. Research on the correlation between the physiological curvature of the cervical spine and Northwick Park neck pain scale on the teenagers with cervical vertebra disease relapse stage%颈椎生理曲度在青少年颈椎病复发阶段与Northwick Park颈痛量表的相关性研究

    Institute of Scientific and Technical Information of China (English)

    王宇澄; 房纬; 张玮

    2013-01-01

    [目的]探讨颈椎生理曲度在青少年颈椎病的复发阶段与Northwick Park颈痛量表的相关性.[方法]将人选的95例患者分为试验组(整脊疗法组)和对照组(理筋手法组),疗程20 d,治疗后1、2、3个月后进行随访,以Northwick Park颈痛量表(NPQ)及颈椎生理曲度恢复情况为观察指标,观察每组各阶段治疗前后和组间客观指标的变化.[结果]经治疗有效病例纳入复发评价,经统计学分析显示颈椎生理曲度改善情况与NPQ呈较强相关性.[结论]颈椎生理曲度异常可能是导致青少年颈椎病反复发病的关键因素.%[Objective] To investigate the correlation between the physiological curvature of the cervical spine and Northwick Park neck pain scale (NPQ) on the teenagers with cervical vertebra disease relapse stage. [Methods] The 95 patients were randomly divided into two groups, 20 days for a course of treatment and follow-up after treatment for 1, 2, 3 months, NPQ and physiological curvature as the e-valuation index and compared the treatment efficacy of the two groups of patients. [Results] The statistical analysis showed that the physiological curvature of the cervical spine and NPQ showed strong correlation in effective treatment of recurrent cases into evaluation. [Conclusion] The physiological curvature of the cervical spine may be the key factors that lead to recurrent disease of teenagers with cervical vertebra disease.

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

    Science.gov (United States)

    Herman, Martin J

    2006-01-01

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

  12. 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...

  13. 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...

  14. 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.

  15. 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.)

  16. 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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-04-01

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

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

    Science.gov (United States)

    Oh, Jason Jaeseong; Asha, Stephen Edward

    2016-04-01

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

  20. 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

  1. 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

  2. 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...

  3. 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

  4. 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.

  5. 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

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

    Science.gov (United States)

    Wójcik, Małgorzata; Siatkowski, Idzi

    2015-04-01

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

  7. MRI Findings of Cervical Spine Lesions among Symptomatic Patients and Their Risk Factors

    Directory of Open Access Journals (Sweden)

    J. Amir orang

    2003-06-01

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

  8. 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...

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

    Energy Technology Data Exchange (ETDEWEB)

    Dai Liyang E-mail: lydai@etang.com

    2004-07-01

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

  10. 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

  11. 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

  12. Insufficient pain management after spine surgery

    DEFF Research Database (Denmark)

    Nielsen, Rikke Vibeke; Fomsgaard, Jonna Storm; Dahl, Jørgen Berg;

    2014-01-01

    INTRODUCTION: A prospective observational quality assurance study was performed at Glostrup Hospital, Denmark, to describe patients undergoing spine surgery with regard to perioperative analgesic management, post-operative pain, opioid consumption and side effects. MATERIAL AND METHODS: Patients...... eligible for the study were identified consecutively from the operation chart. The following data were registered: post-operative visual analogue (VAS) pain score at rest and during mobilisation, opioid consumption for the first 24 h, other analgesics administered and side effects. RESULTS: A total of 87...... patients were included. For instrumented lumbar fusion patients (n = 24), the VAS pain scores at 1, 4 and 24 h after surgery were (median (interquartile range)) 5 (0-7), 2.5 (0-8) and 5.5 (0-9) at rest and 5 (0-8), 3 (0-9) and 7 (3-9) during mobilisation, respectively. The other surgical subgroups...

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

    Science.gov (United States)

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

    2014-06-01

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

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

    Science.gov (United States)

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

    2015-07-01

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

  15. [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

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

    Science.gov (United States)

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

    2013-01-01

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

  17. Osteoid Osteoma of Cervical Spine in two adjacent Vertebrae

    Directory of Open Access Journals (Sweden)

    MR Etemadifar

    2005-09-01

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

  18. 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.

  19. 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.

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

    Science.gov (United States)

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

    2016-01-01

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

  1. 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.)

  2. [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

  3. 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.

  4. 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...

  5. 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...

  6. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-11-01

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

  8. 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

  9. [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

  10. 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.

  11. 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

  12. [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

  13. 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].

  14. 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.

  15. The transoral approach to the cervical spine.

    Science.gov (United States)

    Morgan, S; Murphy, G

    1992-10-01

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

  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. 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.)

  18. 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.)

  19. 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.

  20. 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

  1. 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

    Energy Technology Data Exchange (ETDEWEB)

    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.).

  2. [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

  3. 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.

  4. 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.

  5. 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.

  6. 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, ...

  7. 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

  8. 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.

  9. 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...

  10. Non degenerative disease in MRI cervical spine of symptomatic patients

    Directory of Open Access Journals (Sweden)

    Dan B Karki

    2016-01-01

    Full Text Available Background & Objectives: The most common etiology of neck pain is degenerative disc disease, however non-degenerative disease can be important cause of neck pain. This study aims to study the non-degenerative findings in cervical MRI in symptomatic patients with neck and radicular pain.Materials & Methods: The study was a institutional record based retrospective study performed for the duration of 3 years. MRI performed for patients with neck pain and/ or radiculopathy were reviewed. Patients with post operative findings were excluded from the study. Statistical analysis was done using SPSS 21.0.Results: A total of 721 MRI were performed for neck pain and radiculopathy, among which 91 (12.13% cases had non-degenerative changes. Most common non degenerative change was traumatic lesions followed by neoplastic lesions and syrinx. Traumatic lesions were more common in males as compared to females. Infection was more common in females as compared to males. C5 and C6 vertebrae were most common vertebra involved in trauma and infection. Some cases like signal change in spinal cord, and syrinx were also noted in our study.Conclusion: Non degenerative cause of neck pain were less common but important cause of neck pain. Traumatic lesions were the most common cause of non degenerative neck pain.Journal of College of Medical Sciences-Nepal, Vol.11(4 2015: 20-23

  11. 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.

  12. Cervical disc herniation presenting with neck pain and contralateral symptoms: a case report

    Directory of Open Access Journals (Sweden)

    Yeung Jacky T

    2012-06-01

    Full Text Available Abstract Introduction Cervical disc herniation often results in neck and arm pain in patients as a result of direct impingement of nerve roots and associated inflammatory processes. The clinical presentation usually corresponds with the side of herniation and ipsilateral symptoms predominate the clinical picture. Case presentation A 35-year-old Caucasian man presented to our facility with neck pain and left-sided upper and lower extremity pain. A magnetic resonance imaging scan revealed a right paramedian herniated disc at the C5 to C6 level. All other cervical levels were normal without central canal stenosis or neural foraminal stenosis. Results from magnetic reasonance imaging scans of the brain and lumbar spine were negative. An anterior cervical discectomy was performed at the C5 to C6 level, and an inter-body graft and plate were placed. Our patient had complete resolution of his neck and left arm pain. Conclusions Anterior discectomy and fusion of the cervical spine resulted in complete resolution of our patient’s neck and left arm symptoms and improvement of his contralateral left leg pain. Cervical disc herniation may present with contralateral symptoms that are different from the current perception of this disease.

  13. 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.

  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.

    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

  16. 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

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

    Science.gov (United States)

    Whyte Ferguson, Lucy

    2014-10-01

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

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

    Science.gov (United States)

    Whyte Ferguson, Lucy

    2014-10-01

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

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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)

  4. 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...

  5. 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...

  6. 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 ...

  7. 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 ...

  8. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. [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

  11. 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

  12. 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

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

    International Nuclear Information System (INIS)

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

  14. 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.

  15. Effectiveness of Acupuncture Treatment in Cervical Pain.

    Directory of Open Access Journals (Sweden)

    Norma Ríos García

    2012-09-01

    Full Text Available A study is performed, longitudinal, prospective, descriptive in patients who attended the consultation of The Health Center With Beds (CSCC of Torbeck, in the Southern Department of Haiti, in order to determine the effectiveness of acupuncture treatment in patients with cervical pain, in the period between January and June 2011. We studied a universe of 73 patients and a sample of 60 patients, from these persons 30 used drug therapy (Group B and 30 patients which used acupuncture (Group A. We note that in both groups, the females were the most affected, with a prevalence between 31 and 60. The main symptom for both groups was pain (100%. Patients who were administered the acupuncture successfully evolved between the second and fourth days of starting treatment and patients in group B between 5 and 6 days. Acupuncture is an effective therapy in the management of neck pain, with few adverse reactions of the patient and drug zero cost.

  16. 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...

  17. Chordoma of the low cervical spine presenting with Horner's syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Leone, Antonio [Department of Radiology, Universita Cattolica, School of Medicine, Policlinico ' ' Agostino Gemelli' ' , Largo Agostino Gemelli, 8, 00168 Rome (Italy); Cerase, Alfonso [Unit of Diagnostic and Therapeutic Neuroradiology, Azienda Ospedaliera Senese, Siena (Italy); InterDepartmental Center of Magnetic Resonance, Policlinico ' ' Le Scotte' ' , Siena (Italy); Tarquini, Elisabetta; Mule, Antonio [Department of Pathology, Universita Cattolica, School of Medicine, Policlinico ' ' Agostino Gemelli' ' , Largo Agostino Gemelli, 8, 00168 Rome (Italy)

    2002-07-01

    Chordomas arising from the low cervical spine have been reported rarely. This case report expands the knowledge of chordomas of the low cervical spine by reporting the clinical, radiological, and pathological findings of a case of chordoma arising from C6 vertebra in a 61-year-old man presenting with left Horner's syndrome. This clinical presentation is uncommon for cervical chordomas and resulted from the tumor growth in the left carotid space resulting in the total encasement of common carotid artery and involvement of sympathetic fibers ipsilaterally. (orig.)

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

    Science.gov (United States)

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

    2014-08-01

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

  19. 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

  20. 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

  1. 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

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

    Science.gov (United States)

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

    2016-07-01

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

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

    Science.gov (United States)

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

    2011-06-01

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

  4. [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

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

    Directory of Open Access Journals (Sweden)

    Athanasios K. Petridis

    2012-05-01

    Full Text Available Intervertebral fusion through an anterior approach with polymethylacrylate is a wellestablished 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 who had undergone intervertebral fusion and defined which pre-operative factors could influence the surgical outcome. Between 1993 and 1997, 379 patients were surgically treated with the ventral fusion technique in our hospital. In 2006, we sent a questionnaire to the patients and 164 responses were received. We identified pre-operative presence of severe pain, hypesthesia, palsy and gait disturbance as negative predictive factors, whereas age, body mass index, pre-operative physical strain and the cervical segment involved did not seem to influence prognosis. In conclusion, identifying preoperative factors which influence prognosis after intervetebral fusion will help predict postoperative outcome.

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

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    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.)

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

    Directory of Open Access Journals (Sweden)

    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

  8. Unusual Case of Metastatic Gastrointestinal Adenocarcinoma to the Cervical Spine without a Detectable Primary Source in a Patient with Acquired Immunodeficiency Syndrome: A Case Report

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    Paul E. Kaloostian

    2012-01-01

    Full Text Available The authors report a case of metastatic gastrointestinal adenocarcinoma to the cervical spine in a patient with acquired immunodeficiency syndrome (AIDS being treated with antiretroviral therapy. The source of this tumor could not be identified despite a thorough evaluation. A 49-year-old male being treated for AIDS presents with worsening neck pain and left distal arm weakness. MRI demonstrated an erosive mass within the cervical four vertebral body extending through the pedicle on the left side. Patient underwent needle biopsy followed by combined anterior and posterior fusion procedures. Pathology demonstrated metastatic gastrointestinal adenocarcinoma without known primary origin. He is currently undergoing palliative radiotherapy. This is an unusual case of metastatic gastrointestinal adenocarcinoma to the cervical spine. This should be included on the differential diagnosis of spinal lesions in this patient population and may represent a unique tumor in patients with HIV/AIDS who are on immunosuppressive therapy.

  9. 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

  10. Range of motion and cervical myofascial pain.

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  12. 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.

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

    Science.gov (United States)

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

    2013-05-01

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

  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. 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...

  16. 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 ...

  17. 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...

  18. 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...

  19. 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 ...

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

    Directory of Open Access Journals (Sweden)

    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

  1. 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.

  2. 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

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

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    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.)

  4. 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.

  5. 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)

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

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    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.

  7. 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

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

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    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

  9. 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

  10. 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.

  11. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-01-01

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

  13. 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.

  14. 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.

  15. 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...

  16. 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...

  17. 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

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

    Directory of Open Access Journals (Sweden)

    Terence F. McLoughlin

    2009-03-01

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

  19. 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.

  20. 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

  1. Cervical spine cord compression by eosinophilic granuloma: case report

    Directory of Open Access Journals (Sweden)

    DUARTE-SILVA ELIZABETH BATISTA

    1999-01-01

    Full Text Available 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.

  2. 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.

  3. 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.)

  4. 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...

  5. 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.)

  6. A Discussion of the Issue of Football Helmet Removal in Suspected Cervical Spine Injuries

    OpenAIRE

    Segan, Ross D.; Cassidy, Christine; Bentkowski, Jamie

    1993-01-01

    In some areas, it is a commonly accepted emergency medical technician protocol to remove a helmet during the initial management of suspected cervical spine injures. After a comprehensive survey of relevant literature, four primary reasons why Emergency Medical Services professionals would desire to remove a helmet emerge. Sources suggest that the presence of a helmet might: 1) interfere with immobilization of the athlete; 2) interfere with the ability to visualize injuries; 3) cause hyperflex...

  7. 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.

  8. 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...

  9. 电针合谷和内关穴对颈椎前路手术后急性疼痛的影响%Electro Acupuncture on Hegu Point and Neiguan Point to Treat Acute Pain after Surgery on Anterior Cervical Spine

    Institute of Scientific and Technical Information of China (English)

    周伟; 陈耀雄; 区锦燕

    2014-01-01

    目的:观察电针合谷和内关穴对颈椎前路手术后急性疼痛的有效性和安全性。方法:选择因颈椎骨折入院,择期经颈前路行骨折切开复位内固定术的患者60例,随机分为电针组(30例)和药物组(30例)。电针组使用电针刺激合谷和内关穴,分别于术前30 min,手术结束缝皮时继续电针治疗。麻醉方式及用药两组相同。结果:1)平均动脉压、心率变化:电针组术前、拔管前、拔管后平均动脉压、心率与术中比较P<0.01,拔管后与拔管前比较P>0.05。药物组拔管后与拔管前比较平均动脉压P<0.01,心率P<0.05。2)意识恢复,拔管时间:电针组明显短于药物组,组间比较差异有统计学意义P<0.01。3)对两组患者拔管即刻,拔管后2 h,4 h,8 h,12 h,24 h进行VAS和Ramsay评分显示,电针组在拔管后4 h内镇痛镇静优于药物组,差异有统计学意义P<0.05,拔管后2 h内镇痛差异有统计学意义P<0.01。药物组6例发生恶心、呕吐、便秘等不良反应,电针组1例。术后24 h PCA按压次数药物组共计116次,电针组21次,两组比较差异有统计学意义P<0.05。结论:电针刺激合谷和内关穴可有效减轻颈椎手术后急性疼痛,患者血流动力学平稳,意识恢复和拔管时间短,苏醒快,镇痛效果显著,不良反应降低,提高了手术安全性。%Objective:To observe the effectiveness and safety of electro acupuncture on Hegu point and Neiguan point to treat acute pain after surgery on anterior cervical spine .Methods:Sixty patients with cervical spine fracture who were about to be given relocation and in -ternal fixation were randomly divided into electro acupuncture group (n=30) and drug group (n=30).Patients in electro acupuncture group were given electro acupuncture on Neigu point and Neiguan point 30 mins before the surgery and after surgery being sutured .The anesthesia

  10. 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

  11. 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

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

    Science.gov (United States)

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

    2015-03-01

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

  13. 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.

  14. Correlation between Modic changes in cervical spine and cervical degenerative disease%颈椎Modic改变与颈椎退行性疾病的关系

    Institute of Scientific and Technical Information of China (English)

    许耀丰; 马智佳; 姜宏; 俞鹏飞; 俞振翰; 陈梦菲

    2014-01-01

    Objective To investigate the association between Modic changes in cervical spine and cervical degenera-tive disease. Methods 78 outpatients with both Modic changes in cervical spine and cervical degenerative disease were calculated. The correlation between Modic changes in cervical spine and cervical degenerative disease were ana-lyzed. Results 30 patients (38. 5%) were diagnosed with mild cervical degenerative disease;26 (33. 3%) were diagnosed with moderate cervical degenerative disease, 22 (28. 2%) were diagnosed with severe cervical degenera-tive disease. Conclusions Modic changes in cervical spine often occurs in old patients, mostly type Ⅱ, in C5~6 , C6~7 segments. There is no obvious correlation between Modic changes and the severity of cervical degenerative dis-ease.%目的:探讨颈椎Modic改变与颈椎退行性疾病之间的关系。方法对78例Modic改变患者的颈椎退行性疾病进行统计,分析其与Modic改变之间的关系。结果78例患者中30例(38.5%)诊断为轻度颈椎退行性疾病,26例(33.3%)诊断为中度颈椎退行性疾病,22例(28.2%)诊断为重度颈椎退行性疾病。结论颈椎Modic改变好发于老年患者,以Ⅱ型改变居多,多发生于C5~6、C6~7节段,与颈椎退行性疾病的程度无明显关系。

  15. 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.

  16. 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

  17. 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.)

  18. Result of the arc of movement of lower cervical spine after seven years of arthroplasty

    Directory of Open Access Journals (Sweden)

    Luis Claudio de Velleca e Lima

    2014-09-01

    Full Text Available OBJECTIVE: To quantify the mobility of the lower cervical spine after seven years of total cervical disc replacement at two levels. METHOD: This clinical study was designed randomly and prospectively at the spine surgery center at the Hospital Nossa Senhora das Graças, in Canoas, RS-Brazil and at the Hospital Don João Becker, in Gravataí, RS-Brazil. Seventeen patients were included in the study that was designed to compare the data obtained from annual and sequential manner until the end of seven years. A comparison was made with the prior range of motion (ROM of each patient. All patients were diagnosed with not tractable symptomatic cervical degenerative disc disease with two adjacent levels between C-3 and C-7. RESULTS: A total of patients underwent TDR in two levels and at the end of seven years, only one patient was lost to follow-up. The pre and postoperative ROM was the same in the first three years however after the fourth year there was a gradual decline with a loss of 12% of preoperative ROM in flexion, 21% in extension and 23% in the right and left lateral bending at the end of seven years. CONCLUSIONS: The clinical outcome of this study is evidence level IV in evaluating the ROM for Moby-C(r for TDR in two adjacent levels at the lower cervical spine. These results show that the ROM is maintained during the first three years, gradually declining after that.

  19. Wound infiltration with local anesthetics for post-operative pain relief in lumbar spine surgery

    DEFF Research Database (Denmark)

    Kjærgaard, M; Møiniche, S; Olsen, K S

    2012-01-01

    In this systematic review, we evaluated double-blind, randomized and controlled trials on the effect of wound infiltration with local anesthetics compared with the effect of placebo on post-operative pain after lumbar spine surgery.......In this systematic review, we evaluated double-blind, randomized and controlled trials on the effect of wound infiltration with local anesthetics compared with the effect of placebo on post-operative pain after lumbar spine surgery....

  20. 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 ...

  1. Pain assessment in time to get pain treatment on time – patients’ perspective of time during pain assessment after spine surgery

    DEFF Research Database (Denmark)

    Kaptain, Kirsten; Bregnballe, Vibeke; Dreyer, Pia

    Background: Despite advances in medicine, pharmaceutical and technical knowledge, patients still have postop-erative pain after spine surgery. Studies show that patient participation has positive effect on treatment outcomes and patients require quick individual and efficient pain treatment. Obje...... an efficient and individual pain treatment on time. Knowl-edge about how time affect patients pain assessment is important for nurses in order to make patients participate in pain assessment.......Background: Despite advances in medicine, pharmaceutical and technical knowledge, patients still have postop-erative pain after spine surgery. Studies show that patient participation has positive effect on treatment outcomes and patients require quick individual and efficient pain treatment...... was difficult to use for the patients during activity as intensity of pain changed within seconds in the postoperative phase. The patients elucidated how anaesthesia affected their ability to assess pain and they described how pain medicine and severe pain over time caused variation in ability to communicate...

  2. 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.

  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

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    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. 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

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

    Directory of Open Access Journals (Sweden)

    Basu Saumyajit

    2007-01-01

    Full Text Available Background: There are very few published reports of upper cervical spine injuries from our country and there is a heavy bias towards operative treatment of these injuries. We present below our experience of upper cervical injuries over the last four years. Materials and Methods: Twenty eight patients (20 males, 8 females with upper cervical spine injury (including Occiput, Atlas and Axis were treated and were followed-up for an average of 11.2 months. The data was analyzed retrospectively with regards to the location and type of injury, the treatment offered (conservative or operative as well as the final clinical and radiological outcome. Results: The clinico-radiological outcome of treatment of these injuries is mostly very good with few complications. Other than a single case of mortality due to associated head injury there were no major complications. Conclusion: Management of these patients needs a proper evaluation to arrive at the type of injury and prompt conservative or operative treatment. Treatment is usually safe and effective with good clinical and radiological outcome.

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

    Energy Technology Data Exchange (ETDEWEB)

    Aleme, C.; Mourao, A. P. [Centro Federal de Educacion Tecnologica de Minas Gerais, Biomedical Engineering Center, Belo Horizonte - MG (Brazil); Lyra, M. A., E-mail: carolinaaleme@gmail.com [Universidad Federal de Minas Gerais, Department of Nuclear Engineering, Av. Pdte. Antonio Carlos 6627, Pampulha, 31270-91 Belo Horizonte - MG (Brazil)

    2014-08-15

    The cervical spine is the region of the column that articulates the head and chest. The tests of computed tomography (CT) performed in this region have as main objectives to diagnose fractures, dislocations and tumors. In CT scans the cervical spine volume is limited by the foramen Magnum and the first thoracic vertebra. In this region is the thyroid that is directly irradiated by X-ray beam during cervical scan. Based on this information, it was studied the dose variation deposited in thyroid and in nearby organs, such as: lenses, spinal cord in the foramen Magnum region and breasts, with and without the use of bismuth protector. In this study was used a male anthropomorphic phantom and thermoluminescent s dosimeters (TLD-100) were required to register the individual doses in the organs of interest. CT scans were performed on a GE Bright Speed scanner of 32 channels. With the data obtained, it was found the organ dose variation. The largest recorded dose was in the thyroid. Comparing two scans it was possible to note that the use of the bismuth protector promoted a 26% reduction in the thyroid dose and an increase in the lens dose. (Author)

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

    Energy Technology Data Exchange (ETDEWEB)

    Chiang, Andrew [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON (Canada); Zeng, Liang; Zhang, Liying; Lochray, Fiona; Korol, Renee; Loblaw, Andrew; Chow, Edward [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Sahgal, Arjun, E-mail: arjun.sahgal@sunnybrook.ca [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON (Canada)

    2013-07-15

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

  9. 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.

  10. Cervical spine trauma radiographs: Swimmers and supine obliques; an exploration of current practice

    Energy Technology Data Exchange (ETDEWEB)

    Fell, Michael, E-mail: michael.fell@mkgeneral.nhs.u [Milton Keynes General Hospital, Radiology Standing Way, Eaglestone, Milton Keynes, Buckinghamshire MK6 5LD (United Kingdom)

    2011-02-15

    The study objectives were: to investigate current cervical spine radiographic imaging practices in conscious adult patients with suspected neck injury; reasons behind variation and consideration of dose estimates were explored. Comparison with a previous survey has been made. Questionnaires were sent to superintendent radiographers responsible for accident and emergency X-ray departments in English trusts with over 8500 emergency admissions per year, with a response rate of 97% (n = 181/186). Departmental cervical spine imaging protocols were reported by 82% of respondents. None use fewer than the three standard projections; if the cervicothoracic junction (C7/T1), is not adequately demonstrated 87% use swimmers projections, 9% supine obliques, 3% CT alone. Following projectional radiography, 97% perform CT. A significant (p = 0.018) increase was found since 1999 in CT use once the swimmers projection fails; fewer now use obliques at this point, continuing with CT instead. No significant difference (p = 0.644) was found in choice of first supplementary radiographs; despite British Trauma Society's recommendation to undertake supine obliques, swimmers remain the most widespread technique. An 85% response rate (n = 103/121) completed a second questionnaire, exploring reasons behind the various practices. Several reported a perceived difficulty in interpreting oblique radiographs, some a concern over high dose of the swimmers. Numerous issues affect the acquisition of cervical spine radiographs. Patient radiation dose should be a major consideration in selection of technique. A potential need for training in interpretation of obliques is highlighted. Specific guidelines for optimum projections should be researched, and protocols issued to ensure best practice.

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

    Directory of Open Access Journals (Sweden)

    Ilić Tihomir V.

    2011-01-01

    Full Text Available Bacground/Aim. Diagnostic protocol for patients with degenerative diseases of the cervical spine demands, in parallel with neuroimaging methods, functional evaluation through neurophysiological methods (somatosensitive and motor evoked potentials and electromyoneurography aiming to evaluate possible subclinical affection of spinal medula resulting in neurological signs of long tract abnormalities. Considering diversities of clinical outcomes for these patients, complex diagnostic evaluation provides a prognosis of the disease progression. Methods. The study included 21 patients (48.24 ± 11.01 years of age with clinical presentation of cervical spondylarthropathy, without neuroradiological signs of myelopathy. For each patient, in addition to conventional neurophysiological tests (somatisensory evoked potentials - SSEP, motor evoked potentials - MEP, electromyoneurography - EMG, nerve conduction studies, we calculated central motor conduction time (CMCTF, as well the same parameter in relation to a different position of the head (maximal anteflexion and retroflexion, so-called dynamic tests. Results. Abnormalities of the peripheral motor neurone by conventional EMNeG was established in 2/3 of the patients, correponding to the findings of root condution time. Prolonged conventional CVMPF were found in 29% of the patients, comparing to 43% CVMPF abnormalities found with the dynamic tests. In addition, the SSEP findings were abnormal in 38% of the patients with degenerative diseases of the cervical spine. Conclusion. An extended neurophysiological protocol of testing corticospinal functions, including dynamic tests of central and periheral motor neurons are relevant for detection of subclinical forms of cervical spondylothic myelopathy, even at early stages. In addition to the conventional neurophysiological tests, we found usefull to include the dynamic motor tests and root conduction time measurement in diagnostic evaluation.

  12. 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

  13. Cervico-mandibular muscle activity in females with chronic cervical pain

    OpenAIRE

    Lang, T; Parker, R.; Burgess, T

    2013-01-01

    Pathophysiological mechanisms behind pain in chroniccervical musculoskeletal conditions (MSC) in office workers remainunclear. Chronic cervical pain has established links with temporomandibular(TM) disorders. Yet there is no current published evidence to reportwhether individuals with cervical dysfunction exhibit altered masseterand cervical extensor (CE) muscle activity. Objective: To explore CE andmasseter surface electromyographic (sEMG) activity and teeth clenchinghabits in females with c...

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

    Directory of Open Access Journals (Sweden)

    Sidong Yang

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

  15. Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Jong Won; Lee, Joon Woo; Kim, Sung Hyun; Kwack, Kyu-Sung [Seoul National University Bundang Hospital, Department of Radiology, Gyeonggi-do (Korea); Choi, Ja-Young; Moon, Sung Gyu; Jun, Woo Sun [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea); Yeom, Jin-Sup [Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, Gyeongi-Do (Korea); Kim, Hyun-Jib [Seoul National University Bundang Hospital, Department of Neurosurgery, Gyeongi-Do (Korea); Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Gyeonggi-do (Korea); Seoul National University College of Medicine, Department of Radiology, Seoul (Korea)

    2007-05-15

    To verify the usefulness of a fluoroscopy guided cervical interlaminar epidural steroid injection (CIESI) in patients with neck pain and cervical radiculopathy and to evaluate outcome predictors. We retrospectively analyzed 91 patients from July 2004 to June 2005 in whom CIESI was initially performed for neck pain and cervical radiculopathy. Therapeutic effects were evaluated 2 weeks after the administration of CIESI, and CIESI effectiveness was graded using a five-point scale, namely, whether the pain had disappeared, was much improved, slightly improved, the same, or aggravated. We also used a visual analog scale (VAS) for the clinical evaluation. According to documentation and follow-up charts, we categorized treatments as effective or ineffective. Possible outcome predictors, namely, diagnosis (spinal stenosis vs herniated disc), primary symptoms (neck pain vs radiculopathy vs both), age, gender, and duration of pain (more or less than 6 months) were also analyzed. Fisher's exact test, the chi-square test, and multiple logistic regression analysis were used for the statistical analysis. After their medical records had been reviewed, 76 patients were included in this study. Inclusion criteria were: the availability of a cross-sectional image, such as a CT scan or an MR image, and a follow-up record after injection. The medical records of 76 patients (male:female = 41: 35) of mean age 53.1 years (range 32 years to 82 years) were reviewed. Two weeks after injection, 55 patients (72.4%) had experienced effective pain relief. Patients with herniated discs had significantly better results than patients with spinal stenosis (86.1% vs 60.0%) (P < 0.05). Other non-significant predictors of an improved outcome included: a symptom duration of <6 months, a young age, and the presence of cervical radiculopathy. Multiple regression analysis showed that the only factor that was significantly associated with outcome was the cause of the pain, i.e., herniated disc or

  16. 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

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    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.

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. 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...

  20. 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

  1. 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...

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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...

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

    Science.gov (United States)

    Capó-Juan, M A

    2015-01-01

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

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

    Science.gov (United States)

    Capó-Juan, M A

    2015-01-01

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

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

    Science.gov (United States)

    Anderst, William

    2016-01-01

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

  11. 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.

  12. 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.

  13. 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.

  14. Pain, Depression and Quality of Life in Patients with Chronic Cervical Miyofascial Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Ümit Dundar

    2014-03-01

    Aim: The aim of this study was to investigate the levels of depression, pain and disability in patients with chronic cervical miyofascial pain syndrome (MPS and to determine their association with quality of life. Material and Method: Forty patients with Cervical MPS and 40 age and sex-matched healthy controls enrolled in this study. The social and demographic characteristics of the patients and controls were examined. All patients and controls were evaluated with respect to pain (at night, rest and movement and assessed by visual analog scale (VAS. Neck disability index (NDI was used to calculate functional disability. Quality of life was evaluated with the the Short Form 36 Health Survey (SF-36. Also all of the patients and controls underwent Beck depression inventory (BDI. Results: There was no statistical difference between the patients and control cases according to demographical data. The SF-36 scores of the study patients were lower than controls. NDI, BDI and VAS scores were higher in the patients with chronic cervical MPS compared to controls. BDI scores of the patients with chronic cervical MPS  were negatively and closely associated with subparameters of the SF-36 (physical function (r:-0,599, p<0.001, role limitations due to physical functioning (r:-0,558, p<0.001, bodily pain (r:-0.540, p<0.001, general health (r:- 0,708 p<0.001, vitality (r:-0,692, p<0.001, social functioning (r:-0,559, p<0.001, role limitations due to emotional problems (r:-0,537, p<0.001 and mental health (r: -0,787, p<0.001. Discussion: BDI scores are higher in patients with chronic cervical MPS than healthy controls and negatively affect their quality of life. Psychiatric evaluation of the patients with chronic cervical MPS may improve their quality of life and treatments outcome.

  15. 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)

  16. 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

  17. 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.

  18. 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

  19. 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

  20. 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.)

  1. A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

    DEFF Research Database (Denmark)

    Mathiesen, Ole; Dahl, Benny; Thomsen, Berit A;

    2013-01-01

    in a post-intervention group of 41 consecutive patients undergoing multilevel (median 10) instrumented spinal fusions and compared with 44 patients in a pre-intervention group. RESULTS: Compared to patients in the pre-intervention group, patients treated according to the new protocol consumed less opioid...... and dizziness on POD 1-6. CONCLUSIONS: In this study of patients scheduled for multilevel spine surgery, it was demonstrated that compared to a historic group of patients receiving usual care, a comprehensive and standardized multimodal pain and PONV protocol significantly reduced opioid consumption, improved......PURPOSE: Major spine surgery with multilevel instrumentation is followed by large amount of opioid consumption, significant pain and difficult mobilization in a population of predominantly chronic pain patients. This case-control study investigated if a standardized comprehensive pain...

  2. 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.

  3. Vertebral pain in helicopter pilots

    Science.gov (United States)

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

    1980-01-01

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

  4. The role of B-mode ultrasonography in the musculoskeletal anatomical evaluation of the cervical region of the dog spine

    Directory of Open Access Journals (Sweden)

    Cibely G. Sarto

    2014-01-01

    Full Text Available This study characterized the normal musculoskeletal anatomy of the cervical segment of the spine of dogs by means of B-mode ultrasonography. The objective was to establish the role of B-mode ultrasonography for the anatomical evaluation of the cervical spine segment in dogs, by comparing the ultrasonographic findings with images by computed tomography and magnetic resonance imaging. The ultrasound examination, in transverse and median sagittal sections, allowed to identify a part of the epaxial cervical musculature, the bone surface of the cervical vertebrae and parts of the spinal cord through restricted areas with natural acoustic windows, such as between the atlanto-occipital joint, axis and atlas, and axis and the third cervical vertebra. The images, on transverse and sagittal planes, by low-field magnetic resonance imaging, were superior for the anatomical identification of the structures, due to higher contrast between the different tissues in this modality. Computed tomography showed superiority for bone detailing when compared with ultrasonography. As for magnetic resonance imaging, in addition to the muscles and cervical vertebrae, it is possible to identify the cerebrospinal fluid and differentiate between the nucleus pulposus and annulus fibrosus of the intervertebral discs. Although not the scope of this study, with knowledge of the ultrasonographic anatomy of this region, it is believed that some lesions can be identified, yet in a limited manner, when compared with the information obtained mainly with magnetic resonance imaging. The ultrasound examination presented lower morphology diagnostic value compared with the other modalities.

  5. 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

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

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

    2014-08-01

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

  8. Delayed Esophageal Pseudodiverticulum after Anterior Cervical Spine Fixation: Report of 2 Cases

    Directory of Open Access Journals (Sweden)

    Ali Sadrizadeh

    2015-03-01

    Full Text Available Introduction: Although perforation of the esophagus, in the anterior cervical spine fixation, is well established, cases with delayed onset, especially cases that present pseudodiverticulum, are not common. In addition, management of the perforation in this situation is debated.  Case Report:   Delayed esophageal pseudodiverticulum was managed in two patients with a history of anterior spine fixation. Patients were operated on, the loose plate and screws were extracted, the wall of the diverticulum was excised, the perforation on the nasogastric tube was suboptimally repaired, and a closed suction drain was placed there. The NGT was removed on the 7th day and barium swallow demonstrated no leakage at the operation site; therefore, oral feeding was started without any problem.  Conclusion:  In cases with delayed perforation, fistula, or diverticulum removal of anterior fixation instruments, gentle repair of the esophageal wall without persistence on definitive and optimal perforation closure, wide local drainage, early enteral nutrition via NGT, and antibiotic prescription is suggested.

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

    Directory of Open Access Journals (Sweden)

    John Tran

    2016-05-01

    Full Text Available Introduction: The National Emergency X-radiography Utilization Study (NEXUS criteria are used extensively in emergency departments to rule out C-spine injuries (CSI in the general population. Although the NEXUS validation set included 2,943 elderly patients, multiple case reports and the Canadian C-Spine Rules question the validity of applying NEXUS to geriatric populations. The objective of this study was to validate a modified NEXUS criteria in a low-risk elderly fall population with two changes: a modified definition for distracting injury and the definition of normal mentation. Methods: This is a prospective, observational cohort study of geriatric fall patients who presented to a Level I trauma center and were not triaged to the trauma bay. Providers enrolled non-intoxicated patients at baseline mental status with no lateralizing neurologic deficits. They recorded midline neck tenderness, signs of trauma, and presence of other distracting injury. Results: We enrolled 800 patients. One patient fall event was excluded due to duplicate enrollment, and four were lost to follow up, leaving 795 for analysis. Average age was 83.6 (range 65-101. The numbers in parenthesis after the negative predictive value represent confidence interval. There were 11 (1.4% cervical spine injuries. One hundred seventeen patients had midline tenderness and seven of these had CSI; 366 patients had signs of trauma to the face/neck, and 10 of these patients had CSI. Using signs of trauma to the head/neck as the only distracting injury and baseline mental status as normal alertness, the modified NEXUS criteria was 100% sensitive (CI [67.9-100] with a negative predictive value of 100 (98.7-100. Conclusion: Our study suggests that a modified NEXUS criteria can be safely applied to low-risk elderly falls.

  10. 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

  11. Imaging suspected cervical spine injury: Plain radiography or computed tomography? Systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Cain, Gavin [Diagnostic Radiographer, Colchester Hospital University NHS Foundation Trust, Colchester General Hospital, Turner Road, Colchester, CO4 5JL Essex (United Kingdom)], E-mail: gavincain8@hotmail.com; Shepherdson, Jane; Elliott, Vicki; Svensson, Jon [Faculty of Health and Social Care, Anglia Ruskin University, East Road, Cambridge, CB1 9PT Cambridgeshire (United Kingdom); Brennan, Patrick [UCD School of Medicine and Medical Sciences, Health Science Building, Belfield, Dublin 4 (Ireland)

    2010-02-15

    Aim: (1) to establish which modality offers the greatest accuracy in the detection of cervical spine injury (CSI) Following trauma: plain radiography or computed tomography (CT), and (2) make an evidence-based recommendation for the initial imaging modality of choice. Method: A systematic literature review was performed to identify primary research studies which compare the diagnostic accuracy of plain radiography and CT with the results of a reference standard in the detection of CSI. A search of MEDLINE, EMBASE, CINAHL, Science Direct and Pubmed Central databases was conducted. Results: Ten studies were identified. Critical appraisal identified limitations among all studies. There was heterogeneity in the sensitivity estimates for plain radiography, whereas estimates for CT were consistently high. Examination of the reported sensitivities shows that CT outperforms plain radiography in the detection of CSI. Conclusion: CT is superior to plain radiography in the detection of CSI. However, the optimal imaging strategy depends on the patients' relative risk of injury. If at high-risk cervical CT is indicated. If at low-risk the increased cost and radiation exposure mean that screening CT may not be warranted, good-quality plain radiographs are sufficient.

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

    Energy Technology Data Exchange (ETDEWEB)

    Buch, Karen; Nguyen, Thanh; Norbash, Alex; Mian, Asim [Boston University School of Medicine, Department of Radiology, Boston Medical Center, Boston, MA (United States); Mahoney, Eric; Burke, Peter [Boston University School of Medicine, Department of Surgery, Boston Medical Center, Boston, MA (United States); Libby, Brandon; Calner, Paul [Boston University School of Medicine, Department of Emergency Medicine, Boston Medical Center, Boston, MA (United States)

    2016-02-15

    Blunt cerebrovascular injuries (BCVI) are associated with high morbidity and mortality and can lead to neurological deficits. The established criteria for patients undergoing CT angiography (CTA) for BCVI are broad, and can expose patients to radiation unnecessarily. This study aimed to examine the prevalence of BCVI in patients on CTA and determine presentations associated with the highest rates of BCVI. With IRB approval, patients were selected for CTA screening for BCVI according to a predefined set of criteria at our hospital between 2007 and 2010. Patients were identified from our institution's trauma database. CTAs were retrospectively reviewed for BCVI including vasospasm and dissection. Electronic medical records were reviewed for clinical presentation and hospital course. Of 432 patients, vasospasm (n = 10) and/or dissection (n = 36) were found in 46 patients (10.6 %). BCVI was associated with cervical spine and/or skull-base fracture in 40/46 patients (87 %, P < 0.0001). Significant correlations were seen between dissection and fracture in 31/36 patients (86.2 %, p < 0.0001) and between BCVI and both neurological deficits and fractures (27/44, P < 0.0001). BCVI was significantly associated with cervical and/or skullbase fractures and neurological deficits with coexistent fractures. Patients with these injuries should be prioritized for rapid CTA evaluation for BCVI. (orig.)

  13. 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.)

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

    Science.gov (United States)

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

    2016-09-01

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

  15. [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

  16. 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.

  17. 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.

  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. 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

  20. 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.

  1. Evidence against the use of lumbar spine radiography for low back pain

    International Nuclear Information System (INIS)

    AIM: To review abnormalities reported on plain radiographic examination of the lumbar spine in patients referred with low back pain by general practitioners. Additionally, we evaluated and stratified the prevalence of these abnormalities by age. Finally, the diagnostic impact of lumbar spine radiography for the diagnosis of degenerative change, fracture, infection and possible tumour, was modelled. MATERIALS AND METHODS: A retrospective review of 2007 radiographic reports of patients referred with low back pain for lumbar spine radiography to a large radiology department was performed. The reports were classified into different diagnostic groups and subsequently stratified according to age. The potential diagnostic impact of lumbar spine radiography was modelled by using the prevalence of conditions studied as pre-test probabilities of disease. RESULTS: The prevalence of reported lumbar spine degeneration increased with age to 71% in patients aged 65-74 years. The overall prevalence of fracture, possible infection, possible tumour was low in our study population: 4, 0.8 and 0.7%, respectively. Fracture and possible infection showed no association with age. Possible tumour was only reported in patients older than 55 years of age. CONCLUSION: Although the prevalence of degenerative changes was high in older patients, the therapeutic consequences of diagnosing this abnormality are minor. The prevalence of possible serious conditions was very low in all age categories, which implies radiation exposure in many patients with no significant lesions

  2. Evidence against the use of lumbar spine radiography for low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Bosch, M.A.A.J. van den E-mail: m.a.vandenbosch@azu.nl; Hollingworth, W.; Kinmonth, A.L.; Dixon, A.K

    2004-01-01

    AIM: To review abnormalities reported on plain radiographic examination of the lumbar spine in patients referred with low back pain by general practitioners. Additionally, we evaluated and stratified the prevalence of these abnormalities by age. Finally, the diagnostic impact of lumbar spine radiography for the diagnosis of degenerative change, fracture, infection and possible tumour, was modelled. MATERIALS AND METHODS: A retrospective review of 2007 radiographic reports of patients referred with low back pain for lumbar spine radiography to a large radiology department was performed. The reports were classified into different diagnostic groups and subsequently stratified according to age. The potential diagnostic impact of lumbar spine radiography was modelled by using the prevalence of conditions studied as pre-test probabilities of disease. RESULTS: The prevalence of reported lumbar spine degeneration increased with age to 71% in patients aged 65-74 years. The overall prevalence of fracture, possible infection, possible tumour was low in our study population: 4, 0.8 and 0.7%, respectively. Fracture and possible infection showed no association with age. Possible tumour was only reported in patients older than 55 years of age. CONCLUSION: Although the prevalence of degenerative changes was high in older patients, the therapeutic consequences of diagnosing this abnormality are minor. The prevalence of possible serious conditions was very low in all age categories, which implies radiation exposure in many patients with no significant lesions.

  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. Minimal access versus open spinal surgery in treating painful spine metastasis: a systematic review

    OpenAIRE

    Yang, Zuozhang; Yang, Yihao; Zhang, Ya; Zhang, Zhaoxin; Chen, Yanjin; Shen, Yan; Han, Lei; Xu, Da; Sun, Hongpu

    2015-01-01

    Study design The study design of this paper is a systematic review of literature published in the recent 10 years. Objective It is the objective of this paper to compare the clinical efficacy and safety of minimal access (MIS) spinal surgery and open spinal surgery for treating painful spine metastasis. Methods Two research questions below were determined through a consensus among a panel of spine experts. A systematic review of literature on spinal surgery was conducted by searching PubMed w...

  6. Minimally invasive spine surgery in chronic low back pain patients

    NARCIS (Netherlands)

    Spoor, A. B.; Oner, F. C.

    2013-01-01

    Low back pain (LBP) is a common disorder with a lifetime prevalence of 85%. The pathophysiology of LBP can be various depending on the underlying problem. Only in about 10% of the patients specific underlying disease processes can be identified. Patients with scoliosis, spondylolisthesis, herniated

  7. Cementoplasty for managing painful bone metastases outside the spine

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Gang; Jin, Peng; Liu, Xun-wei; Li, Min; Li, Li [Jinan Military General Hospital, Department of Medical Imaging, Jinan, Shandong Province (China)

    2014-03-15

    To illustrate the effect of treatment with cementoplasty in patients with painful bone metastases in the extraspinal region. A retrospective study was conducted to review 51 consecutive patients who underwent cementoplasty under CT or fluoroscopic guidance, a total of 65 lesions involving the ilium, ischium, pubis, acetabulum, humeral, femur and tibia. In 5 patients with a high risk of impending fracture in long bones based on Mirels' scoring system, an innovative technique using a cement-filled catheter was applied. The clinical effects were evaluated using the visual analogue scale (VAS) preoperatively and postoperatively. All patients were treated successfully with a satisfying resolution of painful symptoms at 3 months' follow-up. Cement leakage was found in 8 lesions without any symptoms. VAS scores decreased from 8.19 ± 1.1 preoperatively to 4.94 ± 1.6 at 3 days, 3.41 ± 2.1 at 1 month and 3.02 ± 1.9 at 3 months postoperatively. There was a significant difference between the mean preoperative baseline score and the mean score at all of the postoperative follow-up points (P < 0.01). Cementoplasty is an effective technique for treating painful bone metastases in extraspinal regions, which is a valuable, minimally invasive, method that allows reduction of pain and improvement of patients' quality of life. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Robert Naish

    2013-09-01

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

  9. Growing heterotopic calcification in the prevertebral space of a cervical spine as a late complication of irradiation: Case report

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    Park, Jina; Lee, Seung Hun; Joo, Kyung Bin [Dept. of Radiology, Hanyang University Hospital, Seoul (Korea, Republic of)

    2014-02-15

    Heterotopic calcification following head and neck irradiation has rarely been reported. It usually develops as a late complication of radiotherapy in patients with malignancies, including breast cancer, lymphoma, and genitourinary malignancies. The occurrence of heterotopic calcification in the prevertebral space of the cervical spine has not been described as a late complication of irradiation. Here, we report a case of prevertebral heterotopic calcification in a patient with history of chemotherapy and radiotherapy for tonsil cancer 21 years ago.

  10. 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

  11. 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.

  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. Destructive spondyloarthropathy of the cervical spine in long-term hemodialyzed patients: a five-year clinical radiological prospective study

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    Leone, A.; Marano, P. [Dept. of Radiology, Univ. Cattolica, Rome (Italy); Sundaram, M. [Dept. of Radiology, Mayo Clinic, Rochester, MN (United States); Cerase, A. [Unit of Neuroradiology, Policlinico ' ' Le Scotte' ' , Siena (Italy); Magnavita, N. [Dept. of Occupational Medicine, Univ. Cattolica, Rome (Italy); Tazza, L. [Dept. of Surgery, Univ. Cattolica, Rome (Italy)

    2001-08-01

    To describe the radiographic features and progression of cervical spine destructive spondyloarthropathy (DSA) in hemodialyzed patients, and to evaluate the relationship between this disease and patient characteristics, biochemical values, and hemodialysis duration. Design and patients: Standard radiographs, and lateral flexion and extension views of the cervical spine, were performed annually for 5 years in 31 hemodialyzed patients who were divided into three groups at the commencement of the study: those showing (I) DSA, (II) vertebral rim erosions (VRE) without DSA, and (III) absence of DSA and VRE. Magnetic resonance (MR) imaging and computed tomography (CT) were performed in seven and two patients respectively. The imaging features were evaluated for the presence and progression of spondyloarthropathy and correlated with clinical and biochemical variables. Statistical analysis was performed using one-way analysis of variance. The duration of hemodialysis appeared to be the main predictive factor (P=0.0003) for DSA, which was found in six patients (19%). DSA was found to correlate with higher levels of beta2-microglobulin (P<0.00001), parathyroid hormone (P<0.05), and alkaline phosphatase (P<0.05). Clinical symptoms were minimal. In two patients, MR imaging revealed changes mimicking spondylodiscitis. In another patient, CT of the craniocervical junction showed bone resorption due to a pseudotumor, and basilar invagination. DSA of the cervical spine is often clinically silent. Pathogenesis of DSA may be multifactorial but its progression is most influenced by the duration of hemodialysis. On MR imaging, DSA may mimic spondylodiscitis. (orig.)

  14. 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...

  15. EFFECTIVENESS OF CRANIO-CERVICAL TRAINING OVER MYOFACIAL PAIN SYNDROME: A CASE STUDY

    Directory of Open Access Journals (Sweden)

    Jeyanthi. S

    2015-06-01

    Full Text Available Background and Purpose: Myofascial pain syndrome (MPS is a syndrome presenting with acute or chronic regional pain originating from trigger points (TPs localized in the muscles or the fascia. TPs are local points showing high irritability, sensitivity to finger pressure and causing characteristic referred pain. The aim of this case study is to assess the effectiveness of cranio-cervical training on neck disability, endurance of deep cervical muscles and pressure pain threshold in a patient with cervical myofascial pain syndrome. Case description: A 36 year old female who was diagnosed with myofascial pain syndrome. She received cranio cervical training, a low load endurance exercises in order to train and/or to regain muscle control of the cervicoscapular and craniocervical regions. The patient received the treatment program for 10 to 15 minutes. The frequency of treatment is five days in a week for a period of 3 weeks. Outcome: The outcome measures were neck disability index, pressure pain threshold and deep cervical endurance test, which were measured prior to treatment and at the end of third week. Conclusion: The craniocervical training programme for a patient with myofascial pain syndrome found to be effective in reducing neck disability, improving the pressure pain threshold and deep cervical flexor muscle endurance.

  16. Recurrent back pain after diskectomy: MRI findings MR of the postoperative lumbar spine

    International Nuclear Information System (INIS)

    Purpose: To show the morphological changes in postoperative lumbar spine. Material and methods: We reviewed 128 Magnetic Resonance Imaging (MRI) studies of lumbar spine. All patients complained of low back pain and had a previous lumbar surgery (1 month to 8 years). All the examinations include axial and sagittal Gadopentate-dimeglumine enhanced T1 weighted imaging. Results: Only 7,8% have the normal appearance of the postoperative lumbar spine. Epidural scar was found in 69% of examinations; of this group, 72% showed radicular involvement, and 28% had no radicular involvement. Recurrent disc herniation was found in 14,8% of exams, using gadopentate-dimeglumine to assist the differentiation from epidural fibrosis; infections like spondylodiscitis and abscess in 12,5%. Other findings included arachnoiditis, pseudomeningoceles and seromas. Conclusions: MRI is a useful method to study the postoperative lumbar spine, specially when enhanced with gadopentate-dimeglumine. Enhanced images can differentiate two of the major complication like epidural fibrosis, and recurrent disc herniation. Spondylodiscitis are important and frequent too. Although the findings of complications in our series in the postoperative lumbar spine represent 92,18 %, these not always explain the symptomatology. Therefore, the interrelation is important with the surgeon to determine which abnormalities are clinically significant. (authors)

  17. Cervical Disc Disease: Biomechanical Aspects

    OpenAIRE

    Kolstad, Frode

    2011-01-01

    Degenerative disc disease in the cervical spine may cause significant pain and disability. Patients present themselves with neck pain, radiculopathy, and/or myelopathy. When the symptoms do not improve with conservative treatment, surgical treatment is considered. The goal of surgical treatment is to decompress nervous structures and to restore the normal anatomical conditions of disc height, alignment, and stability.The present thesis concerns four studies involving the treatment of cervical...

  18. 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

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

    Science.gov (United States)

    Deng, Yihan; Denecke, Kerstin

    2016-01-01

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

  20. Static and dynamic CT imaging of the cervical spine in patients with rheumatoid arthritis

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    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.)

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Science.gov (United States)

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

    2015-05-01

    Upper back pain originating from the cervical disk itself is defined as cervical discogenic upper back pain. Coblation procedures can provide therapeutic effects for neck and radicular pain related to contained cervical disk herniation. However, no studies have reported the performance of coblation procedures, particularly for treating cervical discogenic upper back pain. The purpose of this study was to evaluate the efficacy of coblation procedures in treating cervical discogenic upper back pain.In a prospective, clinical, observational study, 28 consecutive patients with discogenic upper back pain underwent coblation procedures on the cervical disk with a percutaneous anterior approach. Pain visual analogue scale (VAS) scores, patient responses stating significant (≥50%) pain relief, significant (≥50%) reduction in pain medicine intake and Modified MacNab criteria were adopted to evaluate the pain intensity, degree of pain relief, and functional status after 12 months of follow-up.The preoperative pain VAS score was 6.5 ± 1.1 (95% confidence interval [CI] 6.085-6.915), and the pain VAS score significantly decreased to 2.4 ± 1.3 (95% CI 1.929-2.928), 2.5 ± 1.5 (95% CI 1.963-3.109), 2.7 ± 1.4 (95% CI 2.157-3.271), 3.1 ± 1.6 (95% CI 2.457-3.686), and 3.1 ± 1.6 (95% CI 2.471-3.743) at 1 week and 1, 3, 6, and 12 months postoperatively, respectively (P coblation is an effective, safe, minimally invasive, and less uncomfortable procedure for the treatment of discogenic upper back pain.

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

    Science.gov (United States)

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

    2014-10-01

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

  4. 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.

  5. 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

  6. 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

  7. Comorbidity of fibromyalgia and cervical myofascial pain syndrome.

    Science.gov (United States)

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

    2010-04-01

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

  8. Multidetector-row helical computed tomography in the evaluation of cervical spine disorders; Tomografia computadorizada multislice no diagnostico das afeccoes da coluna cervical

    Energy Technology Data Exchange (ETDEWEB)

    Rosemberg, Laercio Alberto; Almeida, Milena Oliveira; Rios, Adriana Martins; Garbaccio, Viviane Ladeira; Kim, Nelson Ji Tae; Daniel, Mauro Miguel; Funari, Marcelo Buarque de Gusmao [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil). Dept. de Imagem]. E-mail: laercio@einstein.br

    2003-07-01

    Multidetector-row computed tomography (MRCT) has advantages in comparison to conventional helical computed tomography, such as reduction of study time, lower radiation doses, fewer metallic artifacts and high quality multiplanar reformatting and three dimensional reconstructions. We reviewed 150 cervical spine examinations and selected the most illustrative cases including congenital anomalies, degenerative lesions, spinal infections, neoplasms, traumatic injuries and postoperative abnormalities. The quality of multiplanar reformatting and volume reconstructions of the MRCT made the detection and evaluation of most of cases with complex anatomy easier and more precise. (author)

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

    OpenAIRE

    Kim, Man-Sig

    2015-01-01

    [Purpose] Smartphone use reportedly changes posture. However, how neck posture is altered in smartphone users with neck pain is unknown. This study examined changes in the posture of young adults with and without mild neck pain (MNP) when using a smartphone. [Subjects] Thirteen control subjects and 14 subjects with MNP who used smartphones were recruited. [Methods] The upper cervical (UC) and lower cervical (LC) angles in the sagittal plane were measured using an ultrasound-based motion analy...

  10. 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

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

    Science.gov (United States)

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

    2010-01-01

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

  12. 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)

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

    Science.gov (United States)

    Wytrazek, Marcin; Huber, Juliusz; Lisinski, Przemyslaw

    2011-01-01

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

  14. 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

    period and maintenance after one year post-surgically. The clinical and functional assessment according to SF-36 and to Denis’ pain and effort scale showed good clinical results with the major postoperative complaints being resultant from the neurological injury degree. The hematoma observed on surgical wound, which required surgical drainage was the only complication reported in a patient. The approach employing arthrodesis and anterior fixation for treating single- or bi-faceted traumatic dislocations of the cervical spine showed good clinical, X-ray, and functional outcomes, as well as a small complications rate, thus justifying our preference for this method when treating these kinds of cervical spine injury.

  15. SPECT/CT imaging of the lumbar spine in chronic low back pain: a case report

    Directory of Open Access Journals (Sweden)

    Carstensen Michael H

    2011-01-01

    Full Text Available Abstract Mechanical low back pain is a common indication for Nuclear Medicine imaging. Whole-body bone scan is a very sensitive but poorly specific study for the detection of metabolic bone abnormalities. The accurate localisation of metabolically active bone disease is often difficult in 2D imaging but single photon emission computed tomography/computed tomography (SPECT/CT allows accurate diagnosis and anatomic localisation of osteoblastic and osteolytic lesions in 3D imaging. We present a clinical case of a patient referred for evaluation of chronic lower back pain with no history of trauma, spinal surgery, or cancer. Planar whole-body scan showed heterogeneous tracer uptake in the lumbar spine with intense localisation to the right lateral aspect of L3. Integrated SPECT/CT of the lumbar spine detected active bone metabolism in the right L3/L4 facet joint in the presence of minimal signs of degenerative osteoarthrosis on CT images, while a segment demonstrating more gross degenerative changes was more quiescent with only mild tracer uptake. The usefulness of integrated SPECT/CT for anatomical and functional assessment of back pain opens promising opportunities both for multi-disciplinary clinical assessment and treatment for manual therapists and for research into the effectiveness of manual therapies.

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

    Directory of Open Access Journals (Sweden)

    Dimitrios K. Filippiadis

    2013-01-01

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

  17. Magnetic resonance imaging of the cervical spine: Frequency of degenerative changes in the intervertebral disc with relation to age

    Energy Technology Data Exchange (ETDEWEB)

    Abdulkarim, J.A.; Dhingsa, R.; Finlay, D.B.L

    2003-12-01

    AIM: To ascertain the level at which intervertebral disc degeneration of the cervical spine most commonly occurs in each decade from 20-79 years. MATERIALS AND METHODS: Using computer analysis, we retrospectively assessed the mean signal intensity from each cervical disc from T2-weighted spin-echo images in 60 symptomatic patients (10 per decade from the third to eighth inclusive). RESULTS: Age, disc level and interaction between age and level were highly significant predictors for the magnetic resonance imaging (MRI) mean signal intensity from intervertebral discs (p<0.0001 for all three terms). The MRI signals were generally lower as age increased and also for the higher discs (C2-C3, etc). CONCLUSION: In our study we have shown that in younger patients the higher discs are more frequently affected by degeneration than the lower ones. As age increases, the process of degeneration becomes more generalized with less variability between discs.

  18. Methodological systematic review: mortality in elderly patients with cervical spine injury: a critical appraisal of the reporting of baseline characteristics, follow-up, cause of death, and analysis of risk factors.

    NARCIS (Netherlands)

    Middendorp, J.J. van; Albert, T.J.; Veth, R.P.H.; Hosman, A.J.F.

    2010-01-01

    STUDY DESIGN: Methodologic systematic review. OBJECTIVE: To determine the validity of reported risk factors for mortality in elderly patients with cervical spine injury. SUMMARY OF BACKGROUND DATA: In elderly patients with cervical spine injury, mortality has frequently been associated with the type

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

    Energy Technology Data Exchange (ETDEWEB)

    Bennett, D. Lee [Department of Radiology, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA (United States); Department of Radiology, Michigan State University, Colleges of Human Medicine and Osteopathic Medicine, East Lansing, MI (United States); Nassar, Lawrence [Department of Sports Medicine and Kinesiology, Michigan State University, College of Osteopathic Medicine, East Lansing, MI (United States); DeLano, Mark C. [Department of Radiology, Michigan State University, Colleges of Human Medicine and Osteopathic Medicine, East Lansing, MI (United States)

    2006-07-15

    Previous studies have shown increased degenerative disk changes and spine injuries in the competitive female gymnast. However, it has also been shown that many of these findings are found in asymptomatic athletic people of the same age. Previous magnetic resonance imaging (MRI) studies evaluating the gymnastic spine have not made a distinction between symptomatic and asymptomatic athletes. Our hypothesis is that MRI will demonstrate the same types of abnormalities in both the symptomatic and asymptomatic gymnasts. Olympic-level female gymnasts received prospectively an MRI exam of the lumbar spine. Each of the gymnasts underwent a physical exam by a sports medicine physician just prior to the MRI for documentation of low back pain. Each MRI exam was evaluated for anterior apophyseal ring avulsion injury, compression deformity of the vertebral body, spondylolysis, spondylolisthesis, degenerative disease, focal disk protrusion/extrusion, muscle strain, epidural mass, and bone-marrow edema. Nineteen Olympic-level female gymnasts (age 12-20 years) were evaluated prospectively in this study. All of these gymnasts were evaluated while attending a specific training camp. Anterior ring apophyseal injuries (9/19) and degenerative disk disease (12/19) were common. Spondylolysis (3/19) and spondylolisthesis (3/19) were found. Focal bone-marrow edema was found in both L3 pedicles in one gymnast. History and physical exam revealed four gymnasts with current low back pain at the time of imaging. There were findings confined to those athletes with current low back pain: spondylolisthesis, spondylolysis, bilateral pedicle bone-marrow edema, and muscle strain. (orig.)

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

    International Nuclear Information System (INIS)

    Previous studies have shown increased degenerative disk changes and spine injuries in the competitive female gymnast. However, it has also been shown that many of these findings are found in asymptomatic athletic people of the same age. Previous magnetic resonance imaging (MRI) studies evaluating the gymnastic spine have not made a distinction between symptomatic and asymptomatic athletes. Our hypothesis is that MRI will demonstrate the same types of abnormalities in both the symptomatic and asymptomatic gymnasts. Olympic-level female gymnasts received prospectively an MRI exam of the lumbar spine. Each of the gymnasts underwent a physical exam by a sports medicine physician just prior to the MRI for documentation of low back pain. Each MRI exam was evaluated for anterior apophyseal ring avulsion injury, compression deformity of the vertebral body, spondylolysis, spondylolisthesis, degenerative disease, focal disk protrusion/extrusion, muscle strain, epidural mass, and bone-marrow edema. Nineteen Olympic-level female gymnasts (age 12-20 years) were evaluated prospectively in this study. All of these gymnasts were evaluated while attending a specific training camp. Anterior ring apophyseal injuries (9/19) and degenerative disk disease (12/19) were common. Spondylolysis (3/19) and spondylolisthesis (3/19) were found. Focal bone-marrow edema was found in both L3 pedicles in one gymnast. History and physical exam revealed four gymnasts with current low back pain at the time of imaging. There were findings confined to those athletes with current low back pain: spondylolisthesis, spondylolysis, bilateral pedicle bone-marrow edema, and muscle strain. (orig.)

  1. 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...

  2. Degenerative diseases of the spine. Rare and often unrecognized causes of pain syndromes

    International Nuclear Information System (INIS)

    The aim of this article is to describe rare and often unrecognized causes of spinal pain syndromes. Intervertebral disc degeneration frequently appears in early adulthood and can have a symptomatic or asymptomatic course. This article discusses incidence, pathophysiology, imaging, and pain symptomatology involved in the origin of back pain. Anulus tears are often found in asymptomatic individuals but could be implicated in lumbar pain symptomatology in correlation with the provocative discography. Transient disorders can lead to pseudarthrosis of the iliac bone and to degeneration or to a reactive hypermobility with intervertebral disc degeneration in the level above. Modic type 1 erosive osteochondrosis is characterized by bone marrow edema near the hyaline cartilage end plate, which mostly elicits severe pain and results in serious limitations in everyday activities. The most important differential diagnosis is spondylodiscitis. Schmorl's nodes can exhibit considerable surrounding bone marrow edema that can be mistaken for metastases. A combination of MRI and CT should be employed for the diagnostic work-up of fatigue fracture of the interarticular portion, which is often overlooked due to its location. Synovial cysts of the facet joints can lead to radicular symptoms. Insufficiency fracture of the sacrum is frequently mistaken for metastasis due to intense scintigraphic enhancement and its signal behavior in MRI. CT provides instructive information. Differential diagnosis should include less common causes such as anulus tears, transient disorders, activated Schmorl's nodes, synovial cysts of the facet joints, fatigue fractures of the interarticular portion of the spine and the sacrum and distinguish from metastases in particular. (orig.)

  3. 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...

  4. 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...

  5. Correction of immune disorders in patients with malignant tumors at level of craniovertebral junction and upper cervical spine

    Directory of Open Access Journals (Sweden)

    Bazhanov S.P.

    2013-06-01

    Full Text Available Objective: To study the cellular and humoral immunity in patients with malignant tumors of the upper cervical spine. Material and methods: The study included 22 patients with malignant tumors of the craniovertebral junction and upper cervical spine. To assess the function of the immune system the methods of population and subpopulation immuno-phenotyping of peripheral blood lymphocytes have been applied. Cytokine parameters and functional status (cytotoxic activity of NK-cells have been studied using immunofermental methods. The indices have been presented in absolute and relative terms. All the patients have been subjected to the adjuvant therapy. Results: Correction of cellular immunity has led to significant increase in CD3 + (T-lymphocytes and CD3 + CD8 + (T-killers. Cytokine levels in the groups studied in the dynamics have not been significantly altered. The changes of cytotoxic (functional activity of NK-cells in the first group after the combined treatment have been considered to be higher than before the treatment. Cytotoxic index of (functional activity of NK-cells in the second group under the study after the combined treatment has been determined to be lower than before the treatment. Conclusion: It has been found out that the application of complex treatment accompanied by immunotropic therapy may positively influence the immune status.

  6. Cervico-mandibular muscle activity in females with chronic cervical pain

    Directory of Open Access Journals (Sweden)

    T. Lang

    2013-12-01

    Full Text Available Pathophysiological mechanisms behind pain in chroniccervical musculoskeletal conditions (MSC in office workers remainunclear. Chronic cervical pain has established links with temporomandibular(TM disorders. Yet there is no current published evidence to reportwhether individuals with cervical dysfunction exhibit altered masseterand cervical extensor (CE muscle activity. Objective: To explore CE andmasseter surface electromyographic (sEMG activity and teeth clenchinghabits in females with chronic cervical dysfunction and no TM disorder.Design: Descriptive cross-sectional correlational study with singleblinding.Participants: University students and staff with or without chroniccervical pain and no TM involvement. Methods: Descriptive and paindata captured from Research Diagnostic Criteria for TM disorders, NeckDisability Index, Computer Usage, Brief Pain Inventory, and EuroQoL-5Dquestionnaires. Female participants allocated to a chronic cervical (n = 20 and a control group (n = 22. Investigator blindedto the study groups recorded sEMG of bilateral masseter and CE muscles (C4/5 level at rest and during light teeth clenching.Results: No differences in socio-demographic profile; or in masseter or CE sEMG activity at rest or during light clench betweengroups. The pain group had higher scores for pain, reported a daytime teeth clenching habit, and had worse scores for the healthrelatedquality of life (HRQoL sub-sections for pain, anxiety/depression, and lower scores for perceived health status. Conclusion:No relationship established between cervico-mandibular sEMG activity and reported disability in females with chronic cervicaldysfunction and no TM disorder. Association between biopsychosocial factors of teeth clenching and anxiety/depression highlightscomplex pathophysiological mechanisms in chronic recurrent cervical pain.

  7. 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

  8. 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.

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

    Science.gov (United States)

    2016-02-22

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

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

    Directory of Open Access Journals (Sweden)

    Beauchamp Kathryn M

    2011-07-01

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

  11. 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

  12. 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

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

    Science.gov (United States)

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

    2016-01-01

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

  14. Cancer and treatment related pains in patients with cervical carcinoma

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    Das Saikat

    2005-01-01

    Full Text Available Pain in carcinoma cervix is a multidimensional experience with sensory, affective and cognitive-evaluative components. Many patients do not receive adequate pain management because of a lack of proper assessment, misconceptions regarding the pharmacologic and non pharmacologic methods of pain management and failure to distinguish between different types of pain. In our audit pelvic and nodal recurrence were the commonest cause of pain presenting as as pelvic pain, [42%], lumbosacral plexopathy [40%] and abdominal pain [34%] [n = 30]. Pain on defaecation caused by rectal obstruction, and suprapubic pain due to pyometra can be relieved by colostomy and drainage. Very little literature is available on the pain syndromes associated with carcinoma cervix. The present article is a review of cancer and treatment related pains in carcinoma cervix.

  15. 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.

  16. 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 ...

  17. 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 ...

  18. 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

  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. 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.

  1. 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.

  2. 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...

  3. Simulated Automobile and Rotary-Wing Aircraft Impacts: Dynamic Neck Response after Surgical Treatment for Cervical Spondylosis

    OpenAIRE

    White, Nicholas Alan

    2014-01-01

    Degeneration of the cervical spine is part of the normal aging process, usually occurring without clinical symptoms. Symptomatic degeneration most often occurs in the lower cervical spine, presenting as axial neck pain, radiculopathy, myelopathy, or any combination of the three. When conservative treatment does not adequately manage these symptoms, surgical intervention may be required. The longstanding surgical treatment for cervical degeneration is arthrodesis achieved through anterior cerv...

  4. Minimally Invasive Posterior Stabilization Improved Ambulation and Pain Scores in Patients with Plasmacytomas and/or Metastases of the Spine

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    Joseph H. Schwab

    2011-01-01

    Full Text Available Background. The incidence of spine metastasis is expected to increase as the population ages, and so is the number of palliative spinal procedures. Minimally invasive procedures are attractive options in that they offer the theoretical advantage of less morbidity. Purpose. The purpose of our study was to evaluate whether minimally invasive posterior spinal instrumentation provided significant pain relief and improved function. Study Design. We compared pre- and postoperative pain scores as well as ambulatory status in a population of patients suffering from oncologic conditions in the spine. Patient Sample. A consecutive series of patients with spine tumors treated minimally invasively with stabilization were reviewed. Outcome Measures. Visual analog pain scale as well as pre- and postoperative ambulatory status were used as outcome measures. Methods. Twenty-four patients who underwent minimally invasive posterior spinal instrumentation for metastasis were retrospectively reviewed. Results. Seven (29% patients were unable to ambulate secondary to pain and instability prior to surgery. All patients were ambulating within 2 to 3 days after having surgery (=0.01. The mean visual analog scale value for the preoperative patients was 2.8, and the mean postoperative value was 1.0 (=0.001. Conclusion. Minimally invasive posterior spinal instrumentation significantly improved pain and ambulatory status in this series.

  5. 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.

  6. A comprehensive subaxial cervical spine injury severity assessment model using numeric scores and its predictive value for surgical intervention.

    Science.gov (United States)

    Tsou, Paul M; Daffner, Scott D; Holly, Langston T; Shamie, A Nick; Wang, Jeffrey C

    2012-02-10

    Multiple factors contribute to the determination for surgical intervention in the setting of cervical spinal injury, yet to date no unified classification system exists that predicts this need. The goals of this study were twofold: to create a comprehensive subaxial cervical spine injury severity numeric scoring model, and to determine the predictive value of this model for the probability of surgical intervention. In a retrospective cohort study of 333 patients, neural impairment, patho-morphology, and available spinal canal sagittal diameter post-injury were selected as injury severity determinants. A common numeric scoring trend was created; smaller values indicated less favorable clinical conditions. Neural impairment was graded from 2-10, patho-morphology scoring ranged from 2-15, and post-injury available canal sagittal diameter (SD) was measured in millimeters at the narrowest point of injury. Logistic regression analysis was performed using the numeric scores to predict the probability for surgical intervention. Complete neurologic deficit was found in 39 patients, partial deficits in 108, root injuries in 19, and 167 were neurologically intact. The pre-injury mean canal SD was 14.6 mm; the post-injury measurement mean was 12.3 mm. The mean patho-morphology score for all patients was 10.9 and the mean neurologic function score was 7.6. There was a statistically significant difference in mean scores for neural impairment, canal SD, and patho-morphology for surgical compared to nonsurgical patients. At the lowest clinical score for each determinant, the probability for surgery was 0.949 for neural impairment, 0.989 for post-injury available canal SD, and 0.971 for patho-morphology. The unit odds ratio for each determinant was 1.73, 1.61, and 1.45, for neural impairment, patho-morphology, and canal SD scores, respectively. The subaxial cervical spine injury severity determinants of neural impairment, patho-morphology, and post-injury available canal SD have

  7. 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.

  8. 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.

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

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    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

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

    Science.gov (United States)

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

    2012-11-01

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

  11. Varicella-Zoster-Mediated Radiculitis Reactivation following Cervical Spine Surgery: Case Report and Review of the Literature

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    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.

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

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    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.

  13. 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...

  14. Granuloma eosinófilo da coluna cervical com manifestação neurológica, liquorica e radiológica atípica Unusual neurological, cerebrospinal fluid and roentgenografic manifestations of eosinophilic granuloma of the cervical spine: a case report

    Directory of Open Access Journals (Sweden)

    Umbertina Conti Reed

    1975-06-01

    Full Text Available É relatado um caso de granuloma eosinófilo da coluna cervical em menino branco de 10 anos de idade que apresentava dor cervical na altura de C5-C6, hemiparesia direita que evoluiu ulteriormente para tetraparesia, mista, de tipo motonêuronio inferior para membros superiores e de tipo motonêuronio superior para membros inferiores. O exame do líquido cefalorraquano (LCR revelou alterações de tipo inflamatório. Radiografias da coluna cervical mostravam apenas aspecto irregular da apófise espinhosa de C6 com rarefação na base. Houve acentuada e rápida melhora do quadro neurológico e normalização do LCR na vigência de córticoterapia e, reagravamento da sintomatologia neurológica bem como das alterações no LCR após supressão da referida medicação. A biópsia do processo espinhoso da sexta vértebra cervical revelou tratar-se de granuloma eosinófilo. A evolução foi excelente após radioterapia local associada a corticosteróides. São discutidas as características do caso e daqueles referidos na literatura.A case of eosinophilic granuloma of the cervical spine in a ten year-old white boy is reported. The patient complained of posterior cervical pain at the level of C5-C6 and right hemiparesis that progressed to mixed tetraparesis (lower motor neuron in upper limbs and upper motor neuron in lower limbs. Examination of the cerebrospinal fluid (CSF disclosed an inflammatory reaction; radiologic studies of the cervical spine showed an irregular aspect with demineralization at the base of spinous process of C6. The patient was treatet intermitently with corticosteroids (prednisone; there was an improvement of neurologic symptoms and the examination of the CSF was normal within a few days, each time he took the drug. Neurologic symptons and abnormalities of the CSF recurred after discontinuation of corticotherapy. Examination of a fragment of the spinous process and neighboring tissues of C6, taken by biopsy, disclosed eosinophilic

  15. 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 ...

  16. Cervical spine operation on patients after transfer safety%探讨颈椎手术后患者的安全转运

    Institute of Scientific and Technical Information of China (English)

    成健; 杨洋

    2012-01-01

    Objective To study the patients with cervical spine surgery within hospital Safe transfer. Methods Retrospective analysis the 853 cases of the cervical spine surgery from the operating room to wards of transport accident happened, from April 2011 to March 2012. Results Among 853 cases with 8 cases had occurred pipeline emergence, heart rate changed of 17 cases, 15 cases of blood oxygen saturation changed, 8 cases had some questions in receiving department. Conclusion cervical spine surgery patients after the transfer process existed all risks, and medical staff of the postoperative transport to give attention, to ensure that patients with cervical spine surgery within hospital safe transfer.%目的:探讨颈椎手术后患者院内安全转运的对策.方法:回顾分析本院2011年4月~2012年3月从手术室转送到病房的颈椎手术后患者发生转运意外的情况.结果:本组853例患者中有8例发生管道脱出,心率改变17例,15例血氧饱和度改变,8例与接收科室沟通不协调交接不清.结论:颈椎手术后患者转运过程中存在各种风险,医务人员对患者术后转运要给予重视,做好针对性的防范对策,以确保颈椎手术后患者安全转运.

  17. One-stage microsurgical excision for intra- and extra-spinal dumbbell-shaped tumors in cervical spine: a report of 11 cases

    Directory of Open Access Journals (Sweden)

    GAO Fang-you

    2013-07-01

    Full Text Available Objective To investigate the clinical characteristics and surgical treatment strategy of intra- and extra-spinal dumbbell-shaped tumors in cervical spine. Methods Clinical data of 11 patients with intra- and extra-spinal dumbbell-shaped tumors in cervical spine were retrospectively studied. Male was in 7 cases, female in 4 cases. The tumors were in stageⅠin 4 cases, Ⅱ in 2 cases, Ⅲ in 4 cases and Ⅳ in one case. The tumors were resected via posterior midline approach alone in 9 cases, among whom unilateral hemilaminectomy was performed in 4 cases (screw fixation via posterior approach was performed for fusion of lesion segments after tumor resection in 2 cases, one was stage Ⅳ tumor, another one was stage Ⅲ tumor in cervicothoracic junction, total laminotomy and reduction by titanium miniplates and screws in 2 cases, and via interlaminar approach in 3 cases. Posterior midline approach combined with anterior lateral approach was performed in the rest 2 cases. Results Tumors were one-stage totally resected in all of the cases. Histological types of the tumors included schwannoma in 10 cases, and ganglioneuroma in one case. The numbness area was enlarged in one case, and the motor function improved in other cases. All of the patients were followed-up from 8 months to 3.50 years with an average of 21 months. No tumor relapse and spinal deformity were found. Conclusion Most cases of intra- and extra-spinal dumbbell-shaped tumors can be treated with one-stage microsurgery. The surgical treatment strategy can be reached according to the location and surgical staging of tumors. Unilateral hemilaminectomy technique is useful to maintain the stability of the cervical spine for most of tumors. Combined approach is needed in some of the tumors and fixation should be implemented in the case of stability of cervical spine damaged after tumor resection.

  18. Inflammatory spine disease as a cause of back pain; Entzuendliche Wirbelsaeulenerkrankungen als Ursache fuer Rueckenschmerzen

    Energy Technology Data Exchange (ETDEWEB)

    Schlossbauer, T.; Panteleon, A.; Becker-Gaab, C. [Klinikum Innenstadt der Ludwig-Maximilians-Universitaet, Institut fuer Klinische Radiologe, Muenchen (Germany)

    2006-06-15

    The aim of this review is to evaluate the role of inflammatory spine disease in patients with chronic back pain. The contribution of imaging modalities for the diagnostic evaluation of back pain is discussed. A systematic literature search based on the classification of seronegative spondyloarthropathies and rheumatoid arthritis was performed. The results of this search and the experiences in a large collective of rheumatological patients are analyzed. The prevalence of rheumatoid arthritis (1-2%) is comparable to that of spondyloarthropathies (1.9%). The etiology of these entities is not fully elucidated. Magnetic resonance imaging is increasingly used for early detection and surveillance of therapy with TNF-{alpha} antagonists. Bone marrow edema, which is only detectable with MRI, represents an early sign of inflammation. Therapy with TNF-{alpha} antagonists is based on clinical and laboratory criteria, and signs of inflammation in MRI. MRI is useful for assessment of the effectiveness of anti-inflammatory therapy. (orig.) [German] Ziel der Arbeit ist, die Bedeutung inflammatorischer Wirbelsaeulenerkrankungen fuer das Leitsymptom Rueckenschmerz zu eroertern. Die Aussagekraft der verschiedenen radiologischen Verfahren wird diskutiert. Basierend auf der Einteilung der seronegativen Spondylarthropathien (SpA) sowie der rheumatoiden Arthritis (RA), erfolgte eine systematische Literaturrecherche. Die Ergebnisse dieser Recherche und die eigenen Erfahrungen mit einem grossen rheumatologischen Krankengut werden analysiert. Die Praevalenz der RA (1-2%) und der Gruppe der SpA (1,9%) ist vergleichbar, wobei die Aetiologie letztlich bei keiner der genannten Erkrankungen bekannt ist. Die bildmorphologische Kriterien koennen sich ueberlappen. Die MRT wird zunehmend bei Frueherkennung und Verlaufsbeurteilung der immunmodulatorischen Therapien (TNF-{alpha}-Antagonisten) eingesetzt. Ein Oedem im Knochen, das nur mit der MRT nachweisbar ist, zeigt die Aktivitaet der Entzuendung

  19. Radiation therapy for chordoma and chondrosarcoma of the skull base and the cervical spine. Prognostic factors and patterns of failure

    Energy Technology Data Exchange (ETDEWEB)

    Noel, G.; Jauffret, E.; Mammar, H.; Ferrand, R. [Centre de Protontherapie d' Orsay, Orsay (France); Habrand, J.L.; Crevoisier, R. de; Haie-Meder, C.; Beaudre, A. [Inst. Gustave Roussy, Villejuif (France); Dederke, S.; Hasboun, D.; Boisserie, G. [Groupe Pitie Salpetriere, AP-HP, Paris (France); Pontvert, D.; Gaboriaud, G. [Inst. Curie, Paris (France); Guedea, F.; Petriz, L. [Catalan Inst. of Oncology, Barcelona (Spain); Mazeron, J.J. [Centre de Protontherapie d' Orsay, Orsay (France); Groupe Pitie Salpetriere, AP-HP, Paris (France)

    2003-04-01

    Background: Prospective analysis of local tumor control, survival and treatment complications in 67 consecutive patients treated with fractionated photon and proton radiation for chordoma or chondrosarcoma of the base of the skull and the cervical spine. Patients and Methods: Between December 1995 and January 2000, 67 patients with a median age of 52 years (range: 14-85 years), were treated at the Centre de Protontherapie d'Orsay (CPO), France, using the 201-MeV proton beam, 49 for chordoma and 18 for chondrosarcoma. Irradiation combined high-energy photons and protons. Photons represented two thirds of the total dose and protons one third. The median total dose delivered within gross tumor volume (GTV) was 67 cobalt gray equivalents (CGE; range: 60-70 CGE). Results: Within a median follow-up of 29 months (range: 4-71 months), the 3-year local control rates were 71% and 85% for chordomas and chondrosarcomas, respectively, and the 3-year overall survival rates 88% and 75%, respectively. 14 tumors (21.5%) failed locally (eight within the GTV, four within the clinical target volume [CTV], and two without further assessment). Seven patients died from their tumor and another one from a nonrelated condition (pulmonary embolism). The maximum tumor diameter and, similarly, the GTV were larger in relapsing patients, compared with the rest of the population: 56 mm vs 44 mm (p = 0.024) and 50 ml vs 22 ml (p = 0.0083), respectively. In univariate analysis, age {<=} 52 years at the time of radiotherapy (p = 0.002), maximum diameter < 45 mm (p = 0.02), and GTV < 28 ml (p = 0.02) impacted positively on local control. On multivariate analysis, only age was an independent prognostic factor of local control. Conclusion: In chordomas and chondrosarcomas of the skull base and cervical spine, combined photon and proton radiation therapy offers excellent chances of cure. In two thirds of the cases, relapses are located in the GTV. Maximum diameter, GTV, and age are prognostic

  20. 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.)

  1. 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.)

  2. Cervical osteomyelitis after carbon dioxide laser excision of recurrent carcinoma of the posterior pharyngeal wall

    NARCIS (Netherlands)

    A.J. Timmermans; D. Brandsma; L.E. Smeele; A.W. Rosingh; M.W.M. van den Brekel; P.J.F.M. Lohuis

    2013-01-01

    Two patients with recurrent carcinoma of the posterior pharyngeal wall, previously treated with carbon dioxide (CO2) laser excision and (chemo)radiotherapy, presented with neck pain due to cervical osteomyelitis. In one patient this led to cervical spine instability, for which a haloframe was applie

  3. Stretch-induced cervicobrachial pain syndrome.

    Science.gov (United States)

    Quintner, J

    1990-01-01

    The case records of 22 patients who presented with severe and persistent cervicobrachial pain were reviewed. The onset of their pain followed the performance of a forceful activity (lifting, pulling or pushing) using one or both arms in the outstretched position. Their symptoms and the findings on physical examination were both consistent with stretch-induced damage to neural tissues related to the painful upper limb. The predominant site of painful neural pathology appeared to be within the cervical spine. PMID:25025877

  4. Pain medication use after spine surgery: is it assessed in the literature? A systematic review, January 2000–December 2009

    OpenAIRE

    Yoshihara, Hiroyuki

    2015-01-01

    Background Spine surgery is one of the most difficult areas in which to achieve a good clinical outcome and pain medication is often used for a long period of time after surgery. The purpose of this study was to investigate whether pain medication use after spine surgery has been assessed previously with respect to clinical outcome. Methods A systematic review of PubMed/MEDLINE databases was conducted from Jan 1st 2000 to Dec 31st 2009 using the search key words, “spine surgery” and “clinical...

  5. 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.

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

    Science.gov (United States)

    Kim, Man-Sig

    2015-01-01

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

  7. 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.

  8. Spine Kinematics During Prone Extension in People With and Without Low Back Pain and Among Classification-Specific Low Back Pain Subgroups.

    Science.gov (United States)

    Mazzone, Brittney; Wood, Ron; Gombatto, Sara

    2016-07-01

    Study Design Cross-sectional observational design. Background Spine extension is used in physical therapy during examination and treatment for low back pain (LBP). However, kinematics during prone extension have not been examined using 3-D motion capture. Objectives The primary purpose was to determine differences in spine kinematics during prone extension between subjects with and without LBP. An exploratory analysis was conducted to examine kinematic differences among LBP subgroups. Methods Kinematics of the thoracic and lumbar spine were examined during prone extension, using optical motion capture, in 18 subjects with LBP and 17 subjects without LBP (control group). Excursion of each spinal region was calculated for the entire movement and during 25% increments of extension movement duration. Subjects with LBP were examined and assigned to subgroups using 3 different classification systems for LBP. Repeated-measures analysis-of-variance tests were used to examine effects of group (LBP, control), spine region, and increment of movement duration, and to explore effects of LBP subgroup. Results For spine kinematics, there was a significant group-by-region interaction effect (Plower lumbar extension (13.3° ± 4.9°) than control subjects (21.4° ± 9.2°). The majority of lower lumbar extension occurred during the first 50% of the motion for subjects with LBP. Subgroup-by-region interaction effects were significant for 2 of 3 LBP classification systems (Plower lumbar extension than control subjects during prone extension. These differences should be considered when evaluating and prescribing prone extension. The interpretation of subgroup differences with prone extension kinematics is limited in the current study by the small sample size, but may need to be considered in future studies of spine kinematics. Level of Evidence Diagnosis, level 4. J Orthop Sports Phys Ther 2016;46(7):571-579. Epub 12 May 2016. doi:10.2519/jospt.2016.6159. PMID:27170528

  9. 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

  10. Demographics features, clinical findings and functional status in a group of subjects with cervical myofascial pain syndrome.

    Science.gov (United States)

    Sahin, Nilay; Karataş, Omer; Ozkaya, Murat; Cakmak, Ayşegül; Berker, Ender

    2008-07-01

    Subjects with myofascial pain of muscles of the neck region may present with various clinical symptoms. The aim of this study was to explore the demographics features, clinical findings and functional status in a group of patients presenting with myofascial pain of the cervical muscles. 94 cervical myofascial pain syndrome patients were recruited from the out-patient clinic. Evaluated of patient short form health survey (SF-36), pain, depression, patient demographics and physical examinations. Outcome measures; SF-36 Health Survey, visual analog scale, Beck Depression Inventory, history, physical examination. A total of 82 patients with a diagnosis of cervical myofascial syndrome were included in the study. All patients were in the young age group 37.4+/-9, and 87.8% were females. 53.1% had trigger points in the trapezius muscle with high percentage of autonomic phenomena like skin reddening, lacrimation, tinnitus and vertigo. 58.5% of the series had suffered from former cervical trauma and 40.2% also had fibromyalgia syndrome and 18.5% had benign Joint hypermobility syndrome. Younger female patients presenting with autonomic phenomena and early onset cervical injury should be examined for cervical myofascial pain syndrome and also for fibromyalgia syndrome since this study demonstrated a high percentage of fibromyalgia syndrome in these patients.

  11. 胸腺类癌脊柱转移一例报告%Thymic carcinoid with spine metastasis:1 case report

    Institute of Scientific and Technical Information of China (English)

    姜良海; 谭明生; 杨峰; 董亮

    2015-01-01

    Objective To report 1 patient diagnosed as thymic carcinoid with spine metastasis.Methods A 56-year-old man had pain in the neck and right shoulder for 1 year. Pain aggravated in nearly 1 month. Cervical MRI showed multiple abnormal signals and C2 soft-tissue mass intruding into the vertebral canal. Cervical vertebrae CT scan showed multiple bone erosion. The diagnosis of thymic carcinoid was acquired by preoperative cervical lymph node biopsy and histopathological examination. The patient underwent cervical laminectomy, internal ifxation and occipitocervical fusion.Results Signiifcant alleviation of the pain in the neck and shoulder was achieved. The postoperative histological examination conifrmed the diagnosis of thymic carcinoid.Conclusions Thymic carcinoid with spine metastasis is a rare disease. Posterior laminectomy, vertebroplasty plus internal fixation is an effective method in the treatment of thymic carcinoid with spine metastasis.

  12. Analysis of Lumbar Spine and Hip Pattern Motion While Stoop Lifting in Subjects with and Without a History of Low Back Pain

    Directory of Open Access Journals (Sweden)

    F. Ghiasi, M.Sc.

    2007-09-01

    Full Text Available Background and purpose: Reports of pattern motion between lumbar spine and hip vary for stoop, loading conditions or the pathology present, such as chronic back pain. Therefore, the purpose of this study was to compare the relative contribution of the hip joint and lumbar spine during stoop lifting in subjects with and without a history of low back pain.Materials and Methods: This clinical trial was performed in Tehran. Fifty subjects were assigned as either a low back pain group or a control group. A Three-Dimensional Optoelectric Motion Analysis System was used to measure the amount of lumbar spine and hip motion during stoop lifting. Each subject performed stoop lifting with and without weight. The data were analyzed using independent t-test and repeated measurement test.Results: These results showed that there were significant differences between patients with low back pain and healthy subjects in the pattern of motion (P<0.05. Individuals with a history of low back pain tended to move from the lumbar spine than those with no history of low back pain.Conclusion: According to the findings, history of backache can affect the change of pattern motion for hip joint and lumbar spine. This change may be a reason for the recurrent incidence of backache.

  13. Treatment of 21 cases with knee pain originated from spine by acupuncture%针刺治疗脊柱源性膝关节痛21例

    Institute of Scientific and Technical Information of China (English)

    高志勇

    2010-01-01

    @@ Knee pain originated from spine is uncommon in clinic. This kind of patients usually manifests as wandering knee pain, and the effect of treatment aiming at knee simply is unobvious. The author treated 21 cases in this type from June 2006 to March 2009,and the condition is as follows.

  14. Biomechanical analysis of the camelid cervical intervertebral disc

    Directory of Open Access Journals (Sweden)

    Dean K. Stolworthy

    2015-01-01

    Full Text Available Chronic low back pain (LBP is a prevalent global problem, which is often correlated with degenerative disc disease. The development and use of good, relevant animal models of the spine may improve treatment options for this condition. While no animal model is capable of reproducing the exact biology, anatomy, and biomechanics of the human spine, the quality of a particular animal model increases with the number of shared characteristics that are relevant to the human condition. The purpose of this study was to investigate the camelid (specifically, alpaca and llama cervical spine as a model of the human lumbar spine. Cervical spines were obtained from four alpacas and four llamas and individual segments were used for segmental flexibility/biomechanics and/or morphology/anatomy studies. Qualitative and quantitative data were compared for the alpaca and llama cervical spines, and human lumbar specimens in addition to other published large animal data. Results indicate that a camelid cervical intervertebral disc (IVD closely approximates the human lumbar disc with regard to size, spinal posture, and biomechanical flexibility. Specifically, compared with the human lumbar disc, the alpaca and llama cervical disc size are approximately 62%, 83%, and 75% with regard to area, depth, and width, respectively, and the disc flexibility is approximately 133%, 173%, and 254%, with regard to range of motion (ROM in axial-rotation, flexion-extension, and lateral-bending, respectively. These results, combined with the clinical report of disc degeneration in the llama lower cervical spine, suggest that the camelid cervical spine is potentially well suited for use as an animal model in biomechanical studies of the human lumbar spine.

  15. 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.

  16. 小针刀治疗早期退行性下颈椎失稳症的临床观察%Clinical study of akupotomye therapy on early degenerative disease of cervical spine instability

    Institute of Scientific and Technical Information of China (English)

    陈青; 龚志贤; 张月娟; 周芳

    2011-01-01

    Objective To observe and compare the clinical efficacy of the treatment in early degenerative disease of cervical spine instability with the akupotomye and neck collar protection.Methods 60 patients the disease were randomly divided into test group (akupotomye group)and control group(cervical collar group), 30 patients in each group.The indexes of neck pain before and after treatment and the changes of AD HD imaging value were measured.Results 1.After treatment, the indexes of pain in both groups were significantly lowered, and the test group was much lower than that in control group (P<0.05); the total effective rate was 83.3% in test group and 73.3% in control group (P<0.05).2.The imaging values of HD in test group was better than that in control group (P<0.05), but the D-value of AD was not significant (P>0.05).Conclusion The akupotomye therapy for early degenerative disorder of lower cervical spine instability can significantly reduce the neck pain index figure and significantly improve the HD and AD values, which is effective therapy for early degenerative disease of the lower cervical spine instability.%目的 观察并比较小针刀与颈托保护治疗早期退行性下颈椎失稳症的临床疗效.方法 早期退行性下颈椎失稳症患者60例,随机分为试验组(针刀组)和对照组(颈托组),每组各30例.观察两组患者治疗前后疼痛指数、影像学水平位移之和(HD)值及角位移(AD)值变化.结果 1.两组治疗后疼痛指数积分均显著降低,试验组优于对照组(P<0.01);颈痛指数疗效试验组总有效率达83.3%,对照组为73.3%,试验组优于对照组(P<0.05).2.两组治疗前后影像学HD差值试验组优于对照组(P<0.05);AD差值两组差异无统计学意义(P<0.05).结论 小针刀治疗早期退行性下颈椎失稳症能明显降低患者颈痛指数,并显著改善HD值及AD值,是治疗早期退行性下颈椎失稳症的一种疗效确切的治疗方法.

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

    Energy Technology Data Exchange (ETDEWEB)

    Soo, M.; Tran-Dinh, H.D.; Quach, T.; Downey, J.; Pohlmann, S. [Westmead Hospital, Westmead, NSW (Australia). Department of Radiology; Dorsch, N.W.C. [Westmead Hospital, Westmead, NSW (Australia). Department of Neurosurgery

    1997-11-01

    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). 22 refs., 3 tabs., 3 figs.

  18. The potential impact of various diagnostic strategies in cases of chronic pain syndromes associated with lumbar spine degeneration

    Directory of Open Access Journals (Sweden)

    Bokov A

    2013-04-01

    of a particular technology be taken into consideration but also the rate of false negative results. Acceptable diagnostic criteria should be based on a rational balance of sensitivity and specificity. Keywords: diagnostic strategy, lumbar spine, noncompressive pain, sensitivity, specificity

  19. Spinal alignment, mobility of the hip and thoracic spine and prevalence of low back pain in young elite cross-country skiers.

    Science.gov (United States)

    Alricsson, Marie; Björklund, Glenn; Cronholm, Martin; Olsson, Oscar; Viklund, Peter; Svantesson, Ulla

    2016-02-01

    This study investigated the association between spinal alignment, mobility of the hips and the thoracic spine and low back pain in adolescent cross-country skiers. Cohort of 51 elite cross-country skiers from a cross-country skiing high school in Sweden participated in the study. Sagittal spinal alignment, active range of motion in flexion, extension and rotation of the thoracic spine as well as passive and active extension of the hips were measured. The participants also completed a questionnaire regarding training, competition, skiing technique and occurrence of low back pain. A simple linear regression was calculated to predict pain score based on thoraco-lumbar relation, with a significant (Pcross-country skiers. This study shows that range of motion of the thoracic spine and hips do not have an effect on the prevalence of low back pain in this population.

  20. Does cervical kyphosis relate to symptoms following whiplash injury?

    DEFF Research Database (Denmark)

    Johansson, Mats Peter; Baann Liane, Martin Skogheim; Bendix, Tom;

    2011-01-01

    The mechanisms for developing long-lasting neck pain after whiplash injuries are still largely unrevealed. In the present study it was investigated whether a kyphotic deformity of the cervical spine, as opposed to a straight or a lordotic spine, was associated with the symptoms at baseline, and...... with the prognosis one year following a whiplash injury. MRI was performed in 171 subjects about 10 d after the accident, and 104 participated in the pain recording at 1-year follow-up. It was demonstrated that postures as seen on MRI can be reliably categorized and that a straight spine is the most...

  1. Imaging features of cervical spine curvature of idiopathic scoliosis%特发性脊柱侧弯颈椎曲度影像学特征分析

    Institute of Scientific and Technical Information of China (English)

    唐瑶; 邓俊才; 明星; 吴非

    2016-01-01

    Objective To analyze the imaging characteristics of cervical spine curvature of idiopathic scoliosis and to explore the relationship between cervical curvature and scoliosis angle size .Methods Frontal and lateral full-spine X-ray imaging of 93 pa-tients with idiopathic scoliosis were retrospectively analyzed .Cervical sagittal Cobb angle and cervical spine angle were measured on lat-eral view,and scoliosis Cobb angle was measured on the anteroposterior films .The differences between cervical Cobb angle and the cer-vical angle were compared and the correlation among cervical sagittal Cobb angle ,scoliosis Cobb angle ,and cervical spine angle was an-alyzed.Results In the 93 patients,the scoliosis Cobb angle was (27.9±16.9)°,cervical sagittal Cobb angle (-3.7±16.0)°and av-erage of cervical angle was (-2.0 ±16.6 ) °.The abnormalities of cervical Cobb angle accounted for 69.89%.The abnormalities of cer-vical angle accounted for 67.74%.There was a significant difference between cervical Cobb angle and the cervical angle ( t =-2.641 , P =0.010 ) .They were highly correlated ( r =0.935 ,P =0.000 ) .The correlations between cervical scoliosis Cobb angle and Cobb angle and between cervical scoliosis Cobb angle and cervical angle were weak ( r =0.246 ,P =0.018 and r =0.215 ,P =0.039 ,re-spectively).Conclusion The abnormalities of curvature in sagittal cervical of idiopathic scoliosis have a high proportion .There is no exactly correlation between the size of the curvature in sagittal cervical and the scoliosis curvature .%目的:探讨特发性脊柱侧弯患者颈椎曲度的特点及颈椎曲度与脊柱侧弯角度大小的关系。方法回顾性分析93例特发性脊柱侧弯患者全脊柱正侧位X射线片影像资料,在标准侧位片上测量颈椎矢状面Cobb角和颈椎夹角,在正位片上测量脊柱侧弯Cobb角。比较颈椎Cobb角和颈椎夹角的差异,分析脊柱侧弯Cobb角、颈椎Cobb角和颈椎夹角的相关性。结果93例特

  2. Evaluation of a single-dose, extended-release epidural morphine formulation for pain control after lumbar spine surgery.

    Science.gov (United States)

    Vineyard, Joseph C; Toohey, John S; Neidre, Arvo; Fogel, Guy; Joyner, Robert

    2014-01-01

    DepoDur, an extended-release epidural morphine, has been used effectively for postoperative pain control following many orthopaedic and general surgery procedures and has provided prolonged analgesia when compared with Duramorph. The goal of this article was to compare the safety and analgesic efficacy of DepoDur versus Duramorph after lumbar spine surgery. A prospective, randomized, double-blind clinical study was completed at a single extended-stay ambulatory surgery center. All patients over 18 undergoing posterior lumbar spine fusions were considered for the study. Sixty patients were randomly assigned to a control or treatment group. The control group received DepoDur before surgery, while the treatment group received Duramorph. Although results show no significant differences between the two groups in postoperative visual analog pain scale scores, use of pain medication, and adverse events, subjects receiving DepoDur were less likely to receive Naloxone and oxygen supplementation, experience nausea or fever, and were more likely to experience hypotension. DepoDur proved to be safe and effective, offering similar prolonged analgesic activity when compared with Duramorph.

  3. The short- and medium-term effectiveness of CT-guided selective cervical nerve root injection for pain and disability

    Energy Technology Data Exchange (ETDEWEB)

    Desai, Amidevi; Saha, Shouvik; Sharma, Naveen; Huckerby, Lauren; Houghton, Russell [Guy' s and St. Thomas' Hospitals, Department of Radiology, London (United Kingdom)

    2014-07-15

    CT-guided cervical nerve root injection with corticosteroid and/or local anesthetic is a recognized technique in the evaluation and treatment of cervical radiculopathy. There are few prospective studies on the efficacy of the various techniques employed in cervical nerve root injection. We present our results from a 1-year prospective series using a CT-guided anterolateral transforaminal approach for cervical nerve root injection of bupivacaine and dexamethasone. Pain using a numeric rating scale was assessed at pre-injection, 15 min post-injection, 1 month, and 3 months. Disability was assessed using the Oswestry Neck Disability Index (NDI) questionnaire at pre-injection, 1 month post-injection, and 3 months. In total, 50 patients were followed for 3 months. The mean reductions in pain were: 15 min (77 %), 1 month (39 %), and 3 months (33 %). The mean reductions in NDI were: 1 month (26 %) and 3 months (also 26 %). Results were statistically significant. CT-guided selective cervical nerve root injection in the treatment of cervical radicular pain and related disability produces statistically significant reductions in pain and disability to at least 3 months post-procedure. (orig.)

  4. The short- and medium-term effectiveness of CT-guided selective cervical nerve root injection for pain and disability

    International Nuclear Information System (INIS)

    CT-guided cervical nerve root injection with corticosteroid and/or local anesthetic is a recognized technique in the evaluation and treatment of cervical radiculopathy. There are few prospective studies on the efficacy of the various techniques employed in cervical nerve root injection. We present our results from a 1-year prospective series using a CT-guided anterolateral transforaminal approach for cervical nerve root injection of bupivacaine and dexamethasone. Pain using a numeric rating scale was assessed at pre-injection, 15 min post-injection, 1 month, and 3 months. Disability was assessed using the Oswestry Neck Disability Index (NDI) questionnaire at pre-injection, 1 month post-injection, and 3 months. In total, 50 patients were followed for 3 months. The mean reductions in pain were: 15 min (77 %), 1 month (39 %), and 3 months (33 %). The mean reductions in NDI were: 1 month (26 %) and 3 months (also 26 %). Results were statistically significant. CT-guided selective cervical nerve root injection in the treatment of cervical radicular pain and related disability produces statistically significant reductions in pain and disability to at least 3 months post-procedure. (orig.)

  5. The role of surgery for treatment of low back pain: insights from the randomized controlled Spine Patient Outcomes Research Trials

    Directory of Open Access Journals (Sweden)

    Peter Abraham

    2016-01-01

    Full Text Available Low back pain (LBP is a common medical problem with high morbidity and healthcare costs. The optimal management strategy, including the role of surgical intervention, remains controversial. The Spine Patient Outcomes Research Trials were randomized controlled studies conducted to assess the effectiveness of surgery for three of the most common conditions implicated in LBP: Intervertebral disc herniation, degenerative spondylolisthesis, and spinal stenosis. Despite challenges in data interpretation related to patient cross over, these studies support the efficacy of surgery as treatment for these three common conditions.

  6. Effect of the Spacing of Backpack Shoulder Straps on Cervical Muscle Activity, Acromion and Scapular Position, and Upper Trapezius Pain

    OpenAIRE

    Kim, Min-Hee; Yoo, Won-gyu

    2013-01-01

    [Purpose] This study investigated the effect of the spacing of backpack shoulder straps on cervical muscle activity, acromion and scapular position, and upper trapezius (UT) pain. [Subjects] Fourteen males aged 20–32 years, were recruited. [Methods] We measured the MPS (midcervical paraspinal) activity, acromial angle, scapular distance, and UT pain after gait carrying a backpack with different shoulder strap spacings. [Results] The MPS, scapular inferior distance, and UT pressure pain thresh...

  7. 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

  8. Incidence and Predictive Factors of Pain Flare After Spine Stereotactic Body Radiation Therapy: Secondary Analysis of Phase 1/2 Trials

    Energy Technology Data Exchange (ETDEWEB)

    Pan, Hubert Y.; Allen, Pamela K. [Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Wang, Xin S. [Department of Symptom Research, University of Texas MD Anderson Cancer, Houston, Texas (United States); Chang, Eric L. [Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Department of Radiation Oncology, USC Norris Cancer Center, Los Angeles, California (United States); Rhines, Laurence D.; Tatsui, Claudio E. [Department of Neurosurgery, University of Texas MD Anderson Cancer, Houston, Texas (United States); Amini, Behrang [Department of Diagnostic Radiology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Wang, Xin A. [Department of Radiation Physics, University of Texas MD Anderson Cancer, Houston, Texas (United States); Tannir, Nizar M. [Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Brown, Paul D. [Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Ghia, Amol J., E-mail: AJGhia@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States)

    2014-11-15

    Purpose/Objective(s): To perform a secondary analysis of institutional prospective spine stereotactic body radiation therapy (SBRT) trials to investigate posttreatment acute pain flare. Methods and Materials: Medical records for enrolled patients were reviewed. Study protocol included baseline and follow-up surveys with pain assessment by Brief Pain Inventory and documentation of pain medications. Patients were considered evaluable for pain flare if clinical note or follow-up survey was completed within 2 weeks of SBRT. Pain flare was defined as a clinical note indicating increased pain at the treated site or survey showing a 2-point increase in worst pain score, a 25% increase in analgesic intake, or the initiation of steroids. Binary logistic regression was used to determine predictive factors for pain flare occurrence. Results: Of the 210 enrolled patients, 195 (93%) were evaluable for pain flare, including 172 (88%) clinically, 135 (69%) by survey, and 112 (57%) by both methods. Of evaluable patients, 61 (31%) had undergone prior surgery, 57 (29%) had received prior radiation, and 34 (17%) took steroids during treatment, mostly for prior conditions. Pain flare was observed in 44 patients (23%). Median time to pain flare was 5 days (range, 0-20 days) after the start of treatment. On multivariate analysis, the only independent factor associated with pain flare was the number of treatment fractions (odds ratio = 0.66, P=.004). Age, sex, performance status, spine location, number of treated vertebrae, prior radiation, prior surgery, primary tumor histology, baseline pain score, and steroid use were not significant. Conclusions: Acute pain flare after spine SBRT is a relatively common event, for which patients should be counseled. Additional study is needed to determine whether prophylactic or symptomatic intervention is preferred.

  9. 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.

  10. 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.

  11. 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.

  12. The effect of thoracic spine mobilization and stabilization exercise on the muscular strength and flexibility of the trunk of chronic low back pain patients.

    Science.gov (United States)

    Yang, Seong-Rae; Kim, Kyung; Park, Sun-Ja; Kim, Kyung

    2015-12-01

    [Purpose] To investigate whether thoracic spine mobilization added to stabilization exercises increases the muscular strength and range of motion of the thoracic vertebrae of chronic low-back pain patients. [Subjects] This study enrolled 20 patients with chronic low back pain, who were divided into two groups. Ten subjects were randomly selected for the stabilization exercise group and the remaining 10 subjects received thoracic spine mobilization in addition to performing the stabilization exercises. [Methods] The patients performed stabilization exercises and received thoracic spine mobilization for 12 weeks. The range of motion and isometric muscular strength of the vertebrae of all subjects were measured before and after the intervention. [Results] In the comparison of muscular strength before and after the intervention, the change in muscular strength of the trunk flexors in the stabilization exercise group was 16.0±7.4 Nm, and that of the thoracic spine mobilization group was 34.2±7.6 Nm, a significant difference in each group. In the post-intervention intergroup comparison, the muscular strength of trunk flexors in the stabilization exercise group was 111.1±16.9 Nm, while that of the thoracic spine mobilization group was 125.9±11.3 Nm, a significant difference. Also, the muscular strength of the trunk extensors in the stabilization exercise group was 148.9±31.8 Nm, while that of the thoracic spine mobilization group was 182.9±37.2 Nm, a significant difference. The thoracic spine flexion in the stabilization exercise group was 29.8±9 degrees, while that of the thoracic spine mobilization group was 38.7±6.9 degrees, a significant difference. However, there was no significant difference in lumbar flexion values between the two groups. [Conclusion] Thoracic spine mobilization added to a stabilization exercise increased the muscular strength of patients with chronic low back pain.

  13. Differential diagnosis of cervical radiculopathy and superior pulmonary sulcus tumor

    Institute of Scientific and Technical Information of China (English)

    GU Rui; KANG Ming-yang; GAO Zhong-li; ZHAO Jian-wu; WANG Jin-cheng

    2012-01-01

    Background The result would be disastrous if the superior pulmonary sulcus tumor (Pancoast tumor) was misdiagnosed as degenerative cervical spine diseases.The aim of this study was to investigate the differential diagnosis methods of cervical radiculopathy and superior pulmonary sulcus tumor.Methods Clinical manifestations,physical,and radiological findings of 10 patients,whose main complaints were radiating shoulder and arm pain and later were diagnosed with superior pulmonary sulcus tumor,were reviewed and compared with those of cervical radiculopathy.Results Superior pulmonary sulcus tumor patients have shorter mean history and fewer complaints of neck pain or limitation of neck movement.Physical examination showed almost normal cervical spine range of motion.Spurling's neck compression test was negative in all patients.Anteroposterior cervical radiographs showed the lack of pulmonary air at the top of the affected lung in all cases and first rib encroachment in one case.The diagnosis of superior pulmonary sulcus tumor can be further confirmed by CT and MRI.Conclusions By the method of combination of history,physical examination,and radiological findings,superior pulmonary sulcus tumor can be efficiently differentiated from cervical radiculopathy.Normal motion range of the cervical spine,negative Spurling's neck compression test,and the lack of pulmonary air at the top of the affected lung in anteroposterior cervical radiographs should be considerad as indications for further chest radiograph examinations.

  14. [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

  15. Cine phase-contrast MRI measurement of CSF flow in the cervical spine: a pilot study in patients with spinal cord injury

    Science.gov (United States)

    Negahdar, MJ; Shakeri, M.; McDowell, E.; Wells, J.; Vitaz, T.; Harkema, S.; Amini, A.

    2011-03-01

    MRI velocimetry (also known as phase-contrast MRI) is a powerful tool for quantification of cerebrospinal fluid (CSF) flow in various regions of the brain and craniospinal junction and has been accepted as a diagnostic tool to assist with the diagnosis of certain conditions such as hydrocephalus and chiari malformations. Cerebrospinal fluid is continually produced in the ventricles of the brain, flows through the ventricular system and then out and around the brain and spinal cord and is reabsorbed over the convexity of the brain. Any disease process which either impedes the normal pattern of flow or restricts the area where flow occurs can change the pattern of these waveforms with the direction and velocity of flow being determined by the pressure transmitted from the pulsation of the heart and circulation of blood within the central nervous system. Therefore, we hypothesized that phase-contrast MRI could eventually be used as a diagnostic aid in determining the degree of spinal cord compression following injury to the cervical or thoracic spine. In this study, we examined CSF flow in 3 normal subjects and 2 subjects with non-acute injuries in the cervical spine using Cine phasecontrast MRI. CSF flow analysis was performed using an in-house developed software. The flow waveform was calculated in both normal subjects (n=3) as well as subjects with spinal cord injury in the cervical spine (n=2). The bulk flow at C2 was measured to be 0.30 +/- 0.05 cc, at 5 cm distal to C2, it was 0.19+/- 0.07 cc, and at 10 cm distal to C2, it was 0.17+/- 0.05 cc. These results were in good agreement with previously published results. In patients with spinal cord injury, at the site of injury in the cervical spine, bulk flow was found to be 0.08 +/- 0.12 cc, at 5 cm proximal to the site of injury it was found to be 0.18 +/- 0.07 cc, and at 5 cm distal to the site of injury, it was found to be 0.12 +/- 0.01 cc.

  16. Meta-analysis of incidence of degenerative and sprained/strained cervical spine diseases in military aviators%军事飞行人员劳损退变性颈椎疾病荟萃分析

    Institute of Scientific and Technical Information of China (English)

    陈立君; 卫杰; 龚成; 孔德良; 王飞; 范宇; 赵平; 王建昌

    2013-01-01

    and 393 English literatures related to degenerative and sprained/strained cervical spine diseases in military aviators,12 Chinese literatures and 22 English literatures,concerning incidence of the disease,were accepted.There were 2 literatures in grade A,7 in grade B,17 in grade C,8 in grade D.Incidence of neck pain related to flying in military aviators was 57.98%,incidence of cervical spondylosis was 32.53%,and incidence of cervical radiculopathy was 0.50%.Incidence of hospitalization was 5.42%.Cervial lumbar spine disease accounted for 10.01%in military aviator hospitalization disease,10.06%in permanent grounding diseases.Conclusion About 60%military aviators would encounter neck pain related to flying,incidence of cervical spondylosis was more than 30%. Thus, cervical and lumbar spine disease was the No 1 disease causing hospitalization and permanent grounding.

  17. 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.

  18. Uniformity of the Borden's and Harrison's methods for measuring cervical spine alignment%Borden氏法与Harrison氏法测量颈椎曲度的一致性比较

    Institute of Scientific and Technical Information of China (English)

    万超; 沈惠良; 刘钊

    2012-01-01

    目的:比较Borden氏法与Harrison氏法测量颈椎曲度的一致性.方法:从2009年1月~2010年12月在我院体检中心接受颈椎X线片检查者中,筛选出近6个月内无颈肩部疼痛、X线片显示颈椎结构清晰完整且无颈椎骨折、感染、肿瘤、畸形、脱位等异常者205例,男93例,女112例,年龄15~79岁,平均38.3岁.在侧位X线片上分别用Borden氏法、Harrison氏法测量颈椎曲度,每种方法测量均由2位骨科医师分别进行,每位医师重复测量3次,测量结果取平均值.Borden氏法所测量的颈椎曲度深度值以相对值(颈椎曲度深度实测值/C4椎体矢状位前后径实测值)表示.对同一测量方法2位医师的测量结果进行配对t检验,了解不同测量人员在使用同一方法测量时所得数据的一致性,从而比较两种方法重复测量的一致性.结果:2位医师用Harrison氏法测得的颈椎曲度分别为33.0°±11.5°、34.8°±11.7°,两组数据之间有显著性差异(P<0.01);2位医师用Borden氏法测得的颈椎曲度分别为0.79±0.27、0.77±0.27,两组数据之间无显著性差异(P>0.01).结论:Borden氏法测量颈椎曲度的一致性较Harrison氏法好.%Objective:To determine the uniformity of the Borden's and Harrison's methods for measuring cervical spine alignment.Method: Lateral X-rays of the cervical spines were taken in cases from healthcare center of Xuanwu Hospital,and patients with neck or shoulder pain in last six months and cervical spine fracture, infection, tumor, deformity or dislocation were excluded in this study .As a result, there were 205 volunteers meeting the inclusion criteria.There were 93 males and 112 females,with the average age of 38.3 years old (range, 15-79 years old).Two orthopaedic doctors were involved in the measurement,with each doctor repeating 3 times.The cervical lordosis measured by Borden's method was defined by the ratio of measured value to sagittal diameter of C4.Paired-sample test

  19. Fatty infiltrate in the cervical extensor muscles is not a feature of chronic, insidious-onset neck pain

    International Nuclear Information System (INIS)

    Aim: To investigate the presence of fatty infiltrate in the cervical extensor musculature in patients with insidious-onset neck pain to better understand the possible pathophysiology underlying such changes in chronic whiplash-associated disorders (WAD). Materials and methods: A sample of convenience of 23 women with persistent insidious-onset neck pain (mean age 29.2 ± 6.9 years) was recruited for the study. Magnetic resonance imaging (MRI) was used to quantify fatty infiltration in the cervical extensor musculature. Quantitative Sensory Testing (QST; pressure and thermal pain thresholds) was performed as sensory features are present in chronic whiplash. Self-reported pain and disability, as well as psychological distress, were measured using the Neck Disability Index (NDI) and the General Health Questionnaire-28 (GHQ-28), respectively. Results: Measures were compared with those of a previous dataset of chronic whiplash patients (n = 79, mean age 29.7 ± 7.8 years). Using a classification tree, insidious-onset neck pain was clearly identified from whiplash (p < 0.001), based on the presence of MRI fatty infiltrate in the cervical extensor musculature (0/102 individuals) and altered temperature thresholds (cold; 3/102 individuals). Conclusion: Fatty infiltrates in the cervical extensor musculature and widespread hyperalgesia were not features of the insidious-onset neck pain group in this study; whereas these features have been identified in patients with chronic WAD. This novel finding may enable a better understanding of the underlying pathophysiological processes in patients with chronic whiplash

  20. Fatty infiltrate in the cervical extensor muscles is not a feature of chronic, insidious-onset neck pain

    Energy Technology Data Exchange (ETDEWEB)

    Elliott, J. [Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane (Australia); Department of Physical Therapy, Rueckert-Hartman School for Health Professions, Regis University, Denver, Colorado (United States); Centre for Magnetic Resonance, University of Queensland, Brisbane (Australia)], E-mail: jelltt@regis.edu; Sterling, M. [Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane (Australia); Noteboom, J.T. [Department of Physical Therapy, Rueckert-Hartman School for Health Professions, Regis University, Denver, Colorado (United States); Darnell, R. [Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane (Australia); Galloway, G. [Centre for Magnetic Resonance, University of Queensland, Brisbane (Australia); Jull, G. [Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane (Australia)

    2008-06-15

    Aim: To investigate the presence of fatty infiltrate in the cervical extensor musculature in patients with insidious-onset neck pain to better understand the possible pathophysiology underlying such changes in chronic whiplash-associated disorders (WAD). Materials and methods: A sample of convenience of 23 women with persistent insidious-onset neck pain (mean age 29.2 {+-} 6.9 years) was recruited for the study. Magnetic resonance imaging (MRI) was used to quantify fatty infiltration in the cervical extensor musculature. Quantitative Sensory Testing (QST; pressure and thermal pain thresholds) was performed as sensory features are present in chronic whiplash. Self-reported pain and disability, as well as psychological distress, were measured using the Neck Disability Index (NDI) and the General Health Questionnaire-28 (GHQ-28), respectively. Results: Measures were compared with those of a previous dataset of chronic whiplash patients (n = 79, mean age 29.7 {+-} 7.8 years). Using a classification tree, insidious-onset neck pain was clearly identified from whiplash (p < 0.001), based on the presence of MRI fatty infiltrate in the cervical extensor musculature (0/102 individuals) and altered temperature thresholds (cold; 3/102 individuals). Conclusion: Fatty infiltrates in the cervical extensor musculature and widespread hyperalgesia were not features of the insidious-onset neck pain group in this study; whereas these features have been identified in patients with chronic WAD. This novel finding may enable a better understanding of the underlying pathophysiological processes in patients with chronic whiplash.

  1. 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

  2. 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, ...

  3. The appropriate use of radiography in clinical practice: a report of two cases of biomechanical versus malignant spine pain

    Directory of Open Access Journals (Sweden)

    Wyatt Lawrence H

    2006-05-01

    Full Text Available Abstract Background To describe the evaluation, treatment, management and referral of two patients with back pain with an eventual malignant etiology, who were first thought to have a non-organic biomechanical disorder. Clinical features The study was a retrospective review of the clinical course of two patients seen by a chiropractor in a multi-disciplinary outpatient facility, who presented with what was thought to be non-organic biomechanical spine pain. Clinical examination by both medical and chiropractic physicians did not indicate the need for radiography in the early course of management of either patient. Upon subsequent re-evaluation, it was decided that certain clinical factors required investigation with advanced imaging. In one instance, the patient responded to conservative care of low back pain for nine weeks, after which she developed severe pain in the pelvis. In the second case, the patient presented with signs and symptoms consistent with uncomplicated musculoskeletal pain that failed to respond to a course of conservative care. He was referred for medical therapy which also failed to relieve his pain. In both patients, malignancy was eventually discovered with magnetic resonance imaging and both patients are now deceased, resulting in an inability to obtain informed consent for the publication of this manuscript. Conclusion In these two cases, the prudent use of diagnostic plain film radiography did not significantly alter the appropriate long-term management of patients with neuromusculoskeletal signs and symptoms. The judicious use of magnetic resonance imaging was an effective procedure when investigating recalcitrant neuromusculoskeletal pain in these two patients.

  4. Correlation of non-traumatic neck pain with cervical angle and shoulder retractor power in adult clerical population

    Directory of Open Access Journals (Sweden)

    Isha Avadhut Godbole

    2015-04-01

    Full Text Available Background: A forward head posture (or chin poking is perhaps the most common abnormality associated with NP and is commonly defined as the protrusion of the head in the sagittal plane so that the head is placed anterior to the trunk. Forward head posture can occur because of an anterior translation of the head, lower cervical flexion, or both, and it is claimed to be associated with an increase in upper-cervical extension. It is suggested that forward head posture leads to an increase in the compressive forces on the cervical apophyseal joints and posterior part of the vertebra and to changes in connective tissue length and strength (because of stretching of the anterior structures of the neck and shortening of the posterior muscles resulting in pain. The objective of the study was to correlate neck pain with cervical angle and shoulder retractor power in non-traumatic neck pain patients. Methods: 50 clerical workers having non traumatic neck pain were included. Neck pain was measured on VAS, cervical angle was measured using photometric method and shoulder retractor power was measured. Results: VAS showed moderate positive correlation with cervical angles (0.63 and 0.72 and moderate negative correlation with shoulder retractor power (-0.59 and -0.71. A moderate positive correlation of craniocervical angle to VAS seen (0.66 whereas there was negative correlation with shoulder retractors I and II (-0.59 and -0.61 A positive correlation was seen between VAS and craniocervical angle but is moderately negative with shoulder retractors I (Rhomboids and II (Middle trapezius (0.78, 0.04, -0.69 and -0.64. Conclusion: A moderate increase in cranio vertebral and craniocervical angle showed plausible weakness in lower Trapezius and rhomboids among clerks` having Non-traumatic neck pain. [Int J Res Med Sci 2015; 3(4.000: 859-862

  5. Nonoperative Management of Cervical Radiculopathy.

    Science.gov (United States)

    Childress, Marc A; Becker, Blair A

    2016-05-01

    Cervical radiculopathy describes pain in one or both of the upper extremities, often in the setting of neck pain, secondary to compression or irritation of nerve roots in the cervical spine. It can be accompanied by motor, sensory, or reflex deficits and is most prevalent in persons 50 to 54 years of age. Cervical radiculopathy most often stems from degenerative disease in the cervical spine. The most common examination findings are painful neck movements and muscle spasm. Diminished deep tendon reflexes, particularly of the triceps, are the most common neurologic finding. The Spurling test, shoulder abduction test, and upper limb tension test can be used to confirm the diagnosis. Imaging is not required unless there is a history of trauma, persistent symptoms, or red flags for malignancy, myelopathy, or abscess. Electrodiagnostic testing is not needed if the diagnosis is clear, but has clinical utility when peripheral neuropathy of the upper extremity is a likely alternate diagnosis. Patients should be reassured that most cases will resolve regardless of the type of treatment. Nonoperative treatment includes physical therapy involving strengthening, stretching, and potentially traction, as well as nonsteroidal anti-inflammatory drugs, muscle relaxants, and massage. Epidural steroid injections may be helpful but have higher risks of serious complications. In patients with red flag symptoms or persistent symptoms after four to six weeks of treatment, magnetic resonance imaging can identify pathology amenable to epidural steroid injections or surgery. PMID:27175952

  6. Immune responses following McKenzie lumbar spine exercise in individuals with acute low back pain: A preliminary study

    Directory of Open Access Journals (Sweden)

    Saud Al-Obaidi

    2014-05-01

    Full Text Available Objective. This study explores the immune responses following 4 weeks of McKenzie lumbar spine exercise in individuals with acute low back pain (ALBP. Patients and methods. Fifteen patients with ALBP and 15 healthy individuals volunteered in this study. Ten ml of peripheral blood were obtained from each patient before and after exercise sessions, and from healthy individuals at the beginning of the study. Flow cytometric analysis was used to evaluate the frequencies of CD4+ T lymphocyte sub-populations and the intracellular cytokine expression within this cell population. Pain perceptions were obtained at baseline and following each week of exercise sessions. Results. In comparison with healthy subjects there was an elevated frequency of memory (CD4+CD45RO+ T cells, helper inducer (CD4+CD29+ T cells, CD3+CD16+CD56+ T cells and a lower frequency of naïve/suppressor (CD4+CD45RA+ T cells at base line in back pain patients (p<0.05. After 4 weeks of McKenzie exercise sessions, pain intensity significantly decreased (p<0.05; however, there was no significant difference in the frequency of memory (CD4+CD45RO+ T cells, helper inducer (CD4+CD29+ T cells, CD3+CD16+CD56+ T cells and naïve/suppressor (CD4+CD45RA+ T cells at base line relative to these cell populations after exercise sessions. The percentage of Pan (CD3+ T cells expressing IL-8 and TNF-α and the CD3+ T cells expressing the anti-inflammatory cytokine IL-4 increased significantly (p<0.05 following exercise sessions in comparison with baseline and healthy references. The reduction in pain scores did not correlate with elevated anti-inflammatory cytokines. Conclusion. McKenzie exercise sessions induced an immune activation state and simultaneously up regulated anti-inflammatory IL-4 cytokines that boost pain relief.

  7. Cervical and shoulder postural assessment of adolescents between 15 and 17 years old and association with upper quadrant pain

    Directory of Open Access Journals (Sweden)

    Rodrigo M. Ruivo

    2014-08-01

    Full Text Available Background: There is sparse literature that provides evidence of cervical and shoulder postural alignment of 15 to 17-year-old adolescents and that analyzes sex differences. Objectives: To characterize the postural alignment of the head and shoulder in the sagittal plane of 15 to 17-year-old Portuguese adolescents in natural erect standing and explore the relationships between three postural angles and presence of neck and shoulder pain. Method: This cross-sectional study was conducted in two secondary schools in Portugal. 275 adolescent students (153 females and 122 males aged 15 to 17 were evaluated. Sagittal head, cervical, and shoulder angles were measured with photogrammetry and PAS software. The American Shoulder and Elbow Surgeons Shoulder Assessment (ASES was used to assess shoulder pain, whereas neck pain was self-reported with a single question. Results: Mean values of sagittal head, cervical, and shoulder angles were 17.2±5.7, 47.4±5.2, and 51.4±8.5º, respectively. 68% of the participants revealed protraction of the head, whereas 58% of them had protraction of the shoulder. The boys showed a significantly higher mean cervical angle, and adolescents with neck pain revealed lower mean cervical angle than adolescents without neck pain. 53% of the girls self-reported regular neck pain, contrasting with 19% of the boys. Conclusions: This data shows that forward head and protracted shoulder are common postural disorders in adolescents, especially in girls. Neck pain is prevalent in adolescents, especially girls, and it is associated with forward head posture.

  8. 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.

  9. 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

  10. [Is there a correlation between back pain and stability of the lumbar spine in pregnancy? A model-based hypothesis].

    Science.gov (United States)

    Liebetrau, A; Puta, C; Schinowski, D; Wulf, T; Wagner, H

    2012-02-01

    During pregnancy approximately 50% of women suffer from low back pain (LBP), which significantly affects their everyday life. The pain could result in chronic insomnia, limit the pregnant women in their ability to work and produce a reduction of their physical activity. The etiology of the pain is still critically discussed and not entirely understood. In the literature different explanations for LBP are given and one of the most common reasons is the anatomical changes of the female body during pregnancy; for instance, there is an increase in the sagittal moments because of the enlarged uterus and fetus and the occurrence of hyperlordosis.The aim of this study was to describe how the anatomical changes in pregnant women affect the stability and the moments acting on the lumbar spine with the help of a simplified musculoskeletal model.A two-dimensional musculoskeletal model of the lumbar spine in the sagittal plane consisting of five lumbar vertebrae was developed. The model included five centres of rotation and three antagonistic pairs of paraspinal muscles. The concept of altered acting torques during pregnancy was explored by varying the geometrical arrangements. The situations non-pregnant, pregnant and pregnant with hyperlordosis were considered for the model-based approach. These simulations were done dependent on the stability of the erect posture and local countertorques of every lumbar segment.In spite of the simplicity of the model and the musculoskeletal arrangement it was possible to maintain equilibrium of the erect posture at every lumbar spinal segment with one minimum physiological cross-sectional area of all paraspinal muscles. The stability of the musculoskeletal system depends on the muscular activity of the paraspinal muscles and diminishing the muscular activity causes unstable lumbar segments.The relationship between the non-pregnant and the pregnant simulations demonstrated a considerable increase of acting segmental countertorques

  11. 人体中、下段颈椎曲率的测量及意义%Curvature of human middle and lower cervical spine:a morphological study

    Institute of Scientific and Technical Information of China (English)

    王柏川; 王闵; 樊仕才; 樊继宏; 朱青安; 金大地

    2001-01-01

    Objective:To measure curvatures of human middle and lower cervical spine and determine optimal curve of anterior cervical plate instrumentation.Methods:Minimal height,coronal and sagittal diameters of cervical vertebral bodies were measured on 129 dry Chinese adult cervical vertebrae.Longitudinal physiological curvatures of cervical spines were measured on lateral radiographs of 43 normal Chinese adults.Results:Bodies from C3 to C6 had similar values of minimal height and minimal sagittal diameters (approximately 10.0 mm and 14.6 mm respectively).The transverse curvature radian of anterior walls of vertebral bodies increased gradually from 9.6 mm at C3 with 1 mm increment per level.As well as the minimal coronal diameter from 19.2 mm at C3 to 23.0 mm at C6 with 1 mm increment per level.Variation of longitudinal physiological curvature was insignificant.Conclusions:The transverse curvature of cervical vertebral bodies decreases gradually in middle and lower cervical spine.The longitudinal physiological curvature can't be determined on a lateral radiograph.%目的:为设计、改进适合国人的颈前路钢板系统提供参考值。方法:用游标卡尺和自制弧度仪测量129例颈椎各椎体最小高度、冠状径、矢状径和前壁横向弧度;测量43例正常成人X线侧位片,计算颈椎的生理曲度。结果:C3~C6最小高度和C3~C5最小矢状径均较接近,分别为10.0 mm和14.6 mm;最小冠状径由C3~C6依次增加,增量约1 mm;椎体前壁横向曲率半径由C3的9.6 mm逐渐增大至C7的14.4 mm;颈椎各节段纵向曲度的变异较大,无明显规律。结论:颈椎中段各椎体的最小高度值、矢状径值相近,中、下段颈椎各椎体的最小冠状径和前壁横向曲度由上至下递减,此规律可帮助确定理想的螺钉长度、钢板宽度和钢板的横向弧度;颈椎纵向生理曲度变异较大,无明显规律性,对确定钢板的纵向弧度帮助不大。

  12. 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 ...

  13. A comparative roentgenographic analysis of the lumbar spine in male army recruits with and without lower back pain

    International Nuclear Information System (INIS)

    AIM: To determine whether there is an association between lumbar spine radiographic findings and reported current and/or past lower back pain (LBP). MATERIALS AND METHODS: Four hundred and sixty-four age-matched (mean age 18 years±2 months) consecutive male army recruits were examined. Half of them had a history of episodes of LBP. An orthopaedic evaluation (including radiographs of the lumbar spine) is part of the routine medical examination for all military recruits. Two senior orthopaedic surgeons and one radiologist who performed the morphological measurements assessed the radiographs. RESULTS: We found an increased frequency of right-sided scoliosis, lumbar lordosis, sacral lumbarization, wedge vertebra, bilateral spondylolysis of L5 and/or a sagittal diameter of less than 12 mm among the recruits with LBP. No such association was found with spina bifida, left-sided scoliosis, hemi-lumbarization, sacralization and hemi-sacralization, Schmorl's nodules or mild degenerative changes. CONCLUSION: Given that radiographic screening shows that LBP is more common in those with spinal deformity it may be a reasonable means of predicting which individuals are more likely to develop LBP

  14. A comparative roentgenographic analysis of the lumbar spine in male army recruits with and without lower back pain

    Energy Technology Data Exchange (ETDEWEB)

    Steinberg, E.L. E-mail: eli_st@netvision.net.il; Luger, E.; Arbel, R.; Menachem, A.; Dekel, S

    2003-12-01

    AIM: To determine whether there is an association between lumbar spine radiographic findings and reported current and/or past lower back pain (LBP). MATERIALS AND METHODS: Four hundred and sixty-four age-matched (mean age 18 years{+-}2 months) consecutive male army recruits were examined. Half of them had a history of episodes of LBP. An orthopaedic evaluation (including radiographs of the lumbar spine) is part of the routine medical examination for all military recruits. Two senior orthopaedic surgeons and one radiologist who performed the morphological measurements assessed the radiographs. RESULTS: We found an increased frequency of right-sided scoliosis, lumbar lordosis, sacral lumbarization, wedge vertebra, bilateral spondylolysis of L5 and/or a sagittal diameter of less than 12 mm among the recruits with LBP. No such association was found with spina bifida, left-sided scoliosis, hemi-lumbarization, sacralization and hemi-sacralization, Schmorl's nodules or mild degenerative changes. CONCLUSION: Given that radiographic screening shows that LBP is more common in those with spinal deformity it may be a reasonable means of predicting which individuals are more likely to develop LBP.

  15. 颈椎损伤的X线与CT诊断%The Diagnosis of X-ray and CT for Cervical Spine Injury

    Institute of Scientific and Technical Information of China (English)

    黄金龙; 周鹏; 高雪梅

    2010-01-01

    目的 探讨常规X线和CT扫描对颈椎损伤的诊断价值.方法 对50例X线和CT诊断为颈椎损伤的病例进行分析.结果 本组50例,受损椎体共60个.低位颈椎骨折并(或)脱位27例,寰椎骨折9例,寰枢椎脱位8例,枢椎骨折6例.X线平片显示椎体后缘联线异常24例,CT片根据脊柱三柱结构诊断不稳定骨折28例,椎管0度狭窄22例,1度狭窄17例,2度狭窄8例,3度狭窄3例.外伤性颈椎间盘脱出10例.结论 对于颈椎损伤的患者,应常规行X线和CT扫描检查,以利于为临床提供更全面可靠的信息.CT能对颈椎损伤做出较全面、准确的诊断,有利于治疗方案的选择,可作为颈椎损伤临床术前诊断和治疗的影像学检查的首选方法.%Objective To evaluate the diagnosis value of X-ray and CT for cervical spine injury. Methods The clinical data of 50 cases of vertebral spine injuries which were neglected due to missed diagnosis were analyzed retrospectively. Results 50 cases with cervical spine injury, among of them, 27 cases with fracture and/(or) dislocation of the lower cervical vertebrae,9 cases had atlantal fracture,8 cases had atlantoaxial dislocation and 6 cases had the axoid fracture. 24 cases showed abnormality in the lines of vertebral posterior border in the X-ray plain films. 28 cases were diagnosed instabitity,22 cases vertebral canal 0° stricture, 17 cases Ⅰ°stricture, 8 cases Ⅱ°stricture,3 cases Ⅲ° stricture were diagnosed according CT films. 10 cases traumatic cervicales disc herniation. Conclusion X-ray and CT have their own localization for injured cervical vertebraes. We must perform X-ray and CT examination in order to provide overall and reliable information for clinical diagnosis. CT is becoming an indispensible and best modality of choices in the diagnosis of atloaxoid injuries helpful for the surgeon to decide clinical management. The advantages of CT are suggested that this diagnostic modality may be the standard method for

  16. 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

  17. 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.

  18. Ultrasound-Guided Spinal Procedures for Pain: A Review.

    Science.gov (United States)

    Hurdle, Mark-Friedrich B

    2016-08-01

    As the population ages, more patients are developing degenerative changes of the spine and associated pain. Although interventional procedures for axial and radicular spine pain have been available for decades, common imaging modalities have relied on ionizing radiation for guidance. Over the past decade, ultrasound has become increasingly popular to image both peripheral musculoskeletal and axial structures. This article reviews the use of ultrasound in the guidance of spine procedures, including cervical and lumbar facet injections and medial branch blocks, third occipital nerve blocks, thoracic facet and costotransverse joint injections, sacroiliac joint injections, and caudal and interlaminar epidural injections. PMID:27468672

  19. Transport Safety Management Strategy with Emergency Department Patients with Cervical Spine Fracture%急诊颈椎骨折患者院内转运的安全管理策略

    Institute of Scientific and Technical Information of China (English)

    高秀梅

    2015-01-01

    Objective To analysis the influence factors of emergency department patients with cervical spine fracture nosocomial transportation safety, improvng the safety of the patients with cervical spine fracture transport. Methods 38 cases with cervical spine fracture from the emergency department to the ward or inspection department accident case were analyzed by continuous observation, the application ef ect evaluation of transhipment assessment management strategy. Results Evaluation management strategy and strengthening the nursing care on the way can improve the security of hospital patients with cervical spine fracture of transshipment. Conclusion Master of various rescue techniques can ensure safety and ef ect of cervical spine fracture patients, which was an important way, saving lives timely, reducing the happening of the disability rate.%目的:分析急诊颈椎骨折患者院内转运安全的影响因素,提高颈椎骨折患者转运的安全性。方法运用连续观察法分析38例从急诊科转运到病房或检查科室的颈椎骨折患者发生意外的情况,评价转运评估管理策略的应用效果。结果运用转运评估管理策略及加强转运途中护理,能够提高院内颈椎骨折患者转运的安全性。结论掌握各种抢救技术是保证颈椎骨折患者院内安全有效转运的重要途径,可及时的拯救生命,减少伤残率的发生。

  20. [Therapy of cervical rheumatoid arthritis].

    Science.gov (United States)

    Kothe, R; Wiesner, L; Rüther, W

    2004-08-01

    The rheumatoid involvement of the cervical spine can be divided into three phases. In the early stage of the disease there is an isolated atlantoaxial subluxation (AAS), followed by vertical instability and subaxial instability. If patients show clear symptoms of cervical myelopathy, which can occur during any stage of the disease, the progression cannot be stopped by conservative treatment, which is of great importance at the beginning of the cervical manifestation. Patient education, physiotherapy and immobilization with a stiff collar can significantly reduce pain. Early and effective DMARD therapy can have a positive effect on the natural history of the disease. In case of progressive instability, cervical myelopathy or severe pain operative treatment is indicated. If there is an isolated AAS, fusion can be restricted to the C1/C2 segment. The Magerl transarticular screw fixation is the preferred technique for stabilization. If there is evidence for vertical instability or severe destruction of the C0/C1 joints, occipital cervical fusion has to be performed. Durin the preoperative planning it is necessary to look for signs of subaxial instability. If this is the case, fusion should include the entire cervical spine. Transoral decompression may be necessary when there is persistent anterior compression of the myelon, typically seen in fixed AAS. Non-ambulatory myelopathic patients are more likely to develop severe surgical complications. Therefore, it is important to avoid the development of severe cervical instability by early surgical intervention. The right timing for surgery is still a matter of controversy. Future prospective randomized trials should address this topic to improve the treatment concept for the rheumatoid patient.

  1. A Randomized Controlled Trial to Assess Pain and Magnetic Resonance Imaging-Based (MRI-Based) Structural Spine Changes in Low Back Pain Patients After Yoga Practice.

    Science.gov (United States)

    Telles, Shirley; Bhardwaj, Abhishek K; Gupta, Ram K; Sharma, Sachin K; Monro, Robin; Balkrishna, Acharya

    2016-01-01

    BACKGROUND The present study aimed at determining whether 12 weeks of yoga practice in patients with chronic LBP and MRI-based degenerative changes would result in differences in: (i) self-reported pain, anxiety, and spinal flexibility; and (ii) the structure of the discs or vertebrae. MATERIAL AND METHODS Sixty-two persons with MRI-proven degenerative intervertebral discs (group mean ±S.D., 36.2±6.4 years; 30 females) were randomly assigned to yoga and control groups. However, testing was conducted on only 40 subjects, so only their data are included in this study. The assessments were: self-reported pain, state anxiety, spinal flexibility, and MRI of the lumbosacral spine, performed using a 1.5 Tesla system with a spinal surface column. The yoga group was taught light exercises, physical postures, breathing techniques, and yoga relaxation techniques for 1 hour daily for 3 months. No intervention was given to the control group except for routine medical care. A repeated-measures analysis of variance (ANOVA) with post hoc analyses (which was Bonferroni-adjusted) was used. The Ethics Committee of Patanjali Research Foundation had approved the study which had been registered in the Clinical Trials Registry of India (CTRI/2012/11/003094). RESULTS The yoga group showed a significant reduction in self-reported pain and state anxiety in a before/after comparison at 12 weeks. A few patients in both groups showed changes in the discs and vertebrae at post-intervention assessment. CONCLUSIONS Within 12 weeks, yoga practice reduced pain and state anxiety but did not alter MRI-proven changes in the intervertebral discs and in the vertebrae. PMID:27619104

  2. A Randomized Controlled Trial to Assess Pain and Magnetic Resonance Imaging-Based (MRI-Based) Structural Spine Changes in Low Back Pain Patients After Yoga Practice

    Science.gov (United States)

    Telles, Shirley; Bhardwaj, Abhishek K.; Gupta, Ram K.; Sharma, Sachin K.; Monro, Robin; Balkrishna, Acharya

    2016-01-01

    Background The present study aimed at determining whether 12 weeks of yoga practice in patients with chronic LBP and MRI-based degenerative changes would result in differences in: (i) self-reported pain, anxiety, and spinal flexibility; and (ii) the structure of the discs or vertebrae. Material/Methods Sixty-two persons with MRI-proven degenerative intervertebral discs (group mean ±S.D., 36.2±6.4 years; 30 females) were randomly assigned to yoga and control groups. However, testing was conducted on only 40 subjects, so only their data are included in this study. The assessments were: self-reported pain, state anxiety, spinal flexibility, and MRI of the lumbosacral spine, performed using a 1.5 Tesla system with a spinal surface column. The yoga group was taught light exercises, physical postures, breathing techniques, and yoga relaxation techniques for 1 hour daily for 3 months. No intervention was given to the control group except for routine medical care. A repeated-measures analysis of variance (ANOVA) with post hoc analyses (which was Bonferroni-adjusted) was used. The Ethics Committee of Patanjali Research Foundation had approved the study which had been registered in the Clinical Trials Registry of India (CTRI/2012/11/003094). Results The yoga group showed a significant reduction in self-reported pain and state anxiety in a before/after comparison at 12 weeks. A few patients in both groups showed changes in the discs and vertebrae at post-intervention assessment. Conclusions Within 12 weeks, yoga practice reduced pain and state anxiety but did not alter MRI-proven changes in the intervertebral discs and in the vertebrae.

  3. 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

  4. 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.

  5. 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

  6. 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

  7. Effect of laser acupuncture versus traditional acupuncture in neck pain of cervical spondylosis

    Science.gov (United States)

    El-Kharbotly, Ahmed M.; El-Gendy, Alyaa A.; Mohammed, Mouchira A.; El-Masry, Manal R.; Daoud, Eitedal M.; Hassan, Nagwa; Abdel-Wahab, Khaled G.; Helmy, Ghada; Mostafa, Taymour

    2014-02-01

    This prospective cohort study aimed to compare the efficiency of laser versus traditional acupuncture in treating cervical spondylosis (CS) pain. Forty female patients were randomized into two equal groups that received 3 sessions / week for 4 weeks. Group A received needle acupuncture therapy with electrical stimulation for 20 min at standard acupoints, ear points and Ashi point on the average 3 points. Group B received low level laser therapy (LLLT) acupuncture at the same acupoints. The results demonstrated that tenderness disappeared in 65% of patients in group A and 75% of patients in group B with improved percentage of 85.5% and 89.2%. Pain on VAS related to direction of motion at 6 directions was improved in all cases where with improvement percentage 76.45% and 85.88%. Pain on VAS at rest was improved in all patients with improvement percentage of 80.41% and 84.28%. NDIQ score improved in all patients with improvement percentage of 69.78% and 73.77%. Follow up of VAS after 6 months from the last session revealed persistent improvement in 55% of patients of group A vs 80% of patients of group B. Mean serum TNF-α was decreased in 85% of patients of group A vs 95% of patients of group B where serum beta endorphins was increased in all patients. It is concluded that both modes of treatment for CS gave improvement regarding pain intensity, disability and quality of life being more evident in LLLT followed for 6 months supported with improved serum TNFα and beta endorphin.

  8. 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 .

  9. The Nijmegen decision tool for chronic low back pain. Development of a clinical decision tool for secondary or tertiary spine care specialists.

    Directory of Open Access Journals (Sweden)

    Miranda L van Hooff

    Full Text Available BACKGROUND: In Western Europe, low back pain has the greatest burden of all diseases. When back pain persists, different medical specialists are involved and a lack of consensus exists among these specialists for medical decision-making in Chronic Low Back Pain (CLBP. OBJECTIVE: To develop a decision tool for secondary or tertiary spine care specialists to decide which patients with CLBP should be seen by a spine surgeon or by other non-surgical medical specialists. METHODS: A Delphi study was performed to identify indicators predicting the outcome of interventions. In the preparatory stage evidence from international guidelines and literature were summarized. Eligible studies were reviews and longitudinal studies. Inclusion criteria: surgical or non-surgical interventions and persistence of complaints, CLBP-patients aged 18-65 years, reported baseline measures of predictive indicators, and one or more reported outcomes had to assess functional status, quality of life, pain intensity, employment status or a composite score. Subsequently, a three-round Delphi procedure, to reach consensus on candidate indicators, was performed among a multidisciplinary panel of 29 CLBP-professionals (>five years CLBP-experience. The pre-set threshold for general agreement was ≥70%. The final indicator set was used to develop a clinical decision tool. RESULTS: A draft list with 53 candidate indicators (38 with conclusive evidence and 15 with inconclusive evidence was included for the Delphi study. Consensus was reached to include 47 indicators. A first version of the decision tool was developed, consisting of a web-based screening questionnaire and a provisional decision algorithm. CONCLUSIONS: This is the first clinical decision tool based on current scientific evidence and formal multidisciplinary consensus that helps referring the patient for consultation to a spine surgeon or a non-surgical spine care specialist. We expect that this tool considerably helps

  10. The immediate effects of sigmoid colon manipulation on pressure pain thresholds in the lumbar spine.

    Science.gov (United States)

    McSweeney, Terence P; Thomson, Oliver P; Johnston, Ross

    2012-10-01

    Visceral manual therapy is increasingly used by UK osteopaths and manual therapists, but there is a paucity of research investigating its underlying mechanisms, and in particular in relation to hypoalgesia. The aim of this study was to investigate the immediate effects of osteopathic visceral mobilisation on pressure pain thresholds. A single-blinded, randomised, within subjects, repeated measures design was conducted on 15 asymptomatic subjects. Pressure pain thresholds were measured at the L1 paraspinal musculature and 1st dorsal interossei before and after osteopathic visceral mobilisation of the sigmoid colon. The results demonstrated a statistically significant improvement in pressure pain thresholds immediately after the intervention (P<0.001). This effect was not observed to be systemic, affecting only the L1 paraspinal musculature. This novel study provides new experimental evidence that visceral manual therapy can produce immediate hypoalgesia in somatic structures segmentally related to the organ being mobilised, in asymptomatic subjects.

  11. EFFECTIVENESS OF TENS VERSUS INTERMITTENT CERVICAL TRACTION IN PATIENTS WITH CERVICAL RADICULOPATHY

    Directory of Open Access Journals (Sweden)

    Himanshi Sharma

    2014-12-01

    Full Text Available Background: Cervical radiculopathy is a dysfunction of nerve root of the cervical spine where C6& C7 nerve roots are the most commonly affected. It encompasses important symptoms other than pain, such as paresthesia, numbness and muscle weakness in dermatomal or myotomal distribution of an affected nerve root. A multitude of physical therapy interventions have been proposed to be effective in the management of cervical radiculopathy, including mechanical cervical traction, manipulation, therapeutic exercises and TENS. Studies to find out the effectiveness of TENS versus Intermittent Cervical Traction among patients with Cervical Radiculopathy are sparse. Hence the present study was undertaken to find out and compare effectiveness of TENS versus Intermittent Cervical Traction a newer technique towards betterment in treatment of cervical radiculopathy patients. Methodology: 30 patients from Baroda association for the blind (Lions club of Baroda, Subhanpura & Sushrut Physiotherapy Clinic, Akota were chosen based on the inclusion and exclusion criteria. Group A comprised of 15 people with cervical radiculopathy were given TENS with Isometric neck exercises and active neck movements. Group B comprised of 15 people with cervical radiculopathy were given Intermittent Cervical Traction with Isometric neck exercise and active neck movements. VAS Scale & Neck Disability Index (NDI were used as outcome measures pre & post treatment. Results: The pre test evaluation showed that, there is no significant difference (P> 0.05 between the two groups for all the variables measured. The post-test evaluation of both groups showed a very high significance (P< 0.05 within the group for all the outcome measurements. A post-test comparison of measured variables, between the groups showed that the Group A demonstrated a statistically significant (P< 0.05 reduction in pain and Neck Disability Index. Conclusion: From the above study concluded that TENS was more effective

  12. A diagnostic and therapeutic challenge involving a case of dysphagia in association with cervical osteophytosis and a dental pain

    Science.gov (United States)

    Dable, Rajani A.; Wasnik, Pradnya B.; Nagmode, Sunilkumar L.; Ali, Mukkaram Faridi

    2013-01-01

    Herein, presenting a case of a 42-year-old female with the chief complaint of dysphagia. The problem was assumed to be of dental origin, due to the onset of dental pain followed by dysphagia. A cervical radiograph revealed the presence of osteophytic lipping which proved to be the cause of dysphagia. Confusing and overlapping disease entities showing similar symptoms need thorough investigation. Dysphagia related to cervical spondylosis may have a direct connection with the person's occupation. Dentistry is considered a potentially hazardous occupation with regard to musculoskeletal disorders. However, additional studies are required to understand the occupational hazards faced by dentists. PMID:24250178

  13. A diagnostic and therapeutic challenge involving a case of dysphagia in association with cervical osteophytosis and a dental pain

    Directory of Open Access Journals (Sweden)

    Rajani A Dable

    2013-01-01

    Full Text Available Herein, presenting a case of a 42-year-old female with the chief complaint of dysphagia. The problem was assumed to be of dental origin, due to the onset of dental pain followed by dysphagia. A cervical radiograph revealed the presence of osteophytic lipping which proved to be the cause of dysphagia. Confusing and overlapping disease entities showing similar symptoms need thorough investigation. Dysphagia related to cervical spondylosis may have a direct connection with the person′s occupation. Dentistry is considered a potentially hazardous occupation with regard to musculoskeletal disorders. However, additional studies are required to understand the occupational hazards faced by dentists.

  14. Does a combination of physical training, specific exercises and pain education improve health-related quality of life in patients with chronic neck pain?

    DEFF Research Database (Denmark)

    Ris Hansen, Inge; Søgaard, Karen; Gram, Bibi;

    2016-01-01

    controlled trial of 200 neck pain patients receiving pain education. The exercise group received additional exercises for neck/shoulder, balance and oculomotor function, plus graded physical activity training. Patient-reported outcome measures (Short Form-36 Physical and Mental component summary scores, Euro...... anterior and cervical spine, Cranio-cervical Flexion, Cervical Extension muscle function, and oculomotion) were recorded at baseline and after 4 months. RESULTS: The exercise group showed statistically significant improvement in physical HR-QoL, mental HR-QoL, depression, cervical pressure pain threshold......AIM: To investigate the effect of combining pain education, specific exercises and graded physical activity training (exercise) compared with pain education alone (control) on physical health-related quality of life (HR-QoL) in chronic neck pain patients. METHODS: A multicentre randomised...

  15. 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%

  16. 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

  17. 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

  18. Differential diagnosis of metastatic bone disease and benign bone disease on spine SPECT in patients with low back pain

    International Nuclear Information System (INIS)

    One or more abnormal vertebrae detected on bone scintigraphy is a common finding in clinical practice, and it could pose a diagnostic dilemma especially in cancer patients, as either metastasis or benign disease may cause scintigraphic abnormality. The purpose of this study was to determine whether additional spine SPECT has a role in differentiating malignant from benign lesions in patients with back pain. We reviewed spine SPECT studies obtained over a three-year period in 108 patients. Among them, forty-five patients with abnormal SPECT and clinically followed records were evaluated (20 cancer patients were included). Uptake patterns were classified as follows: 1. Body: diffusely increased uptake, linear increased uptake of end plate, segmental increased uptake, and cold defect, 2 Posterior element; posterior to body (pedicle), posterior to intervertebral disc space (facet joint), and spinous process. Lesions were correlated with radiological findings and with final diagnosis. Sixty-nine bone lesions were detected on SPECT images, including 18 metastases, 28 degenerative diseases and 21 compression fractures. Cold defect (6) and segmental increased uptake (5) were dominant findings in metastasis: linear increased uptake (12), and facet joint uptake (15) were in degenerative change; and diffuse increased uptake (9), and linear increased uptake (9) were in compression fracture. Cold defect and segmental increased uptake of body were characteristic findings of metastasis, but care should be taken because compression fracture also shows segmental increased uptake in some cases. Degenerative disease was easily diagnosed because of the typical finding of linear increased uptake of end plate and facet joint. Therefore, additional bone SPECT after planar bone scan would be helpful for differentiating metastasis from benign condition in cancer patients

  19. Differential diagnosis of metastatic bone disease and benign bone disease on spine SPECT in patients with low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Hun; Choi, Yun Young; Cho, Suk Shin [College of Medicine, Hanyang Univ., Seoul (Korea, Republic of)

    2001-12-01

    One or more abnormal vertebrae detected on bone scintigraphy is a common finding in clinical practice, and it could pose a diagnostic dilemma especially in cancer patients, as either metastasis or benign disease may cause scintigraphic abnormality. The purpose of this study was to determine whether additional spine SPECT has a role in differentiating malignant from benign lesions in patients with back pain. We reviewed spine SPECT studies obtained over a three-year period in 108 patients. Among them, forty-five patients with abnormal SPECT and clinically followed records were evaluated (20 cancer patients were included). Uptake patterns were classified as follows: 1. Body: diffusely increased uptake, linear increased uptake of end plate, segmental increased uptake, and cold defect, 2 Posterior element; posterior to body (pedicle), posterior to intervertebral disc space (facet joint), and spinous process. Lesions were correlated with radiological findings and with final diagnosis. Sixty-nine bone lesions were detected on SPECT images, including 18 metastases, 28 degenerative diseases and 21 compression fractures. Cold defect (6) and segmental increased uptake (5) were dominant findings in metastasis: linear increased uptake (12), and facet joint uptake (15) were in degenerative change; and diffuse increased uptake (9), and linear increased uptake (9) were in compression fracture. Cold defect and segmental increased uptake of body were characteristic findings of metastasis, but care should be taken because compression fracture also shows segmental increased uptake in some cases. Degenerative disease was easily diagnosed because of the typical finding of linear increased uptake of end plate and facet joint. Therefore, additional bone SPECT after planar bone scan would be helpful for differentiating metastasis from benign condition in cancer patients.

  20. 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.

  1. 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.

  2. 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.

  3. 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

  4. Neck pain and headaches in a patient after a fall.

    Science.gov (United States)

    Young, Brian A; Ross, Michael D

    2009-05-01

    The patient was a 64-year-old woman who reported a sudden onset of neck pain and headaches following a fall 2.5 months prior to her initial physical therapy visit. Cervical spine radiographs, which were ordered by the referring physician, revealed extensive degenerative disc disease of the lower cervical spine. At her initial physical therapy evaluation, cervical spine range of motion was within functional limits except for bilateral rotation, which was limited to 45 degrees due to pain and stiffness. The patient's headache symptoms were abolished with the Sharp-Purser test. Although assessment of symptoms was not the intent of the Sharp-Purser test, a reduction of symptoms during the test would warrant further evaluation. Therefore, the physical therapist ordered cervical spine flexion-extension radiographic views to assess for atlantoaxial instability. The radiologist's report noted a stable atlantodens interval that did not change with cervical flexion and extension and a course of physical therapy was initiated. At the time of discharge from physical therapy, the patient reported no neck pain and only very mild occasional headaches, which she believed she could manage on her own. PMID:19411772

  5. 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

  6. 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.

  7. Risk factors of neurological lesions in low cervical spine fractures and dislocations Fatores de risco de lesão neurológica nas fraturas e luxações da coluna cervical baixa

    Directory of Open Access Journals (Sweden)

    DANILO GONÇALVES COELHO

    2000-12-01

    Full Text Available Eighty-nine patients with lower cervical spine fractures or dislocations were evaluated for risk factors of neurological lesion. The age, sex, level and pattern of fracture and sagittal diameter of the spinal canal were analysed. There were no significant differences on the age, gender, level and Torg's ratio between intact patients and those with nerve root injury, incomplete or complete spinal cord injuries. Bilateral facet dislocations and burst fractures are a significant risk factor of spinal cord injury.O risco de lesão neurológica foi avaliado em 89 pacientes com fraturas ou luxações da coluna cervical baixa. Foram analisados o sexo, a idade, o diâmetro sagital do canal vertebral, o nível e o tipo de fratura ou luxação. Não foram encontradas diferenças significativas para a idade, sexo, nível da fratura ou luxação e razão de Torg entre os pacientes intactos e aqueles com lesão radicular, lesão medular incompleta e lesão medular completa. Luxações bilaterais de facetas articulares e fraturas em explosão são um fator de risco significativo de lesão neurológica.

  8. Assessing the Level of Disability, Deep Cervical Flexor Endurance and Fear Avoidance Beliefs in Bankers with Neck Pain

    Directory of Open Access Journals (Sweden)

    Deptee Warikoo

    2013-08-01

    Full Text Available Objective: To assess the level of disability, the deep cervical flexor endurance and fear avoidance beliefs (FAB in bankers with neck pain and to find a correlation between disability and deep cervical muscle endurance, FAB and disability, FAB and deep flexor muscle endurance. Methods: It ws an observational study. The Subjects who had neck pain and minimum 5 years’ experience as a Banker participated in the study. Total 100 subjects were selected. All the subjects were assessed for their disability by the neck pain and disability score (NPDI, their deep cervical flexor endurance using Pressure Biofeedback using Cranio-Cervical flexion test (CCFT and Fear Avoidance Belief by using questionnaire( FABQ. Results: It was found that bankers have a moderate level of disability. The results showed an elevated fear avoidance belief with a mean value of FABQ-PA 21.61±4.42 and FABQ-W 37.81± 5.69. The results indicated that a negative correlation was found between NPDI and CCFT (r=0.855. A positive correlation was found between NPDI and FABQ-PA(r=0.337, FABQ-W(r=0.500. In the present study a negative correlation was found between CCFT and FABQ-W(r=0.553, FABQ-PA (0.348 and positive correlation (r=0.540 was found between FABQ-PA and FABQ-W. Conclusion: The present study concluded that there was a significant level of disability and significantly decreased endurance level and increased fear avoidance beliefs (both work and physical activity related among bankers with neck pain. In addition to that there was a significant correlation found between NPDI and CCFT, NPDI and FABQ, CCFT and FABQ, FABQ-W and FABQ-PA.

  9. 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...

  10. Surgery versus conservative care for neck pain: A systematic review

    NARCIS (Netherlands)

    M. van Middelkoop (Marienke); S.M. Rubinstein (Sidney); R.W.J.G. Ostelo (Raymond); M.W. van Tulder (Maurits); W.C. Peul (Wilco); B.W. Koes (Bart); A.P. Verhagen (Arianne)

    2013-01-01

    textabstractObjective: General practitioners refer patients with continued neck pain that do not respond well to conservative care frequently to secondary care for further assessment. Are surgical interventions to the cervical spine effective when compared to conservative care for patients with neck

  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. Anterior approach for lower cervical spine fractures and dislocations combined with spinal cord injury%下颈椎骨折脱位并脊髓损伤的前路手术治疗

    Institute of Scientific and Technical Information of China (English)

    贺宝荣; 许正伟; 郝定均; 郭华

    2013-01-01

    Objectives:To discuss the clinical outcome of anterior surgical treatment for lower cervical spine fractures and dislocations combined with spinal cord injury.Methods:From January 2006 to January 2011,196 patients suffering from lower cervical spine fractures and dislocations combined with spinal cord injury in our hospital were reviewed retrospectively.168 cases were data integrity and obtained follow-up,there were 123 males and 45 females with an average age of 38.7 years old(range,18-71 years).21 cases were in ASIA grade A,46 cases in B,60 cases in C,41 cases in D.According to the degree of dislocation,79 cases were in Ⅰ,42 cases in Ⅱ,31 cases in

  13. Cervical Total Disc Arthroplasty

    OpenAIRE

    Basho, Rahul; Hood, Kenneth A.

    2012-01-01

    Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc...

  14. 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

  15. 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...

  16. 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.

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

    Directory of Open Access Journals (Sweden)

    Walker Bruce

    2008-10-01

    Full Text Available Abstract Background The one year prevalence of thoracic back pain has been estimated as 17% compared to 64% for neck pain and 67% for low back pain. At present only one randomised controlled trial has been performed assessing the efficacy of spinal manipulative therapy (SMT for thoracic spine pain. In addition no high quality trials have been performed to test the efficacy and effectiveness of Graston Technique® (GT, a soft tissue massage therapy using hand-held stainless steel instruments. The objective of this trial is to determine the efficacy of SMT and GT compared to a placebo for the treatment of non specific thoracic spine pain. Methods Eighty four eligible people with non specific thoracic pain mid back pain of six weeks or more will be randomised to one of three groups, either SMT, GT, or a placebo (de-tuned ultrasound. Each group will receive up to 10 supervised treatment sessions at the Murdoch University Chiropractic student clinic over a 4-week period. Treatment outcomes will be measured at baseline, one week after their first treatment, upon completion of the 4-week intervention period and at three, six and twelve months post randomisation. Outcome measures will include the Oswestry Back Pain Disability Index and the Visual Analogue Scale (VAS. Intention to treat analysis will be utilised in the statistical analysis of any group treatment effects. Trial Registration This trial was registered with the Australia and New Zealand Clinical Trials Registry on the 7th February 2008. Trial number: ACTRN12608000070336

  18. 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.)

  19. Does a combination of physical training, specific exercises and pain education improve health-related quality of life in patients with chronic neck pain? A randomised control trial with a 4-month follow up

    DEFF Research Database (Denmark)

    Ris Hansen, Inge; Søgaard, Karen; Gram, Bibi;

    2016-01-01

    controlled trial of 200 neck pain patients receiving pain education. The exercise group received additional exercises for neck/shoulder, balance and oculomotor function, plus graded physical activity training. Patient-reported outcome measures (Short Form-36 Physical and Mental component summary scores, Euro...... anterior and cervical spine, Cranio-cervical Flexion, Cervical Extension muscle function, and oculomotion) were recorded at baseline and after 4 months. Results The exercise group showed statistically significant improvement in physical HR-QoL, mental HR-QoL, depression, cervical pressure pain threshold......Abstract Aim To investigate the effect of combining pain education, specific exercises and graded physical activity training (exercise) compared with pain education alone (control) on physical health-related quality of life (HR-QoL) in chronic neck pain patients. Methods A multicentre randomised...

  20. Dysphagia due to anterior cervical osteophytosis: case report

    Directory of Open Access Journals (Sweden)

    Frederico Miguel Santos Silva Marquez Correia

    2014-12-01

    Full Text Available The objective of this study is to highlight the possibility of dysphagia induced by anterior cervical osteophytes. When not diagnosed early this condition may be responsible for complications such as severe dysphagia and potential lung aspiration, especially in elderly patients. Analysis of a case report of a 72-year old woman who presented cervical pain and progressive dysphagia. Imaging studies have shown anterior cervical osteophytosis and multilevel degenerative changes in the cervical spine. The patient underwent surgical excision of the cervical anterior osteophytes (C4, C5 and C6 and C5/C6 arthrodesis through anterior approach. The postoperative period was uneventful and symptoms resolved within 2 weeks. Early diagnosis and treatment led to complete resolution, avoiding late and serious complications associated with this pathology in the geriatric population, especially severe and progressive dysphagia and risk of pulmonary aspiration, and the consequent morbidity and mortality associated. A multidisciplinary approach is essential for the correct assessment of this condition

  1. A pilot evaluation of an educational program that offers visualizations of cervical spine injuries: medical students' self-efficacy increases by training.

    Science.gov (United States)

    Hedman, Leif; Fahlstedt, Madelen; Schlickum, Marcus; Möller, Hans; von Holst, Hans; Felländer-Tsai, Li

    2014-01-01

    In this pilot study, a new method for visualization through imaging and simulation (VIS-Ed) for teaching diagnosis and treatment of cervical spine trauma was formatively evaluated. The aims were to examine if medical students' self-efficacy would change by training using VIS-Ed, and if so these changes were related to how they evaluated the session, and the user interface (UI) of this program. Using a one-group, pre-post course test design 43 Swedish medical students (4th year, 17 males, 26 females) practiced in groups of three participants. Overall the practice and the UI were considered as positive experiences. They judged VIS-Ed as a good interactive scenario-based educational tool. All students' self-efficacy increased significantly by training (p < 0.001). Spearman's rank correlation tests revealed that increased self-efficacy was only associated with: how the session was compared to as expected (p < 0.007). Students' self-efficacy increased significantly by training, but replication studies should determine if this training effect is gender-related.

  2. Anterior cervical decompression and fusion with caspar plate fixation

    International Nuclear Information System (INIS)

    Objective: To evaluate the role of anterior cervical decompression and fixation with Caspar plating in cervical spine injury on neurological outcome. Study Design: A case series. Place and Duration of Study: Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, from July 2008 to March 2011. Methodology: Thirty patients admitted with cervical spine injuries were inducted in the study. All cases were evaluated for their clinical features, level of injury and degree of neurological injury was assessed using Frankel grading. Pre and postoperative record with X-rays and MRI were maintained. Cervical traction was applied to patients with sub-luxation. All patients underwent anterior cervical decompression, fusion and Caspar plate fixation. The follow-up period was 6 months with clinical and radiological assessment. Results: Among 30 patients, 24 (80%) were males and 6 (20%) were females. Age ranged from 15 to 55 years. Causes of injury were road traffic accident (n = 20), fall (n = 8) and assault (n = 2). Commonest mode of injury was road traffic accident (66.6%). Postoperative follow-up showed that pain and neurological deficit were improved in 21 patients. There was no improvement in 7 patients, one patient deteriorated and one expired. All patients developed pain at donor site. Conclusion: Anterior decompression, fusion and fixation with Caspar plate is an effective method with good neurological and radiological outcome. However, it is associated with pain at donor site. (author)

  3. 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

  4. Total cervical disk replacement with a prestige LP® prosthesis: clinical and functional outcomes

    Directory of Open Access Journals (Sweden)

    Rafael Osório Rocha

    2014-01-01

    Full Text Available Objective: To determine the clinical and functional results of short- and medium-term cervical arthroplasty with the Prestige LP® prosthesis for the treatment of compressive myelopathy, radiculopathy and axial pain with radiculopathty. Methods: This retrospective study, conducted from 2009 to 2012, included 18 patients. Only 16 were found for the second stage of research, conducted in 2011 and 2012. Pre- and postoperative assessments were carried out using the CSOQ (Cervical Spine Outcomes Questionnaire. Odom criteria were used only in the postoperative evaluation. Both were translated and adapted to the local culture. Results: There was no postoperative radiculopathy or other complications requiring prolonged hospitalization. In most patients, there was a significant improvement in axial pain and radiculopathy, and there was only one indication of conversion to fusion. Conclusions: In selected cases of cervical degenerative disc disease, herniated cervical disc and compressive myeolopathy, cervical arthroplasty proved to be an effective and safe treatment in the short and medium terms.

  5. 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.

  6. 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

  7. 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

  8. 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.

  9. The Impact of Spinal Cord Nerve Roots and Denticulate Ligaments on Cerebrospinal Fluid Dynamics in the Cervical Spine

    Science.gov (United States)

    Heidari Pahlavian, Soroush; Yiallourou, Theresia; Tubbs, R. Shane; Bunck, Alexander C.; Loth, Francis; Goodin, Mark; Raisee, Mehrdad; Martin, Bryn A.

    2014-01-01

    Cerebrospinal fluid (CSF) dynamics in the spinal subarachnoid space (SSS) have been thought to play an important pathophysiological role in syringomyelia, Chiari I malformation (CM), and a role in intrathecal drug delivery. Yet, the impact that fine anatomical structures, including nerve roots and denticulate ligaments (NRDL), have on SSS CSF dynamics is not clear. In the present study we assessed the impact of NRDL on CSF dynamics in the cervical SSS. The 3D geometry of the cervical SSS was reconstructed based on manual segmentation of MRI images of a healthy volunteer and a patient with CM. Idealized NRDL were designed and added to each of the geometries based on in vivo measurments in the literature and confirmation by a neuroanatomist. CFD simulations were performed for the healthy and patient case with and without NRDL included. Our results showed that the NRDL had an important impact on CSF dynamics in terms of velocity field and flow patterns. However, pressure distribution was not altered greatly although the NRDL cases required a larger pressure gradient to maintain the same flow. Also, the NRDL did not alter CSF dynamics to a great degree in the SSS from the foramen magnum to the C1 level for the healthy subject and CM patient with mild tonsillar herniation (∼6 mm). Overall, the NRDL increased fluid mixing phenomena and resulted in a more complex flow field. Comparison of the streamlines of CSF flow revealed that the presence of NRDL lead to the formation of vortical structures and remarkably increased the local mixing of the CSF throughout the SSS. PMID:24710111

  10. Cervical radiculopathy.

    Science.gov (United States)

    Iyer, Sravisht; Kim, Han Jo

    2016-09-01

    Cervical radiculopathy is a common clinical scenario. Patients with radiculopathy typically present with neck pain, arm pain, or both. We review the epidemiology of cervical radiculopathy and discuss the diagnosis of this condition. This includes an overview of the pertinent findings on the patient history and physical examination. We also discuss relevant clinical syndromes that must be considered in the differential diagnosis including peripheral nerve entrapment syndromes and shoulder pathology. The natural history of cervical radiculopathy is reviewed and options for management are discussed. These options include conservative management, non-operative modalities such as physical therapy, steroid injections, and operative intervention. While the exact indications for surgical intervention have not yet been elucidated, we provide an overview of the available literature regarding indications and discuss the timing of intervention. The surgical outcomes of anterior cervical decompression and fusion (ACDF), cervical disc arthroplasty (CDA), and posterior cervical foraminotomy (PCF) are discussed. PMID:27250042

  11. Thoracic spine pain in the general population: Prevalence, incidence and associated factors in children, adolescents and adults. A systematic review

    Directory of Open Access Journals (Sweden)

    Straker Leon M

    2009-06-01

    Full Text Available Abstract Background Thoracic spine pain (TSP is experienced across the lifespan by healthy individuals and is a common presentation in primary healthcare clinical practice. However, the epidemiological characteristics of TSP are not well documented compared to neck and low back pain. A rigorous evaluation of the prevalence, incidence, correlates and risk factors needs to be undertaken in order for epidemiologic data to be meaningfully used to develop evidence-based prevention and treatment recommendations for TSP. Methods A systematic review method was followed to report the evidence describing prevalence, incidence, associated factors and risk factors for TSP among the general population. Nine electronic databases were systematically searched to identify studies that reported either prevalence, incidence, associated factors (cross-sectional study or risk factors (prospective study for TSP in healthy children, adolescents or adults. Studies were evaluated for level of evidence and method quality. Results Of the 1389 studies identified in the literature, 33 met the inclusion criteria for this systematic review. The mean (SD quality score (out of 15 for the included studies was 10.5 (2.0. TSP prevalence data ranged from 4.0–72.0% (point, 0.5–51.4% (7-day, 1.4–34.8% (1-month, 4.8–7.0% (3-month, 3.5–34.8% (1-year and 15.6–19.5% (lifetime. TSP prevalence varied according to the operational definition of TSP. Prevalence for any TSP ranged from 0.5–23.0%, 15.8–34.8%, 15.0–27.5% and 12.0–31.2% for 7-day, 1-month, 1-year and lifetime periods, respectively. TSP associated with backpack use varied from 6.0–72.0% and 22.9–51.4% for point and 7-day periods, respectively. TSP interfering with school or leisure ranged from 3.5–9.7% for 1-year prevalence. Generally, studies reported a higher prevalence for TSP in child and adolescent populations, and particularly for females. The 1 month, 6 month, 1 year and 25 year incidences were 0

  12. 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.

  13. Cervical Stenosis

    Science.gov (United States)

    ... Accumulation of pus in the uterus is called pyometra. Symptoms Before menopause, cervical stenosis may cause menstrual ... present but not cause symptoms. A hematometra or pyometra can cause pain or cause the uterus to ...

  14. Stellate Ganglion Block Reduces the Radicular Pain and Salivary Alpha-Amylase Activity in Patients with Cervical Spondylosis

    Directory of Open Access Journals (Sweden)

    Takashi Egashira

    2015-03-01

    Full Text Available Background The effects of stellate ganglion block (SGB on radicular pain associated with cervical spondylosis remain to be clarified. So we measured salivary alpha-amylase which reflects sympathetic nerve activity under psychological stress after SGB block or trigger points injection (TPI. Study Design A randomized, prospective, controlled trial Setting After institutional approval and informed consent, 40 patients who was suffered from neck-shoulder pain associated with cervical radiculopathy were randomly divided into two groups according to nerve block treatment. Group A (n=20, male 10 patients, female 10 patients, 50±8yr, mean±SD received SGB and group B (n=20, male 10 patients, female 10 patients, 52±6yr received TPI. SGB or TPI was produced by 6 ml of 1% mepivacaine a total of 5 times (twice per week. Visual analogue scale (VAS and the concentration of salivary alpha-amylase were measured before (T0 each nerve block and 3 days (T1, 6 days (T2, 9 days (T3, 12 days (T4 and 15days (T5 after each nerve block. The consumption of non-steroidal anti-inflammatory drug (NSAID was measured at T0 and T5 in each group. Results In group A, VAS was median 74 (range 60, 78 at T0 and showed a significant decrease at T3 [53 (48, 65, p<0.05], T4 [50 (42, 66, p<0.05] and T5 [48 (26,57, p<0.05]. The concentration of salivary alpha-amylase was median 116 (range 96, 144 KU/ml at T0 and showed a significant decrease at T3 [86 (79, 105, p<0.05], T4 [79 (68, 88] and T5 [70 (55, 84, p<0.05]. In group B, VAS and the concentration of salivary alpha-amylase showed no change throughout the time course. VAS in group A was significant lower than that in group B at T3, T4 and T5. The concentration of salivary alpha-amylase was significant lower than that in group B at T4 and T5. The consumption of NSAID in group A was significantly lower than that in group B at T5. Limitations Subjects are out patients. Patients include radicular pain due to different pathogenesis, e

  15. MRI evaluation of fetal cervical spine length in normal second and third trimester of pregnancy%孕中晚期正常胎儿颈椎长度与胎龄关系的磁共振研究

    Institute of Scientific and Technical Information of China (English)

    赵慧; 林祥涛; 肖连祥; 吴勇; 董金叶; 张忠和; 汤煜春; 刘树伟; 王光彬

    2016-01-01

    目的:研究正常胎儿标本颈椎长度与孕周变化的关系,绘制正常胎儿脊柱长度生长曲线。方法本研究为前瞻性研究,利用3.0T MR扫描仪对65例16~42周自然流产及因母体或胎儿因素引产的胎儿标本行全脊柱3D-T2WI序列扫描,对所得图像进行三方位重建,在正中矢状位上测量颈椎长度及C4椎体的高度,建立相关线性回归方程。结果胎儿颈椎长度及C4椎体高度与孕周的线性回归方程分别为:颈椎长度(cm)=0.193+0.117孕周,R2=0.94,P<0.05;C4椎体高度(cm)=0.025+0.013孕周,R2=0.94,P<0.05。颈段脊柱发育有着时间的不平衡性,在生长发育过程中有两个发育高峰,分别为23~26孕周及31~34孕周;同样在这两个高峰,椎体高度增长速度较快。结论孕中晚期,胎儿颈椎长度的增加与胎龄呈良好相关性,椎体的相关径线是评估胎儿脊椎发育的可靠指标。%Objective Using the magnetic resonance imaging (MRI) to measure the normal fetal cervical spine length at different gestational ages,to investigate a more sensitive nomogram of fetal spine length and gestational ages. Methods This research is a prospective study, Postmortem MR imaging was performed on 65 fetuses ranging from 16 to 42 gestational ages. 3D-T2WI of the whole spine was performed in sagittal plane and the images were reconstructed in the coronal , sagittal and axial planes to measure the length of the cervical spine segments and the 4th cervical vertebra in the midsagittal images. Liner regression equations were established. Results A statistically significant linear relationship was established between the lengths of cervical segments of the fetal spine and gestational ages, and the function were expressed by the regression as: Cervical length = 0.193+0.117 × gestational age,R2 =0.94;The C4 height=-0.586+0.155 × gestational age,R2=0.94. At the same time, the development of the cervical segment and the 4th

  16. A stress fracture of the lumbar spine in a professional rugby player.

    Science.gov (United States)

    Castinel, Bernard H; Adam, Philippe; Prat, Christophe

    2007-05-01

    In modern rugby, the spine is subjected to great physical pressure, with an increased number of impacts, on both the cervical and the lumbar spine. This case report illustrates overuse injuries of the lumbar spine in international professional rugby players. A 32-year-old sportsman had been practising rugby for 24 years and was playing for a championship level French team when he started suffering from a right lateral pain in the lumbosacral spine. A CT scan showed a unilateral isthmolysis and a coronal irregular fracture of the right pars interarticularis of L5. This led to discussion of (1) the importance of the decision on the date of return to playing rugby and (2) the future of professional rugby players with chronic spinal injuries. PMID:17138643

  17. The comparison of the therapeutic massage with the craniosacral method in treating the pain syndrome of the cranial part of the spine

    OpenAIRE

    Miszewski, Waldemar; Miszewska, Agnieszka; Śniegocki, Maciej; Siedlecki, Zygmunt; Grzyb, Sebastian; Siminska, Joanna; Pietkun, Katarzyna; Głowacka, Iwona; Nowacka, Krystyna; Hagner, Wojciech

    2016-01-01

    Miszewski Waldemar, Miszewska Agnieszka, Śniegocki Maciej, Siedlecki Zygmunt, Grzyb Sebastian, Siminska Joanna, Pietkun Katarzyna, Głowacka Iwona, Nowacka Krystyna, Hagner Wojciech. The comparison of the therapeutic massage with the craniosacral method in treating the pain syndrome of the cranial part of the spine. Journal of Education, Health and Sport. 2016;6(4):249-270. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.50158 http://ojs.ukw.edu.pl/index.php/johs/article/view/34...

  18. 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.)

  19. 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...

  20. Multiplanner spine computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Chung, H. K.; Jeon, H. J.; Hong, K. C.; Chung, K. B.; Suh, W. H. [Korea University College of Medicine, Seoul (Korea, Republic of)

    1983-06-15

    The computed tomography is useful in evaluation of bony structures and adjacent soft tissues of the spine. Recently, the multiplanar spine CT scan is highly superior than usual axial scan, because of easily demonstrable longitudinal dimension, level of spine and spinal canal. We evaluated 62 cases of spine CT, whom complains of spinal symptoms, from July, 1982 to January, 1983. The results were as follows: 1. The sex distribution of cases were 45 male and 17 female, ages were from 15 years to 76 years, and sites were 15 cervical spine, 7 thoracic spine, 42 lumbar spine and 21 sacral spine. 2. Sixty two cases of the CT diagnosis were reviewed and shows 19 cases of herniated intervertebral disc, 7 cases of spine fracture, 5 cases of degenerative disease, 4 cases of metastatic cancer, 2 cases of posterior longitudinal ligament ossification, 1 case of cord injury and 24 cases of normal. 3. The CT findings of herniated intervertebral disc were protruding disc, obliteration of anterior epidural fat, with or without indentation of dural sac and calcification within posterior disc margin. In cases of trauma, the multiplanar spine CT scan detects more specific extension of the fracture sites, and it is able to demonstrate relationship between fracture fragment and spinal cord, therefore operability can be decided. In case of posterior longitudinal ligament ossification, it is easy to demonstrate linear high density along posterior margin of vertebral bodies on sagittal reconstruction scan. 4. The computed tomography is diagnostic in detection of spinal disease. However, multiplanar spine CT is more diagnostic than axial computed tomography such as detecting the longitudinal dimension and demonstration of spinal canal.

  1. Prevalence of degenerative and spondyloarthritis-related magnetic resonance imaging findings in the spine and sacroiliac joints in patients with persistent low back pain

    International Nuclear Information System (INIS)

    To estimate the prevalence of degenerative and spondyloarthritis (SpA)-related magnetic resonance imaging (MRI) findings in the spine and sacroiliac joints (SIJs) and analyse their association with gender and age in persistent low back pain (LBP) patients. Degenerative and SpA-related MRI findings in the whole spine and SIJs were evaluated in Spine Centre patients aged 18-40 years with LBP. Among the 1,037 patients, the prevalence of disc degeneration, disc contour changes and vertebral endplate signal (Modic) changes were 87 % (±SEM 1.1), 82 % (±1.2) and 48 % (±1.6). All degenerative spinal findings were most frequent in men and patients aged 30-40 years. Spinal SpA-related MRI findings were rare. In the SIJs, 28 % (±1.4) had at least one MRI finding, with bone marrow oedema being the most common (21 % (±1.3)). SIJ erosions were most prevalent in patients aged 18-29 years and bone marrow oedema in patients aged 30-40 years. SIJ sclerosis and fatty marrow deposition were most common in women. SIJ bone marrow oedema, sclerosis and erosions were most frequent in women indicating pregnancy-related LBP. The high prevalence of SIJ MRI findings associated with age, gender, and pregnancy-related LBP need further investigation of their clinical importance in LBP patients. (orig.)

  2. Prevalence of degenerative and spondyloarthritis-related magnetic resonance imaging findings in the spine and sacroiliac joints in patients with persistent low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Arnbak, Bodil; Jensen, Tue S.; Manniche, Claus [Hospital Lillebaelt, Research Department, Spine Centre of Southern Denmark, Middelfart (Denmark); University of Southern Denmark, Institute of Regional Health Research, Odense C (Denmark); Egund, Niels; Zejden, Anna [Aarhus University Hospital, Department of Radiology, Aarhus C (Denmark); Hoerslev-Petersen, Kim [University of Southern Denmark, Institute of Regional Health Research, Odense C (Denmark); King Christian 10th Hospital for Rheumatic Diseases, Graasten, Graasten (Denmark); Jurik, Anne G. [Hospital Lillebaelt, Research Department, Spine Centre of Southern Denmark, Middelfart (Denmark); University of Southern Denmark, Institute of Regional Health Research, Odense C (Denmark); Aarhus University Hospital, Department of Radiology, Aarhus C (Denmark)

    2016-04-15

    To estimate the prevalence of degenerative and spondyloarthritis (SpA)-related magnetic resonance imaging (MRI) findings in the spine and sacroiliac joints (SIJs) and analyse their association with gender and age in persistent low back pain (LBP) patients. Degenerative and SpA-related MRI findings in the whole spine and SIJs were evaluated in Spine Centre patients aged 18-40 years with LBP. Among the 1,037 patients, the prevalence of disc degeneration, disc contour changes and vertebral endplate signal (Modic) changes were 87 % (±SEM 1.1), 82 % (±1.2) and 48 % (±1.6). All degenerative spinal findings were most frequent in men and patients aged 30-40 years. Spinal SpA-related MRI findings were rare. In the SIJs, 28 % (±1.4) had at least one MRI finding, with bone marrow oedema being the most common (21 % (±1.3)). SIJ erosions were most prevalent in patients aged 18-29 years and bone marrow oedema in patients aged 30-40 years. SIJ sclerosis and fatty marrow deposition were most common in women. SIJ bone marrow oedema, sclerosis and erosions were most frequent in women indicating pregnancy-related LBP. The high prevalence of SIJ MRI findings associated with age, gender, and pregnancy-related LBP need further investigation of their clinical importance in LBP patients. (orig.)

  3. Neck Strength, Position Sense, and Motion in Military Helicopter Crew With and Without Neck Pain

    NARCIS (Netherlands)

    M.H.A.H. van den Oord; V. de Loose; J.K. Sluiter; M.H.W. Frings-Dresen

    2010-01-01

    Introduction: Neck pain in military helicopter pilots and rear aircrew is an occupational health problem that may interfere with flying performance. The aim of the present study was to investigate possible differences in the physical abilities of the cervical spines of helicopter pilots and rear air

  4. Cervical epidural abscess caused by brucellosis.

    Science.gov (United States)

    Lampropoulos, Christos; Kamposos, Panagiotis; Papaioannou, Ioanna; Niarou, Vasiliki

    2012-01-01

    A 70-year-old Greek lady presented with fever, arthralgias of knees, cervical and lumbar pain during the last month. On clinical examination the patient was found to have tenderness of the cervical and the lumbar spine with great motion restriction. The blood tests revealed high erythrocyte sedimentation rate and C-reactive protein, abnormal liver function tests and a positive rheumatoid factor. Serological test for Brucella was positive while cervical MRI revealed epidural abscess and spondylodiscitis. Conservative treatment with streptomycin (it was substituted by rifampicin after the third week) and doxycyclin for 4 months significantly improved her symptoms. The frequency as well as the diagnosis and management of this manifestation are discussed. PMID:23188848

  5. Applying psychological theories to evidence-based clinical practice: identifying factors predictive of lumbar spine x-ray for low back pain in UK primary care practice

    Directory of Open Access Journals (Sweden)

    Thomas Ruth

    2011-05-01

    Full Text Available Abstract Background Psychological models predict behaviour in a wide range of settings. The aim of this study was to explore the usefulness of a range of psychological models to predict the health professional behaviour 'referral for lumbar spine x-ray in patients presenting with low back pain' by UK primary care physicians. Methods Psychological measures were collected by postal questionnaire survey from a random sample of primary care physicians in Scotland and north England. The outcome measures were clinical behaviour (referral rates for lumbar spine x-rays, behavioural simulation (lumbar spine x-ray referral decisions based upon scenarios, and behavioural intention (general intention to refer for lumbar spine x-rays in patients with low back pain. Explanatory variables were the constructs within the Theory of Planned Behaviour (TPB, Social Cognitive Theory (SCT, Common Sense Self-Regulation Model (CS-SRM, Operant Learning Theory (OLT, Implementation Intention (II, Weinstein's Stage Model termed the Precaution Adoption Process (PAP, and knowledge. For each of the outcome measures, a generalised linear model was used to examine the predictive value of each theory individually. Linear regression was used for the intention and simulation outcomes, and negative binomial regression was used for the behaviour outcome. Following this 'theory level' analysis, a 'cross-theoretical construct' analysis was conducted to investigate the combined predictive value of all individual constructs across theories. Results Constructs from TPB, SCT, CS-SRM, and OLT predicted behaviour; however, the theoretical models did not fit the data well. When predicting behavioural simulation, the proportion of variance explained by individual theories was TPB 11.6%, SCT 12.1%, OLT 8.1%, and II 1.5% of the variance, and in the cross-theory analysis constructs from TPB, CS-SRM and II explained 16.5% of the variance in simulated behaviours. When predicting intention, the

  6. Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation.

    Science.gov (United States)

    Li, Jian; Yan, Deng-lu; Zhang, Zai-Heng

    2008-12-01

    Percutaneous disc decompression procedures have been performed in the past. Various percutaneous techniques such as percutaneous discectomy, laser discectomy, and nucleoplasty have been successful. Our prospective study was directly to evaluate the results of percutaneous cervical nucleoplasty (PCN) surgery for cervical disc herniation, and illustrate the effectiveness of PCN in symptomatic patients who had cervical herniated discs. From July of 2002 to June of 2005, 126 consecutive patients with contained cervical disc herniations have presented at the authors' clinic and treated by PCN. The patients' gender distribution for PCN was 65 male, 61 female. The age of patients ranged from 34 to 66 years (mean 51.9 +/- 10.2 years). The levels of involvement were 21 cases at C3-4, 30 cases at C4-5, 40 cases at C5-6, and 35 cases at C6-7. The clinical outcomes, pain reduction and the segment stability were all recorded during this study. A clinical outcome was quantified by the Macnab standard and using VAS. The angular displacement (AD) > or =11 degrees or horizontal displacement (HD) > or =3 mm was considered to be radiographically unstable. In the results of this study, puncture of the needle into the disc space was accurately performed under X-ray guidance in all cases. There was one case where the Perc-D Spine Wand had broken in the disc space during the procedure. The partial Perc-D Spine Wand, which had broken in the disc space could not be removed by the percutaneous cervical discectomy and thus remained there. There were no recurrent cases or complications in our series. Macnab standard results were excellent in 62 cases, good in 41 cases and fair in 23 cases. The rate of excellent and good was 83.73%. The VAS scores demonstrated statistically significant improvement in PCN at the 2-week, 1, 3, 6, and 12-month follow-up visits when compared to preoperational values (P PCN procedure. There was no significant difference in stability either preoperatively or

  7. Cervical chordoma with vertebral artery encasement mimicking neurofibroma: MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Mortele, B.; Lemmerling, M.; Mortele, K.; Verstraete, K.; Defreyne, L.; Kunnen, M. [Department of Radiology, University Hospital, Gent (Belgium); Vandekerckhove, T. [Department of Neurosurgery, University Hospital, Gent (Belgium)

    2000-06-01

    A case of cervical chordoma in a 36-year-old white man with hypoesthesia in the neck and right shoulder, neck pain, and restricted neck mobility is presented. Plain radiographs of the cervical spine showed radiolucency of the body of C2 on the right side and enlargement of the right intervertebral foramen at C2-C3 level. Tumor encasement of the vertebral artery was demonstrated by MR imaging and confirmed by conventional arteriography. This proved to be particularly important for preoperative assessment. (orig.)

  8. Cervical chordoma with vertebral artery encasement mimicking neurofibroma: MRI findings

    International Nuclear Information System (INIS)

    A case of cervical chordoma in a 36-year-old white man with hypoesthesia in the neck and right shoulder, neck pain, and restricted neck mobility is presented. Plain radiographs of the cervical spine showed radiolucency of the body of C2 on the right side and enlargement of the right intervertebral foramen at C2-C3 level. Tumor encasement of the vertebral artery was demonstrated by MR imaging and confirmed by conventional arteriography. This proved to be particularly important for preoperative assessment. (orig.)

  9. Influence of the actions observed on cervical motion in patients with chronic neck pain: a pilot study.

    Science.gov (United States)

    de-la-Puente-Ranea, Lucía; García-Calvo, Beatriz; La Touche, Roy; Fernández-Carnero, Josué; Gil-Martínez, Alfonso

    2016-08-01

    The aim of the present pilot study was to prove if the action-observation (AOb) improved the cervical range of motion (CROM) in patients with nonspecific chronic neck pain (CNP). Double blind pilot study. A total of 28 subjects were randomly assigned to an effective-movement group (n=14) and an ineffective-movement group (n=14). The follow-up consisted of: pretreatment, posttreatment and 10 min after second measurement (motor imagery). Outcome measures were CROM, and pres-sure pain detection thresholds (PPDTs). No statistical differences were found in baseline on CROM and on the PPDT. Test for independent groups revealed significant changes in cervical rotation movement. Both groups in posttreatment (P=0.042; Cohen d=0.81) and after 10 min (P=0.019; Cohen d=0.9). For intragroup PPDT, the Wilcoxon test revealed significant effects in the effective movement at C2 of the pre to 10-min post (P=0.040). However, the ineffective movement revealed a significant reduction in PPDT in zygapophyseal joint of C5-C6 as the pre to post (P=0.010) as the pre to 10-min post (P=0.041) periods. In conclusions this pilot study demonstrated that the effective AOb produced significant changes versus ineffective AOb in the CROM and it could influences in PPT in subject with CNP immediately. PMID:27656633

  10. 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.

  11. 颈椎单节段融合术后相邻各节段运动补偿的规律研究%Research of the motion compensation after single segmental cervical spine fusion surgery

    Institute of Scientific and Technical Information of China (English)

    张睿; 周文钰; 顾洪生; 刘伟强; 白波; 王大平

    2014-01-01

    目的 了解颈椎单节段融合术后上、下相邻及非相邻节段的运动补偿规律.方法 通过三维运动采集系统,捕捉到6具新鲜人尸体颈椎单节段融合术前后C2~T1各节段的运动角度数据.结果 经过归一化处理后,分析得出颈椎单节段融合术后各节段的运动变化规律,发现融合术后其他各节段运动幅度均有不同程度的增加,尤其是下相邻节段,差异有统计学意义(P<0.05).结论 颈椎单节段融合术后邻近节段的代偿性运动幅度增加是导致其退变的重要原因.%Objective To know the motion compensation regulation of each segments after single segmental cervical spine fusion surgery.Methods With the help of 3D motion information collecting system,the movement angle of each segment was recorded before and after single segmental cervical spine fusion surgery.Results All the statistics are dealed with normalization,we got the statistics of the motion compensation regulation of each segments after single segmental cervical spine fusion surgery,range of motion of each segment increased diversely,especially the lower adjacent segment,with statistical significance(P<0.05).Conclusion Compensatory enhancement of the range of motion of adjacent segments is one of the important reasons lead to the degeneration.

  12. 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.

  13. Minimally invasive posterior cervical decompression using tubular retractor: The technical note and early clinical outcome

    Directory of Open Access Journals (Sweden)

    Jung-Woo Hur

    2014-01-01

    Full Text Available Background: The aim of this work is to present a novel decompression technique that approaches cervical spine posteriorly, but through minimal invasive method using tubular retractor avoiding detachment of posterior musculature. Methods: Six patients underwent minimally invasive posterior cervical decompression using the tubular retractor system and surgical microscope. Minimally invasive access to the posterior cervical spine was performed with exposure through a paramedian muscle-splitting approach. With the assistance of a specialized tubular retraction system and deep soft tissue expansion mechanism, multilevel posterior cervical decompression could be accomplished. This approach also allows safe docking of the retractor system on the lateral mass, thus avoiding the cervical spinal canal during exposure. A standard operating microscope was used with ×10 magnification and 400 mm focal length. The hospital charts, magnetic resonance imaging studies, and follow-up records of all the patients were reviewed. Outcome was assessed by neurological status and visual analog scale (VAS for neck and arm pain. Results: There was no significant complication related to operation. The follow-up time was 4-12 months (mean, 9 months. Muscle weakness improved in all patients; sensory deficits resolved in four patients and improved in two patients. Analysis of the mean VAS for radicular pain and VAS for neck pain showed significant improvement. Conclusions: The preliminary experiences with good clinical outcome seem to promise that this minimally invasive technique is a valid alternative option for the treatment of cervical spondylotic myelopathy.

  14. [Langerhans cell histiocytosis causing cervical myelopathy].

    Science.gov (United States)

    Doléagbénou, A K; Mukengeshay Ntalaja, J; Derraz, S; El Ouahabi, A; El Khamlichi, A

    2012-08-01

    Langerhans cell histiocytosis (LCH), a disorder of the phagocytic system, is a rare condition. Moreover, spinal involvement causing myelopathy is even rare and unusual. Here, we report a case of atypical LCH causing myelopathy, which was subsequently treated by corporectomy and fusion. An 8-year-old boy presented with 3 weeks of severe neck pain and limited neck movement accompanying upper and lower limbs motor weakness. CT scans revealed destruction of C5 body and magnetic resonance imaging showed a tumoral process at C5 with cord compression. Interbody fusion using anterior cervical plate packed by autologus iliac bone was performed. Pathological examination confirmed the diagnosis of LCH. After the surgery, the boy recovered from radiating pain and motor weakness of limbs. Despite the rarity of the LCH in the cervical spine, it is necessary to maintain our awareness of this condition. When neurologic deficits are present, operative treatment should be considered. PMID:22552159

  15. Post laminoplasty cervical kyphosis—Case report

    Science.gov (United States)

    Dugoni, D.E.; Mancarella, C.; Landi, A.; Tarantino, R.; Ruggeri, A.G.; Delfini, R.

    2014-01-01

    INTRODUCTION Cervical kyphosis is a progressive cervical sagittal plane deformity that may cause a reduction in the ability to look horizontally, breathing and swallowing difficulties, sense of thoracic oppression and social isolation. Moreover, cervical kyphosis can cause myelopathy due to a direct compression by osteo-articular structures on the spinal cord or to a transitory ischaemic injury. The treatment of choice is surgery. The goals of surgery are: nervous structures decompression, cervical and global sagittal balance correction and vertebral stabilization and fusion. PRESENTATION OF CASE In October 2008 a 35 years old woman underwent surgical removal of a cervical-bulbar ependymoma with C1–C5 laminectomy and a C2–C5 laminoplasty. Five months after surgery, the patient developed a kyphotic posture, with intense neck and scapular girdle pain. The patients had a flexible cervical kyphosis. Therefore, we decided to perform an anterior surgical approach. We performed a corpectomy C4–C5 in order to achieve the anterior decompression; we placed a titanium expansion mesh. DISCUSSION Cervical kyphosis can be flexible or fixed. Some authors have reported the use of anterior surgery only for flexible cervical kyphosis as discectomy and corpectomy. This approach is useful for anterior column load sharing however it is not required for deformity correction. CONCLUSION The anterior approach is a good surgical option in flexible cervical kyphosis. It is of primary importance the sagittal alignment of the cervical spine in order to decompress the nervous structures and to guarantee a long-term stability. PMID:25462050

  16. [Cervical radiculopathy].

    Science.gov (United States)

    Kuijper, B

    2014-10-01

    Cervical radiculopathy is a common cause of pain in the arm. It is caused by nerve root compression in the neck, as a consequence of a herniated disc, or spondyliotic foraminal stenosis. It causes severe pain, especially during the first few weeks, and paraesthesias in the forearm and hand. Patients also suffer from neck pain and loss of strength in the relevant arm. The arm pain can be exacerbated by certain movements of the head; these should be avoided as much as possible. Diagnosis can be made on the basis of history and physical examination. The pain generally disappears without active patient treatment. A semi-rigid cervical collar is recommended to accelerate pain relief. In cases of persistent pain, surgery will be considered. In such cases an MRI should be performed to show the cause and level of nerve root compression. PMID:26185991

  17. Morphometric analysis of cervical vertebrae morphology and correlation of cervical vertebrae morphometry, cervical spine inclination and cranial base angle to craniofacial morphology and stature in an adult skeletal class I and class II population

    Directory of Open Access Journals (Sweden)

    Supriya Nambiar

    2014-01-01

    Full Text Available Objective: The study was carried out to compare the morphometry of the cervical column between adult Class I and Class II individuals and between gender and to analyze the correlation between the cervical column morphology, the cranial base angle, the craniocervical inclination with craniofacial morphology and stature of Angles Class I and Class II individuals. Materials and Methods: The data for this institutional retrospective study were systematically selected according to the specified inclusion and exclusion criteria from the pretreatment cephalometric radiographs of 19 male and 30 female patients visiting the Department of Orthodontics, Manipal College of Dental Sciences, Mangalore, Manipal University, based on their ANB angle. The radiographs were traced and digitized. The reliability of the variables describing the cranial base and vertical and sagittal craniofacial dimensions was assessed. Conclusions: Our results showed that there was no statistically significant variation in the cervical vertebrae dimensions between Class I and Class II patients. There was found to be a definite sexual dimorphism, which was not statistically significant. Correlation exists between sagittal skeletal patterns, especially mandibular length and cervicovertebral morphology, but its use to classify the subjects in different sagittal classes is questionable.

  18. The chronic low back pain region of spine in athletes%运动员脊柱源慢性腰痛的述评

    Institute of Scientific and Technical Information of China (English)

    金晨; 李强; 张璐; 李婧

    2014-01-01

    Chronic back pain is one of the high incidence diseases,which has been plagued athletes. The majority of chronic low back pain is spine source. In this paper,the incidence and causes of chronic low back pain in athletes,and rehabilitation assessments were reviewed. The spinal stabilization system was used as a theoretical basis of damage,to analyze the current short-age of treatment for chronic low back pain,thus to provide the reference of rehabilitation and e-valuation more suitable for athletes.%慢性腰痛一直是困扰运动员的高发病之一,其中以脊柱源慢性腰痛占多数。本文对运动员慢性腰痛的发病率及原因,康复治疗评估进行综述。通过脊柱稳定系统作为损伤的理论基础来分析目前治疗的不足,为慢性腰痛的康复治疗与评估更加适合运动员群体提供参考。

  19. Étude cinématique tridimensionnelle du rachis cervical. Comparaison entre sujets Asymptomatiques et pathologiques

    OpenAIRE

    Boussion, Luc,