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Sample records for high cervical spine

  1. High Grade Infective Spondylolisthesis of Cervical Spine Secondary to Tuberculosis.

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    Hadgaonkar, Shailesh; Shah, Kunal; Shyam, Ashok; Sancheti, Parag

    2015-12-01

    Spondylolisthesis coexisting with tuberculosis is rarely reported. There is a controversy whether spondylolisthesis coexists or precedes tuberculosis. Few cases of pathological spondylolisthesis secondary to tuberculous spondylodiscitis have been reported in the lumbar and lumbosacral spine. All cases in the literature presented as anterolisthesis, except one which presented as posterolisthesis of lumbar spine. Spondylolisthesis in the cervical spine is mainly degenerative and traumatic. Spondylolisthesis due to tuberculosis is not reported in the lower cervical spine. The exact mechanism of such an occurrence of spondylolisthesis with tuberculosis is sparsely reported in the literature and inadequately understood. We report a rare case of high grade pathological posterolisthesis of the lower cervical spine due to tubercular spondylodiscitis in a 67-year-old woman managed surgically with a three-year follow-up period. This case highlights the varied and complex presentation of tuberculosis of the lower cervical spine and gives insight into its pathogenesis, diagnosis, and management.

  2. High cervical spine spondylodiscitis management and literature review

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    André Luis Sebben

    Full Text Available Summary Spondylodiscitis affecting the cervical spine is the most unusual type. Disease progression can be dramatic, even causing quadriplegia and death. We present an unusual case that progressed with osteolytic lesions between C2 and C3, causing cord compression and epidural abscess. The patient was treated surgically by a double approach and improved without neurological deficits and with better inflammatory markers. We reviewed the current literature on the subject.

  3. 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.)

  4. Cervical spine CT scan

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    ... defects of the cervical spine Bone problems Fracture Osteoarthritis Disc herniation Risks Risks of CT scans include: ... Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, ...

  5. An occult cervical spine fracture.

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    Khosla, R

    1997-12-01

    A 16-year-old athlete developed neck pain after being dropped on his head with his neck flexed while recreationally wrestling. Initial cervical spine radiographs were negative, but he continued to have neck and arm pain, especially after heading a wet soccer ball. Two months after the initial injury, he had a positive Spurling test; cervical spine CT then revealed a parasagittal linear fracture through the body of C-7. The patient avoided contact and collision activities and had no further physical problems. For patients who suffer cervical spine trauma, adequate visualization of the cervical spine can help prevent catastrophic outcomes.

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

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    Yesupalan Rajam

    2008-06-01

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

  7. Fractures of the cervical spine

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    Raphael Martus Marcon

    2013-11-01

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

  8. Fractures of the cervical spine

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

    2013-01-01

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

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

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    Barbeito, A; Guerri-Guttenberg, R A

    2014-03-01

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

  10. Cervical spine movement during intubation

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    Amlan Swain

    2017-01-01

    Full Text Available There have been growing concerns following documented instances of neurological deterioration in patients with cervical spine injury as a result of intubation. A significant body of evidence has since evolved with the primary objective of ascertaining the safest way of securing the endotracheal tube in patients with suspected and proven cervical injury. The search for a mode of intubation producing the least movement at the cervical spine is an ongoing process and is limited by logistic and ethical issues. The ensuing review is an attempt to review available evidence on cervical movements during intubation and to comprehensively outline the movement at the cervical spine with a wide plethora of intubation aids. Literature search was sourced from digital libraries including PubMed, Medline and Google Scholar in addition to the standard textbooks of Anaesthesiology. The keywords used in literature search included 'cervical spine motion,' 'neurological deterioration,' 'intubation biomechanics,' 'direct laryngoscopy,' 'flexible fibreoptic intubation,' 'video laryngoscopes' and 'craniocervical motion.' The scientific information in this review is expected to assist neuroanaesthesiologists for planning airway management in patients with neurological injury as well as to direct further research into this topic which has significant clinical and patient safety implications.

  11. 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.

  12. Multilevel noncontiguous cervical spine injury

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    Adetunji Mapaderun Toluse

    2017-01-01

    Full Text Available This case report highlights the successful combination of operative and nonoperative management of a patient with noncontiguous cervical spine fractures and incomplete spinal cord injury. A case report of a 40-year-old male victim of a motor vehicular accident who presented with noncontiguous cervical spine fractures (Anderson and D'Alonzo Type III odontoid fracture and traumatic spondylolisthesis of C4/C5 and incomplete spinal cord injury. The odontoid fracture was managed nonoperatively, whereas anterior cervical discectomy and fusion were done at the C4/C5 vertebral level. The patient made full neurologic recovery with radiologic evidence of successful fusion and fracture healing at 12 weeks postoperation in both levels of injuries. Operative and nonoperative modalities can be utilized to manage selected patients.

  13. Cervical spine injuries in American football.

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

    2009-01-01

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

  14. Adverse effects associated with high-dose recombinant human bone morphogenetic protein-2 use in anterior cervical spine fusion.

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    Shields, Lisa B E; Raque, George H; Glassman, Steven D; Campbell, Mitchell; Vitaz, Todd; Harpring, John; Shields, Christopher B

    2006-03-01

    A retrospective review of patients who underwent an anterior cervical fusion using recombinant human bone morphogenetic protein (rhBMP)-2 with an absorbable collagen sponge (INFUSE; Medtronic Sofamor Danek, Minneapolis, MN). To ascertain the complication rate after the use of high-dose INFUSE in anterior cervical fusions. The rhBMP-2 has been primarily investigated in lumbar spine fusions, where it has significantly enhanced the fusion rate and decreased the length of surgery, blood loss, and hospital stay. We present 151 patients who underwent either an anterior cervical discectomy and fusion (n = 138) or anterior cervical vertebrectomy and fusion (n = 13) augmented with high-dose INFUSE between July 2003 and March 2004. The rhBMP-2 (up to 2.1 mg/level) was used in the anterior cervical discectomy and fusions. A total of 35 (23.2%) patients had complications after the use of high-dose INFUSE in the cervical spine. There were 15 patients diagnosed with a hematoma, including 11 on postoperative day 4 or 5, of whom 8 were surgically evacuated. Thirteen individuals had either a prolonged hospital stay (> 48 hours) or hospital readmission because of swallowing/breathing difficulties or dramatic swelling without hematoma. A significant rate of complications resulted after the use of a high dose of INFUSE in anterior cervical fusions. We hypothesize that in the cervical area, the putative inflammatory effect that contributes to the effectiveness of INFUSE in inducing fusion may spread to adjacent critical structures and lead to increased postoperative morbidity. A thorough investigation is warranted to determine the optimal dose of rhBMP-2 that will promote cervical fusion and minimize complications.

  15. AOSpine subaxial cervical spine injury classification system

    NARCIS (Netherlands)

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

    2016-01-01

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

  16. AOSpine subaxial cervical spine injury classification system

    NARCIS (Netherlands)

    Vaccaro, Alexander R.; Koerner, John D.; Radcliff, Kris E.; Oner, F. Cumhur|info:eu-repo/dai/nl/188615326; Reinhold, Maximilian; Schnake, Klaus J.; Kandziora, Frank; Fehlings, Michael G.; Dvorak, Marcel F.; Aarabi, Bizhan; Rajasekaran, Shanmuganathan; Schroeder, Gregory D.; Kepler, Christopher K.; Vialle, Luiz R.

    2016-01-01

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

  17. 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.

  18. Sport injuries of the cervical spine

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    Bargon, G.

    1981-03-01

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

  19. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population.

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    Schotanus, Maaike; van Middendorp, Joost J; Hosman, Allard J F

    2010-09-01

    Prospective single cohort study. To analyze the incidence, associated injuries, treatment outcomes and associated adverse events of isolated transverse process fractures (TPFs) of the subaxial cervical spine in a high-energy blunt trauma population. Currently, TPFs of the subaxial cervical spine are considered to be clinically insignificant. However, this hypothesis is based on clinical experience and has never been supported by research previously. During a 32-month period, routine computed tomography scans of the spine were obtained in high-energy blunt trauma patients. Patients with isolated TPFs of the subaxial cervical spine were prospectively identified. For each enrolled patient, gender, age, mechanism of injury, trauma severity, neurologic deficit, injury levels, affected structures, treatment, radiographic follow-up, functional outcome (Cybex goniometer, neck disability index), and patient satisfaction (10 point visual analog scale) were recorded. Of 865 enrolled patients, 21 patients (2.4%) had 25 isolated TPFs of the subaxial cervical spine. The seventh vertebra was involved predominantly (76%). The initial treatment regimen was unrestricted movement in all patients. No associated adverse events were observed. A follow-up of 13 to 39 months was available in 14 patients. Follow-up showed a stable and intact subaxial cervical spine in all patients' radiographs, a patient satisfaction of 9.3 (SD 1.48), a Cybex measured range of motion in the sagittal plane of 109 degrees (SD 12.5, 95-129), the frontal plane of 70 (SD 17.8, 37-100) and the transverse plane of 144 (SD 12.5, 116-164), and a mean neck disability index score of 3.93 (SD 8.24). The incidence of isolated TPFs of the subaxial cervical spine was 2.4%. Unrestricted movement resulted in satisfying functional, anatomic, and neurologic outcomes without associated adverse events. This study confirms that isolated TPFs of the subaxial cervical spine can be considered as clinically insignificant and do not

  20. Cervical spine balance: postoperative radiologic changes in adult scoliosis surgery.

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    Boissière, Louis; Bernard, Jean; Vital, Jean-Marc; Pointillart, Vincent; Mariey, Rémi; Gille, Olivier; Obeid, Ibrahim

    2015-07-01

    Cervical spine alignment interests appeared recently and relationships between the pelvis and the cervical spine have been reported but remain unclear. In this study, postoperative changes for cranial, cervical, lumbar and sagittal balance parameters have been measured in adult scoliosis surgery without major sagittal malalignment to appreciate the adaptation of the cervical spine. Twenty-nine consecutive patients with a surgical adult degenerative scoliosis treated with a T8-T11 to iliac fusion without PSO or multiple Ponte's osteotomies had preoperative and postoperative full spine EOS radiographies to measure spino-pelvic parameters. Correlation analysis between the different parameters was performed. Lower cervical, lordosis, lumbar lordosis and thoracic kyphosis were increased in postoperative as no changes were observed for upper cervical lordosis. C1-C7 CL highly correlated (0.85 in preoperative and 0.87 in postoperative) with C7 slope, which highly correlated itself with global balance parameters (0.74 in preoperative and 0.71 in postoperative for CAM-PL) underlining the relationship between cervical spine alignment and global malalignment. Modifications of lower CL are observed, as upper CL remains constant. If no correlation was found for LL, TK and CL changes, CL appears to be highly correlated with C7 slope, which highly correlated itself with sagittal global balance parameters. C7 slope appears as a base for CL influenced by the spine global alignment.

  1. Flexion/extension cervical spine views in blunt cervical

    OpenAIRE

    Nasir Sadaf; Hussain Manzar; Mahmud Roomi

    2012-01-01

    【Abstract】Objective: To examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma, who show loss of cervical lordosis and neck pain. Methods: All patients who presented to our emer-gency department following blunt trauma were enrolled in this study, except those with schiwora, neurological defi-cits or fracture demonstrated on cross-table cervical spine X-rays, and tho...

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

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

    2016-01-01

    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.

  3. Vertigo in patients with cervical spine dysfunction

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    Galm, R.; Rittmeister, M.; Schmitt, E.

    1998-01-01

    To our knowledge, quantitative studies on the significance of disorders of the upper cervical spine as a cause of vertigo or impaired hearing do not exist. We examined the cervical spines of 67 patients who presented with symptoms of dizziness. Prior to the orthopaedic examination, causes of vertigo relating to the field of ENT and neurology had been ruled out. Fifty patients of the above-mentioned group were studied. They followed the outlined treatment protocol with physical therapy and wer...

  4. Tophaceous gout in the cervical spine

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

    2005-12-01

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

  5. Tuberculous retropharyngeal abscess without cervical spine TB

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    ChandrakantPatil; RashmiKharatPatil; PrasadDeshmukh; SameerSinghal; BlendaDSouza

    2011-01-01

    Tuberculous retropharyngeal abscess is a rare presentation. It is present in adults usually due to involvement of cervical spine by tuberculosis. Retropharyngeal space usually gets involved in children due to pyogenic organisms or secondary to trauma. Here is a case of tuberculous retropharyngeal abscess in an adult female, with pulmonary tuberculosis. The patient was not having tuberculous involvement of cervical spine and was managed surgically by aspirating the retropharyngeal abscess transorally and AKT Category I.

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

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    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.

  7. Flexion/extension cervical spine views in blunt cervical

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    Nasir Sadaf

    2012-06-01

    Full Text Available 【Abstract】Objective: To examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma, who show loss of cervical lordosis and neck pain. Methods: All patients who presented to our emer-gency department following blunt trauma were enrolled in this study, except those with schiwora, neurological defi-cits or fracture demonstrated on cross-table cervical spine X-rays, and those who were either obtunded or presented after cervical spine surgery. Adequacy of flexion and exten-sion views was checked by the neurosurgery and radiology team members. All these patients underwent cross-table cervical spine view followed by flexion/extension views based on the loss of lordosis on cross-table imaging and the presence of neck pain. Results: A total of 200 cases were reviewed, of whom 90 (45% underwent repeat X-rays because of either inadequate exposure or limited motion. None of the patients with loss of lordosis on cross-table view had positive flexion and extension views of cervical spine for instability. Conclusions: Our results show that in patients who underwent acute radiographic evaluation of blunt cervical spine trauma, flexion and extension views of the cervical spine are unlikely to yield positive results in the presence of axial neck pain and/or loss of cervical lordosis. We can also hypothesize that performing flexion and extension views will be more useful once the acute neck pain has settled. Key words: X-rays; Cervical vertebrae; Lordosis

  8. Flexion/extension cervical spine views in blunt cervical trauma

    Institute of Scientific and Technical Information of China (English)

    Sadaf Nasir; Manzar Hussain; Roomi Mahmud

    2012-01-01

    Objective: To examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma,who show loss of cervical lordosis and neck pain.Methods: All patients who presented to our emergency department following blunt trauma were enrolled in this study,except those with schiwora,neurological deficits or fracture demonstrated on cross-table cervical spine X-rays,and those who were either obtunded or presented after cervical spine surgery.Adequacy of flexion and extension views was checked by the neurosurgery and radiology team members.All these patients underwent cross-table cervical spine view followed by flexion/extension views based on the loss of lordosis on cross-table imaging and the presence of neck pain.Results: A total of 200 cases were reviewed,of whom 90 (45%) underwent repeat X-rays because of either inadequate exposure or limited motion.None of the patients with loss of lordosis on cross-table view had positive flexion and extension views of cervical spine for instability.Conclusions: Our results show that in patients who underwent acute radiographic evaluation of blunt cervical spine trauma,flexion and extension views of the cervical spine are unlikely to yield positive results in the presence of axial neck pain and/or loss of cervical lordosis.We can also hypothesize that performing flexion and extension views will be more useful once the acute neck pain has settled.

  9. 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.

  10. Complications of halo fixation of the cervical spine.

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    Hayes, Victor M; Silber, Jeff S; Siddiqi, Farhan N; Kondrachov, Dmitriy; Lipetz, Jason S; Lonner, Baron

    2005-06-01

    Halo fixators play an integral role in stabilizing the cervical spine. They are most widely used after upper cervical to midcervical spine fractures and dislocations and as a supplement to various surgical fixation techniques. Compared with supine cervical traction techniques, halo fixators allow early patient mobilization and shorten hospital stays. The incidence of halo-fixator complications remains high. Minor complications include pin loosening, localized infection, periorbital edema, superficial pressure sores, and unsightly scars. Major complications include pin penetration, osteomyelitis, subdural abscess, nerve palsies, fracture overdistraction, and persistent instability. Many of these potential complications can be avoided with proper pin placement and meticulous pin care.

  11. Respiratory Disorders in Complicated Cervical Spine Injury

    Directory of Open Access Journals (Sweden)

    S. A. Pervukhin

    2016-01-01

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

  12. Developmental biomechanics of the human cervical spine.

    Science.gov (United States)

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

    2013-04-05

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

  13. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population.

    NARCIS (Netherlands)

    Schotanus, M.; Middendorp, J.J. van; Hosman, A.J.F.

    2010-01-01

    STUDY DESIGN: Prospective single cohort study. OBJECTIVE: To analyze the incidence, associated injuries, treatment outcomes and associated adverse events of isolated transverse process fractures (TPFs) of the subaxial cervical spine in a high-energy blunt trauma population. SUMMARY OF BACKGROUND

  14. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population.

    NARCIS (Netherlands)

    Schotanus, M.; Middendorp, J.J. van; Hosman, A.J.F.

    2010-01-01

    STUDY DESIGN: Prospective single cohort study. OBJECTIVE: To analyze the incidence, associated injuries, treatment outcomes and associated adverse events of isolated transverse process fractures (TPFs) of the subaxial cervical spine in a high-energy blunt trauma population. SUMMARY OF BACKGROUND DAT

  15. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population.

    NARCIS (Netherlands)

    Schotanus, M.; Middendorp, J.J. van; Hosman, A.J.F.

    2010-01-01

    STUDY DESIGN: Prospective single cohort study. OBJECTIVE: To analyze the incidence, associated injuries, treatment outcomes and associated adverse events of isolated transverse process fractures (TPFs) of the subaxial cervical spine in a high-energy blunt trauma population. SUMMARY OF BACKGROUND DAT

  16. Cervical spine reposition errors after cervical flexion and extension.

    Science.gov (United States)

    Wang, Xu; Lindstroem, René; Carstens, Niels Peter Bak; Graven-Nielsen, Thomas

    2017-03-13

    Upright head and neck position has been frequently applied as baseline for diagnosis of neck problems. However, the variance of the position after cervical motions has never been demonstrated. Thus, it is unclear if the baseline position varies evenly across the cervical joints. The purpose was to assess reposition errors of upright cervical spine. Cervical reposition errors were measured in twenty healthy subjects (6 females) using video-fluoroscopy. Two flexion movements were performed with a 20 s interval, the same was repeated for extension, with an interval of 5 min between flexion and extension movements. Cervical joint positions were assessed with anatomical landmarks and external markers in a Matlab program. Reposition errors were extracted in degrees (initial position minus reposition) as constant errors (CEs) and absolute errors (AEs). Twelve of twenty-eight CEs (7 joints times 4 repositions) exceeded the minimal detectable change (MDC), while all AEs exceeded the MDC. Averaged AEs across the cervical joints were larger after 5 min' intervals compared to 20 s intervals (p cervical spine. The cervical spine returns to the upright positions with a 2° average absolute difference after cervical flexion and extension movements in healthy adults.

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

    Directory of Open Access Journals (Sweden)

    Nanjundappa S. Harshavardhana

    2014-10-01

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

  18. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1998-03-01

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

  20. Cervical human spine loads during traumatomechanical investigations

    NARCIS (Netherlands)

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

    1996-01-01

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

  1. Cervical human spine loads during traumatomechanical investigations

    NARCIS (Netherlands)

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

    1996-01-01

    The last decade's improvements in automotive safety resulted into a significant decrease of fatal injuries. However, due to the use of belts and airbags it can be observed that cervical spine injuries, non-severe and severe, have become more important. It seems that inertial loading of the neck by t

  2. Cervical human spine loads during traumatomechanical investigations

    NARCIS (Netherlands)

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

    1996-01-01

    The last decade's improvements in automotive safety resulted into a significant decrease of fatal injuries. However, due to the use of belts and airbags it can be observed that cervical spine injuries, non-severe and severe, have become more important. It seems that inertial loading of the neck by t

  3. Variation of neck muscle strength along the human cervical spine.

    Science.gov (United States)

    Oi, Nelson; Pandy, Marcus G; Myers, Barry S; Nightingale, Roger W; Chancey, Valeta Carol

    2004-11-01

    The aim of this study was to describe and explain the variation of neck muscle strength along the cervical spine. A three-dimensional model of the head-neck complex was developed to test the hypothesis that the moment-generating capacity of the neck musculature is lower in the upper cervical spine than in the lower cervical spine. The model calculations suggest that the neck muscles can protect the lower cervical spine from injury during extension and lateral bending. The maximum flexor moment developed in the lower cervical spine was 2 times higher than that developed in the upper spine. The model also predicted that the neck musculature is 30% stronger in the lower cervical spine during lateral bending. Peak compressive forces (up to 3 times body weight) were higher in the lower cervical spine. These results are consistent with the clinical finding that extension loading of the neck often leads to injuries in the upper cervical spine. Analysis of the model results showed that neck flexor strength was greater in the lower cervical spine because of the relatively large size of the sternocleidomastoid muscle. The hyoid muscles developed significant flexor moments about the joints of the upper cervical spine, as these muscles had relatively large flexor moment arms; however, this effect was offset by the action of the sternocleidomastoid, which exerted a large extensor moment in the upper spine. Lateral bending strength of the neck muscles was governed by geometry (i.e., moment arms) rather than by muscle size.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-11-01

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

  5. [Reduction and positioning of cervical spine injuries].

    Science.gov (United States)

    Blauth, M; Knop, C; Bastian, L; Schmidt, U

    1998-01-01

    Prerequisites for successful reduction of cervical spine injuries are an exact analysis and classification of every lesion. In locked dislocations disc protrusion should be excluded prior to reduction by MRI or CT-scan. For manual reduction and closed manipulation by the trauma surgeon we use a halo-ring which is applied in local anaesthesia and fluoroscopic control. The anatomic position is maintained by a halo-fixator until surgery. Skeletal traction is used mainly for locked dislocations and late malalignements. Traction is provided by a halo-ring and weights up to 20 kg. Repeated clinical and neurological examinations are necessary to rule out overdistraction of the spine or neurologic deterioration. The weight may be reduced after reduction to 2 kg. For intraoperative positioning and reduction of cervical spine injuries we designed a special device which is connected to the halo ring and allows to fix the head and spine in any desired position. It may be used in prone or supine position of the patient. Operative reductions are rarely necessary on the cervical spine. Typical indication are fractures of posterior elements of the spine preventing closed reduction. Reduction manoeuvers depend on the kind of injury and are mainly composed of traction and a reversal of the trauma mechanism. The most severe complication is a neurologic deterioration. Reports in literature about 13 patients having sustained such a fate are showing the following: In most cases disc material dislocated in the spinal canal during reduction could be made responsible for the catastrophic course. Especially at risk are patients with open reduction from a posterior approach.

  6. The vertical stability of the cervical spine.

    Science.gov (United States)

    Pal, G P; Sherk, H H

    1988-05-01

    The concept of the three-column cervical spine and load transmission through each column was experimentally tested. Material consisted of five cervical columns removed from cadavers. The experiment was conducted on an Instron load testing machine. Load was applied on superior articular surfaces of the axis vertebra and was recorded below from each column separately at the level of the sixth cervical vertebra. It was found that 36% of the total load applied on the top of the specimen is transmitted through the anterior column formed by bodies and intervertebral discs and 32% each through the two posterior cervical columns formed by the articular processes. The experiment very strongly supported the role of neural arch in transmission of vertebral compressive forces.

  7. [High-resolution computed tomography in injuries to the cervical spine].

    Science.gov (United States)

    Gigli, F; Burzi, M; Sartoni Galloni, S; Laus, M

    1989-03-01

    Correct orthopedic therapy for traumas of the cervical rachis requires perfect knowledge of the spatial balance of the fracture focus. The authors believe Computed Tomography (CT) to be the most suitable, and often indispensable, method for this purpose. Twenty-four patients were examined for traumatic pathology of the cervical rachis. In 7 cases with clinically minor traumas, the negative outcome of the traditional exam was considered reliable and sufficient for therapeutic purposes. The extant 17 patients were examined also by means of CT, either to better determine the characteristics of skeletal lesions already ascertained with traditional techniques or to assess the presence of clinically-suspected osteo-articular lesions, even with negative conventional X-rays. For 9 of these patients orthopedic treatment was considered sufficient, whereas 8 patients underwent surgery and were subsequently examined with CT, which allowed correct evaluation of postoperative pictures even in the presence of metal prostheses. In 10 cases CT demonstrated the presence of lesions which had not been diagnosed with traditional X-ray techniques.

  8. Pediatric cervical spine: normal anatomy, variants, and trauma.

    Science.gov (United States)

    Lustrin, Elizabeth Susan; Karakas, Sabiha Pinar; Ortiz, A Orlando; Cinnamon, Jay; Castillo, Mauricio; Vaheesan, Kirubahara; Brown, James H; Diamond, Alan S; Black, Karen; Singh, Sudha

    2003-01-01

    Emergency radiologic evaluation of the pediatric cervical spine can be challenging because of the confusing appearance of synchondroses, normal anatomic variants, and injuries that are unique to children. Cervical spine injuries in children are usually seen in the upper cervical region owing to the unique biomechanics and anatomy of the pediatric cervical spine. Knowledge of the normal embryologic development and anatomy of the cervical spine is important to avoid mistaking synchondroses for fractures in the setting of trauma. Familiarity with anatomic variants is also important for correct image interpretation. These variants include pseudosubluxation, absence of cervical lordosis, wedging of the C3 vertebra, widening of the predental space, prevertebral soft-tissue widening, intervertebral widening, and "pseudo-Jefferson fracture." In addition, familiarity with mechanisms of injury and appropriate imaging modalities will aid in the correct interpretation of radiologic images of the pediatric cervical spine.

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

    OpenAIRE

    Sherekar S; Yadav Y; Basoor A; Baghel Arvind; Adam Nelson

    2006-01-01

    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 w...

  10. Cervical spine alignment, sagittal deformity, and clinical implications: a review.

    Science.gov (United States)

    Scheer, Justin K; Tang, Jessica A; Smith, Justin S; Acosta, Frank L; Protopsaltis, Themistocles S; Blondel, Benjamin; Bess, Shay; Shaffrey, Christopher I; Deviren, Vedat; Lafage, Virginie; Schwab, Frank; Ames, Christopher P

    2013-08-01

    This paper is a narrative review of normal cervical alignment, methods for quantifying alignment, and how alignment is associated with cervical deformity, myelopathy, and adjacent-segment disease (ASD), with discussions of health-related quality of life (HRQOL). Popular methods currently used to quantify cervical alignment are discussed including cervical lordosis, sagittal vertical axis, and horizontal gaze with the chin-brow to vertical angle. Cervical deformity is examined in detail as deformities localized to the cervical spine affect, and are affected by, other parameters of the spine in preserving global sagittal alignment. An evolving trend is defining cervical sagittal alignment. Evidence from a few recent studies suggests correlations between radiographic parameters in the cervical spine and HRQOL. Analysis of the cervical regional alignment with respect to overall spinal pelvic alignment is critical. The article details mechanisms by which cervical kyphotic deformity potentially leads to ASD and discusses previous studies that suggest how postoperative sagittal malalignment may promote ASD. Further clinical studies are needed to explore the relationship of cervical malalignment and the development of ASD. Sagittal alignment of the cervical spine may play a substantial role in the development of cervical myelopathy as cervical deformity can lead to spinal cord compression and cord tension. Surgical correction of cervical myelopathy should always take into consideration cervical sagittal alignment, as decompression alone may not decrease cord tension induced by kyphosis. Awareness of the development of postlaminectomy kyphosis is critical as it relates to cervical myelopathy. The future direction of cervical deformity correction should include a comprehensive approach in assessing global cervicalpelvic relationships. Just as understanding pelvic incidence as it relates to lumbar lordosis was crucial in building our knowledge of thoracolumbar deformities, T

  11. Posterior approach to the degenerative cervical spine.

    Science.gov (United States)

    Yonenobu, Kazuo; Oda, Takenori

    2003-10-01

    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. Several laminoplasty techniques and supplementary techniques are described, together with expected outcomes and complications of surgery.

  12. Dysphagia associated with cervical spine and postural disorders.

    Science.gov (United States)

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

    2013-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Ahmadi Koorosh

    2014-07-01

    Full Text Available 【Abstract】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 tenderness 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 tenderness is eliminated after acetaminophen infusion. This analgesia could be considered as a diagnostic and therapeutic intervention. Key words: Acetaminophen; Diagnosis; Spinal Injuries; Cervical vertebrae; Radiography

  14. Cervical spine injury in the elderly: imaging features

    Energy Technology Data Exchange (ETDEWEB)

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

    2001-01-01

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

  15. Micromechanics of Minor Cervical Spine Injuries

    Science.gov (United States)

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

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

  16. [Tumours of the upper cervical spine].

    Science.gov (United States)

    Hernández García, Borja Jesús; Isla Guerrero, Alberto; Castaño, Ana; Alvarez Ruiz, Fernando; Gómez de la Riva, Alvaro

    2013-01-01

    Vertebral tumours arising in the upper cervical spine are rare. We present our experience in managing these neoplasms. We retrospectively reviewed the case histories of patients treated at our institution between January 2000 and June 2011. There were 9 patients with tumours in C1-C2-C3: 2metastases, 3chordomas, 2plasmocytomas, 1chondrosarcoma and 1osteochondroma. All patients complained of neck pain at the time of diagnosis. Three patients underwent an anterior and posterior approach, 3 an exclusively posterior approach and 3 an exclusively anterior surgical approach. Tumour resection was intralesional in 7 cases. Chemo-radiotherapy was used as adjuvant therapy in patients with malignant tumours. Vertebral tumours in the upper cervical spine are usually malignant. Achieving en bloc resection is particularly challenging and is technically unfeasible in many cases. This worsens the prognosis and makes adjuvant treatment very important. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  17. Upper airway obstruction after cervical spine fusion surgery: role of cervical fixation angle.

    Science.gov (United States)

    Lee, Yi-Hui; Hsieh, Pei-Fang; Huang, Hui-Hsun; Chan, Kuang-Cheng

    2008-09-01

    Upper airway obstruction is one of the life-threatening events in cervical spine surgery. The risk is particularly great during the period immediately after operation. We present the case of a 56-year-old female with breast cancer and metastasis to the cervical spine. The surgical procedure involved C2-C3 laminectomy, posterior fixation (C0-C5), and C2 neurectomy. Tracheal extubation was carried out in the intensive care unit, and upper airway obstruction immediately followed. Emergency cricothyrotomy was performed under well-managed ventilation with a laryngeal mask after several failed intubation attempts. Over-flexion of the cervical spine fixation and severe prevertebral soft tissue swelling were the most probable causes of upper airway obstruction. With a well-adjusted angle for fixation of the cervical spine under fluoroscopic guidance before the procedure, such a surgical mishap could be avoided. Reintubation with a fiberscope might be considered first, and sustaining intubation for 2-3 days postoperatively could be safer in such high risk patients.

  18. Anterolateral meningioma of the foramen magnum and high cervical spine presenting intradural and extradural growth in a child: case report and literature review.

    Science.gov (United States)

    Athanasiou, Alkinoos; Magras, Ioannis; Sarlis, Panagiotis; Spyridopoulos, Evangelos; Polyzoidis, Konstantinos

    2015-12-01

    We report a rare case of anterolateral meningioma of the foramen magnum (FMM) and high cervical spine presenting both intradural and extradural growth in a 7.5-year-old boy. We also performed a review of the relevant peer-reviewed literature. The patient presented with progressive tetraparesis and gait instability. Neuroimaging revealed an anterolateral tumor of the foramen magnum, C1 and C2 cervical spine level. The patient was treated in two stages: During the first operation, the extradural part was resected while the intradural part was removed in a second operation. Following the second operation, the patient showed almost complete neurological recovery as a result of cervical spinal cord and brainstem decompression but was complicated with cerebrospinal fluid leakage and infection by Acinetobacter. He sustained two further operations for dural sealing and external ventricular drainage and was treated with intraventricular administration of antibiotics. Histopathology of the tumor confirmed a meningotheliomatous meningioma. At the 6-month post-op follow-up examination, the patient exhibited complete neurological recovery and no radiological tumor recurrence. To the authors' best knowledge, we report the third case of sporadic pediatric meningioma of the foramen magnum and high cervical compartments with an extradural growth. Accurate pre-operative estimation of possible extradural growth is crucial towards surgical planning and sufficient treatment. Treatment of choice is total resection in a single operating session to avoid re-operations and increased risk of complications. If not possible, a re-operation should always attempt to secure the desired result.

  19. Sagittal alignment of the cervical spine after neck injury.

    Science.gov (United States)

    Beltsios, Michail; Savvidou, Olga; Mitsiokapa, Evanthia A; Mavrogenis, Andreas F; Kaspiris, Angelos; Efstathopoulos, Nikolaos; Papagelopoulos, Panayiotis J

    2013-07-01

    The normal sagittal alignment of the cervical spine is lordotic and is affected by the posture of the head and neck. The question of whether loss of cervical lordosis is the result of muscle spasm after injury or a normal variation, and the clinical significance of such changes in sagittal profile of the cervical spine has been an issue of several studies. The purpose of this paper is to study the incidence of normal cervical lordosis and its changes after neck injury compared to the healthy population. We studied the lateral radiographs of the cervical spine of 60 patients with neck injury compared to 100 patients without a neck injury. Lateral radiographs were obtained in the standing or sitting position, and the curvature of the cervical spine was measured using the angle formed between the inferior end plates of the C2 and C7 vertebrae. In the patients without neck injury, lordotic and straight cervical spine sagittal alignment was observed in 36.5% each, double curvature in 17%, and kyphotic in 10%. In the patients with neck injury, lordotic sagittal alignment was observed in 36%, straight in 34%, double curvature in 26% and kyphotic in 4%. No significant difference between the two groups regarding all types of sagittal alignment of the cervical spine was found (p > 0.100). The alterations in normal cervical lordosis in patients with neck injury must be considered coincidental. These alterations should not be associated with muscle spasm caused by neck pain.

  20. 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.

  1. Classification and Management of Pediatric Subaxial Cervical Spine Injuries.

    Science.gov (United States)

    Madura, Casey J; Johnston, James M

    2017-01-01

    Appropriate management of subaxial spine injury in children requires an appreciation for the differences in anatomy, biomechanics, injury patterns, and treatment options compared with adult patients. Increased flexibility, weak neck muscles, and cranial disproportion predispose younger children to upper cervical injuries and spinal cord injury without radiographic abnormality. A majority of subaxial cervical spine injuries can be treated nonoperatively. Surgical instrumentation options for children have significantly increased in recent years. Future studies of outcomes for children with subaxial cervical spine injury should focus on injury classification and standardized outcome measures to ensure continued improvement in quality of care for this patient population.

  2. 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.

  3. Combined injuries in the upper cervical spine: clinical and epidemiological data over a 14-year period

    OpenAIRE

    Gleizes, V; Jacquot, F. P.; Signoret, F.; Féron, J.-M. G.

    2000-01-01

    Concomitant traumatic injuries in the upper cervical spine are often encountered and rarely reported. We examined the data concerning 784 patients with cervical spine injuries following trauma, including 116 patients with upper cervical spine injuries. Twenty-six percent of patients with upper cervical spine injuries (31 cases) were found to have combined injuries involving either the upper or the upper and lower cervical spine. The frequent patterns were combined type I bipedicular fracture ...

  4. Should we abandon cervical spine manipulation for mechanical neck pain? : yes

    OpenAIRE

    2012-01-01

    Cervical spine manipulation (a high velocity, low amplitude, end range thrust manoeuvre) is a common\\ud treatment option for mechanical neck pain yet may carry the potential for serious neurovascular\\ud complications, specifically vertebral artery dissection and subsequent vertebrobasilar stroke. The nonsuperiority\\ud of manipulation to alternative treatments, coupled with concerns regarding safety, renders\\ud cervical spine manipulation unnecessary and inadvisable.

  5. Incidence of combined cranial and cervical spine injuries in patients with blunt minor trauma: are combined CT examinations of the head and cervical spine justified?

    Science.gov (United States)

    Vahldiek, Janis L; Thieme, Stefan; Hamm, Bernd; Niehues, Stefan M

    2017-07-01

    Background The use of computed tomography (CT) scans of the head and cervical spine has markedly increased in patients with blunt minor trauma. The actual likelihood of a combined injury of head and cervical spine following a minor trauma is estimated to be low. Purpose To determine the incidence of such combined injuries in patients with a blunt minor trauma in order to estimate the need to derive improved diagnostic guidelines. Material and Methods A total of 1854 patients were retrospectively analyzed. All cases presented to the emergency department and in all patients combined CT scans of head and cervical spine were conducted. For the following analysis, only 1342 cases with assured blunt minor trauma were included. Data acquisition covered age, sex, and presence of a head injury as well as presence of a cervical spine injury or both. Results Of the 1342 cases, 46.9% were men. The mean age was 65.6 years. CT scans detected a head injury in 116 patients; of these, 70 cases showed an intracranial hemorrhage, 11 cases a skull fracture, and 35 cases an intracranial hemorrhage as well as a skull fracture. An injury of the cervical spine could be detected in 40 patients. A combined injury of the head and cervical spine could be found in one patient. Conclusion The paradigm of the coincidence of cranial and cervical spine injuries should be revised in patients with blunt minor trauma. Valid imaging decision algorithms are strongly needed to clinically detect high-risk patients in order to save limited resources.

  6. MRI cervical spine findings in asymptomatic fighter pilots.

    Science.gov (United States)

    Petrén-Mallmin, M; Linder, J

    1999-12-01

    MRI of the cervical spine for evaluation concerning degenerative lesions was performed on asymptomatic experienced military high performance aircraft pilots (mean age 42 yr with mean accumulated flying time of 2600 h), and for comparison on age-matched controls without military flying experience. Young military high performance aircraft pilots (mean age 23 yr with 220 h of flying per person) were also examined. There were significantly more osteophytes, disk protrusions, compressions of the spinal cord and foraminal stenoses in the experienced pilots than in the age-matched controls. Low frequency of low grade degenerative lesions was found in the young and inexperienced pilots.

  7. Pediatric cervical spine trauma imaging: a practical approach

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-05-15

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

  8. Dysphagia Due to Anterior Cervical Spine Osteophyte: A Case Report

    Directory of Open Access Journals (Sweden)

    Hossein Mashhadinezhad

    2010-07-01

    Full Text Available Introduction: Degenerative changes of the cervical spine are more common in elderly, but anterior cervical osteophytes that cause problems in swallowing are rare. The most common cause of this problem is DISH disease (diffuse idiopathic skeletal hyperostosis. Trauma is also suggested as a potential cause in osteophyte formation. Case Report: We report a rare case of anterior cervical osteophyte with problems in swallowing that was caused by cervical spine trauma in a car accident 4 years ago, treated with a cervical collar. Dysphagia was the initial symptom of the disease. Barium swallowing showed a large cervical osteophyte at the C3-C4 level with compression effect on the esophagus. X-ray, CT scan and MRI of the cervical spine confirmed the osteophyte and its correlation with the esophagus. Endoscopic study of esophagus and stomach also ruled out other disorders. Surgical osteophytectomy was performed. Conclusion: Up to now, only two cases of post-traumatic anterior cervical osteophyte have been cited in the literature. In this report, we introduce an unusual case of dysphagia caused by cervical spine trauma.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    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 spine...

  10. 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.)

  11. Comparison of three prehospital cervical spine protocols for missed injuries.

    Science.gov (United States)

    Hong, Rick; Meenan, Molly; Prince, Erin; Murphy, Ronald; Tambussi, Caitlin; Rohrbach, Rick; Baumann, Brigitte M

    2014-07-01

    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. 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. 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. 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 criteria may also be more difficult to implement due to the

  12. Emergency department evaluation and treatment of cervical spine injuries.

    Science.gov (United States)

    Kanwar, Rajdeep; Delasobera, Bronson E; Hudson, Korin; Frohna, William

    2015-05-01

    Most spinal cord injuries involve the cervical spine, highlighting the importance of recognition and proper management by emergency physicians. Initial cervical spine injury management should follow the ABCDE (airway, breathing, circulation, disability, exposure) procedure detailed by Advanced Trauma Life Support. NEXUS (National Emergency X-Radiography Utilization Study) criteria and Canadian C-spine Rule are clinical decision-making tools providing guidelines of when to obtain imaging. Computed tomography scans are the preferred initial imaging modality. Consider administering intravenous methylprednisolone after discussion with the neurosurgical consultant in patients who present with spinal cord injuries within 8 hours.

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

    Directory of Open Access Journals (Sweden)

    Yi-Jie Kuo

    2007-04-01

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

  14. Cervical spine involvements in Reiter's syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Moilanen, A.; Yli-Kerrtula, U.; Vippula, A.

    1984-07-01

    Cervical spine radiographs of 38 patients orginating from 145 consecutive cases with Reiter's syndrome (RS) were reviewed. Five of these 145 patients (3.4%) had cervical spine manifestations: anterior atlanto-axial dislocation 2, craniovertebral lesions typical for rhreumatoid arthritis (RA), spondylitis typical for ankylosing spondylitis (AS) and anterior ossification, one each. Four of these patients were males. Cervical lesions in RS turned out to be rare. These lesions are alone indistinguisable from those of other chronic rheumatic inflammatory diseases.

  15. Fatal Vertebral Artery Injury in Penetrating Cervical Spine Trauma

    Directory of Open Access Journals (Sweden)

    Chadi Tannoury

    2015-01-01

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

  16. Changes in the cervical spine in chronic polyarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Miehle, W.; Schattenkirchner, M.; Lattermann, K.

    1985-02-01

    In 93 patients with classical chronic polyarthritis (rheumatoid arthritis) (at least five ARA-criterias) there were inflammatory lesions of dens epistropheus in 48.4%, ventral atlantoaxial subluxations in 25.8%, lateral atlantoaxial dislocations in 14% and pseudobasilary invagination in 5.4%. Step-ladder-subluxation between C 2/C 7 was found in 31.2%, discitis in 12.5% and spondylarthritis in 38% of cases. Inflammatory signs of the cervical spine were correlated to the Steinbrocker-Grade IV, ANA level 1 : 40 and the degree of Waaler-Rose. The correlation between long standing steroid-therapy and signs of cervical involvement during c.p. - specially in C/sub 1//C/sub 2/ - is found to be proven. There are connections between the duration of c.p. (more than 10 years) and manifestation of cervical spine lesions, further, in a protective sense between longstanding gold therapy and cervical spine lesions.

  17. Dual cervical thoracic coil for spine magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Totterman, S.; Foster, T.H.; Plewes, D.B.; Simon, J.H.; Ekholm, S.; Wicks, A. (Rochester Univ., NY (USA). Dept. of Radiology Rochester Univ., NY (USA). Dept. of Physics and Astronomy)

    The need for repositioning of surface coils and patients in MR examinations of the cervical and thoracic spin prolongs examination time. A new receiver design is proposed which overcomes this problem. The device is composed of two actively decoupled receiver coils mounted on the frame of a Philadelphia collar. These coils may be used separately to image either the thoracic or cervical spine or together to produce larger field-of-view images of the combined region. Signal-to-noise ratios of the separate cervical and thoracic spine images are not degraded as a result of mounting the receivers together. The full cervical and thoracic region is shown to be imaged at a signal-to-noise ratio significantly higher than that afforded by the body coil. A retrospective review of our case load suggests that a time saving could be achieved in approximately 1/3 of spine examinations by using this coil. (orig.).

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1988-04-01

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

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

    Science.gov (United States)

    Morin, Michael; Langevin, Pierre

    2016-01-01

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

  20. Catastrophic Cervical Spine Injuries in Contact Sports.

    Science.gov (United States)

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

    2016-11-01

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

  1. Catastrophic Cervical Spine Injuries in Contact Sports

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-07-01

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

  3. X-Ray Exam: Cervical Spine

    Science.gov (United States)

    ... the bones in the back of the neck (cervical vertebrae). During the examination, an X-ray machine sends ... or hand. It can detect fractures in the cervical vertebrae or dislocation of the joints between the vertebrae. ...

  4. 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...

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

    Directory of Open Access Journals (Sweden)

    G S Umamaheswara Rao

    2008-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1996-11-01

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

  7. Cervical spine clearance in obtunded patients after severe polytrauma

    Institute of Scientific and Technical Information of China (English)

    SHEN Hong-xing; LI Ming

    2009-01-01

    To provide clinicians with data support-ing three different clearance techniques in the obtunded patients after severe polytrauma, Methods: This study gave an overview of the avail-able and pertinent literature regarding cervical spine clear-ance in obtunded patients after severe polytrauma. Results: Currently, there were three accepted tech-niques for clearance of the cervical spine in obtunded pa-tients after severe polytrauma. Each of these methods has advantages and disadvantages to both of the patients and the clinicians. Condusions: There are continuous improvements in both computed tomography (CT) and magnetic resonance imaging (MRI) techniques that increase their sensitivities. The continued use of plain radiographs is called into ques-tion with respect to cost and time requirements. An algo-rithmic approach to the evaluation of the cervical spine in the obtunded patients will lead to fewer missed injuries.

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

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Ullerup, Rita; Vesterby, Annie

    2006-01-01

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

  9. Intra-osseous ultrasound for pedicle screw positioning in the subaxial cervical spine: an experimental study.

    Science.gov (United States)

    Kantelhardt, Sven Rainer; Bock, Hans Christoph; Siam, Laila; Larsen, Jörg; Burger, Ralf; Schillinger, Wolfgang; Bockermann, Volker; Rohde, Veit; Giese, Alf

    2010-04-01

    In contrast to other regions of the human spine, dorsal fixation with rods and pedicle screws is comparatively rarely performed in the cervical spine. Although this technique provides a higher mechanical strength than the more frequently used lateral mass screws, many surgeons fear the relatively high rate of misplacements. This higher incidence is mainly due to the complex vertebral anatomy in this spinal segment. For correct screw placement, the availability of an immediate and efficient intra-operative imaging tool to ascertain the accuracy of the pedicle screw hole position would be beneficial. We have previously investigated the usefulness of an intraspinal, specifically, intra-osseous ultrasound technique in the lumbar spine. In this study its accuracy as a means of controlling intrapedicular screw hole positioning has been evaluated in the cervical spine. An endovascular ultrasound transducer was used for the intra-luminal scanning of 54 pedicle screw holes in cadaveric human spine specimens. Twenty-three of these had been intentionally misplaced (cortex breached). The resulting image files were assessed by three investigators blinded to both the procedure and the corresponding CT findings. The investigators differentiated correctly between adequately and poorly placed pedicle screw holes in 96% of cases. False negatives and false positives both occurred in no more than 1.8% of cases. Intrapedicular ultrasonography of pedicle screw holes in the cervical spine is a promising technique for the intra-operative assessment of bore hole placement and may increase operative safety and postoperative outcome in posterior cervical fusion surgery.

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Kimbroe J Carter

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-12-15

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

  13. 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.

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

    Science.gov (United States)

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

    2015-01-01

    Purpose Anterior cervical discectomy and fusion (ACDF) has become a common spine procedure, however, there have been no previous studies on whole spine alignment changes after cervical fusion. Our purpose in this study was to determine whole spine sagittal alignment and pelvic alignment changes after ACDF. Materials and Methods Forty-eight patients who had undergone ACDF from January 2011 to December 2012 were enrolled in this study. Cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis (SVA), and pelvic parameters were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Clinical outcomes were assessed using Visual Analog Scale (VAS) scores and Neck Disability Index (NDI) values. Results Forty-eight patients were grouped according to operative method (cage only, cage & plate), operative level (upper level: C3/4 & C4/5; lower level: C5/6 & C6/7), and cervical lordosis (high lordosis, low lordosis). All patients experienced significant improvements in VAS scores and NDI values after surgery. Among the radiologic parameters, pelvic tilt increased and sacral slope decreased at 12 months postoperatively. Only the high cervical lordosis group showed significantly-decreased cervical lordosis and a shortened SVA postoperatively. Correlation tests revealed that cervical lordosis was significantly correlated with SVA and that SVA was significantly correlated with pelvic tilt and sacral slope. Conclusion ACDF affects whole spine sagittal alignment, especially in patients with high cervical lordosis. In these patients, alteration of cervical lordosis to a normal angle shortened the SVA and resulted in reciprocal changes in pelvic tilt and sacral slope. PMID:26069131

  15. Developmental biomechanics of the cervical spine: Tension and compression.

    Science.gov (United States)

    Nuckley, David J; Ching, Randal P

    2006-01-01

    Epidemiological data and clinical indicia reveal devastating consequences associated with pediatric neck injuries. Unfortunately, neither injury prevention nor clinical management strategies will be able to effectively reduce these injuries or their effects on children, without an understanding of the cervical spine developmental biomechanics. Thus, we investigated the relationship between spinal development and the functional (stiffness) and failure biomechanical characteristics of the cervical spine in a baboon model. A correlation study design was used to define the relationships between spinal tissue maturation and spinal biomechanics in both tension and compression. Eighteen baboon cervical spine specimens distributed across the developmental spectrum (1-26 human equivalent years) were dissected into osteoligamentous functional spinal units. Using a servo-hydraulic MTS, these specimens (Oc-C2, C3-C4, C5-C6, C7-T1) were non-destructively tested in tension and compression and then displaced to failure in tension while measuring the six-axes of loads and displacements. The functions describing the developmental biomechanical response of the cervical spine for stiffness and normalized stiffness exhibited a significant direct relationship in both tension and compression loading. Similarly, the tensile failure load and normalized failure load demonstrated significant maturational increases. Further, differences in biomechanical response were observed between the spinal levels examined and all levels exhibited clinically relevant failure patterns. These data support our understanding of the child cervical spine from a developmental biomechanics perspective and facilitate the development of injury prevention or management schema for the mitigation of child spine injuries and their deleterious effects.

  16. 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

  17. Congenital spine deformities: a new screening indication for blunt cerebrovascular injuries after cervical trauma?

    Science.gov (United States)

    Capone, Christine; Burjonrappa, Sathyaprasad

    2010-12-01

    Blunt cerebrovascular injuries (BCVI) carry significant morbidity if not diagnosed and treated early. A high index of clinical suspicion is needed to recognize the injury patterns associated with this condition and to order the requisite imaging studies needed to diagnose it accurately. We report of BCVI associated with a congenital cervical spine malformation after blunt trauma. We recommend inclusion of cervical spine malformations to the current Eastern Association for the Surgery of Trauma screening criteria for BCVI and explain our rationale for the same.

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

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

    1989-04-01

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

  19. Central nervous system and cervical spine abnormalities in Apert syndrome.

    Science.gov (United States)

    Breik, Omar; Mahindu, Antony; Moore, Mark H; Molloy, Cindy J; Santoreneos, Stephen; David, David J

    2016-05-01

    Apert syndrome characterized by acrocephalosyndactyly is a rare autosomal dominant congenital malformation with a prevalence of 1/65,000 births. With an extensive range of phenotypic and developmental manifestations, its management requires a multidisciplinary approach. A variety of craniofacial, central nervous system (CNS), and cervical spine abnormalities have been reported in these patients. This study aimed to determine the incidence of these CNS abnormalities in our case series. Retrospective review of Australian Craniofacial Unit (ACFU) database for Apert patients was performed. Data collected that included demographics, place of origin, age at presentation, imaging performed, and images were reviewed and recorded. Where available, developmental data was also recorded. Ninety-four patients seen and managed at the ACFU had their CNS and cervical spine abnormalities documented. The main CNS abnormalities were prominent convolutional markings (67 %), ventriculomegaly (48 %), crowded foramen magnum (36 %), deficient septum pellucidum (13 %), and corpus callosum agenesis in 11 %. Major C-spine findings were present in 50.8 % of patients and included fusion of posterior elements of C5/C6 (50 %) and C3/4 (27 %). Multilevel fusion was seen in 20 %. Other abnormalities were C1 spina bifida occulta (7 %) and atlanto-axial subluxation (7 %). Multiple CNS and cervical spine (c-spine) abnormalities are common in Apert syndrome. The significance of these abnormalities remains largely unknown. Further research is needed to better understand the impact of these findings on growth, development, and treatment outcomes.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  1. 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.

  2. Utility of STIR MRI in pediatric cervical spine clearance after trauma.

    Science.gov (United States)

    Henry, Mark; Scarlata, Katherine; Riesenburger, Ron I; Kryzanski, James; Rideout, Leslie; Samdani, Amer; Jea, Andrew; Hwang, Steven W

    2013-07-01

    Although MRI with short-term T1 inversion recovery (STIR) sequencing has been widely adopted in the clearance of cervical spine in adults who have sustained trauma, its applicability for cervical spine clearance in pediatric trauma patients remains unclear. The authors sought to review a Level 1 trauma center's experience using MRI for posttraumatic evaluation of the cervical spine in pediatric patients. A pediatric trauma database was retrospectively queried for patients who received an injury warranting radiographic imaging of the cervical spine and had a STIR-MRI sequence of the cervical spine performed within 48 hours of injury between 2002 and 2011. Demographic, radiographic, and outcome data were retrospectively collected through medical records. Seventy-three cases were included in the analysis. The mean duration of follow-up was 10 months (range 4 days-7 years). The mean age of the patients at the time of trauma evaluation was 8.3 ± 5.8 years, and 65% were male. The majority of patients were involved in a motor vehicle accident. In 70 cases, the results of MRI studies were negative, and the patients were cleared prior to discharge with no clinical suggestion of instability on follow-up. In 3 cases, the MRI studies had abnormal findings; 2 of these 3 patients were cleared with dynamic radiographs during the same admission. Only 1 patient had an unstable injury and required surgical stabilization. The sensitivity of STIR MRI to detect cervical instability was 100% with a specificity of 97%. The positive predictive value was 33% and the negative predictive value was 100%. Although interpretation of our results are diminished by limitations of the study, in our series, STIR MRI in routine screening for pediatric cervical trauma had a high sensitivity and slightly lower specificity, but may have utility in future practices and should be considered for implementation into protocols.

  3. Parameters that effect spine biomechanics following cervical disc replacement.

    Science.gov (United States)

    Goel, Vijay K; Faizan, Ahmad; Palepu, Vivek; Bhattacharya, Sanghita

    2012-06-01

    Total disc replacement (TDR) is expected to provide a more physiologic alternative to fusion. However, long-term clinical data proving the efficacy of the implants is lacking. Limited clinical data suggest somewhat of a disagreement between the in vitro biomechanical studies and in vivo assessments. This conceptual paper presents the potential biomechanical challenges affecting the TDR that should be addressed with a hope to improve the clinical outcomes and our understanding of the devices. Appropriate literature and our own research findings comparing the biomechanics of different disc designs are presented to highlight the need for additional investigations. The biomechanical effects of various surgical procedures are analyzed, reiterating the importance of parameters like preserving uncinate processes, disc placement and its orientation within the cervical spine. Moreover, the need for a 360° dynamic system for disc recipients who may experience whiplash injuries is explored. Probabilistic studies as performed already in the lumbar spine may explore high risk combinations of different parameters and explain the differences between "standard" biomechanical investigations and clinical studies. Development of a patient specific optimized finite element model that takes muscle forces into consideration may help resolve the discrepancies between biomechanics of TDR and the clinical studies. Factors affecting long-term performance such as bone remodeling, subsidence, and wear are elaborated. In vivo assessment of segmental spine motion has been, and continues to be, a challenge. In general, clinical studies while reporting the data have placed lesser emphasis on kinematics following intervertebral disc replacements. Evaluation of in vivo kinematics following TDR to analyze the quality and quantity of motion using stereoradiogrammetric technique may be needed.

  4. 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. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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

    Science.gov (United States)

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

    2016-05-24

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

  6. [Changes of sagittal balance of cervical spine after open-door expansive laminoplasty].

    Science.gov (United States)

    Lin, Shengrong; Zhou, Feifei; Sun, Yu; Chen, Zhongqiang; Zhang, Fengshan; Pan, Shengfa

    2014-09-23

    To explore the changes of sagittal balance of cervical spine after open-door expansive laminoplasty. The clinical and radiological data were analyzed retrospectively for 90 patients undergoing open-door expansive laminoplasty due to cervical spondylotic myelopathy. The Japanese Orthopedic Association (JOA) score and 3 cervical sagittal parameters including C2-C7 SVA, C0-2 Cobb angle and T1-Slope on lateral view radiographs were recorded before operation and at the final follow-up. The average follow-up period was 16.7 (3-40) months. The post-operative JOA score rose to 14.6 ± 0.2 from pre-operative 12.2 ± 0.3 with 43.5% ± 4.2% recovery rate. The post-operative values of C2-C7 SVA, C0-2 Cobb angle and T1-Slope were significantly different from pre-operative ones (P = 0.022, P cervical spine significantly changes after open-door expansive laminoplasty with forward tilting of cervical vertebra. And compensation occurs by excessive high-strength contraction of posterior muscles to maintain lordosis in upper cervical spine. A higher pre-OP T1-Slope affects the outcomes of open-door expansive laminoplasty.

  7. The cervical spine of professional front-row rugby players: correlation between degenerative changes and symptoms.

    Science.gov (United States)

    Hogan, B A; Hogan, N A; Vos, P M; Eustace, S J; Kenny, P J

    2010-06-01

    Injuries to the cervical spine (C-spine) are among the most serious in rugby and are well documented. Front-row players are particularly at risk due to repetitive high-intensity collisions in the scrum. This study evaluates degenerative changes of the C-spine and associated symptomatology in front-row rugby players. C-spine radiographs from 14 professional rugby players and controls were compared. Players averaged 23 years of playing competitive rugby. Two consultant radiologists performed a blind review of radiographs evaluating degeneration of disc spaces and apophyseal joints. Clinical status was assessed using a modified AAOS/NASS/COSS cervical spine outcomes questionnaire. Front-row rugby players exhibited significant radiographic evidence of C-spine degenerative changes compared to the non-rugby playing controls (P < 0.005). Despite these findings the rugby players did not exhibit increased symptoms. This highlights the radiologic degenerative changes of the C-spine of front-row rugby players. However, these changes do not manifest themselves clinically or affect activities of daily living.

  8. Intraoperative radiological visualization of the occipito-cervical transition and upper cervical spine: technical note

    OpenAIRE

    Marcelo Luis Mudo; Andrea Vieira Amantéa; Sérgio Cavalheiro; Andrei Fernandes Joaquim

    2009-01-01

    Relatamos nota técnica para melhor visualização radiológica intraoperatória em cirurgias da região occipitocervical e coluna cervical superior.Relatamos nota técnica para mejor visualización radiológica intraoperatória en las cirugías de la región occipito-cervical y de la columna cervical alta.We report a technical note to obtain a better intraoperative radiological view in surgeries of the craniocervical junction and upper cervical spine.

  9. Intraoperative radiological visualization of the occipito-cervical transition and upper cervical spine: technical note

    OpenAIRE

    Marcelo Luis Mudo; Andrea Vieira Amantéa; Sérgio Cavalheiro; Andrei Fernandes Joaquim

    2009-01-01

    Relatamos nota técnica para melhor visualização radiológica intraoperatória em cirurgias da região occipitocervical e coluna cervical superior.Relatamos nota técnica para mejor visualización radiológica intraoperatória en las cirugías de la región occipito-cervical y de la columna cervical alta.We report a technical note to obtain a better intraoperative radiological view in surgeries of the craniocervical junction and upper cervical spine.

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

    Science.gov (United States)

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

    2013-06-01

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

  11. Mechanisms of cervical spine injuries for non-fatal motorcycle road crash.

    Science.gov (United States)

    Ooi, S S; Wong, S V; Radin Umar, R S; Azhar, A A; Yeap, J S; Megat Ahmad, M M H

    2004-06-01

    Cervical spine injuries such as subluxation and fracture dislocation have long been known to result in severe consequences, as well as the trauma management itself. The injury to the region has been identified as one of the major causes of death in Malaysian motorcyclists involved in road crashes, besides head and chest injuries (Pang, 1999). Despite this, cervical spine injury in motorcyclists is not a well-studied injury, unlike the whiplash injury in motorcar accidents. The present study is a retrospective study on the mechanisms of injury in cervical spine sustained by Malaysian motorcyclists, who were involved in road crash using an established mechanistic classification system. This will serve as an initial step to look at the cervical injuries pattern. The information obtained gives engineer ideas to facilitate design and safety features to reduce injuries. All cervical spine injured motorcyclists admitted to Hospital Kuala Lumpur between January 1, 2000 and December 31, 2001 were included in the present study. Based on the medical notes and radiological investigations (X-rays, CT and MRI scans), the mechanisms of injuries were formulated using the injury mechanics classification. The result shows that flexion of the cervical vertebrae is the most common vertebral kinematics in causing injury to motorcyclists. This indicates that the cervical vertebrae sustained a high-energy loading at flexion movement in road crash, and exceeded its tolerance level. The high frequency of injury at the C5 vertebra, C6 vertebra and C5-C6 intervertebral space are recorded. Classification based on the Abbreviated Injury Scale (AIS) is made to give a view on injury severity, 9.1% of the study samples have been classified as AIS code 1, 51.5% with AIS 2 and 21.2% with AIS 3.

  12. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-02-01

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

  14. Negative Pressure Pulmonary Edema Associated with Anterior Cervical Spine Surgery

    Science.gov (United States)

    Yoneda, Masana; Tanaka, Yasuhito

    2014-01-01

    We report a very rare case of negative pressure pulmonary edema (NPPE) that occurred immediately after anterior cervical discectomy and fusion (ACDF). The patient was a 25-year-old man who sustained a facet fracture-dislocation of C5 during a traffic accident. After ACDF, he developed NPPE and needed mechanical ventilation. Fortunately, he recovered fully within 24 hours. NPPE is a rare postoperative complication that may occur after cervical spine surgery. The aims of this report are to present information regarding the diagnosis and emergent treatment of NPPE, and to review the previous literature regarding this serious complication. PMID:25558327

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

    Directory of Open Access Journals (Sweden)

    M. Zafrullah Arifin

    2012-06-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-10-15

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

  17. 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.

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

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Ullerup, Rita; Vesterby, Annie

    2006-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Chien-Shiung Wang

    2012-11-01

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

  20. 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.

  1. The Effect of the Cervical Orthosis on Swallowing Physiology and Cervical Spine Motion During Swallowing.

    Science.gov (United States)

    Mekata, Kojiro; Takigawa, Tomoyuki; Matsubayashi, Jun; Toda, Kazukiyo; Hasegawa, Yasuhiro; Ito, Yasuo

    2016-02-01

    Cervical orthosis is used to immobilize the neck in various disorders such as trauma and post-operation. However, it is still uncertain how cervical orthosis restricts the degree of movement of the cervical spine during swallowing and how they affect swallowing physiology. The purpose of this study was to evaluate these issues using the Philadelphia(®) Collar. We conducted videofluorography of swallowing in 39 healthy subjects (23 men, 16 women; mean age of 34.3 years) with and without cervical orthosis. To compare the two conditions regarding the cervical spine motion, we determined the angular and positional changes of the occipital bone (C0) and each cervical vertebra (C1-C7) from the oral phase to the pharyngeal phase. Similarly, to compare swallowing physiology, we assessed the start and end times and the durations of soft palate elevation, rapid hyoid anterosuperior movement, epiglottis inversion, closure of the laryngeal vestibule, and pharyngoesophageal segment (PES) opening. Finally, we compared the transit times of contrast agent in the two conditions. The respective extensions of C1, C2, and C3 were 0.31°, 0.07°, and 0.05° (mean) with cervical orthosis, and the respective flexions of C1, C2, and C3 were 0.98°, 1.42°, and 0.85° (mean) without. These results suggested that cervical orthosis restricted the flexion of C1-C3. Analysis of swallowing physiology revealed that the average durations of hyoid anterosuperior elevation, epiglottic inversion, and PES opening were prolonged by 0.09, 0.19, and 0.05 s, respectively. In conclusion, the cervical orthosis restricted the movement of the cervical spine during swallowing and changed swallowing physiology.

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

    Science.gov (United States)

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

    2015-02-01

    The aim of this study was to define the temporal and spatial (postural) characteristics of the head and cervical vertebral column (spine) of behaving rats in order to better understand their suitability as a model to study human conditions involving the head and neck. Time spent in each of four behavioral postures was determined from video tape recordings of rats (n = 10) in the absence and presence of an intruder rat. Plain film radiographic examination of a subset of these rats (n = 5) in each of these postures allowed measurement of head and cervical vertebral column positions adopted by the rats. When single they were quadruped or crouched most (∼80%) of the time and bipedal either supported or free standing for only ∼10% of the time. The introduction of an intruder significantly (P cervical spine was orientated (median, 25-75 percentile) near vertical (18.8°, 4.2°-30.9°) when quadruped, crouched (15.4°, 7.6°-69.3°) and bipedal supported (10.5°, 4.8°-22.6°) but tended to be less vertical oriented when bipedal free standing (25.9°, 7.7°-39.3°). The range of head positions relative to the cervical spine was largest when crouched (73.4°) and smallest when erect free standing (17.7°). This study indicates that, like humans, rats have near vertical orientated cervical vertebral columns but, in contrast to humans, they displace their head in space by movements at both the cervico-thoracic junction and the cranio-cervical regions. © 2014 Wiley Periodicals, Inc.

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

    Science.gov (United States)

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

    1998-01-01

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

  4. 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.

  5. 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.

  6. 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.

  7. Local and global subaxial cervical spine biomechanics after single-level fusion or cervical arthroplasty.

    Science.gov (United States)

    Finn, Michael A; Brodke, Darrel S; Daubs, Michael; Patel, Alpesh; Bachus, Kent N

    2009-10-01

    An experimental in vitro biomechanical study was conducted on human cadaveric spines to evaluate the motion segment (C4-C5) and global subaxial cervical spine motion after placement of a cervical arthroplasty device (Altia TDI,Amedica, Salt Lake City, UT) as compared to both the intact spine and a single-level fusion. Six specimens (C2-C7) were tested in flexion/extension, lateral bending, and axial rotation under a +/- 1.5 Nm moment with a 100 N axial follower load. Following the intact spine was tested; the cervical arthroplasty device was implanted at C4-C5 and tested. Then, a fusion using lateral mass fixation and an anterior plate was simulated and tested. Stiffness and range of motion (ROM) data were calculated. The ROM of the C4-C5 motion segment with the arthroplasty device was similar to that of the intact spine in flexion/extension and slightly less in lateral bending and rotation, while the fusion construct allowed significantly less motion in all directions. The fusion construct caused broader effects of increasing motion in the remaining segments of the subaxial cervical spine, whereas the TDI did not alter the adjacent and remote motion segments. The fusion construct was also far stiffer in all motion planes than the intact motion segment and the TDI, while the artificial disc treated level was slightly stiffer than the intact segment. The Altia TDI allows for a magnitude of motion similar to that of the intact spine at the treated and adjacent levels in the in vitro setting.

  8. 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].

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

    OpenAIRE

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

    2014-01-01

    Temporomandibular dysfunction (TMD) is considered to be associated with imbalance of the whole body. This study aimed to evaluate the influence of TMD therapy on cervical spine range of movement (ROM) and reduction of spinal pain. The study group consisted of 60 patients with TMD, cervical spine pain, and limited cervical spine range of movements. Subjects were interviewed by a questionnaire about symptoms of TMD and neck pain and had also masticatory motor system physically examined (accordi...

  10. [Assessment of whiplash and cervical spine injury].

    Science.gov (United States)

    Marx, P

    2011-12-01

    Formulating an expert opinion on whiplash injuries requires that consideration be given to biomechanical, orthopedic, neurological, psychiatric and medicolegal aspects. The greatest difficulties are encountered in cases of mild whiplash where patients complain of constant pain without any physical correlative. Diverse assessments and principles for approving a claim are reflected in the fact that the prevalence of chronic spine pain after whiplash injuries (late whiplash syndrome) varies between 16% and 71% in different countries, and the proportion of whiplash injuries involved in petitions for compensation differs greatly across Europe (UK 75%, Germany 47%, Finland 8.5% and France 3% of all personal injuries).Important biomechanical, orthopedic, neurological, psychiatric and medicolegal aspects of expert testimony on whiplash associated disorders (WAD) are delineated.

  11. Findings in osteosarcoma of the cervical spine

    Energy Technology Data Exchange (ETDEWEB)

    Abdel-Dayem, H. [Saint Vincents Hospital and Medical Centre, New York (United States)

    1998-12-01

    A 39-year-old male was diagnosed in 1974 with Hodgkin`s disease in the left side of the neck and treated with radiotherapy that same year. In April 1998, he developed weakness and pain in the left shoulder. Further investigation revealed a tumor in the fourth cervical vertebra. A laminectomy and biopsy were performed that confirmed the diagnosis of radiation-induced bone sarcoma, for which further treatment was indicated. A subsequent MRI showed enhanced lesions in the same area, suggestive of either postoperative changes or local recurrence of the tumor. The {sup 18} FDG study carried out prior to surgery, using an ADAC gamma camera with MCD/AC, has demonstrated that the attenuation-corrected (AC) images improve the definition of the borders of the tumor

  12. 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.

  13. Deep Surgical Site Infections Following Pediatric Cervical Spine Surgery.

    Science.gov (United States)

    Porter, David A; Glotzbecker, Michael P; Timothy Hresko, M; Hedequist, Daniel J

    2016-06-08

    This is the first reported series looking specifically at factors associated with deep surgical site infections (SSI) following pediatric cervical spine surgery. To identify risk factors present in pediatric patients who are at risk for SSI following cervical spine surgery. Level of evidence: level IV-retrospective case series. To date there are no studies regarding SSI in pediatric cervical spine surgery and thus no benchmark data or risk factors have been identified. Patients with acute deep SSIs occurring within 90 days of the index operation were identified. Patient and surgical characteristics were analyzed for possible predictors of SSI outcome using penalized likelihood logistic regression analysis. Characteristics analyzed included: age, diagnosis, comorbidity, levels fused, approach, implants used, allograft, halo, body mass index, revision, antibiotic dosing, and occipital plating. A total of 112 patients were included in the study at a mean age of 12.5 years (2 to 18 y). Comorbidities were present in 51 (46%) patients, 15 patients had a documented connective tissue disorder (CTD). The mean number of levels fused was 3.7 (2 to 7) and mean number of screws was 4.4 (2 to 11). Allograft was used alone in 48 patients, occipital plating in 28 patients, and a halo in 39 patients. Deep SSI occurred in 3 patients: two of which had a CTD (1 Trisomy 21, 1 Ehlers-Danlos) and 1 patient with postradiation cervical kyphosis. All were gram-positive infections requiring return to operating room with prolonged IV antibiotics. All patients recovered and fused with spinal implant retention. The incidence of deep SSI was 2.7%. It was determined that a CTD was the only significant predictor of SSI. Subjects with a CTD had 12 times the odds of SSI [odds ratio=12 (1.5, 137.0); P=0.02]. In our series of pediatric patients the incidence of a deep SSI was 2.7%. The only predictor of SSI was the presence of a CTD.

  14. 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.)

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

    Science.gov (United States)

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

    2008-06-01

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

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

    Science.gov (United States)

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

    2002-09-01

    during growth. Degenerative changes in the cervical spine are common, but vertebral anomalies are rare. Prevalence of SBO is high.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-09-01

    displacement usually resolve spontaneously during growth. Degenerative changes in the cervical spine are common, but vertebral anomalies are rare. Prevalence of SBO is high. (orig.)

  18. 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.

  19. From less to maximally invasiveness in cervical spine surgery

    Science.gov (United States)

    Visocchi, M.; Conforti, G.; Roselli, R.; La Rocca, G.; Spallone, A.

    2015-01-01

    Introduction Multilevel cervical myelopathy without surgical treatment is generally poor in the neurological deficit without surgical decompression. The two main surgical strategies used for the treatment of multilevel cervical myelopathy are anterior decompression via anterior corpectomy or posterior decompression via laminctomy/laminoplasty. Presentation of case We present the case of a 62 year-old lady, harboring rheumatoid artritis (RA) with gait disturbances, pain, and weakness in both arms. A C5 and C6 somatectomy, C4–C7 discectomy and, instrumentation and fusion with telescopic distractor “piston like”, anterior plate and expandable screws were performed. Two days later the patient complained dysfagia, and a cervical X-ray showed hardware dislocation. So a C4 somatectomy, telescopic extension of the construct up to C3 with expandible screws was performed. After one week the patient complained again soft dysfagia. New cervical X-ray showed the pull out of the cranial screws (C3). So the third surgery “one stage combined” an anterior decompression with fusion along with posterior instrumentation, and fusion was performed. Discussion There is a considerable controversy over which surgical approach will receive the best clinical outcome for the minimum cost in the compressive cervical myelopathy. However, the most important factors in patient selection for a particular procedure are the clinical symptoms and the radiographic alignment of the spine. the goals of surgery for cervical multilevel stenosis include the restoration of height, alignment, and stability. Conclusion We stress the importance of a careful patients selection, and invocated still the importance for 360° cervical fixation. PMID:25734320

  20. Reduced field-of-view DTI segmentation of cervical spine tissue.

    Science.gov (United States)

    Tang, Lihua; Wen, Ying; Zhou, Zhenyu; von Deneen, Karen M; Huang, Dehui; Ma, Lin

    2013-11-01

    The number of diffusion tensor imaging (DTI) studies regarding the human spine has considerably increased and it is challenging because of the spine's small size and artifacts associated with the most commonly used clinical imaging method. A novel segmentation method based on the reduced field-of-view (rFOV) DTI dataset is presented in cervical spinal canal cerebrospinal fluid, spinal cord grey matter and white matter classification in both healthy volunteers and patients with neuromyelitis optica (NMO) and multiple sclerosis (MS). Due to each channel based on high resolution rFOV DTI images providing complementary information on spinal tissue segmentation, we want to choose a different contribution map from multiple channel images. Via principal component analysis (PCA) and a hybrid diffusion filter with a continuous switch applied on fourteen channel features, eigen maps can be obtained and used for tissue segmentation based on the Bayesian discrimination method. Relative to segmentation by a pair of expert readers, all of the automated segmentation results in the experiment fall in the good segmentation area and performed well, giving an average segmentation accuracy of about 0.852 for cervical spinal cord grey matter in terms of volume overlap. Furthermore, this has important applications in defining more accurate human spinal cord tissue maps when fusing structural data with diffusion data. rFOV DTI and the proposed automatic segmentation outperform traditional manual segmentation methods in classifying MR cervical spinal images and might be potentially helpful for detecting cervical spine diseases in NMO and MS.

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

    Science.gov (United States)

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

    2017-01-01

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

  2. 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.

  3. [Cervicogenic dysphagia: swallowing difficulties caused by functional and organic disorders of the cervical spine].

    Science.gov (United States)

    Grgić, Vjekoslav

    2013-01-01

    Cervical spine disorders which can cause swallowing difficulties (cervicogenic dysphagia; CD) are: chronic multisegmental/MS dysfunction (dysfunction=functional blockade) of the facet joints, changes in physiological curvature of the cervical spine, degenerative changes (anterior osteophytes, anterior disc herniation, osteochondrosis, osteoarthritis), inflammatory rheumatic diseases, diffuse idiopathic skeletal hyperostosis, injuries, conditions after anterior cervical spine surgery, congenital malformations and tumors. According to our clinical observations, degenerative changes in the cervical discs and facet joints and chronic MS dysfunction of the cervical spine facet joints are disorders which can cause swallowing difficulties. However, these disorders have not been recognized enough as the causes of dysphagia and they are not even mentioned in differential diagnosis. Because of the close anatomical relationship of cervical spine with the pharynx and cervical part of esophagus, the consequences of the degenerative changes in the cervical discs and facet joints and chronic MS dysfunction of the cervical spine facet joints such as the changes in the physiological curvature of the cervical spine, changes in elasticity and contractility in the neck muscles and decreased mobility of the cervical spine, adversely affect the dimensions of the pharynx and cervical part of esophagus, that is, swallowing capacity which can result in dysphagia. Degenerative changes in the cervical discs and facet joints are common additional cause of dysphagia in elderly people with disorders of the central control of swallowing (stroke, Parkinson's disease, senile dementia etc). The most important therapeutic options in patients with CD are: medicamentous therapy, physical therapy, manual therapy, kinesiotherapy and surgical treatment. The aim of the conservative therapy in patients with CD is to improve the swallowing capacity (for example, soft tissue techniques, stretching of the

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-05-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Robotti, G.C.; Geissmann, A.; Steinsiepe, K.

    1986-02-01

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

  6. A Dynamic Model of the Cervical Spine and Head

    Science.gov (United States)

    1981-11-01

    Extension in the cervical spine is limited at the upper end by the superior facets of the atlas whose posterior edges lock into the occi- pital condylar ...McKenzie (1971), leaving about 6.2 kg for neck. By distributing the total neck mass to each slice according to the volume of the slice an approximate...divide the volume of the muscle by its length. This figure is called the physiological cross-section. Since the internal arrangement of the fibers was

  7. Cervical spine evaluation in urban trauma centers: lowering institutional costs and complications through helical CT scan.

    Science.gov (United States)

    Grogan, Eric L; Morris, John A; Dittus, Robert S; Moore, Derek E; Poulose, Benjamin K; Diaz, Jose J; Speroff, Theodore

    2005-02-01

    In the evaluation of the cervical spine (c-spine), helical CT scan has higher sensitivity and specificity than plain radiographs in the moderate- and high-risk trauma population, but is more costly. We hypothesize that institutional costs associated with missed injuries make helical CT scan the least costly approach. A cost-minimization study was performed using decision analysis examining helical CT scan versus radiographic evaluation of the c-spine. Parameter estimates were obtained from the literature for probability of c-spine injury, probability of paralysis after missed injury, plain film sensitivity and specificity, CT scan sensitivity and specificity, and settlement cost of missed injuries resulting in paralysis. Institutional costs of CT scan and plain radiography were used. Sensitivity analyses tested robustness of strategy preference, accounted for parameter variability, and determined threshold values for individual parameters on strategy preference. C-spine evaluation with helical CT scan has an expected cost of US 554 dollars per patient compared with US 2,142 dollars for plain films. CT scan is the least costly alternative if threshold values exceed US 58,180 dollars for institutional settlement costs, 0.9% for probability of c-spine fracture, and 1.7% for probability of paralysis. Plain films are least costly if CT scan costs surpass US 1,918 dollars or plain film sensitivity exceeds 90%. Helical CT scan is the preferred initial screening test for detection of cervical spine fractures among moderate- to high-risk patients seen in urban trauma centers, reducing the incidence of paralysis resulting from false-negative imaging studies and institutional costs, when settlement costs are taken into account.

  8. The cervical spine in Saethre-Chotzen syndrome.

    Science.gov (United States)

    Anderson, P J; Hall, C M; Evans, R D; Hayward, R D; Harkness, W J; Jones, B M

    1997-01-01

    Twenty patients with a diagnosis of Saethre-Chotzen syndrome had their cervical spine radiographs reviewed. Radiologic abnormalities including vertebral fusion were present in 9 of the 20 patients. Fusion of both the vertebral bodies and the posterior elements was noted, although the latter site was more common. C2-3 was the level most commonly involved, although other levels were recorded. Analysis of sequential radiographs in nine patients revealed evidence of progression in seven patients. In those studies in children aged under 2 years, only 1 of 18 films showed evidence of fusion, while in those over 2 years of age, 10 of 12 showed evidence of fusion. These results reveal that the incidence of cervical anomalies in Saethre-Chotzen syndrome is greater than that in the general population. There is both direct and indirect evidence that the vertebral fusions are progressive during childhood.

  9. Cervical Spine Motion During Extrication: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Shafer, Jeffrey S

    2009-05-01

    Full Text Available Spinal immobilization is one of the most commonly performed pre-hospital procedures. Little research has been done on the movement of the neck during immobilization and extrication. In this study we used a sophisticated infrared six-camera motion-capture system (Motion Analysis Corporation, Santa Rosa, CA, to study the motion of the neck and head during extrication. A mock automobile was constructed to scale, and volunteer patients, with infrared markers on bony prominences, were extricated by experienced paramedics. We found in this pilot study that allowing an individual to exit the car under his own volition with cervical collar in place may result in the least amount of motion of the cervical spine. Further research should be conducted to verify these findings. In addition, this system could be utilized to study a variety of methods of extrication from automobile accidents. [WestJEM. 2009;10:74-78.

  10. Percutaneous Vertebroplasty Relieves Pain in Cervical Spine Metastases

    Science.gov (United States)

    Bao, Li; Jia, Pu; Li, Jinjun; Chen, Hao; Dong, Yipeng; Feng, Fei; Yang, He; Chen, Mengmeng

    2017-01-01

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

  11. Improved MR imaging of the cervical spine, 2; Study of disk protrusion in the cervical spine in flexion-versus-extension views

    Energy Technology Data Exchange (ETDEWEB)

    Tanno, Munehiko; Kyomasu, Yoshinori; Nakayama, Masafumi (Tokyo Metropolitan Geriatric Hospital, Tokyo (Japan)) (and others)

    1990-12-01

    Comparative study of incidence of disk protrusion was performed on the basis of MR imaging in a state of flexion versus extension. The results showed that the incidnece of disk protrusion at each disk level was generally higher on the extension images than on the flexion images at the corresponding levels. The degree of difference in the incidence of the disk protrusion on flexion and extension was the greatest at the mid-cervical level spine. Based on the results with respect to features of the cervical spine in extension and flexion, it appears that the difference in incidence of disk protrusion is probably caused by movement in response to bending of the cervical spine. These results may provide information concerning the dynamic of cervical disks and may partly explain cases in which patients have symptoms of cervical myelopathy and/or radiculopathy but have no disk protrusion on images in the neutral position. (author).

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

    Science.gov (United States)

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

    2015-10-01

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

  13. Kinematic of cervical thoracic spine in the context of whole body posture

    OpenAIRE

    Vláčilová, Ivana

    2015-01-01

    Title: Kinematic of cervical thoracic spine in the context of whole body posture Problematics: This work describes the kinematics of upper thoracic spine during specific movement of the shoulder girdle. The kinematic changes are evaluated with the relationship of the whole body posture. Aim: To develop the objective evaluation of the posture and the amount of the segmental spinal movement of cervical thoracic spine. To describe the relationship between the specific movement of arm - adduction...

  14. Morphological character of cervical spine for anterior transpedicular screw fixation

    Directory of Open Access Journals (Sweden)

    Rong-Ping Zhou

    2013-01-01

    Full Text Available Background: Anterior cervical interbody grafts/cages combined with a plate were frequently used in multilevel discectomies/corpectomies. In order to avoid additional posterior stabilization in patients who undergo anterior reconstructive surgery, an anterior cervical transpedicular screw fixation, which offers higher stability is desirable. We investigated in this study the anatomical (morphologic characters for cervical anterior transpedicular screw fixation. Materials and Methods: Left pedicle parameters were measured on computed tomography (CT images based on 36 cervical spine CT scans from healthy subjects. The parameters included outer pedicle width (Distance from lateral to medial pedicle surface in the coronal plane, outer pedicle height (OPH (Distance from upper to lower pedicle surface in the sagittal plane, maximal pedicle axis length (MPAL, distance transverse insertion point (DIP, distance of the insertion point to the upper end plate (DIUP, pedicle sagittal transverse angle (PSTA and pedicle transverse angle (PTA at C3 to C7. Results: The values of outer pedicle width and MPAL in males were larger than in females from C3 to C7. The OPH in males was larger than in females at C3 to C6, but there was no difference at C7. The DIP and PTA were significantly greater in males than in females at C3, but there was no difference in the angle at C4-7. The PSTA was not statistically different between genders at C3, 4, 7, but this value in males was larger than females at C5, 6. The DIUP was significantly greater in males at C3, 4, 6, 7 but was non significant at C5. Conclusions: The placement of cervical anterior transpedicular screws should be individualized for each patient and based on a detailed preoperative planning.

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

    Science.gov (United States)

    Holsgrove, Timothy P.; Preatoni, Ezio; Gill, Harinderjit S.; Trewartha, Grant

    2017-01-01

    Cervical spine trauma from sport or traffic collisions can have devastating consequences for individuals and a high societal cost. The precise mechanisms of such injuries are still unknown as investigation is hampered by the difficulty in experimentally replicating the conditions under which these injuries occur. We harness the benefits of computer simulation to report on the creation and validation of i) a generic musculoskeletal model (MASI) for the analyses of cervical spine loading in healthy subjects, and ii) a population-specific version of the model (Rugby Model), for investigating cervical spine injury mechanisms during rugby activities. The musculoskeletal models were created in OpenSim, and validated against in vivo data of a healthy subject and a rugby player performing neck and upper limb movements. The novel aspects of the Rugby Model comprise i) population-specific inertial properties and muscle parameters representing rugby forward players, and ii) a custom scapula-clavicular joint that allows the application of multiple external loads. We confirm the utility of the developed generic and population-specific models via verification steps and validation of kinematics, joint moments and neuromuscular activations during rugby scrummaging and neck functional movements, which achieve results comparable with in vivo and in vitro data. The Rugby Model was validated and used for the first time to provide insight into anatomical loading and cervical spine injury mechanisms related to rugby, whilst the MASI introduces a new computational tool to allow investigation of spinal injuries arising from other sporting activities, transport, and ergonomic applications. The models used in this study are freely available at simtk.org and allow to integrate in silico analyses with experimental approaches in injury prevention. PMID:28052130

  16. Changes in human cervical and lumbar spine curves while bicycling with different handlebar heights.

    Science.gov (United States)

    Chen, Yi-Lang; He, Kuo-Chang

    2012-01-01

    Cycling is a daily activity that needs a high demand of human-bicycle fitness. However, studies into the fitness or ergonomic aspects are very little. In this study, the simulated 20 min bicycling test were performed by 26 male participants under 5 handle height conditions. Body joint angles and external cervical/lumbar spine lordosis were measured at the initial and cycling after 20 min. Results show that different handle heights did cause various trunk inclinations. Trunk inclination was negatively and positively correlated with lumbosacral angle (r = -0.620, p < 0.001) and cervical angle (r = 0.510, p < 0.001), respectively. In this study, regression models were also developed to predict the internal cervical and lumbar spine movements by external trunk inclination and head extension, respectively. The explanatory abilities for the variance of the models were 67.2% for LSA and 82.8% for CE prediction. This can be used to understand the cyclist's spine movements while field study of bicycling.

  17. 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.

  18. 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.

  19. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-12-15

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

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

    Directory of Open Access Journals (Sweden)

    Karolina Walczyńska-Dragon

    2014-01-01

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

  2. Correlation between TMD and cervical spine pain and mobility: is the whole body balance TMJ related?

    Science.gov (United States)

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

    2014-01-01

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

  5. 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.

  6. Surgical management of the symptomatic cervical spine in rheumatoid arthritis.

    Science.gov (United States)

    Smith, D S; Yuan, H A

    1982-05-01

    Eleven spinal fusions were performed on 10 patients with symptomatic cervical spines secondary to rheumatoid arthritis. A variety of surgical procedures and various types of postoperative immobilization were used. The average patient age at surgery was 43.2 years, with an average followup of 36.9 months. Six of these patients had instability at C1-2, one each at C4-5, C5-6, and C6-7, and one patient had a complete myelographic block without instability at C5-6. Six of the patients presented with neurologic symptoms - all improved; some dramatically. There were no deaths, four transient complications, and no pseudarthroses. Some authors advocate routine, supine, prolonged skull traction postoperatively. We believe that this is not necessary in the uncomplicated rheumatoid spinal fusion, and may be detrimental. Other recommendations for conservative and surgical management are also made. Copyright 2013, SLACK Incorporated.

  7. 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.

  8. Three Dimensional Movements Of The Upper Cervical Spine

    Science.gov (United States)

    Panjabi, Manohar M.; Dvorak, Jiri; Duranceau, Joanne; Yamamoto, Isao

    1989-04-01

    Ten fresh cadaveric whole cervical spine specimens (occiput to C7) were studied using well established techniques to document the movements in flexion, extension, left and right lateral bending and left and right axial rotation. Pure moments of maximum 1.5 newton meters were applied incrementally and three dimensional movements of the bones were recorded using stereophotogrammetry. Each moment was applied individually and in a three load/unload cycles. The motion measurements were made on the third load cycle. Parameters of neutral zone, elastic zone and range of motion were computed. Neutral zones for flexion/extension, right/left lateral bending and right/left axial rotation were respectively: 1.1, 1.5 and 1.6 (occiput-C1); and 3.2, 1.2 and 29.6 degrees (C1-C2). Ranges of motion for flexion, extension, lateral bending (one side) and axial rotation (one side) were respectively: 3.5, 21.0, 5.5 and 7.2 degrees (occiput-Cl joint) and 11.5, 10.9, 6.7 and 38.9 degrees (CI-CZ joint). The highest intervertebral motion in the spine was the axial rotation at the Cl-C2 joint, neutral zone constituting 75% of this motion.

  9. 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.

  10. Biomechanics of the Spine III. The Cranio-Cervical Junction.

    Science.gov (United States)

    Izzo, R; Ambrosanio, G; Cigliano, A; Cascone, D; Gallo, G; Muto, M

    2007-04-30

    By virtue of its unique anatomy and functions the cranial-cervical junction was excluded in previous reviews on the general biomechanics of the spine, being a world apart. The special design of the cranial-cervical (CCJ) junction responds to seemingly opposed necessities being at same time loose enough to allow a great variety of movements and strong enough to preserve the spinal cord and vertebral arteries and to resist the head weight and muscular action. The primary goal of the CCJ is to ensure the maximal mobility of the head for visual and auditory exploration of space. Like a cardan joint the CCJ allows simultaneous independent movements about three axes in order to repeat and extend eye movements under the control of vestibular receptors. Several muscular groups and a number of ligaments control the movements of the CCJ and ensure its stability. Although composed of two seemingly distinct joints the CCJ forms a unique functional complex whose stability is ensured by ligaments and bony restraints often operating on both joint components: the occipitoatlantal and atlantoaxial joints.

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

    Science.gov (United States)

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

    2013-06-01

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

  12. Kinematic analysis of the relationship between Modic changes and sagittal balance parameters in the cervical spine.

    Science.gov (United States)

    Ma, Zikun; Liu, Peng; Liu, Jingpei; Mou, Jianhui; Wang, Zhaolin; Sun, Dong; Cheng, Jie; Zhang, Dengwei; Xiao, Jianlin

    2017-08-01

    The aim of this study is to investigate the relationship between the Modic changes (MCs) and sagittal parameters of the cervical spine.We conducted a retrospective review of 100 outpatients with magnetic resonance imaging (MRI) scans of the cervical spine (50 male and 50 female). MRI parameters were measured, including neck tilt, T1 slope (T1 ), thoracic inlet angle (TIA), and cervical lordosis (CL: Cobb C2-7). Patients were divided into 4 groups according to the presence or absence of MC and T1s, respectively: MC(+) and MC(-) groups, as well as H-T1s (T1s ≥25°) and L-T1s subgroups (T1s spine and other parameters were evaluated via Spearman correlation coefficient. Radiologic parameters were compared between the MC(+) group and MC(-) group, and the prevalences of MC were compared between the H-T1s and L-T1s groups.T1s was significantly correlated with TIA and CL, with correlation coefficients of 0.562 and 0.725, respectively. T1 slope was significantly higher in patients with MC than those without MC (P = .041), and the prevalence of MC was higher in the H-T1s group than the L-T1s group (37.5% and 17.1%, respectively). However, the relationship between the parameters of sagittal balance and MC was not significant.The present study demonstrated that high T1 slope is a potential risk factor for the development of MC due to impaired sagittal balance, especially in the C5-6 cervical segment.

  13. Influence of T1 Slope on the Cervical Sagittal Balance in Degenerative Cervical Spine: An Analysis Using Kinematic MRI.

    Science.gov (United States)

    Weng, Chong; Wang, Justin; Tuchman, Alexander; Wang, Jian; Fu, Changfeng; Hsieh, Patrick C; Buser, Zorica; Wang, Jeffrey C

    2016-02-01

    A retrospective kinematic magnetic resonance imaging (kMRI) study. To evaluate the utility of kMRI in determining the relationship between cervical sagittal balance and TI alignment. Thoracic inlet parameters play an important role in cervical spine sagittal balance. However, most of the literature is based on lower resolution cervical X-rays or CT scans in the supine position. Cervical spine kMRI of 83 patients with degenerative cervical spine conditions (20-68 yr of age) was analyzed for: (1) cervical spine parameters: C2-C7 angle, C2-C7 sagittal vertical axis (SVA), cranial tilt, and cervical tilt; and (2) T1 parameters: thoracic inlet angle (TIA), T1 slope, and neck tilt (NT). Multiple logistic regression analysis and Pearson correlation coefficients were performed. The mean TIA, T1 slope, and NT were 78.0, 33.2, and 44.8°, respectively. The mean C2-7 angle, SVA of C2-C7, cervical tilt, and cranial tilt were -15.4°, 22.0 mm, 18.1°, and 15.1°, respectively. The ratio of cervical:cranial tilt was maintained as 55:45%. A significant correlation was found between the C2-C7 angle and T1 slope (r = 0.731), TIA and C2-C7 angle (r = 0.406), cervical tilt with C2-C7 angle (r = 0.671), T1 slope with TIA (r = 0.429), TIA with neck tilt (r = 0.733), TIA with cervical tilt (r = 0.377), SVA C2-C7 with cervical tilt (r = -0.480), SVA C2-C7 with cranial tilt (r = 0.912), and C2-7 SVA with the ratio of cranial tilt to cervical tilt (r = 0.694). An individual with a large T1 slope required large cervical lordosis to preserve physiologic sagittal balance of the cervical spine. Cranial tilt was the cervical parameter most strongly correlated with SVA C2-C7, and thus may be a good parameter to assess decompensation of cervical sagittal balance. 3.

  14. 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.

  15. 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.

  16. Case series of an intraoral balancing appliance therapy on subjective symptom severity and cervical spine alignment.

    Science.gov (United States)

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

    2013-01-01

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

  17. Cervical Spine Functional Anatomy and the Biomechanics of Injury Due to Compressive Loading

    OpenAIRE

    Swartz, Erik E; Floyd, R. T; Cendoma, Mike

    2005-01-01

    Objective: To provide a foundation of knowledge concerning the functional anatomy, kinematic response, and mechanisms involved in axial-compression cervical spine injury as they relate to sport injury.

  18. 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)

  19. When to suspect head injury or cervical spine injury in maxillofacial trauma?

    Science.gov (United States)

    Rahman, Sajjad A; Chandrasala, Soumithran

    2014-05-01

    The global status report of the World Health Organization (WHO) on road safety suggested that India is leading in road traffic accidents in the world. According to the report on road accidents in India in 2010 by the Transport Research Wing, Ministry of Road Transport and Highways, New Delhi, Kerala ranked third in accidents per lakh population and second in persons injured per lakh population. As the face, brain, and cervical spine are in close proximity with one another, associated injuries can be suspected. The aim of this study was to determine the relationship between the severity of head, cervical spine, and facial injury and incidence of facial injury in patients with head and/or cervical spine injury. A prospective cohort study was conducted over a period of one year. The study population included all patients having computed tomography (CT)-demonstrable head injury, radiographic evidence of cervical spine injury, and associated head or cervical spine injury with facial injury. Data were analyzed using the chi-square test using statistical package SPSS. A P value less than 0.05 was considered statistically significant. Of 124 patients, 59 (47.6%) had facial injuries. As severity of head injury increased, the number of facial injuries decreased. Statistically, no significant association between facial and head injury was seen. A statistically significant association between dentoalveolar involvement and cervical spine injury was seen (P < 0.001). The proportion of injuries in patients with cervical spine injuries alone was significantly lower in the frontal (P = 0.001) and orbital (P = 0.004) regions and higher in the mandibular region (P = 0.010). Midface injuries were more commonly associated with head injuries. Decreased facial involvement leads to increased severity of head injury. Simple injuries of the cervical spine were more commonly associated with facial injuries.

  20. Kinematic analysis of the lower cervical spine in the protracted and retracted neck flexion positions

    OpenAIRE

    Park, So Hyun

    2015-01-01

    [Purpose] The aim of this study was to analyze lower cervical spine kinematics in protracted and retracted neck flexion positions in healthy people. [Subjects and Methods] The craniovertebral angle (CVA) and intervertebral body angles of the lower cervical spine of 10 healthy individuals were analyzed using fluoroscopy in a neutral sitting with the head in the neutral (N), protracted (Pro), and retracted (Ret) positions and with the neck in full flexion with the head in the neutral (N-fx), pr...

  1. A 12 month clinical audit of cervical spine imaging in multiply injured and intubated patients.

    Science.gov (United States)

    Ball, C; Watson, D

    2010-03-01

    Previous work has questioned how plain films should be used when imaging the cervical spine of trauma patients. The authors wanted to identify whether the National Institute for Clinical Excellence (NICE) guidelines were being followed with respect to the imaging of patients presenting with cervical spine injury over a 1 year period. Data retrieved from the Electronic Digital Information Service (EDIS) computerised database records of all patients presenting with a triage code 1 or 2 between 1 September 2007 and 31 August 2008 were used to conduct a retrospective audit that identified multiply injured and intubated patients who did not undergo CT of the cervical spine and to highlight the use of plain films when the patient was to undergo CT of the head and cervical spine. A clinical record search identified 52 patients with a mean age of 32 years, of whom 73% were males, who had been admitted with multiple traumas and had undergone imaging of the cervical spine. Although no patient was intubated without undergoing CT of the cervical spine or head, seven patients had plain films when it was clear that they were to undergo CT. In conclusion, the audit emphasised the excellent work of emergency department and radiology staff in identifying and imaging multiple trauma patients, as all patients requiring CT of the cervical spine received this investigation. However, careful thought should be given to ordering plain films before CT, as some patients who clearly required CT of the cervical spine underwent unnecessary lateral plain films in the emergency department, delaying their progression to definitive care.

  2. When to suspect head injury or cervical spine injury in maxillofacial trauma?

    Directory of Open Access Journals (Sweden)

    Sajjad A Rahman

    2014-01-01

    Full Text Available Background: The global status report of the World Health Organization (WHO on road safety suggested that India is leading in road traffic accidents in the world. According to the report on road accidents in India in 2010 by the Transport Research Wing, Ministry of Road Transport and Highways, New Delhi, Kerala ranked third in accidents per lakh population and second in persons injured per lakh population. As the face, brain, and cervical spine are in close proximity with one another, associated injuries can be suspected. The aim of this study was to determine the relationship between the severity of head, cervical spine, and facial injury and incidence of facial injury in patients with head and/or cervical spine injury. Materials and Methods: A prospective cohort study was conducted over a period of one year. The study population included all patients having computed tomography (CT-demonstrable head injury, radiographic evidence of cervical spine injury, and associated head or cervical spine injury with facial injury. Data were analyzed using the chi-square test using statistical package SPSS. A P value less than 0.05 was considered statistically significant. Results: Of 124 patients, 59 (47.6% had facial injuries. As severity of head injury increased, the number of facial injuries decreased. Statistically, no significant association between facial and head injury was seen. A statistically significant association between dentoalveolar involvement and cervical spine injury was seen (P < 0.001. The proportion of injuries in patients with cervical spine injuries alone was significantly lower in the frontal (P = 0.001 and orbital (P = 0.004 regions and higher in the mandibular region (P = 0.010. Conclusion: Midface injuries were more commonly associated with head injuries. Decreased facial involvement leads to increased severity of head injury. Simple injuries of the cervical spine were more commonly associated with facial injuries.

  3. Harvesting and preparation of cadaveric osseoligamentous lower cervical spine (C2-C7) for biomechanical testing

    OpenAIRE

    Yeh, J; Jackowski, A

    1998-01-01

    Cadaveric osseoligamentous lower cervical spines (C2-C7) are often used in the investigation of spinal biomechanics in vitro. Surprisingly, however, the techniques of harvesting at postmortem and preparation of cadaveric osseoligamentous lower cervical spine for biomechanical testing have not been described in detail. We describe a simple and effective method that can be readily integrated into the routine autopsy procedure. Points on the avoidance of disfiguring the cadaver and damaging the ...

  4. MDCT of acute subaxial cervical spine trauma: a mechanism-based approach

    OpenAIRE

    Raniga, Sameer B.; Menon, Venugopal; Al Muzahmi, Khamis S.; Butt, Sajid

    2014-01-01

    Injuries to the spinal column are common and road traffic accidents are the commonest cause. Subaxial cervical spine (C3–C7) trauma encompasses a wide spectrum of osseous and ligamentous injuries, in addition to being frequently associated with neurological injury. Multidetector computed tomography (MDCT) is routinely performed to evaluate acute cervical spine trauma, very often as first-line imaging. MDCT provides an insight into the injury morphology, which in turn reflects the mechanics of...

  5. 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.

  6. INTEREXAMINER RELIABILITY OF CHIROPRACTIC EVALUATION FOR CERVICAL SPINE PROBLEMS—A Pilot Study

    OpenAIRE

    Tuchin, Peter J.; Hart, Christopher J.; Johnson, Catriona; Colman, Robert; Gee, Adam; Edwards, Ian; Plucknett, Mark; Bonello, Rod

    1996-01-01

    Objective: A pilot study was conducted to determine whether untrained examiners could agree on palpatory findings in the cervical spine. Design: Fifty-three university students, (most of whom were chiropractic students), had their cervical spines examined by seven different chiropractors using their own clinical methods, of which motion palpation was a common, but not standard component. Setting: Chiropractic Centre in Macquarie University. Participants: Volunteer university students. Main Ou...

  7. Rheumatoid Arthritis and the Cervical Spine: A Review on the Role of Surgery

    Directory of Open Access Journals (Sweden)

    John L. Gillick

    2015-01-01

    Full Text Available Rheumatoid arthritis (RA is a chronic systemic inflammatory disease affecting a significant percentage of the population. The cervical spine is often affected in this disease and can present in the form of atlantoaxial instability (AAI, cranial settling (CS, or subaxial subluxation (SAS. Patients may present with symptoms and disability secondary to these entities but may also be neurologically intact. Cervical spine involvement in RA can pose a challenge to the clinician and the appropriate role of surgical intervention is controversial. The aim of this paper is to describe the pathology, pathophysiology, clinical manifestations, and diagnostic evaluation of rheumatoid arthritis in the cervical spine in order to provide a better understanding of the indications and options for surgery. Both the medical and surgical treatment options for RA have improved, so has the prognosis of the cervical spine disease. With the advent of disease modifying antirheumatic drugs (DMARDs, fewer patients are presenting with cervical spine manifestations of RA; however, those that do, now have improved surgical techniques available to them. We hope that, by reading this paper, the clinician is able to better evaluate patients with RA in the cervical spine and determine in which patients surgery is indicated.

  8. Absent cervical spine pedicle: report of a case in a mediaeval skeleton

    Energy Technology Data Exchange (ETDEWEB)

    Mays, Simon [English Heritage Centre for Archaeology, Ancient Monuments Laboratory, Portsmouth (United Kingdom)

    2007-08-15

    This paper presents a first dry-bone study of the anatomy of an absent cervical spine pedicle and briefly reviews the literature involving this anomaly. The case study is of the absence of the right cervical spine pedicle at C6 in a mediaeval skeleton from England. Key features of the anomaly, including, in addition to the absent pedicle, dysplasia of the ipsilateral transverse process, dorsal displacement of the articular pillar, and reversal of the ipsilateral facet articulation with the supra-adjacent vertebra, are illustrated. Compromise of cervical spine stability is demonstrated. Literature review revealed 69 cases of absent cervical spine pedicle; all were unilateral, and there was no side or gender preference. The current case is a first description of an absent cervical spine pedicle in an archaeological skeleton. It indicates the presence of the anomaly in a European population more than 600 years before the first clinical description. Absent cervical spine pedicle appears to be a rare variant today; the paucity of archaeological cases shows that this was also the case in the past. (orig.)

  9. 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.

  10. [A scale for measuring symptoms related to degenerative diseases of the cervical spine. A reference in determining indications and evaluating surgical outcome].

    Science.gov (United States)

    Koller, M; Kienapfel, H; Hinder, D; Sabau, E; Wingert, G; Pfeiffer, M; Griss, P; Lorenz, W

    1999-11-01

    A scale for measuring symptoms related to degenerative diseases of the cervical spine is presented. Twenty typical symptoms are listed, e. g., neck pain, dysesthesia, and reduced mobility. Responses are assessed via a 6-point scaling ("did not have symptom" - "had symptom and suffered very strongly".) The cervical spine scale was tested in three samples: patients having undergone cervical spine surgery (n = 70), patients with other orthopedic diagnoses (n = 104), and healthy students (n = 100). The single items of the scale were aggregated into four scores: total number of symptoms, degree of overall symptom distress, functional disability, and pain/psychological distress. Statistical analyses proved the high reliability (Cronbach's alpha = 0.85 to 0.95) and validity (content, convergent, discriminant) of all scores. The scale differs clearly between cervical spine patients, other orthopedic patients and healthy individuals, and between cervical spine patients with different subjective operative outcomes. For applied clinical purposes the cervical spine scale can be included in a quality of life profile (QL-profile); this allows for a readily understandable graphic depiction of individual patients' QL-status.

  11. Diagnostic accuracy of upper cervical spine instability tests: a systematic review

    NARCIS (Netherlands)

    Hutting, N.; Scholten-Peeters, G.G.M.; Vijverman, V.; Keesenberg, M.D.; Verhagen, A.P.

    2013-01-01

    BACKGROUND: Patients with neck pain, headache, torticollis, or neurological signs should be screened carefully for upper cervical spine instability, as these conditions are "red flags" for applying physical therapy interventions. However, little is known about the diagnostic accuracy of upper cervic

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

    Directory of Open Access Journals (Sweden)

    Fahad H. Abduljabbar

    2015-09-01

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

  13. 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.

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

    Directory of Open Access Journals (Sweden)

    Tschoeke Sven K

    2008-06-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Nielsen, Edith; Vesterby, Annie

    2005-01-01

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

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

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Nielsen, Edith; Vesterby, Annie

    2005-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-10-01

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

  19. Do design variations in the artificial disc influence cervical spine biomechanics? A finite element investigation

    OpenAIRE

    Faizan, Ahmad; Goel, Vijay K.; Garfin, Steven R.; Serhan, Hassan; Biyani, Ashok; Elgafy, Hossein; Krishna, Manoj; Friesem, Tai; Bono, Christopher M

    2009-01-01

    Various ball and socket-type designs of cervical artificial discs are in use or under investigation. Many artificial disc designs claim to restore the normal kinematics of the cervical spine. What differentiates one type of design from another design is currently not well understood. In this study, authors examined various clinically relevant parameters using a finite element model of C3–C7 cervical spine to study the effects of variations of ball and socket disc designs. Four variations of b...

  20. 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.)

  1. 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.

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

    Science.gov (United States)

    Cowley, Alan; Hague, Ashley; Durge, Neal

    2016-09-29

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

  3. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-07-15

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

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

    Science.gov (United States)

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

    2013-03-01

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

  6. Simulated Pain and Cervical Motion in Patients with Chronic Disorders of the Cervical Spine

    Directory of Open Access Journals (Sweden)

    Zeevi Dvir

    2004-01-01

    Full Text Available The primary objective of the present study was to determine how simulated severe cervical pain affects cervical motion in patients suffering from two distinct chronic cervical disorders: whiplash (n=25 and degenerative changes (n=25. The second objective was to derive an index that would allow the differentiation of maximal from submaximal performances of cervical range of motion. Patients first performed maximal movement of the head (maximal effort in each of the six primary directions and then repeated the test as if they were suffering from a much more intense level of pain (submaximal effort. All measurements were repeated within four to seven days. In both groups, there was significant compression of cervical motion during the submaximal effort. This compression was also highly stable on a test-retest basis. In both groups, a significantly higher average coefficient of variation was associated with the imagined pain and it was significantly different between the two clinical groups. In the whiplash group, a logistic regression model allowed the derivation of coefficient of variation-based cutoff scores that might, at selected levels of probability and an individual level, identify chronic whiplash patients who intentionally magnify their motion restriction using pain as a cue. However, the relatively small and very stable compression of cervical motion under pain simulation supports the view that the likelihood that chronic whiplash patients are magnifying their restriction of cervical range of motion using pain as a cue is very low.

  7. Quantifying cervical-spine curvature using Bézier splines.

    Science.gov (United States)

    Klinich, Kathleen D; Ebert, Sheila M; Reed, Matthew P

    2012-11-01

    Knowledge of the distributions of cervical-spine curvature is needed for computational studies of cervical-spine injury in motor-vehicle crashes. Many methods of specifying spinal curvature have been proposed, but they often involve qualitative assessment or a large number of parameters. The objective of this study was to develop a quantitative method of characterizing cervical-spine curvature using a small number of parameters. 180 sagittal X-rays of subjects seated in automotive posture with their necks in neutral, flexed, and extended postures were collected in the early 1970s. Subjects were selected to represent a range of statures and ages for each gender. X-rays were reanalyzed using advanced technology and statistical methods. Coordinates of the posterior margins of the vertebral bodies and dens were digitized. Bézier splines were fit through the coordinates of these points. The interior control points that define the spline curvature were parameterized as a vector angle and length. By defining the length as a function of the angle, cervical-spine curvature was defined with just two parameters: superior and inferior Bézier angles. A classification scheme was derived to sort each curvature by magnitude and type of curvature (lordosis versus S-shaped versus kyphosis; inferior or superior location). Cervical-spine curvature in an automotive seated posture varies with gender and age but not stature. Average values of superior and inferior Bézier angles for cervical spines in flexion, neutral, and extension automotive postures are presented for each gender and age group. Use of Bézier splines fit through posterior margins offers a quantitative method of characterizing cervical-spine curvature using two parameters: superior and inferior Bézier angles.

  8. Flexion and extension structural properties and strengths for male cervical spine segments.

    Science.gov (United States)

    Nightingale, Roger W; Carol Chancey, V; Ottaviano, Danielle; Luck, Jason F; Tran, Laura; Prange, Michael; Myers, Barry S

    2007-01-01

    New vehicle safety standards are designed to limit the amount of neck tension and extension seen by out-of-position motor vehicle occupants during airbag deployments. The criteria used to assess airbag injury risk are currently based on volunteer data and animal studies due to a lack of bending tolerance data for the adult cervical spine. This study provides quantitative data on the flexion-extension bending properties and strength on the male cervical spine, and tests the hypothesis that the male is stronger than the female in pure bending. An additional objective is to determine if there are significant differences in stiffness and strength between the male upper and lower cervical spine. Pure-moment flexibility and failure testing was conducted on 41 male spinal segments (O-C2, C4-C5, C6-C7) in a pure-moment test frame and the results were compared with a previous study of females. Failures were conducted at approximately 90 N-m/s. In extension, the male upper cervical spine (O-C2) fails at a moment of 49.5 (s.d. 17.6)N-m and at an angle of 42.4 degrees (s.d. 8.0 degrees). In flexion, the mean moment at failure is 39.0 (s.d. 6.3 degrees) N-m and an angle of 58.7 degrees (s.d. 5.1 degrees). The difference in strength between flexion and extension is not statistically significant. The difference in the angles is statistically significant. The upper cervical spine was significantly stronger than the lower cervical spine in both flexion and extension. The male upper cervical spine was significantly stiffer than the female and significantly stronger than the female in flexion. Odontoid fractures were the most common injury produced in extension, suggesting a tensile mechanism due to tensile loads in the odontoid ligamentous complex.

  9. Declining incidence of catastrophic cervical spine injuries in French rugby: 1996-2006.

    Science.gov (United States)

    Bohu, Yoann; Julia, Marc; Bagate, Christian; Peyrin, Jean-Claude; Colonna, Jean-Pierre; Thoreux, Patricia; Pascal-Moussellard, Hugues

    2009-02-01

    To investigate the incidence and the risk factors of catastrophic cervical spine injuries in French rugby. Descriptive epidemiology study. The patients included had cervical spine injuries causing neurological disorder classified from the ASIA scale, grade A to D. A retrospective review of all cases that occurred between the 1996-1997 and the 2005-2006 seasons was made. Circumstances of the injuries and of the clinical outcome were collected by interview. There were 37 cases of catastrophic cervical spine injuries in French rugby for the last 10 years. The incidence of the cervical spine injuries decreased during this period. The rates of injury were 2.1 per 100,000 players per year during the 1996-1997 season and 1.4 during the 2005-2006 season (P scrum was a major cause of injury, accounting for 51.3% (19/37). The forwards represented 89.2% (33/37) of the injured players. The hookers were involved in 37.8% (14/37) of the cases. The measures of prevention with the modification of the rules of scrum and the creation of a medical certificate required for players to play in the front row must have been successful. The incidence of disabling cervical spine injuries in French rugby has decreased for the last 10 years, which is linked to the decreasing incidence of injuries in the scrum. This epidemiological study shows the effectiveness of the preventive measures on cervical spine injuries in French rugby players. A national register of catastrophic cervical spine injuries extends our epidemiological observations.

  10. 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.

  11. Cervical Spine Injuries - Numerical Analyses and Statistical Survey

    OpenAIRE

    2002-01-01

    Injuries to the neck, or cervical region, are very importantsince there is a potential risk of damage to the spinal cord.Any neck injury can have devastating if not life threateningconsequences. High-speed transportation as well as leisure-timeadventures have increased the number of serious neck injuriesand made us increasingly aware of its consequences.Surveillance systems and epidemiological studies are importantprerequisites in defining the scope of the problem. Thedevelopment of mechanica...

  12. 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.

  13. Risk Factors for Medical Complication after Cervical Spine Surgery: a multivariate analysis of 582 patients

    Science.gov (United States)

    Lee, Michael J.; Konodi, Mark A.; Cizik, Amy M.; Weinreich, Mark A.; Bransford, Richard J.; Bellabarba, Carlo; Chapman, Jens

    2012-01-01

    Study Design Multivariate analysis of prospectively collected registry data Objective Using multivariate analysis, to determine significant risk factors for medical complication after cervical spine surgery. Summary of Background Data Several studies have examined the occurrence of medical complication after spine surgery. However many of these studies have been done utilizing large national databases. While these allow for analysis of thousands of patients, potentially influential co-variates are not accounted for in these retrospective studies. Furthermore, the accuracy of these retrospective data collection in these databases has been called into question. Methods The Spine End Results Registry (2003–2004) is a collection prospectively collected data on all patients who underwent spine surgery at our two institutions. Extensive demographic and medical information were prospectively recorded as described previously by Mirza et al. Complications were defined in detail a priori and were prospectively recorded for at least 2 years after surgery. We analyzed risk factors for medical complication after lumbar spine surgery using univariate and multivariate analysis. Results We analayzed data from 582 patients who met out inclusion criteria. The cumulative incidences of complication after cervical spine surgery per organ system are as follows: cardiac – 8.4%, pulmonary – 13%, gastrointestinal – 3.9%, neurological – 7.4%, hematological – 10.8% and urologic complications – 9.2%. The occurrence of cardiac or respiratory complication after cervical spine surgery was significantly associated with death within 2 years (RR 4.32, 6.43 respectively). Relative risk values with 95% confidence intervals and p values are listed individually in Tables 2 and 3. Conclusion Risk factors identified in this study can be beneficial to clinicians and patients alike when considering surgical treatment of the cervical spine. Future analyses and models that predict the

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

    Directory of Open Access Journals (Sweden)

    G.R. Bahadorkhan

    2009-04-01

    Full Text Available ObjectivesMajor 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 & MethodsOne 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 groupsResultsThe 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. None

  15. LEVEL OF EVIDENCE IN THE PLACEMENT OF TRANSPEDICULAR SCREWS IN SUBAXIAL CERVICAL SPINE

    Directory of Open Access Journals (Sweden)

    Cristóbal Herrera Palacios

    Full Text Available ABSTRACT The high-energy trauma mainly involves vertebral lesions and 6% occur in the cervical region. This poses a challenge to spine surgeons in surgical decision-making, both in terms of approach as the instrumentation. International recommendations establish that the procedures performed are reproducible, safe, and effective. The techniques for placement of pedicle screws are complicated and have been based on intraoperative navigation (limited by cost and fluoroscopy (greater exposure of health care professionals and patients to radiation. Therefore, the freehand technique is an option. The goal was to identify the level of evidence and grade of recommendation in the medical literature regarding the safety and efficacy of pedicle screw instrumentation with freehand technique in subaxial cervical spine. To this end, we carried out a systematic review with the following MeSH terms: safety, efficacy, vertebral artery. Articles were evaluated twice in a standardized and blind way by two observers skilled in systematic analysis, after CLEIS 3401 authorization in November 2014. Due to the nature of the study and the variables, articles with a high level of evidence and grade of recommendation were not found. Level of Evidence obtained on safety and efficacy in the placement of pedicle screws in subaxial column with freehand technique: 2b. Degree of Recommendation obtained on safety and efficacy in the placement of pedicle screws in subaxial column with freehand technique: B, favorable recommendation.

  16. An Upper and Middle Cervical Spine Posterior Arch Defect Leading to Myelopathy and a Thoracic Spine Posterior Arch Defect.

    Science.gov (United States)

    Yun, Dong-Ju; Hwang, Byeong-Wook; Kim, Dae Jin; Lee, Sang-Ho

    2016-09-01

    Abnormalities of the posterior arches of the upper and middle cervical spine that can cause myelopathy are rare, and no reports of such defects at the thoracic spinal level have been published. A 29-year-old male patient reported right arm weakness and pain for 1 year. Magnetic resonance imaging of the cervical spine showed spinal canal stenosis at the C3-4 and C4-5 levels, as well as a posterior arch defect at the C2, 3, and 4 levels that was compressing the spinal cord. Three-dimensional cervical computed tomography (CT) showed that the spinous process and a piece of lamina were fused at each of the posterior C2, 3, and 4 levels, producing a free-floating bony structure. Spina bifida occulta was observed at C1. Osseous formation had failed between the lateral mass and spinous process at the C2 and C3 levels bilaterally, and the C4 level unilaterally. Three-dimensional thoracolumbar CT showed blocked vertebrae and spinous process fusion at T11 and T12. Osseous formation had failed between the lamina and spinous process at the T11 level unilaterally, and the T12 level bilaterally. The free-floating bony structure was successfully removed surgically. A posterior arch defect of the upper and middle cervical spine leading to myelopathy combined with the same defect at the thoracic spine is a rare disease. If this congenital defect is detected at any spinal level, whole-spine CT can be helpful for accurately diagnosing the congenital anomaly. Copyright © 2016 Elsevier Inc. All rights reserved.

  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. 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.

  19. Study Effect of Different Endotracheal Intubation General Anesthesia in High Cervical Spine Fracture With Cervical Spinal Cord Injury%不同气管插管全麻方式应用于高位颈椎骨折伴颈髓损伤的效果研究

    Institute of Scientific and Technical Information of China (English)

    刘卫忠

    2015-01-01

    Objective To investigate the effect of different endotracheal intubation and general anesthesia in high cervical spine fracture with cervical spinal cord injury.Methods 75 patients were randomly divided into three groups, and compared the cervical lfexion degree change, intubation time, the time of the exposure and the success rate of one intubation. Results The three groups of intubation time and glottic exposure time,t he laryngeal mask group intubation time and glottis exposure for the longest time, shikani laryngoscope group was the shortest,P0.05, had no difference statistically significance.Conclusion Shikani laryngoscope in high cervical spine fracture with cervical spinal cord injury of tracheal intubation with intubation laryngeal mask and direct laryngoscope has more advantages.%目的 探讨不同气管插管全麻方式应用于高位颈椎骨折伴颈髓损伤的效果.方法 将75例患者随机分为3组,并比较颈椎屈曲度变化、插管时间、声门显露时间和一次插管成功率.结果 3组插管时间和声门暴露时间比较,插管型喉罩组插管时间和声门暴露时间最长,视可尼喉镜组最短,P<0.05,差异具有统计学意义;在暴露声门时,视可尼喉镜组和插管型喉罩组颈椎屈曲度变化低于直接喉镜组,P<0.05,差异具有统计学意义,气管插入后,视可尼喉镜组颈椎屈曲度变化低于直接喉镜组,P < 0.05,差异具有统计学意义.三种方式在一次插管成功率方面对比,P > 0.05,差异不具有统计学意义.结论 视可尼喉镜在高位颈椎骨折伴颈髓损伤气管插管中较插管性喉罩和直接喉镜有更优势.

  20. 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

  1. The Study of Cobb Angular Velocity in Cervical Spine during Dynamic Extension-Flexion.

    Science.gov (United States)

    Ren, Dong; Hu, Zhihao; Yuan, Wen

    2016-04-01

    A kinematic study of cervical spine. The aim of the study was to confirm the interesting manifestation observed in the dynamic images of the cervical spine movement from full-extension to full-flexion. To further explore the fine motion of total process of cervical spine movement with the new concept of Cobb angular velocity (CAV). Traditionally range of motion (ROM) is used to describe the cervical spine movement from extension to flexion. It is performed with only end position radiographs. However, these radiographs fail to explain how the elaborate movement happens. The dynamic images of the cervical spine movement from full-extension to full-flexion of 12 asymptomatic subjects were collected. After transforming these dynamic images to static lateral radiographs, we overlapped C7 cervical vertebrae of each subject and divided the total process of cervical spine movement into five equal partitions. Finally, CAV values from C2/3 to C6/7 were measured and analyzed. A broken line graph was created based on the data of CAV values. A simple motion process was observed in C2/3 and C3/4 segments. The motion processes of C4/5 and C5/6 segments exhibited a more complex track of "N" and "W" than the other segments. The peak CAV values of C4/5 and C5/6 were significantly greater than the other segments. From C2/3 to C6/7, the peak CAV value appeared in sequence. The intervertebral movements of cervical spine did not take a uniform motion form when the cervical spine moved from full-extension to full-flexion. From C2/3 to C6/7, the peak CAV value appeared in order. The C4/5 and C5/6 segments exhibited more complex kinematic characteristics in sagittal movement. This leads to C4/5 and C5/6 more vulnerable to injury and degeneration. We had a hypothesis that there was a positive correlation between injury/degeneration and complexity of intervertebral movement in the view of CAV. N/A.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1986-08-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2001-05-01

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

  4. Functional turbo spin echo magnetic resonance imaging versus tomography for evaluating cervical spine involvement in rheumatoid arthritis

    NARCIS (Netherlands)

    Oostveen, JCM; Roozeboom, AR; van de Laar, MAFJ; Heeres, J; den Boer, JA; Lindeboom, SF

    1998-01-01

    Study Design. Comparison of findings in plain radiography and conventional tomography with findings in plain radiography and magnetic resonance imaging of the upper cervical spine in consecutive patients with rheumatoid arthritis and with known or suspected abnormalities of the cervical spine. Objec

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

    Science.gov (United States)

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

    2013-12-01

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

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

    Science.gov (United States)

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

    2016-08-01

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

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

    Science.gov (United States)

    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.

  8. 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.

  9. Clearing the Cervical Spine in a War Zone: What Other Injuries Matter?

    Science.gov (United States)

    2015-07-01

    NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) USAF School of Aerospace Medicine...negative clinical examination of the cervical spine. Coexisting injuries identified in patients with negative physical examination included...injuries in proximity to the neck (head, thoracic spine, chest, or humerus) in 17 (85%) patients. In 3 patients(15%), coexisting injuries were not in

  10. Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

    OpenAIRE

    2011-01-01

    The aim of this study is to quantify the changes in the sagittal alignment of the cervical spine in patients with adolescent idiopathic scoliosis following posterior spinal fusion. Patients eligible for study inclusion included those with a diagnosis of mainly thoracic adolescent idiopathic scoliosis treated by means of posterior multisegmented hook and screw instrumentation. Pre and post-operative anterior–posterior and lateral radiographs of the entire spine were reviewed to assess the chan...

  11. The assessment of the cervical spine. Part 1: Range of motion and proprioception.

    Science.gov (United States)

    Strimpakos, Nikolaos

    2011-01-01

    Neck pain and headache of cervical origin are complaints affecting an increasing number of the general population. Mechanical factors such as sustained neck postures or movements and long-term "abnormal" physiologic loads on the neck are believed to affect the cervical structures and compromise neck function. A comprehensive assessment of neck function requires evaluation of its physical parameters such as range of motion, proprioception, strength and endurance/fatigue. The complicated structure of the cervical spine however, makes it difficult for any clinician to obtain reliable and valid results. The aim of the first part of this systematic critical review is to identify the factors influencing the assessment of range of motion and proprioception of the cervical spine.

  12. Assessment of MR signal intensity of cranium and cervical spine bone marrow

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Min; Joh, Young Duk; Huh, Jin Do; Kim, So Sun [Kosin Medical College, Pusan (Korea, Republic of)

    1993-11-15

    The components of bore marrow change dramatically during lifetime. To evaluate the bone marrow of cranium and upper cervical spine, the authors retrospectively evaluated 300 examinations of cranium and the second cervical bone in patients without known bone marrow abnormality. T1-weighted images were used to analyze the changes of lone marrow signal intensity according to the age and sex. The signal intensity of bone marrow of cranium increased most rapidly from birth to age of 10 years. Between 11 and 20 years of age, gradual increase of signal intensity was noted. There was minimal augment of signal intensity after age of 20 tears. The examination of signal intensity of bone marrow of the cranium revealed slightly higher score in male than in female. The synchondrosis of the second cervical vertebra was visible in 97%. These results may be useful in the detection of abnormal bone marrow signal of cranium and upper cervical spine.

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

    Science.gov (United States)

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

    2014-05-01

    From a comparative study of 222 human and 261 nonhuman primates complete cervical spines, two bony variants associated to the course of the vertebral artery are proposed as unique to genus Homo within primates. First, the opening of the foramen transversarium at C2, a trait present at low frequency in humans (3 to 5.6%). Second, the presence of a bipartite foramen transversarium in the cervical segment C3-C6, a trait that can be observed fully formed in human fetal skeletons, with a clear frequency pattern along the cervical spine (C3>C4>C5>C6primate cervical spine.

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

    Directory of Open Access Journals (Sweden)

    Young Jun Lee

    2013-01-01

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

  15. Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis.

    Science.gov (United States)

    Canavese, Federico; Turcot, Katia; De Rosa, Vincenzo; de Coulon, Geraldo; Kaelin, André

    2011-07-01

    The aim of this study is to quantify the changes in the sagittal alignment of the cervical spine in patients with adolescent idiopathic scoliosis following posterior spinal fusion. Patients eligible for study inclusion included those with a diagnosis of mainly thoracic adolescent idiopathic scoliosis treated by means of posterior multisegmented hook and screw instrumentation. Pre and post-operative anterior-posterior and lateral radiographs of the entire spine were reviewed to assess the changes of cervical sagittal alignment. Thirty-two patients (3 boys, 29 girls) met the inclusion criteria for the study. The average pre-operative cervical sagittal alignment (CSA) was 4.0° ± 12.3° (range -30° to 40°) of lordosis. Postoperatively, the average CSA was 1.7° ± 11.4° (range -24° to 30°). After surgery, it was less than 20° in 27 patients (84.4%) and between 20° and 40° in 5 patients (15.6%). The results of the present study suggest that even if rod precontouring is performed and postoperative thoracic sagittal alignment is restored, improved or remains unchanged after significant correction of the deformity on the frontal plane, the inherent rigidity of the cervical spine limits changes in the CSA as the cervical spine becomes rigid over time.

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

    OpenAIRE

    2015-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  18. Male and Female Cervical Spine Biomechanics and Anatomy: Implication for Scaling Injury Criteria.

    Science.gov (United States)

    Yoganandan, Narayan; Bass, Cameron R; Voo, Liming; Pintar, Frank A

    2017-05-01

    There is an increased need to develop female-specific injury criteria and anthropomorphic test devices (dummies) for military and automotive environments, especially as women take occupational roles traditionally reserved for men. Although some exhaustive reviews on the biomechanics and injuries of the human spine have appeared in clinical and bioengineering literatures, focus has been largely ignored on the difference between male and female cervical spine responses and characteristics. Current neck injury criteria for automotive dummies for assessing crashworthiness and occupant safety are obtained from animal and human cadaver experiments, computational modeling, and human volunteer studies. They are also used in the military. Since the average human female spines are smaller than average male spines, metrics specific to the female population may be derived using simple geometric scaling, based on the assumption that male and female spines are geometrically scalable. However, as described in this technical brief, studies have shown that the biomechanical responses between males and females do not obey strict geometric similitude. Anatomical differences in terms of the structural component geometry are also different between the two cervical spines. Postural, physiological, and motion responses under automotive scenarios are also different. This technical brief, focused on such nonuniform differences, underscores the need to conduct female spine-specific evaluations/experiments to derive injury criteria for this important group of the population.

  19. Motion generated in the unstable cervical spine during the application and removal of cervical immobilization collars.

    Science.gov (United States)

    Prasarn, Mark L; Conrad, Bryan; Del Rossi, Gianluca; Horodyski, MaryBeth; Rechtine, Glenn R

    2012-06-01

    Many studies have compared the restriction of motion that immobilization collars provide to the injured victim. No previous investigation has assessed the amount of motion that is generated during the fitting and removal process. The purpose of this study was to compare the three-dimensional motion generated when one-piece and two-piece cervical collars are applied and removed from cadavers intact and with unstable cervical spine injuries. Five fresh, lightly embalmed cadavers were tested three times each with either a one-piece or two-piece cervical collar in the supine position. Testing was performed in the intact state, following creation of a global ligamentous instability at C5-C6. The amount of angular motion resulting from the collar application and removal was measured using a Fastrak, three-dimensional, electromagnetic motion analysis device (Polhemus Inc., Colchester, VT). The measurements recorded in this investigation included maximum values for flexion/extension, axial rotation, medial/lateral flexion, anterior/posterior displacement, axial distraction, and medial/lateral displacement at the level of instability. There was statistically more motion observed with application or removal of either collar following the creation of a global instability. During application, there was a statistically significant difference in flexion/extension between the one-piece (1.8 degrees) and two-piece (2.6 degrees) collars, p = 0.009. There was also a statistically significant difference in anterior/posterior translation between the one-piece (3.6 mm) and two-piece (3.4 mm) collars, p = 0.015. The maximum angulation and displacement during the application of either collar was 3.4 degrees and 4.4 mm. Statistical analysis revealed no significant differences between the one-piece and two-piece collars during the removal process. The maximum angulation and displacement during removal of either collar type was 1.6 degrees and 2.9 mm. There were statistically significant

  20. Multi-Level 3D Printing Implant For Reconstructing Cervical Spine With Metastatic Papillary Thyroid Carcinoma.

    Science.gov (United States)

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

    2017-05-11

    A unique case report. A three-dimensional (3D) printing technology is proposed for reconstructing multi-level cervical spine (C2-C4) after resection of metastatic papillary thyroid carcinoma in a middle-age female patient. Papillary thyroid carcinoma is a malignant neoplasm with a relatively favorable prognosis. A metastatic lesion in multi-level cervical spine (C2-C4) destroys neurological functions and causes local instability. Radical excision of the metastasis and reconstruction of the cervical vertebrae sequence conforms with therapeutic principles, while the special-shaped multi-level upper-cervical spine requires personalized implants. 3D printing is an additive manufacturing technology that produces personalized products by accurately layering material under digital model control via a computer. Reporting of this recent technology for reconstructing multi-level cervical spine (C2-C4) is rare in the literature. Anterior-posterior surgery was performed in one stage. Radical resection of the metastatic lesion (C2-C4) and thyroid gland, along with insertion of a personalized implant manufactured by 3D printing technology, were performed to rebuild the cervical spine sequences. The porous implant was printed in Ti6AL4 V with perfect physicochemical properties and biological performance, such as biocompatibility and osteogenic activity. Finally, lateral mass screw fixation was performed via a posterior approach. Patient neurological function gradually improved after the surgery. The patient received 11/17 on the Japanese Orthopedic Association scale and ambulated with a personalized skull-neck-thorax orthosis on postoperative day 11. She received radioiodine I therapy. The plane X-rays and computed tomography revealed no implant displacement or subsidence at the 12-month follow-up mark. The presented case substantiates the use of 3D printing technology, which enables the personalization of products to solve unconventional problems in spinal surgery. 5.

  1. Distal Junctional Disease after Occipitothoracic Fusion for Rheumatoid Cervical Disorders: Correlation with Cervical Spine Sagittal Alignment.

    Science.gov (United States)

    Tanouchi, Tetsu; Shimizu, Takachika; Fueki, Keisuke; Ino, Masatake; Toda, Naofumi; Manabe, Nodoka; Itoh, Kanako

    2015-10-01

    Study Design Retrospective radiographic study. Objective We have performed occipitothoracic (OT) fusion for severe rheumatoid cervical disorders since 1991. In our previous study, we reported that the distal junctional disease occurred in patients with fusion of O-T4 or longer due to increased mechanical stress. The present study further evaluated the association between the distal junctional disease and the cervical spine sagittal alignment. Methods Among 60 consecutive OT fusion cases between 1991 and 2010, 24 patients who underwent O-T5 fusion were enrolled in this study. The patients were grouped based on whether they developed postoperative distal junctional disease (group F) or not (group N). We measured pre- and postoperative O-C2, C2-C7, and O-C7 angles and evaluated the association between these values and the occurrence of distal junctional disease. Results Seven (29%) of 24 patients developed adjacent-level vertebral fractures as distal junctional disease. In group F, the mean pre- and postoperative O-C2, C2-C7, and O-C7 angles were 12.1 and 16.8, 7.2 and 11.2, and 19.4 and 27.9 degrees, respectively. In group N, the mean pre- and postoperative O-C2, C2-C7, and O-C7 angles were 15.9 and 15.0, 4.9 and 5.8, and 21.0 and 20.9 degrees, respectively. There were no significant differences between the two groups. The difference in the O-C7 angle (postoperative angle - preoperative angle) in group F was significantly larger than that in group N (p = 0.04). Conclusion Excessive correction of the O-C7 angle (hyperlordotic alignment) is likely to cause postoperative distal junctional disease following the OT fusion.

  2. 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

  3. Usefulness of polyetheretherketone (PEEK) cage with plate augmentation for anterior arthrodesis in traumatic cervical spine injury.

    Science.gov (United States)

    Song, Kyung-Jin; Choi, Byung-Wan; Kim, Gyu-Hyung; Song, Ji-Hun

    2010-01-01

    cases went through additional surgery, two posterior fusions for delayed union and posterior instability and one AIF for adjacent level disease. The PEEK cage and additional plate fixation is a surgical procedure that decreases donor site morbidity, obtains high fusion rate with rigid fixation, and provides satisfactory clinical outcome for traumatic cervical spine injuries, regardless of the numbers of the involved levels. Copyright 2010 Elsevier Inc. All rights reserved.

  4. Cervical Spine Clearance in Pediatric Trauma Centers: The Need for Standardization and an Evidence-based Protocol.

    Science.gov (United States)

    Pannu, Gurpal S; Shah, Mitesh P; Herman, Marty J

    Cervical spine clearance in the pediatric trauma patient represents a particularly challenging task. Unfortunately, standardized clearance protocols for pediatric cervical clearance are poorly reported in the literature and imaging recommendations demonstrate considerable variability. With the use of a web-based survey, this study aims to define the methods utilized by pediatric trauma centers throughout North America. Specific attention was given to the identification of personnel responsible for cervical spine care, diagnostic imaging modalities used, and the presence or absence of a written pediatric cervical spine clearance protocol. A 10-question electronic survey was given to members of the newly formed Pediatric Cervical Spine Study Group, all of whom are active POSNA members. The survey was submitted via the online service SurveyMonkey (https://www.surveymonkey.com/r/7NVVQZR). The survey assessed the respondent's institution demographics, such as trauma level and services primarily responsible for consultation and operative management of cervical spine injuries. In addition, respondents were asked to identify the protocols and primary imaging modality used for cervical spine clearance. Finally, respondents were asked if their institution had a documented cervical spine clearance protocol. Of the 25 separate institutions evaluated, 21 were designated as level 1 trauma centers. Considerable variation was reported with regards to the primary service responsible for cervical spine clearance. General Surgery/Trauma (44%) is most commonly the primary service, followed by a rotating schedule (33%), Neurosugery (11%), and Orthopaedic Surgery (8%). Spine consults tend to be seen most commonly by a rotating schedule of Orthopaedic Surgery and Neurosurgery. The majority of responding institutions utilize computed tomographic imaging (46%) as the primary imaging modality, whereas 42% of hospitals used x-ray primarily. The remaining institutions reported using a

  5. Course of atlanto-axial involvement and disc narrowing of the cervical spine in rheumatoid arthritis

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    de Carvalho, A.; Graudal, H.

    1981-07-01

    In 188 patients with rheumatoid arthritis 585 radiological examinations of the cervical spine were performed. Subluxation of C1-2 was found more often than expected; it was often the only radiological change in that segment, and its degree was not related to the duration of the disease. Lateral radiographs taken in full flexion were important for the diagnosis. Age over 40 years at the onset of RA, increased ESR at least on one occasion and seropositivity were related to more severe degrees of involvement. The presence of subcutaneous nodules, high titres of the Rose-Waaler reaction and the presence of antinuclear antibodies had no definite relation to the degree of involvement.

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  7. An extension contracture of the cervical spine combined with headache: An unusual combination - A case report

    NARCIS (Netherlands)

    Geertzen, J.H.B.; Rietman, J.S.; Robinson, P.H.; Eisma, W.H.

    1996-01-01

    A case of a rare condition is reported. A 28-year old female had an extension contraction of the cervical spine in combination with a headache, secondary to a very tight nuchal ligament. There was no underlying disease. A surgical release relieved the complaints.

  8. Diagnostic accuracy of upper cervical spine instability tests: A systematic review

    NARCIS (Netherlands)

    N. Hutting (Nathan); G.G.M. Scholten-Peeters (Gwendolijne); V. Vijverman (Veerle); M.D.M. Keesenberg (Martin ); A.P. Verhagen (Arianne)

    2013-01-01

    textabstractBackground. Patients with neck pain, headache, torticollis, or neurological signs should be screened carefully for upper cervical spine instability, as these conditions are "red flags" for applying physical therapy interventions. However, little is known about the diagnostic accuracy of

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

    NARCIS (Netherlands)

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

    2013-01-01

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

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

    NARCIS (Netherlands)

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

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  13. A biomechanical model for the analysis of the cervical spine in static postures

    NARCIS (Netherlands)

    C.J. Snijders (Chris); G.A. Hoek van Dijke; E.R. Roosch (E.)

    1991-01-01

    textabstractTo gain a better understanding of the forces working on the cervical spine, a spatial biomechanical computer model was developed. The first part of our research was concerned with the development of a kinematic model to establish the axes of rotation and the mutual position of the head

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

    Directory of Open Access Journals (Sweden)

    Vestri Anna R

    2009-12-01

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

  15. Osteoradionecrosis of the subaxial cervical spine following treatment for head and neck carcinomas.

    Science.gov (United States)

    Khorsandi, A S; Su, H K; Mourad, W F; Urken, M L; Persky, M S; Lazarus, C L; Jacobson, A S

    2015-01-01

    To study MRI and positron emission tomography (PET)/CT imaging of osteoradionecrosis (ORN) of the subaxial cervical spine, a serious long-term complication of radiation therapy (RT) for head and neck cancers that can lead to pain, vertebral instability, myelopathy and cord compression. This is a single-institution retrospective review of patients diagnosed and treated for ORN of the subaxial cervical spine following surgery and radiation for head and neck cancer. We report PET/CT imaging and MRI for four patients, each with extensive treatment for recurrent head and neck cancer. Osteomyelitis (OM) and discitis are the end-stage manifestations of ORN of the subaxial spine. ORN of the subaxial spine has variable imaging appearance and needs to be differentiated from recurrent or metastatic disease. Surgical violation of the posterior pharyngeal wall on top of the compromised vasculature in patients treated heavily with RT may pre-dispose the subaxial cervical vertebrae to ORN, with possible resultant OM and discitis. MRI and PET/CT imaging are complimentary in this setting. PET/CT images may be misinterpreted in view of the history of head and neck cancer. MRI should be utilized for definitive diagnosis of OM and discitis in view of its imaging specificity. We identify the end-stage manifestation of ORN in the sub-axial spine on PET/CT and MRI to facilitate its correct diagnosis.

  16. MDCT of acute subaxial cervical spine trauma: a mechanism-based approach.

    Science.gov (United States)

    Raniga, Sameer B; Menon, Venugopal; Al Muzahmi, Khamis S; Butt, Sajid

    2014-06-01

    Injuries to the spinal column are common and road traffic accidents are the commonest cause. Subaxial cervical spine (C3-C7) trauma encompasses a wide spectrum of osseous and ligamentous injuries, in addition to being frequently associated with neurological injury. Multidetector computed tomography (MDCT) is routinely performed to evaluate acute cervical spine trauma, very often as first-line imaging. MDCT provides an insight into the injury morphology, which in turn reflects the mechanics of injury. This article will review the fundamental biomechanical forces underlying the common subaxial spine injuries and resultant injury patterns or "fingerprints" on MDCT. This systematic and focused analysis enables a more accurate and rapid interpretation of cervical spine CT examinations. Mechanical considerations are important in most clinical and surgical decisions to adequately realign the spine, to prevent neurological deterioration and to facilitate appropriate stabilisation. This review will emphasise the variables on CT that affect the surgical management, as well as imaging "pearls" in differentiating "look-alike" lesions with different surgical implications. It will also enable the radiologist in writing clinically relevant CT reports of cervical spine trauma. Teaching Points • Vertebral bodies and disc bear the axial compression forces, while the ligaments bear the distraction forces.• Compressive forces result in fracture and distractive forces result in ligamentous disruption.• Bilateral facet dislocation is the most severe injury of the flexion-distraction spectrum.• Biomechanics-based CT reading will help to rapidly and accurately identify the entire spectrum of injury.• This approach also helps to differentiate look-alike injuries with different clinical implications.

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

    Directory of Open Access Journals (Sweden)

    Pankaj Gupta

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Lisa M Poole

    2017-01-01

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

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

    Science.gov (United States)

    Poole, Lisa M.; Le, Phong; Drake, Rachel M.; Helmer, Stephen D.; Haan, James M.

    2017-01-01

    Background: Cervical spine fractures occur in 2.6% to 4.7% of trauma patients aged 65 years or older. Mortality rates in this population ranges from 19% to 24%. A few studies have specifically looked at dysphagia in elderly patients with cervical spine injury. Aims: The aim of this study is to evaluate dysphagia, disposition, and mortality in elderly patients with cervical spine injury. Settings and Design: Retrospective review at an the American College of Surgeons-verified level 1 trauma center. Methods: Patients 65 years or older with cervical spine fracture, either isolated or in association with other minor injuries were included in the study. Data included demographics, injury details, neurologic deficits, dysphagia evaluation and treatment, hospitalization details, and outcomes. Statistical Analysis: Categorical and continuous data were analyzed using Chi-square analysis and one-way analysis of variance, respectively. Results: Of 136 patients in this study, 2 (1.5%) had a sensory deficit alone, 4 (2.9%) had a motor deficit alone, and 4 (2.9%) had a combined sensory and motor deficit. Nearly one-third of patients (n = 43, 31.6%) underwent formal swallow evaluation, and 4 (2.9%) had a nasogastric tube or Dobhoff tube placed for enteral nutrition, whereas eight others (5.9%) had a gastrostomy tube or percutaneous endoscopic gastrostomy tube placed. Most patients were discharged to a skilled nursing unit (n = 50, 36.8%), or to home or home with home health (n = 48, 35.3%). Seven patients (5.1%) died in the hospital, and eight more (5.9%) were transferred to hospice. Conclusion: Cervical spine injury in the elderly patient can lead to significant consequences, including dysphagia and need for skilled nursing care at discharge. PMID:28243007

  20. 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.

  1. Dwarf with dual spinal kyphotic deformity at the cervical and dorsal spine unassociated with odontoid hypoplasia: Surgical management

    Directory of Open Access Journals (Sweden)

    Guru Dutta Satyarthee

    2016-01-01

    Full Text Available Morquio's syndrome is associated with systemic skeletal hypoplasia leading to generalized skeletal deformation. The hypoplasia of odontoid process is frequent association, which is responsible for atlantoaxial dislocation causing compressive myelopathy. However, development of sub-axial cervical kyphotic deformity unassociated with odontoid hypoplasia is extremely rare, and coexistence of dorsal kyphotic deformity is not reported in the western literature till date and represents first case. Current case is 16-year-old boy, who presented with severe kyphotic deformity of cervical spine with spastic quadriparesis. Interestingly, he also had additional asymptomatic kyphotic deformity of dorsal spine; however, odontoid proves hypoplasia was not observed. He was only symptomatic for cervical compression, accordingly surgery was planned. The patient was planned for correction of cervical kyphotic deformity under general anesthesia, underwent fourth cervical corpectomy with resection of posterior longitudinal ligament and fusion with autologous bone graft derived from right fibula, which was refashioned approximating to the width of the corpectomy size after harvesting and fixed between C3 and C5 vertebral bodies and further secured with anterior cervical plating. He tolerated surgical procedure well with improvement in power with significant reduction in spasticity. Postoperative X-ray, cervical spine revealed complete correction of kyphotic deformity cervical spine. At follow-up 6 months following surgery, he is doing well. Successful surgical correction of symptomatic cervical kyphotic deformity can be achieved utilizing anterior cervical corpectomy, autologous fibular bone graft, and anterior cervical plating.

  2. Dwarf with dual spinal kyphotic deformity at the cervical and dorsal spine unassociated with odontoid hypoplasia: Surgical management

    Science.gov (United States)

    Satyarthee, Guru Dutta; Mankotia, Dipanker Singh

    2016-01-01

    Morquio's syndrome is associated with systemic skeletal hypoplasia leading to generalized skeletal deformation. The hypoplasia of odontoid process is frequent association, which is responsible for atlantoaxial dislocation causing compressive myelopathy. However, development of sub-axial cervical kyphotic deformity unassociated with odontoid hypoplasia is extremely rare, and coexistence of dorsal kyphotic deformity is not reported in the western literature till date and represents first case. Current case is 16-year-old boy, who presented with severe kyphotic deformity of cervical spine with spastic quadriparesis. Interestingly, he also had additional asymptomatic kyphotic deformity of dorsal spine; however, odontoid proves hypoplasia was not observed. He was only symptomatic for cervical compression, accordingly surgery was planned. The patient was planned for correction of cervical kyphotic deformity under general anesthesia, underwent fourth cervical corpectomy with resection of posterior longitudinal ligament and fusion with autologous bone graft derived from right fibula, which was refashioned approximating to the width of the corpectomy size after harvesting and fixed between C3 and C5 vertebral bodies and further secured with anterior cervical plating. He tolerated surgical procedure well with improvement in power with significant reduction in spasticity. Postoperative X-ray, cervical spine revealed complete correction of kyphotic deformity cervical spine. At follow-up 6 months following surgery, he is doing well. Successful surgical correction of symptomatic cervical kyphotic deformity can be achieved utilizing anterior cervical corpectomy, autologous fibular bone graft, and anterior cervical plating. PMID:27857796

  3. Diagnostic value of high resolutional computed tomography of spine

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    Yang, S. M.; Im, S. K.; Sohn, M. H.; Lim, K. Y.; Kim, J. K.; Choi, K. C. [Jeonbug National University College of Medicine, Seoul (Korea, Republic of)

    1984-03-15

    Non-enhanced high resolution computed tomography provide clear visualization of soft tissue in the canal and bony details of spine, particularly of the lumbar spine. We observed 70 cases of spine CT using GE CT/T 8800 scanner during the period from Dec. 1982 to Sep. 1983 at Jeonbug National University Hospital. The results were as follows: 1. The sex distribution of cases were 55 males and 15 females : age was from 17 years to 67 years; sites were 11 cervical spine, 5 thoracic spine and 54 lumbosacral spine. 2. CT diagnosis showed 44 cases of lumbar disc herniation, 7 cases of degenerative disease, 3 cases of spine fracture and each 1 cases of cord tumor, metastatic tumor, spontaneous epidural hemorrhage, epidural abscess, spine tbc., meningocele with diastematomyelia. 3. Sites of herniated nucleus pulposus were 34 cases (59.6%) between L4-5 interspace and 20 cases (35.1%) between L5-S1 interspace. 13 cases (29.5%) of lumbar disc herniation disclosed multiple lesions. Location of herniation were central type in 28 cases(49.1%), right-central type in 12 cases(21.2%), left-central type in 11 cases (19.2%) and far lateral type in 6 cases(10.5%). 4. CT findings of herniated nucleus pulposus were as follows : focal protrusion of posterior disc margin and obliteration of anterior epidural fat in all cases, dural sac indentation in 26 cases(45.6%), soft tissue mass in epidural fat in 21 cases(36.8%), displacement or compression of nerve root sheath in 12 cases(21%). 5. Multiplanar reformatted images and Blink mode provide more effective evaluation about definite level and longitudinal dimension of lesion, such as obscure disc herniation, spine fracture, cord tumor and epidural abscess. 6. Non-enhanced and enhanced high resolutional computed tomography were effectively useful in demonstrating compression or displacement of spinal cord and nerve root, examing congenital anomaly such as meningocele and primary or metastatic spinal lesions.

  4. 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.

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

    Science.gov (United States)

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

    2015-09-01

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

  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. Motion within the unstable cervical spine during patient maneuvering: the neck pivot-shift phenomenon.

    Science.gov (United States)

    Lador, Ran; Ben-Galim, Peleg; Hipp, John A

    2011-01-01

    Cervical extrication collars are applied to millions of blunt trauma victims despite the lack of any evidence that a collar can protect against secondary injuries to the cervical spine. Cadaver studies support that in the presence of a dissociative injury, substantial motion can occur within the occipitocervical spine with collar application or during patient transfers. Little is known about the biomechanics of cervical stabilization; hence, it is difficult to develop and test improved immobilization strategies. Severe unstable injuries were created in seven fresh whole human cadavers. Rigid collars were applied with the body in a neutral position. Computed tomographic examinations were obtained before and after tilting the body or backboard as would be done during patient transport or to inspect the back. Relative displacements between vertebrae at the site of the injury were measured from the Computed tomographic examinations. The overall relative alignment between body and collar was assessed to understand the mechanisms that may facilitate motion at the injury site. Intervertebral motion averaged 7.7 mm±6.8 mm in the axial plain and 2.9 mm±2.5 mm in the cranial-caudal direction. The rigid collars appeared to create pivot points where the collar contacts the head in the region under the ear and where the collar contacts the shoulders. Rigid cervical collars appear to create pivot points that shift the center of rotation lateral to the spine and contribute to the intervertebral motions that were measured. Immobilization strategies that avoid these neck pivot-shift phenomena may help to reduce secondary injuries to the cervical spine. The whole cadaver model with simulation of patient maneuvers may provide an effective test method for cervical immobilization.

  8. Prolonged upright posture induces degenerative changes in intervertebral discs of rat cervical spine.

    Science.gov (United States)

    Liang, Qian-Qian; Cui, Xue-Jun; Xi, Zhi-Jie; Bian, Qin; Hou, Wei; Zhao, Yong-Jian; Shi, Qi; Wang, Yong-Jun

    2011-01-01

    An in vivo study of the cervical intervertebral discs (IVDs) response to upright posture was performed using an amputated bipedal rat model. To investigate the effects of upright posture on IVDs of rat cervical spine. The distinct arrangement of human neck muscle from that of cat and rhesus indicated that in the evolution process, upright posture might have affected cervical spine of human ancestors. However, the effects of upright posture on cervical spine have not been assessed. Forty-one-month-old rats were randomly divided into 5-month-control, 5-month-surgery, 7-month-control, and 7-month surgery group (n = 10 per group). Both forelimbs of 2 surgery group rats were amputated, and those rats were then induced to be upright in the custom-made cages. Two control group rats were kept in regular cages. These rats were respectively killed at the fifth and seventh month after surgery and the IVD samples of lumbar spine were harvested for histologic and immunohistochemical studies. Total RNA isolated from these samples were used for real-time polymerase chain reaction of type II collagen (Col2a1), type X collagen, matrix metalloproteinase 13 (MMP-13), MMP-3, aggre-can, and aggrecanase-2 (ADAMTS-5). Upright posture affects histologic changes of the cervical IVDs such as fissures of anulus fibrosus and decreased height of disc, decreased protein level of Col2a1 at nucleus pulposus and anulus fibrosus, up-regulated MMP-13, MMP-3, ADAMTS-5, and type X collagen mRNA expression, and downregulated mRNA expression of Col2a1 and aggrecan. Upright stance accelerates cervical disc degeneration in rats.

  9. Factors determining cervical spine sagittal balance in asymptomatic adults: correlation with spinopelvic balance and thoracic inlet alignment.

    Science.gov (United States)

    Lee, Sang-Hun; Son, Eun-Seok; Seo, Eun-Min; Suk, Kyung-Soo; Kim, Ki-Tack

    2015-04-01

    Based on the previous studies, cervical lordosis (CL) is a parameter influenced by thoracic kyphosis (TK); however, the correlations still remain unclear. Few studies have analyzed the correlations between the cervical spine lordosis and global spinopelvic balance. To date, there has been no study focused on the factors determining cervical spine sagittal balance. Seventy-seven asymptomatic volunteers without the history of symptoms related to whole spine. Statistical significance of correlations of radiographic parameters on cervical spine and whole-spine standing lateral radiograph. To analyze the factors determining cervical spine sagittal balance, including global spinopelvic balance and thoracic inlet (TI) alignment in asymptomatic adults. A prospective radiographic study. Cervical and whole-spine standing lateral radiographs were taken to analyze the following parameters: spinopelvic parameters pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and TK; TI parameters thoracic inlet angle (TIA) and T1 slope; and cervical spine parameters C0-C2, C2-C7, and C0-C7 angles and cervical tilting. Statistical analysis was performed using the Pearson correlation coefficients and multiple regression analysis. All the parameters showed a normal distribution. There was a significant sequential linkage between PI and SS (r=0.653), SS and LL (r=0.807), LL and TK (r=-0.516), and TK and C0-C7 angle (r=-0.322). There was a significant relationship between TK and T1 slope (r=0.351) but no significant relationship between TK and TIA. There were significant sequential relationships between TIA and T1 slope (r=0.694), T1 slope and C2-C7 angle (r=-0.624), and C2-C7 and C0-C2 angles (r=-0.547). T1 slope was the only parameter that demonstrated a significant correlation with both SP and TI parameters. A linear regression model showed that T1 slope had a stronger relationship with TIA (r=0.694) than TK (r=0.351). T1 slope was a key factor determining cervical spine

  10. Functional cervical MRI within the scope of whiplash injuries: presentation of a new motion device for the cervical spine.

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    Birnbaum, Klaus; Maus, Uwe; Tacke, Josef

    2010-02-01

    Frequently following a whiplash injury of the cervical spine, patients suffer from persistent pain symptoms. The MRI will in some of these cases show changes consistent with disk pathology or spinal stenosis, although in most instances the imaging studies will offer no adequate explanation for the described symptoms. The goal of our research was to develop and test a new MRI compatible device that will allow functional imaging of the cervical spine. A total of 30 patients with whiplash injuries were evaluated during the first 6 weeks following trauma with the functional MRI. The examination was carried out with a T2-weighted turbo spin-echo sequence utilizing a new apparatus consisting of an inflatable air bag contained in a Plexiglas housing. Thanks to a valve placed outside of the examination room, it was possible to individually regulate the amount of air used to fill the pillow, thereby obtaining a full range of motion between flexion and extension. In 25 cases no pathology was found during this examination. Two patients presented with scarring of the alar ligaments, indicative of a traumatic lesion. In two other instances the images in reclination revealed a bulging disk, while in one case a widening of the disk space was found as a sign for a rupture of the anterior longitudinal ligament. Our study was able to demonstrate the applicability of the new functional testing device, which permits a standardized, continuous and dynamic evaluation of the cervical spine in a closed MRI.

  11. 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

  12. Quantitative Analyses of Pediatric Cervical Spine Ossification Patterns Using Computed Tomography

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    Yoganandan, Narayan; Pintar, Frank A.; Lew, Sean M.; Rao, Raj D.; Rangarajan, Nagarajan

    2011-01-01

    The objective of the present study was to quantify ossification processes of the human pediatric cervical spine. Computed tomography images were obtained from a high resolution scanner according to clinical protocols. Bone window images were used to identify the presence of the primary synchondroses of the atlas, axis, and C3 vertebrae in 101 children. Principles of logistic regression were used to determine probability distributions as a function of subject age for each synchondrosis for each vertebra. The mean and 95% upper and 95% lower confidence intervals are given for each dataset delineating probability curves. Posterior ossifications preceded bilateral anterior closures of the synchondroses in all vertebrae. However, ossifications occurred at different ages. Logistic regression results for closures of different synchondrosis indicated p-values of vertebra. Fifty percent probability of three, two, and one synchondroses occurred at 2.53, 6.97, and 7.57 years of age for the atlas; 3.59, 4.74, and 5.7 years of age for the axis; and 1.28, 2.22, and 3.17 years of age for the third cervical vertebrae, respectively. Ossifications occurring at different ages indicate non-uniform maturations of bone growth/strength. They provide an anatomical rationale to reexamine dummies, scaling processes, and injury metrics for improved understanding of pediatric neck injuries PMID:22105393

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

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

    2016-02-15

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

  14. Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children.

    Science.gov (United States)

    Chaves, Thaís Cristina; Grossi, Débora Bevilaqua; de Oliveira, Anamaria Siriani; Bertolli, Fabiana; Holtz, Amanda; Costa, Dirceu

    2005-01-01

    Neck accessory respiratory muscles and mouth breathing suggest a direct relationship among asthma, Temporomandibular (TMD) and Cervical Spine (CSD) Disorders. This study was performed to evaluate and correlate TMD, CSD in asthmatic and non-asthmatic. Thirty asthmatic children (7.1 +/- 2.6 years old), 30 non-asthmatic predominantly mouth breathing children (Mouth Breathing Group - MBG) (8.80 +/- 1.61 years) and 30 non-asthmatic predominantly nasal breathing children (Nasal breathing Group - NBG) (9.00 +/- 1.64 years) participated in this study and they were submitted to clinical index to evaluate stomatognathic and cervical systems. Spearman correlation test and Chi-square were used. The level of significance was set at p temporomandibular joint (TMJ), TMJ sounds, pain during cervical extension and rotation, palpatory tenderness of sternocleidomastoids and paravertabrae muscles and a severe reduction in cervical range of motion were observed in AG. Both AG and MBG groups demonstrated palpatory tenderness of posterior TMJ, medial and lateral pterygoid, and trapezius muscles when compared to NBG. Results showed a positive correlation between the severity of TMD and CSD signs in asthmatic children (r = 0.48). No child was considered normal to CSD and cervical mobility. The possible shortening of neck accessory muscles of respiration and mouth breathing could explain the relationship observed between TMD, CSD signs in asthmatic children and emphasize the importance of the assessment of temporomandibular and cervical spine regions in asthmatic children.

  15. Effects of decreasing endotracheal tube cuff pressures during neck retraction for anterior cervical spine surgery.

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    Ratnaraj, Jebadurai; Todorov, Alexandre; McHugh, Tom; Cheng, Mary Ann; Lauryssen, Carl

    2002-09-01

    The authors' goal was to determine whether the incidence of postoperative sore throat, hoarseness, and dysphagia associated with anterior spine surgery is reduced by maintaining endotracheal tube cuff pressure (ETCP) at 20 mm Hg during the period of neck retraction. Fifty-one patients scheduled for anterior cervical spine surgery were enrolled. After intubation, ETCP was adjusted to 20 mm Hg in all patients. Following placement of neck retractors, ETCP was measured. Patients were randomized to a control (no adjustment) or treatment group (ETCP adjusted to 20 mm Hg). A blinded observer questioned the patients about the presence of sore throat, dysphagia, and hoarseness at 1 hour, 24 hours, and 1 week postoperatively. No differences between groups at 1 hour postoperatively were demonstrated. At 24 hours, 51% of patients in the treatment group complained of sore throat compared with 74% of control patients (p predictors of postoperative throat discomfort following anterior cervical spine surgery in which neck retraction is performed: increased ETCP during neck retraction (sore throat), neck retraction time (dysphagia), and female sex (sore throat and hoarseness). The simple maneuver of decreasing ETCP to 20 mm Hg may be helpful in improving patient comfort following anterior cervical spine surgery.

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

    Directory of Open Access Journals (Sweden)

    Andrei Fernandes Joaquim

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

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

    Science.gov (United States)

    Ohnmeiß, Maren; Kinzinger, Gero; Wesselbaum, Julia; Korbmacher-Steiner, Heike M

    2014-03-24

    Interactions between the cervical spine and the stomatognathic system have been discussed in literature. The present study was conducted to investigate whether, and to what extent, orthodontically induced mandibular advancement produces changes in cervical spine posture. Furthermore, possible appliance-specific effects should be distinguished. The cephalograms of 64 patients with skeletal class II were analysed before and after mandibular advancement. Linear and angular cephalometric parameters were identified to define the position of the atlanto-occipital and atlantoaxial joints. The total example was divided into two subgroups (comprising 32 individuals each) according to the employed appliance: activator versus bite-jump appliance (BJA). Student's t-test and analysis of covariance were used for statistical analysis. Overall, a significant straightening of the cervical spine was observed during the treatment. This conclusion is based on changes of Chamberlain (p = 0.0055), CVT (p = 0.0003), OPT (p spine changes. In the activator subgroup the observed effects were more pronounced than those in the BJA subgroup. Further studies including a control group comprised with non-treated class II patients are needed to assess whether these effects may be caused directly by the appliances irrespective of growth.

  18. Characteristics of Cervical Spine Trauma in Patients with Ankylosing Spondylitis and Ossification of the Posterior Longitudinal Ligament.

    Science.gov (United States)

    Lee, Chang Kyu; Yoon, Do Heum; Kim, Keung Nyun; Yi, Seong; Shin, Dong Ah; Kim, Byeongwoo; Lee, Nam; Ha, Yoon

    2016-12-01

    To compare the clinical characteristics of cervical spine trauma in patients with ankylosing spondylitis (AS) and cervical ossification of the posterior longitudinal ligament (OPLL) with those of a control group. A total of 124 patients with cervical spine trauma from January 2004 to December 2013 were reviewed. Fourteen patients were diagnosed with AS and 25 patients were diagnosed with OPLL; 85 patients were controls. C-spine plain radiography, computed tomography, and magnetic resonance imaging were obtained for evaluation of cervical spine trauma. The American Spinal Injury Association impairment scale and Subaxial Cervical Spine Injury Classification were used to evaluate the neurologic status of patients and the fracture mechanism. Patients with AS or OPLL had more spinal injuries associated with minor trauma than did the control group. All patients with AS had spinal fracture injuries after cervical spine trauma, but patients with OPLL mostly had spinal cord injuries without bony fractures. After cervical spine trauma, delayed diagnosis occurred in 3 patients with AS (21.4%) and 4 patients with OPLL (15.6%). Improvement from neurologic deficit after treatment showed better outcomes in patients with AS and OPLL than in controls (P = 0.106). Patients with AS or OPLL who had cervical spine trauma showed different characteristics and outcomes than control patients. Proper surgical treatment led to better outcomes in both patients with AS and patients with OPLL than in control patients. Moreover, it is important to thoroughly examine patients with AS or OPLL after cervical trauma so as not to delay diagnosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. An assessment of the most reliable method to estimate the sagittal alignment of the cervical spine: analysis of a prospective cohort of 138 cases.

    Science.gov (United States)

    Donk, Roland D; Fehlings, Michael G; Verhagen, Wim I M; Arnts, Hisse; Groenewoud, Hans; Verbeek, André L M; Bartels, Ronald H M A

    2017-05-01

    OBJECTIVE Although there is increasing recognition of the importance of cervical spinal sagittal balance, there is a lack of consensus as to the optimal method to accurately assess the cervical sagittal alignment. Cervical alignment is important for surgical decision making. Sagittal balance of the cervical spine is generally assessed using one of two methods; namely, measuring the angle between C-2 and C-7, and drawing a line between C-2 and C-7. Here, the best method to assess sagittal alignment of the cervical spine is investigated. METHODS Data from 138 patients enrolled in a randomized controlled trial (Procon) were analyzed. Two investigators independently measured the angle between C-2 and C-7 by using Harrison's posterior tangent method, and also estimated the shape of the sagittal curve by using a modified Toyama method. The mean angles of each quantitative assessment of the sagittal alignment were calculated and the results were compared. The interrater reliability for both methods was estimated using Cronbach's alpha. RESULTS For both methods the interrater reliability was high: for the posterior tangent method it was 0.907 and for the modified Toyama technique it was 0.984. For a lordotic cervical spine, defined by the modified Toyama method, the mean angle (defined by Harrison's posterior tangent method) was 23.4° ± 9.9° (range 0.4°-52.4°), for a kyphotic cervical spine it was -2.2° ± 9.2° (range -16.1° to 16.9°), and for a straight cervical spine it was 10.5° ± 8.2° (range -11° to 36°). CONCLUSIONS An absolute measurement of the angle between C-2 and C-7 does not unequivocally define the sagittal cervical alignment. As can be seen from the minimum and maximum values, even a positive angle between C-2 and C-7 could be present in a kyphotic spine. For this purpose, the modified Toyama method (drawing a line from the posterior inferior part of the vertebral body of C-2 to the posterior upper part of the vertebral body of C-7 without any

  20. Lower cervical spine injury treated with lateral mass plates and pedicle screws through posterior approach

    Institute of Scientific and Technical Information of China (English)

    ZHAO Xue-ling; ZHAO Hong-bin; WANG Bin; ZHU Xiao-song; LI Lin-zhi; ZHANG Chun-qiang

    2005-01-01

    Objective: To treat injury of the lower cervical spine C6 to C7 with cervical lateral mass plates and T1 pedicle screws through posterior approach. Methods: The data of 8 patients with lower cervical spine C6 or C7 injury (6 patients with fracture and dislocation in C6 and C7 and 2 with fracture in C7) were analyzed retrospectively in this study. For the preoperative American Spinal Injury Association (ASIA) classification, Grade C was found in 3 cases and Grade D in 5 cases. Screws were placed on the lateral masses and the first thoracic pedicle with Margerl technique. Lamina or facet bone allografting was used to achieve a long-term stability. Results: All the 8 patients were followed up for 5-37 months (mean: 15 months). No operative death occurred. There were no examples of aggravation of spinal cord injury or vertebral artery injury, cerebrospinal fluid leak, nerve roots injury, screw malposition or back-out, loose of alignment or implant failure. Clinical symptoms and ASIA classification were improved in all the patients. Postoperative MRI scanning confirmed the satisfactory screw placement in all the cases. Conclusions: Lateral mass plates and pedicle screws through posterior approach are safe and beneficial for patients with lower cervical spine C6 or C7 injury.

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

    Directory of Open Access Journals (Sweden)

    Iyore AO James

    2014-01-01

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

  2. Immediate effects of active cranio-cervical flexion exercise versus passive mobilisation of the upper cervical spine on pain and performance on the cranio-cervical flexion test.

    Science.gov (United States)

    Lluch, Enrique; Schomacher, Jochen; Gizzi, Leonardo; Petzke, Frank; Seegar, Dagmar; Falla, Deborah

    2014-02-01

    This study compared the immediate effects of an assisted plus active cranio-cervical flexion exercise (exercise group) versus a passive mobilisation plus assisted cranio-cervical flexion (mobilisation group) on performance of the cranio-cervical flexion test (CCFT), cervical range of motion (ROM) and pain in patients with chronic neck pain. Eighteen volunteers with chronic idiopathic neck pain participated in the study and were randomised to one of the two intervention groups. Current level of pain, cervical ROM and pain perceived during movement, pressure pain threshold (PPT) and surface electromyography (EMG) during performance of the CCFT were measured before and immediately after the intervention. A significant reduction in resting pain and PPT measured over cervical sites was observed immediately following both interventions, although a greater change was observed for the exercise group. No change in cervical ROM was observed after either intervention. Reduced sternocleidomastoid and anterior scalene EMG amplitude were observed during stages of the CCFT but only for the participants in the active exercise group. Although both active and passive interventions offered pain relief, only the exercise group improved on a task of motor function highlighting the importance of specific active treatment for improved motor control of the cervical spine.

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

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    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.)

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

    Directory of Open Access Journals (Sweden)

    Wildermuth Simon

    2010-11-01

    Full Text Available Abstract Background Congenital spinal abnormalities can easily be misdiagnosed on plain radiographs. Additional imaging is warranted in doubtful cases, especially in a setting of acute trauma. Case Presentation 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. Conclusion 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.

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

    Science.gov (United States)

    Guggenberger, Roman; Andreisek, Gustav; Scheffel, Hans; Wildermuth, Simon; Leschka, Sebastian; Stolzmann, Paul

    2010-11-09

    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.

  6. The role of allometry and posture in the evolution of the hominin subaxial cervical spine.

    Science.gov (United States)

    Arlegi, Mikel; Gómez-Olivencia, Asier; Albessard, Lou; Martínez, Ignacio; Balzeau, Antoine; Arsuaga, Juan Luis; Been, Ella

    2017-03-01

    Cervical vertebrae not only protect the spinal cord but also are the insertion and origin points for muscles related to the movement of the head, upper limb, and trunk, among others, and are thus important elements in primate evolution. While previous work has been undertaken on the first two cervical vertebrae, there is a dearth of studies on the subaxial cervical spine in hominines. In this paper, we provide detailed morphological information on two important aspects of the subaxial cervical vertebrae (C3 - C7): mid-sagittal morphology and superior facet orientation. We studied large samples of African apes including modern humans and the most complete fossil hominin subaxial cervical vertebrae using both traditional and geometric morphometrics. There are significant differences between extant hominoids related to the relative length and orientation of the spinous process as well as to the orientation of the articular facets, which are related to size, locomotion, and neck posture. In fact, fossil hominins do not completely conform to any of the extant groups. Our assessment of mid-sagittal morphology and superior articular facet orientation shows that australopiths have more Homo-like upper subaxial cervical vertebrae coupled with more "primitive" lower cervical vertebrae. Based on these results, we hypothesize that those changes, maybe related to postural changes derived from bipedalism, did not affect the entire subaxial cervical spine at once. From a methodological point of view, the combination of traditional and geometric morphometric data provides a more integrative perspective of morphological change and evolution, which is certainly useful in human evolutionary studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Simulated Pain and Cervical Motion in Patients with Chronic Disorders of the Cervical Spine

    OpenAIRE

    Zeevi Dvir; Noga Gal-Eshel; Boaz Shamir; Evgeny Pevzner; Chava Peretz; Nachshon Knoller

    2004-01-01

    The primary objective of the present study was to determine how simulated severe cervical pain affects cervical motion in patients suffering from two distinct chronic cervical disorders: whiplash (n=25) and degenerative changes (n=25). The second objective was to derive an index that would allow the differentiation of maximal from submaximal performances of cervical range of motion. Patients first performed maximal movement of the head (maximal effort) in each of the six primary directions an...

  8. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-01-01

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

  10. The relationship between the type of destructive spondyloarthropathy and its 10 years ago cervical spine alignment.

    Science.gov (United States)

    Maruyama, Koji; Matsuyama, Yukihiro; Yanase, Makoto; Sakai, Yoshihito; Katayama, Yoshito; Imagama, Shiro; Ito, Zenya; Wakao, Norimitsu; Yukawa, Yasutsugu; Ito, Keigo; Kamiya, Mitsuhiro; Kanemura, Tokumi; Sato, Koji; Ishiguro, Naoki

    2009-06-01

    The objective of this retrospective study was to analyze the relationship between the type of destructive spondyloarthropathy (DSA) and its 10 years ago cervical spine alignment. DSA was reported as a serious complication of long-term hemodialysis. Although previous reports in regard to risk factor of DSA dealt with the period of hemodialysis and the patient's age upon commencement of hemodialysis, we could not find any reports of the relationship between the type of DSA and its 10 years ago cervical spine alignment. In 96 DSA patients who were the subjects of our study, 8 patients were defined as stage 1, 39 patients as stage 2, 5 patients as stage 3 type A, 11 patients as stage 3 type B, and 33 patients as stage 3 type D. The C2/C7 angle of stage 3 type B was statistically low. The number of the abnormal local cervical alignment was larger in stage 3 types A and B. Multivariate analysis revealed that the risk factors of stage 3 types A and B were the C2/C7 angle and the existence of local abnormal alignment. Fifty-four patients were symptomatic due to DSA and treated at our hospital. Forty-four patients were treated conservatively with medications, physiotherapy, or wearing cervical brace. Ten patients underwent surgical treatment. The loss of physiological lordosis of cervical spine promoted the progression of DSA. Furthermore, the number of the abnormalities of local cervical alignment was statistically larger in stage 3 types A and B; they were the crucial factor promoting the progression of DSA stage 3 types A and B.

  11. 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)

  12. 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.

  13. Comparison of the laryngeal view during intubation using Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization and mouth opening limitation

    OpenAIRE

    Koh, Jae-Chul; Lee, Jong Seok; Lee, Youn-Woo; Chang, Chul Ho

    2010-01-01

    Background For patients suspicious of cervical spine injury, a Philadelphia cervical collar is usually applied. Application of Philadelphia cervical collar may cause difficult airway. The aim of this study was to evaluate the laryngeal view and the success rate at first intubation attempt of the Airtraq and conventional laryngoscopy in patients with simulated cervical spine injury after application of a Philadelphia cervical collar. Methods Anesthesia was induced with propofol, remifentanil, ...

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

    OpenAIRE

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

    2012-01-01

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

  15. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1984-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Rong Wang

    2017-06-01

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

  18. Dimensional changes of the neuroforamina in subaxial cervical spine during in vivo dynamic flexion-extension.

    Science.gov (United States)

    Mao, Haiqing; Driscoll, Sean J; Li, Jing-Sheng; Li, Guoan; Wood, Kirkham B; Cha, Thomas D

    2016-04-01

    Neuroforaminal stenosis is one of the key factors causing clinical symptoms in patients with cervical radiculopathy. Previous quantitative studies on the neuroforaminal dimensions have focused on measurements in a static position. Little is known about dimensional changes of the neuroforamina in the cervical spine during functional dynamic neck motion under physiological loading conditions. This study aimed to investigate the in vivo dimensional changes of the neuroforamina in human cervical spine (C3-C7) during dynamic flexion-extension neck motion. A case-control study was carried out. Ten asymptomatic subjects were recruited for this study. The cervical spine of each subject underwent magnetic resonance image scanning for construction of three-dimensional (3-D) vertebrae models from C3 to C7. The cervical spine was then imaged using a dual fluoroscopic system while the subject performed a dynamic flexion-extension neck motion in a sitting position. The 3-D vertebral models and the fluoroscopic images were used to reproduce the in vivo vertebral motion. The dimensions (area, height, and width) were measured for each cervical neuroforamen (C3/C4, C4/C5, C5/C6, and C6/C7) in the following functional positions: neutral position, maximal flexion, and maximal extension. Repeated measures analysis of variance and post hoc analysis were used to examine the differences between levels and positions. Compared with the neutral position, almost all dimensional parameters (area, height, and width) of the subaxial cervical neuroforamina decreased in extension and increased in flexion, except the neuroforaminal area at C5/C6 (p=.07), and the neuroforaminal height at C6/C7 (p=.05) remained relatively constant from neutral to extension. When comparisons of the overall change fromextension to flexion were made between segments, the overall changes of the neuroforaminal area and height revealed no significant differences between segments, and the width overall change of the upper

  19. 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

  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

    and specificity of the diagnostic procedure were also calculated. Results Kappa coefficients (K showed substantial overall agreement for identification of the segment of greatest hypomobility (K = 0.65, with substantial (K = 0.76 and moderate (K = 0.46 agreement for hypomobility at C2-3 and C5-6 respectively. Sensitivity ranged from 55% at the C5-6 CBV to 78% at the C2-3 level. Specificity of the procedure was high (91 – 98%. Conclusion This study indicates that relatively inexperienced examiners are capable of correctly identifying inter-segmental fixations (CBV in the cervical spine using 2 commonly employed motion palpation tests. The use of a 'gold standard' (CBV in this study and the substantial agreement achieved lends support to the validity of motion palpation in detecting major spinal fixations in the cervical spine.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-02-15

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

  2. 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.

  3. Fracture and Viscoelastic Characteristics of the Human Cervical Spine,

    Science.gov (United States)

    1986-01-01

    flexion moments ranging from -800 N-mm to - 4r 9000 N-mm with no dependence on cervical spinal level. In future testing, the angles of rotation should...loaded in compression while controlling the anterior-posterior shear load at zero and the flexion - extension angle at a constant setting. The final...specimen, tests were performed at fixed flexion -extension angles of 0 degrees, 2 degrees extension and 2 degrees flexion in sequence. The test lasted 1

  4. Surgical treatment of cervical spine trauma: Our experience and results

    Science.gov (United States)

    Dobran, Mauro; Iacoangeli, Maurizio; Nocchi, Niccolò; Di Rienzo, Alessandro; di Somma, Lucia Giovanna Maria; Nasi, Davide; Colasanti, Roberto; Al-Fay, Mohuammad; Scerrati, Massimo

    2015-01-01

    Objective and Background: The objective of this study is to evaluate how the neurological outcome in patients operated for cervical spinal cord injury (SCI) is influenced by surgical timing, admission American Spinal Injury Association (ASIA) grading system, and age. Materials and Methods: From January 2004 to December 2011, we operated 110 patients with cervical SCI. Fifty-seven of them (44 males and 13 females) with preoperative neurological deficit, were included in this study with a complete follow-up. Age, sex, associated comorbidities (evaluated with Charlson comorbidity index [CCI]), mechanism of trauma, preoperative and follow-up ASIA score, time elapsed from injury to surgical treatment, preoperative cervical computed tomography scan or magnetic resonance imaging, type of fractures, and surgical procedure were evaluated for each patient. The patient population was divided into two groups related to the timing of surgery: Ultra-early surgery group (within 12 h from the trauma, 27 patients) and early surgery (within 12–72 h from the trauma, 30 patients). Statistical Analysis Used: The univariate analysis of data was carried out by the Chi-square test for discrete variables, the t-test for the continuous ones. Logistic regression was used for the multivariate analysis. Results: Neurological outcome was statistically better in ultra-early surgery group (<12 h) than in patient underwent surgery within 12–72 h (82.14% vs. 31%, multivariate analysis P = 0.005). The neurological improvement was also correlated with the age and the ASIA grade at admission in the univariate analysis (P = 0.006 and P = 0.017 respectively) and in the multivariate 1 (P = 0.037 and P = 0.006 respectively) while the CCI was correlated with the improvement only in the univariate analysis (P = 0.007). Conclusion: Nowadays, in patients with cervical SCI early surgery could be associated with improved outcome, most in case of young people with mild neurological impairment. PMID:26396608

  5. The effect of lateral eccentricity on failure loads, kinematics, and canal occlusions of the cervical spine in axial loading.

    Science.gov (United States)

    Van Toen, C; Melnyk, A D; Street, J; Oxland, T R; Cripton, P A

    2014-03-21

    Current neck injury criteria do not include limits for lateral bending combined with axial compression and this has been observed as a clinically relevant mechanism, particularly for rollover motor vehicle crashes. The primary objectives of this study were to evaluate the effects of lateral eccentricity (the perpendicular distance from the axial force to the centre of the spine) on peak loads, kinematics, and spinal canal occlusions of subaxial cervical spine specimens tested in dynamic axial compression (0.5 m/s). Twelve 3-vertebra human cadaver cervical spine specimens were tested in two groups: low and high eccentricity with initial eccentricities of 1 and 150% of the lateral diameter of the vertebral body. Six-axis loads inferior to the specimen, kinematics of the superior-most vertebra, and spinal canal occlusions were measured. High speed video was collected and acoustic emission (AE) sensors were used to define the time of injury. The effects of eccentricity on peak loads, kinematics, and canal occlusions were evaluated using unpaired Student t-tests. The high eccentricity group had lower peak axial forces (1544 ± 629 vs. 4296 ± 1693 N), inferior displacements (0.2 ± 1.0 vs. 6.6 ± 2.0 mm), and canal occlusions (27 ± 5 vs. 53 ± 15%) and higher peak ipsilateral bending moments (53 ± 17 vs. 3 ± 18 Nm), ipsilateral bending rotations (22 ± 3 vs. 1 ± 2°), and ipsilateral displacements (4.5 ± 1.4 vs. -1.0 ± 1.3 mm, pcervical spine injuries with lateral eccentricities. © 2013 Published by Elsevier Ltd.

  6. When to suspect head injury or cervical spine injury in maxillofacial trauma?

    OpenAIRE

    Sajjad A Rahman; Soumithran Chandrasala

    2014-01-01

    Background: The global status report of the World Health Organization (WHO) on road safety suggested that India is leading in road traffic accidents in the world. According to the report on road accidents in India in 2010 by the Transport Research Wing, Ministry of Road Transport and Highways, New Delhi, Kerala ranked third in accidents per lakh population and second in persons injured per lakh population. As the face, brain, and cervical spine are in close proximity with one another, associa...

  7. 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.)

  8. 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.

  9. Cervical spine malformation in cornelia de lange syndrome: a report of three patients.

    Science.gov (United States)

    Bettini, Laura Rachele; Locatelli, Laura; Mariani, Milena; Cianci, Paola; Giussani, Carlo; Canonico, Francesco; Cereda, Anna; Russo, Silvia; Gervasini, Cristina; Biondi, Andrea; Selicorni, Angelo

    2014-06-01

    Cornelia de Lange syndrome (CdLS) is a complex genetic disease with skeletal involvement mostly related to upper limb malformations. We report on three males with clinical and molecular diagnoses of CdLS. Besides typical CdLS features, all showed different cervical spine malformations. To the best of our knowledge, this is an unusual malformation in the CdLS phenotypic spectrum. © 2014 Wiley Periodicals, Inc.

  10. Dry needling versus cervical spine manipulation combined with dry needling of infraspinatus muscle myofascial trigger points

    OpenAIRE

    2013-01-01

    M.Tech. (Chiropractic) Objective: The purpose of this study was to compare dry needling with cervical spine manipulation combined with dry needling, in the treatment of infraspinatus muscle myofascial trigger points. Study Design: This was a randomized experimental study Setting: The participants were treated at the University of Johannesburg chiropractic day clinic Subjects: 30 participants volunteered for the study. The participants were divided into groups by randomly drawing thirty num...

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

    OpenAIRE

    2013-01-01

    Objective. The objective of this study was to investigate the effect of a holistic intraoral appliance (OA) on cervical spine alignment and subjective symptom severity. Design. An observational study on case series with holistic OA therapy. Setting. An outpatient clinic for holistic temporomandibular joint (TMJ) therapy under the supervision of the Pain Center, CHA Biomedical center, CHA University. Subjects. Ambulatory patients presenting with diverse chief complaints in the holistic TMJ cli...

  12. A stiff collar can restrict atlantoaxial instability in rheumatoid cervical spine in selected cases.

    OpenAIRE

    Kauppi, M; Anttila, P.

    1995-01-01

    OBJECTIVE--To study the efficiency of a stiff collar in restricting the instability of anterior atlantoaxial subluxation (AAS). METHODS--Twenty two successive patients with an unstable AAS were studied. Lateral view radiographs were taken of the cervical spine in flexion, extension, and neutral positions without a collar, and in full flexion with a custom made stiff collar. RESULTS--The collar restricted more than 30% of the maximal instability of the AAS in 50% of the patients. These patient...

  13. Kinematic analysis of the lower cervical spine in the protracted and retracted neck flexion positions.

    Science.gov (United States)

    Park, So Hyun

    2015-01-01

    [Purpose] The aim of this study was to analyze lower cervical spine kinematics in protracted and retracted neck flexion positions in healthy people. [Subjects and Methods] The craniovertebral angle (CVA) and intervertebral body angles of the lower cervical spine of 10 healthy individuals were analyzed using fluoroscopy in a neutral sitting with the head in the neutral (N), protracted (Pro), and retracted (Ret) positions and with the neck in full flexion with the head in the neutral (N-fx), protracted (Pro-fx), and retracted (Ret-fx) positions. [Results] There were significant differences in the CVA and intervertebral body angle at the C3-4 level, and the Ret position showed the highest values followed by the N and Pro positions. Regarding the intervertebral body angle at the C4-5 level, the Pro position showed a higher value than the N and Ret positions. At the C6-7 level, the Pro position showed the lowest value compared with the N and Ret positions. In the CVA, the Ret-fx position showed a higher value than the N-fx and Ret-fx positions. [Conclusion] The results suggest that in the neutral sitting position, protraction is an ineffective posture due to overstress of the C6-7 segment, which is placed in a hyperflexed position at this level. Instead, retraction is the recommend posture for the patient with C6-7 degeneration, which makes for a more flexed position in the upper cervical spine and a less flexed position in the lower cervical spine.

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

    OpenAIRE

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

    2008-01-01

    Introduction In blunt trauma, comatose patients (Glasgow Coma Scale score 3 to 8) with a negative comprehensive cervical spine (CS) computed tomography assessment and no apparent spinal deficit, CS clearance strategies (magnetic resonance imaging [MRI] and prolonged cervical collar use) are controversial. Methods We conducted a literature review to delineate risks for coma, CS instability, prolonged cervical collar use, and CS MRI. Results Based on our search of the literature, the numbers of...

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

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    Allmann, K.H.; Uhl, M.; Uhrmeister, P.; Neumann, K.; Langer, M. [Freiburg Univ. (Germany). Radiologische Universitaetsklinik; Kempis, J. von [Freiburg Univ. (Germany). Abt. Rheumatologie und Klinische Immunologie

    1998-09-01

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

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

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

    2002-02-01

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

  17. Do design variations in the artificial disc influence cervical spine biomechanics? A finite element investigation.

    Science.gov (United States)

    Faizan, Ahmad; Goel, Vijay K; Garfin, Steven R; Bono, Christopher M; Serhan, Hassan; Biyani, Ashok; Elgafy, Hossein; Krishna, Manoj; Friesem, Tai

    2012-06-01

    Various ball and socket-type designs of cervical artificial discs are in use or under investigation. Many artificial disc designs claim to restore the normal kinematics of the cervical spine. What differentiates one type of design from another design is currently not well understood. In this study, authors examined various clinically relevant parameters using a finite element model of C3-C7 cervical spine to study the effects of variations of ball and socket disc designs. Four variations of ball and socket-type artificial disc were placed at the C5-C6 level in an experimentally validated finite element model. Biomechanical effects of the shape (oval vs. spherical ball) and location (inferior vs. superior ball) were studied in detail. Range of motion, facet loading, implant stresses and capsule ligament strains were computed to investigate the influence of disc designs on resulting biomechanics. Motions at the implant level tended to increase following disc replacement. No major kinematic differences were observed among the disc designs tested. However, implant stresses were substantially higher in the spherical designs when compared to the oval designs. For both spherical and oval designs, the facet loads were lower for the designs with an inferior ball component. The capsule ligament strains were lower for the oval design with an inferior ball component. Overall, the oval design with an inferior ball component, produced motion, facet loads, implant stresses and capsule ligament strains closest to the intact spine, which may be key to long-term implant survival.

  18. 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.

  19. Interrelationship between temporomandibular joint osteoarthritis (OA) and cervical spine pain: Effects of intra-articular injection with hyaluronic acid.

    Science.gov (United States)

    Guarda-Nardini, Luca; Cadorin, Cristina; Frizziero, Antonio; Masiero, Stefano; Manfredini, Daniele

    2017-09-01

    The aim of this study was to evaluate cervical spine pain and function after five sessions of viscosupplementation with hyaluronic acid (HA) in patients with temporomandibular joint (TMJ) osteoarthritis. Forty-nine patients, (79% females, aged between 43-81 years), affected by TMJ osteoarthritis and concurrent cervical spine pain and limited function were recruited. All patients underwent a cycle of five weekly arthrocenteses and viscosupplementation with 1 ml of medium molecular weight HA according to the single-needle arthrocentesis technique. Outcome variables were TMJ pain (VAS), cervical active ranges of motion, cervical disability (NPDS), and presence of painful palpation sites. Assessments were carried out at baseline and at one, three and six months after the end of treatment protocol. A significant reduction over time was shown both in TMJ pain levels and in NPDS values with respect to baseline (p < 0.001). Most parameters of active cervical range of motion showed an improvement with time. Benefits remained stable throughout six months after the viscosupplementation protocol. A protocol of TMJ intra articular arthrocentesis and viscosupplementation improved cervical function and reduced disability in patients with concurrent cervical spine pain. These findings add to the complex amount of literature on the relationship between temporomandibular disorders and cervical spine disorders.

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

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    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.

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

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    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.

  2. Geometry of inferior endplates of the cervical spine.

    Science.gov (United States)

    Lou, Jigang; Liu, Hao; Rong, Xin; Li, Huibo; Wang, Beiyu; Gong, Quan

    2016-03-01

    Device subsidence is a well-known complication following cervical disc arthroplasty. Its occurrence has been closely tied with the endplate-implant contact interface. But current literature on the geometry of cervical endplate is very scarce. The aim of this anatomical investigation was to analyze geometry of inferior endplates of the cervical vertebrae, thereby identifying the common endplate shape patterns and providing morphological reference values consummating the design of the implant. Reformatted CT scans of 85 individuals were analyzed and endplate concave depth, endplate concave apex location, sagittal diameter of endplate, coronal concave angle, as well as transverse diameter of endplate were measured in mid-sagittal plane and specified coronal plane. According to the endplate concave apex location, the inferior endplates in mid-sagittal plane were classified into 3 types: type I with posteriorly positioned apex, type II with middle situated concave apex and type III with anteriorly positioned apex. Moreover, the inferior endplates in specified coronal plane were also classified into three types: concave, flat and irregular. Based on visual assessment, for the mid-sagittal plane, type I endplate accounted for 26.9% of all the 510 endplates of 85 individuals, while the proportion of type II and type III endplates were 53.9 and 19.2% respectively. For the specified coronal plane, 68.6% of all the 510 endplates were evaluated as concave, 26.9% as flat and the remaining 4.5% as irregular. Among all measured segments, C3 had the largest endplate concave depth values in mid-sagittal plane, while C7 the least; C5 and C6 had the largest sagittal endplate diameter values, while C2 the least. For each level, the sagittal endplate concave depth and endplate diameter of females were significantly smaller than those of males (P0.05). Increasing from C2 to C7, the endplate transverse diameters of females were significantly smaller than those of males (Psagittal and

  3. Cervical spine degeneration in fighter pilots and controls: a 5-yr follow-up study.

    Science.gov (United States)

    Petrén-Mallmin, M; Linder, J

    2001-05-01

    At 5 yr after MRI of the cervical spine, for evaluation concerning degenerative lesions, follow-up MRI was performed on asymptomatic experienced military high performance aircraft pilots (mean age 47 yr; mean accumulated flying time 3,100 h) and on age-matched controls without military flying experience. Young military high performance aircraft pilots (mean age 28 yr, mean accumulated flying time 915 h) were also re-examined. Compared with baseline MRI 5 yr earlier, there was significant increase in disk protrusions in all groups, in osteophytes in controls, and in foraminal stenoses in experienced pilots, and a significant reduction in disk signal intensity in young pilots. The difference between experienced pilots and controls was markedly reduced compared with that at baseline MRI. Thus, military high performance aircraft pilots seem to be at increased risk of premature development of degenerative lesions of the same type as are seen in an aging population. With increasing age the difference between pilots and controls diminishes.

  4. OUR EXPERIENCE WITH MAGERL’S MODIFIED TECHNIQUE FOR STABILIZATION OF SUBAXIAL CERVICAL SPINE

    Directory of Open Access Journals (Sweden)

    Haritonov Dimitar

    2015-03-01

    Full Text Available Aim: There are different surgical techniques for massa lateralis screw instrumentation of subaxial cervical spine--those of Roy-Camille, Magerl, Anderson, and An. Each has different starting point and trajectorys of screw implantation.For each technique there is a potential risk to affect vascular and neural structures.In this paper we share our experience in using a modified Magerl's technique for stabilization of subaxial cervical spine. Method:We present a retrospective study and clinical follow-up of 27 patients operated on the occasion of cervical injury that we have used the modified technique of Magerl. In 8 patients was carried and an anterior decompression and stabilization. Results: In these patients was carried posterior or combined -- posterior and anterior stabilization. The posterior fixation was massa lateralis with this modified technique of Magerl with multiaxial screws. With this technique were inserted 160 multiaxial screws and the most common length of the implants were 108 mm (108 from 160 or 67.5%. Conclusion: Based on world literature, experience and analysis of clinical cases, we believe that this modified technique for subaxial cervical fixation is effective (the pull-out strength approach to the strength of pedicle screw instrumentation and is much safer.

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

    Science.gov (United States)

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

    2016-01-01

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

  6. Cervical Spine Deformity in Long-Standing, Untreated Congenital Muscular Torticollis.

    Science.gov (United States)

    Hussein, Mohammed Ahmed; Yun, In Sik; Park, Hanna; Kim, Yong Oock

    2017-01-01

    Congenital muscular torticollis (CMT) is a benign condition. With early diagnosis and appropriate management, it can be cured completely, leaving no residual deformity. However, long-standing, untreated CMT can lead to permanent craniofacial deformities and asymmetry. Four adult patients presented to the author with long-standing, untreated CMT. Initial clinical assessment demonstrated tightness of the sternocleidomastoid muscle on the affected side. Investigation of cervical spine using 3-dimensional computed tomography scans with cervical segmentation allowed a 3-dimensional module to be separately created for each vertebra to detect any anatomical changes. A change in the axis of the vertebral column was noted when compared to that of the skull. Also, there were apparent anatomical changes affecting the vertebrae, which were most noticeable at the level of the atlas and axis vertebrae. These changes decreased gradually till reaching the seventh cervical vertebra, which appeared to be normal in all patients. The changes in the atlas vertebra were mostly due to its intimate relation with the skull base. The changes of the axis were the most significant, affecting mainly the superior articular facet, the lamina, and the body. There were seemingly permanent changes along the cervical spine region in the adult patients with long-standing, untreated CMT in the form of bending and rotation deformities that might result in residual torticollis postoperatively.

  7. Airway management in a patient of ankylosing spondylitis with traumatic cervical spine injury

    Directory of Open Access Journals (Sweden)

    Nilesh Kumar

    2015-01-01

    Full Text Available Traumatic cervical lesions compressing the spinal cord pose a significant risk of exacerbating the existing neurological condition during tracheal intubation and subsequent positioning. Preexisting ankylosing spondylitis with spinal column involvement renders the spinal column more rigid and introduces difficulty in airway management of the patient with traumatic cervical spinal cord. To improve ease and success, and reduce cervical spine movement, awake fibreoptic intubation (FOI is considered the gold standard technique for airway management in such cases. Attaining appropriate position for intubation was challenge in this case due to rigid curvature of the ankylosed spinal column. To prevent neurological injury to the spinal cord and preserve spinal cord function, minimizing movement during intubation and attaining appropriate position was of prime concern. Optimal sedation with self-positioning by the patient in a comfortable posture is quite imperative and assures both airway as well as neurological protection in such expected difficult situations. We report the use of dexmedetomidine for self-positioning and awake FOI in a patient with ankylosing spondylitis having traumatic cervical spine who was otherwise neither able to co-operative nor able to give appropriate position for FOI.

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

    Directory of Open Access Journals (Sweden)

    Sicong Ren

    2016-08-01

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

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

    Science.gov (United States)

    Ren, Sicong; Wong, Duo Wai-Chi; Yang, Hui; Zhou, Yan; Lin, Jin; Zhang, Ming

    2016-01-01

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

  10. 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。

  11. Three-dimensional dynamic in vivo motion of the cervical spine: assessment of measurement accuracy and preliminary findings.

    Science.gov (United States)

    McDonald, Colin P; Bachison, Casey C; Chang, Victor; Bartol, Stephen W; Bey, Michael J

    2010-06-01

    Previous research has quantified cervical spine motion with conventional measurement techniques (eg, cadaveric studies, motion capture systems, and fluoroscopy), but these techniques were not designed to accurately measure three-dimensional (3D) dynamic cervical spine motion under in vivo conditions. The purposes of this study were to characterize the accuracy of model-based tracking for measuring 3D dynamic cervical spine kinematics and to demonstrate its in vivo application. Through accuracy assessment and application of technique, in vivo cervical spine motion was measured. The accuracy of model-based tracking for measuring cervical spine motion was determined in an in vitro experiment. Tantalum beads were implanted into the vertebrae of an ovine specimen, and biplane X-ray images were acquired as the specimen's neck was manually moved through neck extension and axial neck rotation. The 3D position and orientation of each cervical vertebra were determined from the biplane X-ray images using model-based tracking. For comparison, the position and orientation of each vertebra were also determined by tracking the position of the implanted beads with dynamic radiostereometric analysis. To demonstrate in vivo application of this technique, biplane X-ray images were acquired as a human subject performed two motion tasks: neck extension and axial neck rotation. The positions and orientations of each cervical vertebra were determined with model-based tracking. Cervical spine motion was reported with standard kinematic descriptions of translation and rotation. The in vitro validation demonstrated that model-based tracking is accurate to within +/-0.6 mm and +/-0.6 degrees for measuring cervical spine motion. For the in vivo application, there were significant rotations about all three anatomical axes for both the neck extension and axial neck rotation motion tasks. Model-based tracking is an accurate technique for measuring in vivo, 3D, dynamic cervical spine motion

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

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    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1991-08-01

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

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

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    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.

  15. Positional change of hyoid bone after anesthesia in anterior surgery of upper cervical spine.

    Science.gov (United States)

    Lim, Jong-Han; Wang, Seong-Il; Kim, Do-Yeon; Song, Kyung-Jin; Kim, Tae Gyun; Lee, Kwang-Bok

    2014-09-01

    The hyoid bone is used as a landmark in anterior upper cervical spine operations and is supposed to represent the level of C3 body. However, this correspondence between hyoid bone position and cervical level is not static and changes during surgery (extension after anesthesia). To find the cervical level corresponding to the position of hyoid bone before and after anesthesia and to evaluate the adequacy of its usage as a surgical landmark. A retrospective study. One hundred twenty-eight patients with degenerative cervical diseases who had undergone anterior cervical discectomy and fusion. Radiologic measure. For each patient, preanesthesia neutral, preanesthesia extension, and postanesthesia induction extension C-spine lateral image were obtained. The level of cervical vertebra that midline of hyoid bone indicated was measured by radiological method. A cervical vertebra was divided into three segments, consisting of upper half, lower half, and disc space, and each of these segments was considered as one level. The differences between pre- and postanesthesia induction hyoid positions were classified as minimal change (one level or less) and significant change (two levels or greater). Relationship between positional change of hyoid bone to gender, obesity, and age were respectively investigated. There were 20 cases of one-level distal displacement of the hyoid bone, 40 cases of two-level distal displacement, 34 cases of three-level distal displacement, 16 cases of 4-level distal displacement, and two cases of five-level distal displacement. In eight cases, there was no level change, and in the remaining 8 cases, the hyoid bone had been displaced proximally. There were 34 cases of minimal change. The remaining 94 cases (73.4%) had significant changes. No respective relationship was found between sex, obesity, age and pre-and postanesthesia induction positional change of hyoid bone. Among the 128 cases studied, 73.4% hyoid bone positions had changed by more than one

  16. Does the sagittal alignment of the cervical spine have an impact on disk degeneration? Minimum 10-year follow-up of asymptomatic volunteers

    OpenAIRE

    2009-01-01

    There have been few studies that investigated and clarified the relationships between progression of degenerative changes and sagittal alignment of the cervical spine. The objective of the study was to longitudinally evaluate the relationships among progression of degenerative changes of the cervical spine with age, the development of clinical symptoms and sagittal alignment of the cervical spine in healthy subjects. Out of 497 symptom-free volunteers who underwent MRI and plain radiography o...

  17. Influence of Cervical Spine Mobility on the Focal and Postural Components of the Sit-to-Stand Task.

    Science.gov (United States)

    Hamaoui, Alain; Alamini-Rodrigues, Caroline

    2017-01-01

    The aim of this study was to determine the influence of cervical spine mobility on the focal and postural components of the sit-to-stand transition, which represent the preparatory and execution phases of the task, respectively. Sixteen asymptomatic female participants (22 ± 3 years, 163 ± 0,06 cm, 57,5 ± 5 kg), free of any neurological or musculoskeletal disorders, performed six trials of the sit-to-stand task at maximum speed, in four experimental conditions varying the mobility of the cervical spine by means of three different splints. A six-channel force plate, which collected the reaction forces and moments applied at its top surface, was used to calculate the center of pressure displacements along the anterior-posterior and medial-lateral axes. The local accelerations of the head, spine, and pelvis, were assessed by three pairs of accelerometers, oriented along the vertical and anterior-posterior axes. Restriction of cervical spine mobility resulted in an increased duration of the focal movement, associated with longer and larger postural adjustments. These results suggest that restricted cervical spine mobility impairs the posturo-kinetic capacity during the sit-to-stand task, leading to a lower motor performance and a reorganization of the anticipatory postural adjustments. In a clinical context, it might be assumed that preserving the articular free play of the cervical spine might be useful to favor STS performance and autonomy.

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

    OpenAIRE

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

    2016-01-01

    Summary Background Gunshot wounds to the cervical spine most frequently concur with serious injuries to the spinal cord and cervical vessels and often have a fatal outcome. Case Report We describe the case of a 35-year-old male with a complex fracture of the C2 vertebra body and a mandibular fracture after a penetration gunshot to the cervical spine. Computed tomography (CT) at admission revealed the exact extent of the fractures and the small caliber bullet lodged next to the C2 vertebra. In...

  19. Extension and flexion in the upper cervical spine in neck pain patients.

    Science.gov (United States)

    Ernst, Markus J; Crawford, Rebecca J; Schelldorfer, Sarah; Rausch-Osthoff, Anne-Kathrin; Barbero, Marco; Kool, Jan; Bauer, Christoph M

    2015-08-01

    Neck pain is a common problem in the general population with high risk of ongoing complaints or relapses. Range of motion (ROM) assessment is scientifically established in the clinical process of diagnosis, prognosis and outcome evaluation in neck pain. Anatomically, the cervical spine (CS) has been considered in two regions, the upper and lower CS. Disorders like cervicogenic headache have been clinically associated with dysfunctions of the upper CS (UCS), yet ROM tests and measurements are typically conducted on the whole CS. A cross-sectional study assessing 19 subjects with non-specific neck pain was undertaken to examine UCS extension-flexion ROM in relation to self-reported disability and pain (via the Neck Disability Index (NDI)). Two measurement devices (goniometer and electromagnetic tracking) were employed and compared. Correlations between ROM and the NDI were stronger for the UCS compared to the CS, with the strongest correlation between UCS flexion and the NDI-headache (r = -0.62). Correlations between UCS and CS ROM were fair to moderate, with the strongest correlation between UCS flexion and CS extension ROM (r = -0.49). UCS flexion restriction is related to headache frequency and intensity. Consistency and agreement between both measurement systems and for all tests was high. The results demonstrate that separate UCS ROM assessments for extension and flexion are useful in patients with neck pain.

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

    Science.gov (United States)

    Malik, S A; Murphy, M; Connolly, P; O'Byrne, J

    2008-04-01

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

  1. Effect of biological agents on cervical spine lesions in rheumatoid arthritis.

    Science.gov (United States)

    Kaito, Takashi; Hosono, Noboru; Ohshima, Shirou; Ohwaki, Hajime; Takenaka, Shota; Fujiwara, Hiroyasu; Makino, Takahiro; Yonenobu, Kazuo

    2012-09-15

    A retrospective cohort analysis. To determine the effect of biological agents (BAs) on the development and progression of cervical spine lesions and identify predictors of lesion progression. The introduction of BAs has facilitated advances in the treatment of rheumatoid arthritis (RA). BAs reduce disease activity and limit structural joint damage. However, the effect of BAs on cervical spine lesions remains unclear. Thirty-eight subjects who received more than 2 years of continuous BA treatment were enrolled. The mean x-ray interval was 4.4 years. RA activity was evaluated by disease activity score (DAS)-C reactive protein (CRP) and matrix metalloproteinase (MMP)-3. Radiographical definitions of cervical lesions were atlanto-dental interval (ADI) more than 3 mm for atlanto-axial subluxation (AAS), Ranawat value less than 13 mm for vertical subluxation (VS), and anterior or posterior listhesis more than 2 mm for subaxial subluxation (SS). Definitions of radiographical progression were an increase of ADI more than 2 mm for AAS, a decrease of both Ranawat and Redlund-Johnell values more than 2 mm for VS, and an increase of listhesis more than 2 mm for SS. RA activity responded dramatically to BA therapy (DAS-CRP from 4.3 to 2.3, P < 0.01; MMP-3 from 207.9 ng/mL to 105.6 ng/mL, P < 0.01). Baseline radiographical evaluation showed no pre-existing cervical spine lesions in 12 cases, AAS in 15 cases, and VS in 11 cases. Radiological progression was found in 1 (8%) patient in the no lesion group, 12 patients (80%) in the AAS group, and 9 patients (80%) in the VS group. The incidence of progression was significantly lower in the no lesion group compared with the other groups. Multivariate regression analysis showed that the presence of pre-existing cervical lesions was the single greatest predictor of progression. BAs prevented the development of de novo cervical spine lesions in patients with RA, but failed to inhibit progression of pre-existing RA lesions.

  2. Is there a difference in head posture and cervical spine movement in children with and without pediatric headache?

    Science.gov (United States)

    Budelmann, Kim; von Piekartz, Harry; Hall, Toby

    2013-10-01

    Pediatric headache is an increasingly reported phenomenon. Cervicogenic headache (CGH) is a subgroup of headache, but there is limited information about cervical spine physical examination signs in children with CGH. Therefore, a cross-sectional study was designed to investigate cervical spine physical examination signs including active range of motion (ROM), posture determined by the craniovertebral angle (CVA), and upper cervical ROM determined by the flexion-rotation test (FRT) in children aged between 6 and 12 years. An additional purpose was to determine the degree of pain provoked by the FRT. Thirty children (mean age 120.70 months [SD 15.14]) with features of CGH and 34 (mean age 125.38 months [13.14]) age-matched asymptomatic controls participated in the study. When compared to asymptomatic controls, symptomatic children had a significantly smaller CVA (p upper cervical spine in children with CGH and provides evidence of the clinical utility of the FRT when examining children with CGH.

  3. Is there an association between fractures of the cervical spine and first- and second-rib fractures?

    Energy Technology Data Exchange (ETDEWEB)

    Logan, P.M. [Dalhouse Univ., Dept. of Radiology, Halifax, Nova Scotia (Canada); Queen Elizabeth II Health Science Centre, Victoria General Site, Halifax, Nova Scotia (Canada)

    1999-02-01

    Objective: To investigate a potential association between cervical spine injury and first- and second-rib fractures. Methods: Retrospective review of the radiologic and medical records of 28 consecutive patients admitted to an acute spinal injury unit. Results: A total of 10 (36%) of the patients with cervical spine trauma also had fractures of either the first or second ribs. Eight of these 10 patients had a fracture or fracture-subluxation of the seventh cervical vertebra or the C6/7 segment. Conclusion: Almost one-third of patients with traumatic cervical spine injury have an associated upper-rib fracture. The strongest association is between injury at the C7 level and first-rib fracture. (author)

  4. Quality of systematic reviews: an example of studies comparing artificial disc replacement with fusion in the cervical spine.

    Science.gov (United States)

    Tashani, Osama A; El-Tumi, Hanan; Aneiba, Khaled

    2015-01-01

    Cervical artificial disc replacement (C-ADR) is now an alternative to anterior cervical discectomy and fusion (ACDF). Many studies have evaluated the efficacy of C-ADR compared with ACDF. This led to a series of systematic reviews and meta-analyses to evaluate the evidence of the superiority of one intervention against the other. The aim of the study presented here was to evaluate the quality of these reviews and meta-analyses. Medline via Ovid, Embase, and Cochrane Library were searched using the keywords: (total disk replacement, prosthesis, implantation, discectomy, and arthroplasty) AND (cervical vertebrae, cervical spine, and spine) AND (systematic reviews, reviews, and meta-analysis). Screening and data extraction were conducted by two reviewers independently. Two reviewers then assessed the quality of the selected reviews and meta-analysis using 11-item AMSTAR score which is a validated measurement tool to assess the methodological quality of systematic reviews. Screening of full reports of 46 relevant abstracts resulted in the selection of 15 systematic reviews and/or meta-analyses as eligible for this study. The two reviewers' inter-rater agreement level was high as indicated by kappa of >0.72. The AMSTAR score of the reviews ranged from 3 to 11. Only one study (a Cochrane review) scored 100% (AMSTAR 11). Five studies scored below (AMSTAR 5) indicating low-quality reviews. The most significant drawbacks of reviews of a score below 5 were not using an extensive search strategy, failure to use the scientific quality of the included studies appropriately in formulating a conclusion, not assessing publication bias, and not reporting the excluded studies. With a significant exception of a Cochrane review, the methodological quality of systematic reviews evaluating the evidence of C-ADR versus ACDF has to be improved.

  5. Acute neck pain: cervical spine range of motion and position sense prior to and after joint mobilization.

    Science.gov (United States)

    McNair, Peter J; Portero, Pierre; Chiquet, Christophe; Mawston, Grant; Lavaste, Francois

    2007-11-01

    Despite the relatively high prevalence of cervical spine pain, the efficacy of treatment procedures is limited. In the current study, range of motion and proprioception was assessed prior to and after specific cervical spine mobilisation techniques. A 44-year-old male office worker presented with a history of cervical pain of 1 day duration. He had woken with pain, stiffness and a loss of range of motion. Examination findings indicated pain to be at C5-6 on the left side. Measurement of maximal three-dimensional cervical motion was undertaken using a Zebris system. A position matching task tested the individual's ability to actively reposition their head and neck. The treatment undertaken involved grade III down-slope mobilisations on the left side at C5-6 and C6-7 in supine lying. This technique was then progressed by placing the subject in an upright sitting position, and sustained natural apophyseal glides were performed at C6. Immediately following the treatment, the patient reported a considerable decrease in pain, less difficulty in movement and reduced stiffness. Motion analyses showed the most marked percentage improvements in range of motion after treatment were in flexion (55%), extension (35%), left rotation (56%), and left lateral flexion (22%). Ipsilateral lateral flexion with axial rotation was also notably improved following treatment. No change in proprioceptive ability was found following the treatment. The findings showed that the application of standardised specific mobilisation techniques led to substantial improvements in the range of motion and the restitution of normal coupled motion.

  6. 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.

  7. 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.

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

    Directory of Open Access Journals (Sweden)

    I. P. Ardashev

    2012-01-01

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

  9. Acceleration-caused injury of the cervical spine. Whiplash injury; Beschleunigungsverletzung der Halswirbelsaeule. HWS-Schleudertrauma

    Energy Technology Data Exchange (ETDEWEB)

    Wedig, Hans-Dieter (eds.) [Kanzlei Dr. W.G. Schmidt, Sonthofen (Germany); Graf, Michael; Grill, Christian

    2009-07-01

    Acceleration injuries of the cervical spine are mostly caused by car accidents. Due to the high traffic density and the increasing number of car accidents with personal injuries the number of concerned persons is also increasing. A large percentage of injured persons suffer ongoing troubles following ineffective therapy trials up to occupational disability. Therefore the whiplash injury is a significant medical and legal problem. The book includes contributions of international experts on the latest state of research and the actual knowledge on the controversial discussed field. An interdisciplinary forum discusses medical, injury-mechanical, consultant-related and legal questions and therapeutic approaches that might be successful. [German] Beschleunigungsverletzungen der Halswirbelsaeule treten ueberwiegend nach Autounfaellen auf. Aufgrund der hohen Verkehrsdichte und der steigenden Anzahl an Verkehrsunfaellen mit Personenschaeden steigt auch die Zahl der Betroffenen stetig an. Einer grossen Zahl von Unfallgeschaedigten, die nach kurzer Zeit beschwerdefrei leben koennen, steht leider eine wachsende Zahl von Betroffenen mit anhaltenden Beschwerden, erfolglosen Therapieversuchen bis hin zur Berufsunfaehigkeit gegenueber. Das 'HWS-Schleudertrauma' stellt nach wie vor ein erhebliches medizinisches und rechtliches Problem dar. In diesem Buch beschreiben international ausgewiesene Experten den neuesten Forschungsstand, das aktuelle Wissen und die Lehrmeinungen auf diesem kontrovers diskutierten und komplexen Gebiet. In einem interdisziplinaeren Ansatz werden medizinische, verletzungsmechanische, gutachterliche und gerichtliche Fragestellungen diskutiert und Erfolg versprechende Therapieansaetze eroertert. Aerzte, Juristen, Versicherungen und Betroffene werden in einen gemeinsamen Dialog gebracht, mit dem Ziel, konstruktive Loesungen zu erarbeiten. Eine praktische Arbeitshilfe - das Buch fuer alle, die mit dieser Problematik befasst sind. (orig.)

  10. ANALYSIS OF 111 PATIENTS WITH CERVICAL SPINE FRACTURES IN A TERTIARY HOSPITAL

    Directory of Open Access Journals (Sweden)

    Hugo Vilchis Sámano

    Full Text Available ABSTRACT Objective: To describe the epidemiology of 111 patients to determine the age group affected, the level of fracture, fracture classification, and type of treatment. Methods: Descriptive study of 111 cases of cervical spine fracture treated at the Hospital of Traumatology and Orthopedics Lomas Verdes - IMSS from March 2009 to October 2014. Results: The condition appeared in 88% of men. The age range was 16-81 years, with an average of 40 years. The most common fracture according to the AO classification was type A (57%. The segments most affected were C5-C6, C6-C7, C6 and C4-C5 (24.32%, 17.1%, 9.9% and 8.1%. Neurological involvement occurred in 46.8%. The most common mechanism of injury was high energy. Surgical treatment was performed in 78.4% of patients, being one-level corpectomy with placement of mesh and plate, and posterior fixation with facet screws the most appropriate procedures (31.5% and 27.9%, respectively. Conclusions: Males were the most affected, the highest incidence was in C5-C6 and C6-C7 levels and the surgical procedure was the most used.

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

    Science.gov (United States)

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

    2016-01-01

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

  12. 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

  13. Image Segmentation and Analysis of Flexion-Extension Radiographs of Cervical Spines

    Directory of Open Access Journals (Sweden)

    Eniko T. Enikov

    2014-01-01

    Full Text Available We present a new analysis tool for cervical flexion-extension radiographs based on machine vision and computerized image processing. The method is based on semiautomatic image segmentation leading to detection of common landmarks such as the spinolaminar (SL line or contour lines of the implanted anterior cervical plates. The technique allows for visualization of the local curvature of these landmarks during flexion-extension experiments. In addition to changes in the curvature of the SL line, it has been found that the cervical plates also deform during flexion-extension examination. While extension radiographs reveal larger curvature changes in the SL line, flexion radiographs on the other hand tend to generate larger curvature changes in the implanted cervical plates. Furthermore, while some lordosis is always present in the cervical plates by design, it actually decreases during extension and increases during flexion. Possible causes of this unexpected finding are also discussed. The described analysis may lead to a more precise interpretation of flexion-extension radiographs, allowing diagnosis of spinal instability and/or pseudoarthrosis in already seemingly fused spines.

  14. Range of motion in the upper and lower cervical spine in people with chronic neck pain.

    Science.gov (United States)

    Rudolfsson, Thomas; Björklund, Martin; Djupsjöbacka, Mats

    2012-02-01

    Reduced cervical range of motion (ROM) is a common finding in people with neck pain. With few exceptions, only the angle between head and thorax has been measured. Our aim was to use an extended model to compare active cervical flexion and extension, separate for upper and lower cervical levels, between people with chronic non-traumatic neck pain and controls. We also investigated associations between ROM measures, symptoms and self-rated functioning. In this cross-sectional study, 102 subjects with neck pain and 33 healthy controls participated. An electromagnetic tracker system was used to measure the kinematics to construct a three-segment model including the thorax, cervical spine and head. Neutral flexion/extension were defined at subjects' self-selected seated posture. We found that in the neck pain group, extension in the upper cervical levels and predominately flexion for the lower levels were reduced. The ratio between ROM for the upper and lower levels was altered in the neck pain group so that the lower levels contributed to a lesser extent to the total sagittal ROM compared to controls. These findings could not be explained by a greater forward head posture but must have other origins. For the neck pain group, ROM measures were weakly associated to pain and self-rated functioning. Altogether, this implies that using a three-segment model for assessment of ROM can be a valuable improvement for characterisation of patients and treatment evaluation.

  15. The valuation of using FDG PET-CT in detecting osteoid osteoma of the cervical spine.

    Science.gov (United States)

    Kong, Jinhai; Xiao, Hui; Liu, Tielong; Yan, Wangjun; Qian, Ming; Song, Dian Wen; Yang, Xinghai; Wang, Ting; Sun, Zhengwang; Xiao, Jianru

    2015-03-01

    Osteoid osteomas (OOs) are bone tumors that rarely occur in the cervical spine. The current study is a retrospective analysis on 10 patients who were diagnosed with this rare spinal bone tumor. We have excised OOs of the cervical spine with the use of FDG Positron emission tomography-computed tomography (PET-CT) for preoperative diagnosis. With the help of the FDG PET-CT, we can confidently remove the nidus of the OOs, while minimize iatrogenic injury of the surrounding normal bone elements, and preserve the stability of the cervical spine. OO of the cervical spine is frequently located at the nerve root adjacent to the vertebral artery, spinal cord. PET-CT is a sensitive tool with applications in the detection of bone lesions, especially in patients with difficult diagnosis or continuing misdiagnosis of tumors. Ten patients (8 male and 2 female patients) underwent surgery for tumor removal using PET-CT in our department. Various diagnostic imaging modalities including x-ray, magnetic resonance imaging, CT, bone scintigraphy, and PET-CT were used. PET-CT scan results were measured using standard uptake value. (The size of the cases series was from 4×5 mm to 12×15 mm.) Pain was evaluated using the visual analogue score. Clinical outcome was evaluated immediately postoperatively and at a mean follow-up of 49.8±0.2 months (range, 7-92 mo). All tumors were successfully diagnosed with the use of PET-CT. The average standard uptake value was 2.7±0.1 (range, 2.0-3.4). The nidus of the OO was detected and removed, and the peripheral elements were preserved. The visual analogue score was 8.1±0.1 preoperation, and it significantly decreased to 2.5±0.3 (Ppain symptoms. There was no injury of the vertebral artery, leakage of cerebrospinal fluid, infectious complications, and neurological injury during the procedure. It is valuable of using of PET-CT to diagnose OOs of the cervical vertebra. Subsequently, it is a good way that helps us in efficient removal of the OOs

  16. Biomechanical evaluation of Caspar and Cervical Spine Locking Plate systems in a cadaveric model.

    Science.gov (United States)

    Clausen, J D; Ryken, T C; Traynelis, V C; Sawin, P D; Dexter, F; Goel, V K

    1996-06-01

    There exist two markedly different instrumentation systems for the anterior cervical spine: the Cervical Spine Locking Plate (CSLP) system, which uses unicortical screws with a locking hub mechanism for attachment, and the Caspar Trapezial Plate System, which is secured with unlocked bicortical screws. The biomechanical stability of these two systems was evaluated in a cadaveric model of complete C5-6 instability. The immediate stability was determined in six loading modalities: flexion, extension, right and left lateral bending, and right and left axial rotation. Biomechanical stability was reassessed following fatigue with 5000 cycles of flexion-extension, and finally, the spines were loaded in flexion until the instrumentation failed. The Caspar system stabilized significantly in flexion before (p < 0.05) but not after fatigue, and it stabilized significantly in extension before (p < 0.01) and after fatigue (p < 0.01). The CSLP system stabilized significantly in flexion before (p < 0.01) but not after fatigue, and it did not stabilize in extension before or after fatigue. The moment needed to produce failure in flexion did not differ substantially between the two plating systems. The discrepancy in the biomechanical stability of these two systems may be due to differences in bone screw fixation.

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

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    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.

  18. 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

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

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    Basu Saumyajit

    2007-01-01

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

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

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

    2014-08-15

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

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

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    Muhle, C. [Univ. of Kiel, (Germany). Dept. of Nuclear Medicine; Ahn, J.M. [Univ. of Kiel, (Germany). Dept. of Radiology; Biederer, J.; Schaefer, F.K.W.; Frahm, C.H.; Mohr, A.; Brossmann, J. [Samsung Medical Center, Seoul (Korea, Republic of). Dept. of Radiology; Resnick, D. [Veterans Affairs Medical Center, San Diego, CA (United States). Dept. of Radiology

    2002-04-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2014-11-01

    We report a case of the coexistence of different spinal tumors at the same level of the cervical spine, without neurofibromatosis (NF), which was successfully treated with surgery. A 72-year-old female presented with right upper-limb clumsiness and weakness. Magnetic resonance imaging revealed an intradural, extramedullary tumor mass at the right C3-4 level with extradural extension into the intervertebral foramen. The extradural tumor was removed, and the pathology showed neurofibroma. After incision of the dura, the intradural tumor was removed, and was identified as meningioma in the pathological report. The patient did not meet the criteria of NF. Coexistence of neurofibroma and meningioma at exactly the same level of the spine without NF is extremely rare. Exploration of the intradural space may be necessary after resection of an extradural tumor if the surgical finding does not correlate well with the preoperative images. Copyright © 2014. Published by Elsevier Taiwan.

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

    Directory of Open Access Journals (Sweden)

    Kai-Yuan Chen

    2014-11-01

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

  5. A CT-Based Simulation Study to Compare the Risk of Facet Joint Violation by the Cervical Pedicle Screw Between Degenerative and Nondegenerative Cervical Spines.

    Science.gov (United States)

    Lee, Dong-Ho; Noh, Hyounmin; Hwang, Chang Ju; Lee, Choon Sung; Abumi, Kuniyoshi; Cho, Jae Hwan

    2017-02-01

    A retrospective case-control study. This study aimed (A) to compare entry points and trajectories of the cervical pedicle screw (CPS) between degenerative and nondegenerative spines, and (B) to evaluate the risk of facet joint violation by the CPS according to the degree of facet degeneration. Entry point, trajectories, and risk of misplacement of the CPS have been widely researched; however, its application to degenerative cervical spine has to be elucidated. Sixty patients who underwent cervical surgeries at our institution were classified into two groups according to cervical facet joint degeneration. A simulation program with 0.7-mm thickness axial computed tomographic images was used to evaluate facet joint violation by the CPS from C3 to C6. Horizontal and vertical offsets of entry points were measured from two different anatomical landmarks on lateral mass, namely the lateral notch and the center of the superior ridge. The transverse and sagittal angles of the screws were also measured. Facet joint violation was evaluated and classified into either "minor" (cervical spine group at all levels (P = 0.001-0.026). In addition, facet joint violation was more frequently found in severely degenerated facet joints than in mild to moderately degenerated facet joints (P = 0.011). The entry point of CPS was moved more superiorly in the degenerative cervical spine in this study, which increased the risk of facet joint violation in our patients. Thus, surgeons need to modify the insertion technique of the CPS or to insert lateral mass screw instead of the CPS when it is considered to insert screws at the uppermost vertebra in the degenerative cervical spine. 4.

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

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    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.

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

    Science.gov (United States)

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

    2015-05-01

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

  8. Morphometric analysis of the cervical spine of Indian population by using computerized tomography

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    Partha Sarathi Banerjee

    2012-08-01

    Full Text Available The purpose of the present study was to measure the surgically important morphological parameters of cervical spine region of a representative sample of Indian population from the images obtained through computerized tomography (CT. Another purpose has been to compare the computed statistical mean, standard deviation and range of variation of these data with those of other Asian population and also European/American populations. With that aim, ninety five (95 CT scan data of Indian people (73 for male patients and 22 for female patients pertaining to undeformed normal cervical spine has been collected from an Indian hospital. From these, 15 important morphological parameters have been measured. These values have been tabulated and their mean, standard deviation and range of variation have been computed. It has been found that pedicle dimensions of Indian people are smaller at almost all vertebra levels as compared to Caucasian people. Pedicle axis length for Indian people are found to be smaller at C3, C4 and C5 levels than those for other Asian people including Chinese people, but it is bigger at C6 and C7 levels. Indian people have longer measurements of pedicle length + lateral mass on an average than their other Asian counterparts at C5, C6 and C7 levels, but shorter measurements at C3 and C4 levels. The results of the present work may help in better understanding of morphological parameters of cervical spine region of Indian population. It may be further useful in designing spinal implants which would be biomechanically compatible to the anatomy of Indian people.

  9. Pharyngeal function in patients with rheumatoid arthritis of the cervical spine and temporomandibular joint

    Energy Technology Data Exchange (ETDEWEB)

    Ekberg, O.; Redlund-Johnell, I.; Sjoeblom, K.G.

    Pharyngeal function was studied in 31 patients with rheumatoid arthritis. Eighteen of these patients had dysphagia. Cervical spine abnormalities were present in 14. Destruction of the capitulum and/or ramus of the mandible was registered in 9. Pharyngeal dysfunction was revealed in 20. Patients with a vertical dislocation of the C1-C2 in relation to the occipital bone and patients with destruction of the capitulum and/or ramus of the mandible had an increased frequency of pharyngeal dysfunction. Pharyngeal dysfunction is thought to be due to mechanical factors and caused by derangements of muscular attachments and turning points.

  10. Cervical spine osteoblastoma presenting as mechanical neck pain: a case report

    OpenAIRE

    1994-01-01

    Osteoblastoma is a benign bone-forming tumor that represents approximately 1% of all primary bone tumors. It occurs 40% of the time in the spine, most commonly in the posterior elements. The clinical presentation in this case is of chronic neck pain and stiffness. Although most lesions are well visualized on plain films, a bone scan or CT scan may be of better diagnostic value. Treatment is via surgical excision. In this report we present a case of cervical osteoblastoma mistaken for mechanic...

  11. Percutaneous aspiration biopsy in cervical spine lytic lesions. Indications and technique

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    Tampieri, D.; Weill, A.; Melanson, D.; Ethier, R. (Montreal Neurological Inst. and Hospital, PQ (Canada). Dept. of Neuroradiology)

    1991-02-01

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

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

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

    1995-06-01

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

  13. Outcomes of C1 and C2 posterior screw fixation for upper cervical spine fusion.

    Science.gov (United States)

    De Iure, F; Donthineni, R; Boriani, S

    2009-06-01

    To achieve stable fixation of the upper cervical spine in posterior fusions, the occiput is often included. With the newer techniques, excluding fixation to the occiput will retain the occiput-cervical motion, while still allowing a stable fixation. Harms's technique has been adapted at our institution and its effectiveness for indications such as C2 complex fractures and tumors using C1 or C2 as endpoints of a posterior fixation are reviewed. Fourteen cases were identified, consisting of one os odontoideum; four acute fractures and four non-unions of the odontoid; three tumors and two complex fractures of C2 vertebral body, and one C2-C3 post-traumatic instability. One misplaced screw without clinical consequences was the only complication recorded. Screw loosening or migration was not observed at follow-up, showing a stable fixation.

  14. True oblique axis fracture associated with congenital anomalies of the upper cervical spine: Case report of an unusual fracture pattern

    Science.gov (United States)

    Robles, Luis A.

    2017-01-01

    Background: Acute traumatic axis fractures are common cervical spine injuries often caused by road accidents or falls. They are usually classified into three different types, namely, odontoid fractures, Hangman's fractures, and miscellaneous fractures. Congenital malformations of the craniovertebral junction (CVJ), although typically asymptomatic, may result in neural compression or instability, especially following trauma. Here, the authors present an unusual oblique axis fracture occurring in conjunction with several malformations of the upper cervical spine. Case Description: Following a motor vehicle accident, a 25-year-old female's radiographic studies showed an oblique axis fracture involving both the anterior and posterior elements along with an anterior and posterior Klippel–Feil syndrome (KFS) anomaly. Following treatment in a halo vest, the patient maintained alignment, and ultimately the fracture was fused. Conclusions: True oblique fractures of the axis are rare, as in the case presented, and may occasionally occur in conjunction with KFS of the upper cervical spine. PMID:28217386

  15. Cervical spine clearance when unable to be cleared clinically: a pooled analysis of combined computed tomography and magnetic resonance imaging.

    Science.gov (United States)

    Plackett, Timothy P; Wright, Franklin; Baldea, Anthony J; Mosier, Michael J; Thomas, Casey; Luchette, Fred A; Ton-That, Hieu H; Esposito, Thomas J

    2016-01-01

    The role of cervical spine magnetic resonance imaging (MRI) in the evaluation of clinically unevaluable blunt trauma patients has been called into question by several recent studies. A PubMed search was performed for all studies comparing computed tomography and MRI in the assessment of the cervical spine in patients who cannot be evaluated clinically. The radiologic findings and clinical outcomes from each study were collated for analysis. Data for 1,714 patients were available. All patients had a negative computed tomography scan and then underwent an MRI. There were 271 (15.8%) patients who had a previously undocumented finding on MRI with the majority (98.2%) being a ligamentous injury. Only 5 injuries (1.8%) resulted in surgical intervention. MRI identifies additional injuries; however, the vast majority are of minor clinical significance. Routine MRI after a negative computed tomography of the cervical spine is not supported by the current literature. Published by Elsevier Inc.

  16. Chronic spinal cord injury in the cervical spine of a young soccer player.

    Science.gov (United States)

    Kato, Yoshihiko; Koga, Michiaki; Taguchi, Toshihiko

    2010-05-12

    A 17-year-old male soccer player presented with numbness in the upper- and lower-left extremities of 6 months' duration. He had no apparent history of trauma but experienced neck pain during heading of the ball 5 years prior. A high-signal intensity area was seen on T2-weighted magnetic resonance imaging (MRI) of the cervical spine. No muscle weakness was observed. Hypoesthesia was observed in bilateral forearms, hands, and extremities below the inguinal region. Plain radiographs in the neutral position showed local kyphosis at C3/4. A small protrusion of the C3/4 disk was observed on T1-weighted MRI. A high-signal area in the spinal cord at the C3/4 level was observed on T2-weighted MRI, but this was not enhanced by gadolinium. Multiple sclerosis, intramedullary spinal cord tumor, sarcoidosis and malignant lymphoma, and spinal cord injury were all considered in the differential diagnosis. However, in view of the clinical, laboratory, and radiological investigations, we concluded that repeated impacts to the neck caused by heading of the ball during soccer induced a chronic, minor spinal cord injury. This contributed to the high-signal intensity change of the spinal cord in T2-weighted MRI. The present case demonstrates that repeated impact may cause chronic spinal cord injury. Soccer, American football, or rugby players presenting with neck or extremity symptoms should not be overlooked for the possibility of latent spinal cord injury, as this could present later development of more severe or unrecoverable spinal cord injuries. Copyright 2010, SLACK Incorporated.

  17. [Correction of kyphotic deformity of the cervical spine in ankylosing spondylitis using pedicle subtraction osteotomy of the seventh cervical vertebra].

    Science.gov (United States)

    Vaněk, P; Votavová, M; Ostrý, S; Beneš, V; Pavelka, K

    2014-01-01

    The aim of the study is to present the technique of pedicle subtraction osteotomy (PSO) of the seventh cervical vertebra (C7) for correction of rigid kyphotic deformity of the cervicothoracic junction (C/Th) in patients with severe ankylosing spondylitis (AS).. The PSO technique for correction of rigid deformity of the C/Th spine was used in five patients with the aim to restore their ability of horizontal vision. The follow-up in all patients lasted two years at least. Clinical assessment of treatment results was based on the patients' neurological status and their satisfaction with the correction achieved. Improvement in a vertical 2) line of sight was evaluated using the angle measured between the forehead-chin line and the vertical (FCv angle) in a lateral view photograph of the standing patient. The achieved correction of kyphotic deformity was assessed by comparing the pre-operative Cobb's angle between the second cervical and the fourth thoracic vertebra with the post-operative one. The average operative time was 4 hours (range, 3.5 to 5 h). The average blood loss was 1600 ml (range, 800 to 2100 ml). On the average, the FCv angle was reduced by 45.2° and Cobb's angle was corrected) by 54.6°. All patients were satisfied with the degree of correction achieved and reported alleviation of neck pain. none of the patients showed any significant loss of correction or neurological deterioration at two-year follow-up. The theoretical and technical principles of corrective osteotomy at the C7 level performed for rigid kyphotic deformity of the spine at the C/Th junction are presented in our group of patients. Our results give support to the superiority of instrumented PSO used currently over the previous techniques. In accordance with the relevant literature data, attention is drawn to a relatively higher risk of this procedure in comparison with corrective surgery performed at the other spinal levels. Corrective osteotomy of a rigid kyphotic deformity at the C

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

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    Ilić Tihomir V.

    2011-01-01

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

  19. Pressure ulcers, indentation marks and pain from cervical spine immobilization with extrication collars and headblocks: An observational study.

    Science.gov (United States)

    Ham, Wietske H W; Schoonhoven, Lisette; Schuurmans, Marieke J; Leenen, Luke P H

    2016-09-01

    To describe the occurrence and severity of pressure ulcers, indentation marks and pain from the extrication collar combined with headblocks. Furthermore, the influence of time, injury severity and patient characteristics on the development of pressure ulcers, indentation marks and pain was explored. Observational. Level one trauma centre in the Netherlands. Adult trauma patients admitted to the Emergency Department in an extrication collar combined with headblocks. Between January and December 2013, 342 patients were included. Study outcomes were incidence and severity of pressure ulcers, indentation marks and pain. The following dependent variables were collected: time in the cervical collar and headblocks, Glasgow Coma Scale, Mean Arterial Pressure, haemoglobin, Injury Severity Score, gender, age, and Body Mass Index. 75.4% of the patients developed a category 1 and 2.9% a category 2 pressure ulcer. Indentation marks were observed in 221 (64.6%) patients; 96 (28.1%) had severe indentation marks. Pressure ulcers and indentation marks were observed most frequently at the back, shoulders and chest. 63.2% experienced pain, of which, 38.5% experienced severe pain. Pain was mainly located at the occiput. Female patients experienced significantly more pain (NRS>3) compared to male patients (OR=2.14, 95% CI 1.21-3.80) None of the investigated variables significantly increased the probability of developing PUs or indentation marks. The high incidence of category 1 pressure ulcers and severe indentation marks indicate an increased risk for pressure ulcer development and may well lead to more severe PU lesions. Pain due to the application of the extrication collar and headblocks may lead to undesirable movement (in order to relieve the pressure) or to bias clinical examination of the cervical spine. It is necessary to revise the current practice of cervical spine immobilization. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Traumatic spondyloptosis of the cervical spine: A case report and discussion of worldwide treatment trends.

    Science.gov (United States)

    Wong, Kelly E; Chang, Peter S; Monasky, Mark S; Samuelson, Rodney M

    2017-01-01

    Cervical spondyloptosis is defined as the dislocation of the spinal column most often caused by trauma. Due to compression or transection of the spinal cord, severe neurological deficits are common. Here, we review the literature and report a case of traumatic C5-6 spondyloptosis that was successfully treated using an anterior-only surgical approach. The patient presented with quadriplegia and absent sensation distal to the C5 dermatome following a rollover motor vehicle accident. The preoperative American Spinal Injury Association Impairment Scale was A. Computed tomography of the cervical spine revealed C5-6 spondyloptosis, lamina fractures on the right side at the C3-4 level, and widened facet joint on the right side at C6-7. The patient underwent cervical traction and anterior cervical discectomy and fusion at the C5-6, C6-7 levels; no 360° fusion was warranted. Six months postoperatively, the patient remained quadriplegic below the C5 level. Presently, no consensus is present regarding the best treatment for spondyloptosis. Worldwide, the 360° approach is the most commonly used (45%), followed by anterior-only surgery (31%) and posterior-only surgery (25%). The surgical choice depends upon patient-specific features but markedly varies among geographical regions.

  1. 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.

  2. Cervical Spine Muscle-Tendon Unit Length Differences Between Neutral and Forward Head Postures: Biomechanical Study Using Human Cadaveric Specimens.

    Science.gov (United States)

    Khayatzadeh, Saeed; Kalmanson, Olivia A; Schuit, Dale; Havey, Robert M; Voronov, Leonard I; Ghanayem, Alexander J; Patwardhan, Avinash G

    2017-07-01

    Forward head posture (FHP) may be associated with neck pain and poor health-related quality of life. Literature describes only qualitative muscle length changes associated with FHP. The purpose of this study was to quantify how muscle-tendon unit lengths are altered when human cadaveric specimens are placed in alignments representing different severities of FHP. This biomechanical study used 13 fresh-frozen cadaveric cervical spine specimens (Occiput-T1, 54±15 y). Specimens' postural changes simulating increasing FHP severity while maintaining horizontal gaze were assessed. Specimen-specific anatomic models derived from computed tomography-based anatomic data were combined with postural data and specimen-specific anatomy of muscle attachment points to estimate the muscle length changes associated with FHP. Forward head posture was associated with flexion of the mid-lower cervical spine and extension of the upper cervical (sub-occipital) spine. Muscles that insert on the cervical spine and function as flexors (termed "cervical flexors") as well as muscles that insert on the cranium and function as extensors ("occipital extensors") shortened in FHP when compared to neutral posture. In contrast, muscles that insert on the cervical spine and function as extensors ("cervical extensors") as well as muscles that insert on the cranium and function as flexors ("occipital flexors") lengthened. The greatest shortening was seen in the major and minor rectus capitis posterior muscles. These muscles cross the Occiput-C2 segments, which exhibited extension to maintain horizontal gaze. The greatest lengthening was seen in posterior muscles crossing the C4-C6 segments, which exhibited the most flexion. This cadaver study did not incorporate the biomechanical influence of active musculature. This study offers a novel way to quantify postural alignment and muscle length changes associated with FHP. Model predictions are consistent with qualitative descriptions in the literature.

  3. A new low-cost method for difficult airway management in non-missile-penetrating cervical spine injury

    Directory of Open Access Journals (Sweden)

    Taopheeq B Rabiu

    2012-01-01

    Full Text Available Accessing and maintaining the airway in penetrating cervical spine injury is a challenge for anaesthetists globally. This is more so in resource-poor settings, where advanced techniques for intubation in difficult airway situations are unavailable. We describe a new, low-cost, easily adaptable method of managing the airway used in a middle-aged man who sustained screw driver injury to the cervical spine with C4 Brown-Séquard syndrome. The deployment of readily available and cheap materials led to successful anaesthesia management of the patient.

  4. Tracheal intubation in patients with rigid collar immobilisation of the cervical spine: a comparison of Airtraq and LMA CTrach devices.

    Science.gov (United States)

    Arslan, Z I; Yildiz, T; Baykara, Z N; Solak, M; Toker, K

    2009-12-01

    The aim of this study was to evaluate the effectiveness of the Airtraq and CTrach in lean patients with simulated cervical spine injury after application of a rigid cervical collar. Eighty-six consenting adult patients of ASA physical status 1 or 2, who required elective tracheal intubation were included in this study in a randomised manner. Anaesthesia was induced using 1 microg kg(-1) fentanyl, 3 mg kg(-1) propofol and 0.6 mg kg(-1) rocuronium, following which a rigid cervical collar was applied. Comparison was then made between tracheal intubation techniques using either the AirTraq or CTrach device. The mean (SD) time to see the glottis was shorter with the Airtraq than the CTrach (11.9 (6.8) vs 37.6 (16.7)s, respectively; p cervical spine immobilisation.

  5. Comparison of tracheal intubation using the Airtraq® and Mc Coy laryngoscope in the presence of rigid cervical collar simulating cervical immobilisation for traumatic cervical spine injury

    Directory of Open Access Journals (Sweden)

    Padmaja Durga

    2012-01-01

    Full Text Available Background: It is difficult to visualise the larynx using conventional laryngoscopy in the presence of cervical spine immobilisation. Airtraq® provides for easy and successful intubation in the neutral neck position. Objective: To evaluate the effectiveness of Airtraq in comparison with the Mc Coy laryngoscope, when performing tracheal intubation in patients with neck immobilisation using hard cervical collar and manual in-line axial cervical spine stabilisation. Methods: A randomised, cross-over, open-labelled study was undertaken in 60 ASA I and II patients aged between 20 and 50 years, belonging to either gender, scheduled to undergo elective surgical procedures. Following induction and adequate muscle relaxation, they were intubated using either of the techniques first, followed by the other. Intubation time and Intubation Difficulty Score (IDS were noted using Mc Coy laryngoscope and Airtraq. The anaesthesiologist was asked to grade the ease of intubation on a Visual Analogue Scale (VAS of 1-10. Chi-square test was used for comparison of categorical data between the groups and paired sample t-test for comparison of continuous data. IDS score and VAS were compared using Wilcoxon Signed ranked test. Results: The mean intubation time was 33.27 sec (13.25 for laryngoscopy and 28.95 sec (18.53 for Airtraq (P=0.32. The median IDS values were 4 (interquartile range (IQR 1-6 and 0 (IQR 0-1 for laryngoscopy and Airtraq, respectively (P=0.007. The median Cormack Lehane glottic view grade was 3 (IQR 2-4 and 1 (IQR 1-1 for laryngoscopy and Airtraq, respectively (P=0.003. The ease of intubation on VAS was graded as 4 (IQR 3-5 for laryngoscopy and 2 (IQR 2-2 for Airtraq (P=0.033. There were two failures to intubate with the Airtraq. Conclusion: Airtraq improves the ease of intubation significantly when compared to Mc Coy blade in patients immobilised with cervical collar and manual in-line stabilisation simulating cervical spine injury.

  6. Occupant and crash characteristics for case occupants with cervical spine injuries sustained in motor vehicle collisions.

    Science.gov (United States)

    Stein, Deborah M; Kufera, Joseph A; Ho, Shiu M; Ryb, Gabriel E; Dischinger, Patricia C; O'Connor, James V; Scalea, Thomas M

    2011-02-01

    Motor vehicle collisions (MVCs) are the leading cause of spine and spinal cord injuries in the United States. Traumatic cervical spine injuries (CSIs) result in significant morbidity and mortality. This study was designed to evaluate both the epidemiologic and biomechanical risk factors associated with CSI in MVCs by using a population-based database and to describe occupant and crashes characteristics for a subset of severe crashes in which a CSI was sustained as represented by the Crash Injury Research Engineering Network (CIREN) database. Prospectively collected CIREN data from the eight centers were used to identify all case occupants between 1996 and November 2009. Case occupants older than 14 years and case vehicles of the four most common vehicle types were included. The National Automotive Sampling System's Crashworthiness Data System, a probability sample of all police-reported MVCs in the United States, was queried using the same inclusion criteria between 1997 and 2008. Cervical spinal cord and spinal column injuries were identified using Abbreviated Injury Scale (AIS) score codes. Data were abstracted on all case occupants, biomechanical crash characteristics, and injuries sustained. Univariate analysis was performed using a χ analysis. Logistic regression was used to identify significant risk factors in a multivariate analysis to control for confounding associations. CSIs were identified in 11.5% of CIREN case occupants. Case occupants aged 65 years or older and those occupants involved in rollover crashes were more likely to sustain a CSI. In univariate analysis of the subset of severe crashes represented by CIREN, the use of airbag and seat belt together (reference) were more protective than seat belt alone (odds ratio [OR]=1.73, 95% confidence interval [CI]=1.32-2.27) or the use of neither restraint system (OR=1.45, 95% CI=1.02-2.07). The most frequent injury sources in CIREN crashes were roof and its components (24.8%) and noncontact sources (15

  7. Intubation biomechanics: laryngoscope force and cervical spine motion during intubation in cadavers-effect of severe distractive-flexion injury on C3-4 motion.

    Science.gov (United States)

    Hindman, Bradley J; Fontes, Ricardo B; From, Robert P; Traynelis, Vincent C; Todd, Michael M; Puttlitz, Christian M; Santoni, Brandon G

    2016-11-01

    OBJECTIVE With application of the forces of intubation, injured (unstable) cervical segments may move more than they normally do, which can result in spinal cord injury. The authors tested whether, during endotracheal intubation, intervertebral motion of an injured C3-4 cervical segment 1) is greater than that in the intact (stable) state and 2) differs when a high- or low-force laryngoscope is used. METHODS Fourteen cadavers underwent 3 intubations using force-sensing laryngoscopes while simultaneous cervical spine motion was recorded with lateral fluoroscopy. The first intubation was performed with an intact cervical spine and a conventional high-force line-of-sight Macintosh laryngoscope. After creation of a severe C3-4 distractive-flexion injury, 2 additional intubations were performed, one with the Macintosh laryngoscope and the other with a low-force indirect video laryngoscope (Airtraq), used in random order. RESULTS During Macintosh intubations, between the intact and the injured conditions, C3-4 extension (0.3° ± 3.0° vs 0.4° ± 2.7°, respectively; p = 0.9515) and anterior-posterior subluxation (-0.1 ± 0.4 mm vs -0.3 ± 0.6 mm, respectively; p = 0.2754) did not differ. During Macintosh and Airtraq intubations with an injured C3-4 segment, despite a large difference in applied force between the 2 laryngoscopes, segmental extension (0.4° ± 2.7° vs 0.3° ± 3.3°, respectively; p = 0.8077) and anterior-posterior subluxation (0.3 ± 0.6 mm vs 0.0 ± 0.7 mm, respectively; p = 0.3203) did not differ. CONCLUSIONS The authors' hypotheses regarding the relationship between laryngoscope force and the motion of an injured cervical segment were not confirmed. Motion-force relationships (biomechanics) of injured cervical intervertebral segments during endotracheal intubation in cadavers are not predicted by the in vitro biomechanical behavior of isolated cervical segments. With the limitations inherent to cadaveric studies, the results of this study suggest

  8. 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.

  9. Cervical spine injury. Diagnosis, prognosis and management; Trauma der Halswirbelsaeule. Diagnose, Prognose und Management

    Energy Technology Data Exchange (ETDEWEB)

    Schueller-Weidekamm, C. [AKH, Medizinische Universitaet Wien (Austria). Abteilung fuer Neuroradiologie und Muskuloskelettale Radiologie

    2008-05-15

    Cervical spine injuries are a common occurrence in multi-trauma patients and should be taken into account when planning further clinical management. This review describes in detail upper and lower cervical spine injuries and introduces the sub-axial injury classification (SLIC) that is based on three components: injury morphology, integrity of the discoligamentous complex and the neurologic status of the patient. If the total SLIC score is <3, non-surgical treatment is recommended. If the total is {>=}5, operative treatment is indicated as such a score is associated with instability and probably neurologic deficits. The precise diagnosis of the radiologist, which would include the SLIC classification, should facilitate clinical decision-making about further management. (orig.) [German] Halswirbelsaeulenverletzungen sind bei polytraumatisierten Patienten haeufig und sollten beim klinischen Management des Patienten beruecksichtigt werden. Verletzungen der oberen Halswirbelsaeule werden als Sonderformen eingeteilt. Die subaxialen Verletzungen koennen nach der SLIC-Klassifikation ('sub-axial injury classification') gescort werden, die auf der Morphologie der Verletzung, dem diskoligamentaeren Komplex und dem neurologischen Status basiert. Bei einem Score <3 wird ein konservatives Management empfohlen. Bei einem Score {>=}5 sollte eine operative Versorgung der Halswirbelsaeule vorgenommen werden, da die Verletzung eine Instabilitaet und moeglicherweise auch ein neurologisches Defizit verursacht. Anhand einer praezisen Diagnose des Radiologen unter Beruecksichtigung der SLIC-Klassifikation sollte dem Kliniker die Entscheidung fuer das weitere Management erleichtert werden. (orig.)

  10. 颈椎损伤的现场救治%First aid of cervical spine injury

    Institute of Scientific and Technical Information of China (English)

    张进军

    2013-01-01

    Spinal injury is a common disease in pre-hospital emergency .Timely and correct rescue is im-portant to save lives and improve prognosis for cervical spine injury patients .In this paper ,the author makes a brief introduction on the first aid of cervical spine injury based on the clinical and teaching experience and the related lit -erature analysis in recent years ,so as to provide a reference for the relevant clinical workers .%颈椎损伤是院前急救工作中的常见病、多发病。及时正确的现场救治对于挽救颈椎损伤患者的生命和改善预后具有极为重要的意义。本文结合笔者近年来的临床、教学经验和相关文献分析,就颈椎损伤的现场急救做一简要介绍,可为相关临床工作者提供参考。

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

    Institute of Scientific and Technical Information of China (English)

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

    2013-01-01

    Objective:To report a case series of six neglected cervical spine dislocations without neurological deficit,which were managed operatively.Methods:The study was conducted fromAugust 2010 to December 2011 and cases were selected from the out-patient department of Postgraduate Institute of Medical Education and Research,India.The patients were in the age group of 30 to 50 years.All patients were operated via both anterior and posterior approaches.Results:During the immediate postoperative period,five (83.33%) patients had normal neurological status.One (16.67%) patient who had C5-C6 subluxation developed neurological deficit with sensory loss below C6 level and motor power of 2/5 in the lower limb and 3/5 in the upper limb below C6 level.Conclusion:There is no role of skull traction in neglected distractive flexion injuries to cervical spine delayed for more than 3 weeks.Posterior followed by anterior approach saves much time.If both approaches are to be done in the same sitting,there is no need for instrumentation posteriorly.But if staged procedure is planed,posterior stabilization is recommended,as there is a risk of deterioration in neurological status.

  12. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Gillams, A.R.; Soto, J.A.; Carter, A.P. [Department of Radiology, Boston University Medical School and Boston City Hospital Imaging Foundation, Boston, MA 02118 (United States)

    1997-10-01

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

  14. Quantification of C2 cervical spine rotatory fixation by X-ray, MRI and CT

    Energy Technology Data Exchange (ETDEWEB)

    Gradl, Georg [Chirurgische Klinik und Poliklinik der Universitaet Rostock, Abteilung Unfall- und Wiederherstellungschirurgie, Rostock (Germany); Maier-Bosse, Tamara; Staebler, Axel [Institut fuer Radiologische Diagnostik der Universitaet Muenchen, Klinikum Grobetahadern, Munich (Germany); Penning, Randolph [Institut fuer Rechtsmedizin der Universitaet Muenchen, Munich (Germany)

    2005-02-01

    Atlanto-axial rotatory displacement is known to be a cause of childhood torticollis and may as well be responsible for chronic neck pain after rear-end automobile collisions. The objective was to determine whether quantification of C2 malrotation is possible by plain radiographs in comparison to CT as the golden standard. MR imaging was evaluated as to whether it was of equal value in the detection of bony landmarks. C2 vertebra of five human cadaveric cervical spine specimens, ligamentously intact, were rotated using a Steinmann pin in steps of 5 up to 15 right and 15 left. Plain radiographs, CT and MRI images were taken in each rotational step. Data were analyzed for quantification of C2 rotation by three independent examiners. A rotation of 5 led to a spinous process deviation (SPD) from the midline of 3 mm as measured on an a.p. plain radiograph. A coefficient of rotation was calculated (1.62 mm{sup -1}). Data analyzed by three examiners revealed a small coefficient of variation (0.03). MRI and CT measurements showed comparable results for the quantification of rotation; however, in both techniques the 15 rotation was underestimated. Quantification of upper cervical spine malrotation was possible on plain radiographs using the SPD and a rotation coefficient. MRI and CT were equally successful in the assessment of C2 malrotation. (orig.)

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

    Science.gov (United States)

    Arts, Mark P; Rettig, Thijs C D; de Vries, Jessica; Wolfs, Jasper F C; in't Veld, Bas A

    2013-09-25

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

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

    Science.gov (United States)

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

    2015-10-01

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

  17. Clinical measurements of cervical lordosis using flexirule and inclinometer methods in individuals with and without cervical spine dysfunction: A reliability and validity study.

    Science.gov (United States)

    McFarland, Carol; Wang-Price, Sharon; Richard, Shanan

    2015-01-01

    The purposes of this study were to determine the reliability and validity of two clinical measurements of cervical lordosis and to compare these measurements of individuals with cervical spine symptoms to those of asymptomatic individuals. Fifty-seven participants were recruited for the study: 18 following cervical fusion, 20 with neck pain and no surgery, and 19 with no neck pain. Cervical lordosis was measured using a flexible ruler (flexirule) and a modified bubble inclinometer. Intertester and intratester reliability were calculated for both methods. Validity was assessed by correlating measurements taken using both methods to Cobb angles between C2 and C7 on lateral view radiography of the participants in the cervical fusion and the neck pain groups. Intraclass correlation coefficients (ICCs) revealed good intratester reliability for both methods. Intertester reliability was fair for the flexirule method but good for the inclinometer method. Pearson correlations with radiographic angles were poor for both methods. ANOVAs showed no significant difference in cervical lordosis measurements between asymptomatic and symptomatic groups. Although both the flexirule and inclinometer methods are reliable, neither method correlated with the Cobb angle on the radiography, suggesting these methods may measure different aspects of cervical spine alignment.

  18. Abscess of the cervical spine secondary to injection site infection in a heifer.

    Science.gov (United States)

    Braun, Ueli; Gerspach, Christian; Kühn, Karolin; Bünter, Julia; Hilbe, Monika

    2017-01-31

    Abscesses in the neck region can result from infection associated with injection of drugs into the neck muscles. To our knowledge, there have been no reports of osteomyelitis of the cervical vertebra and spinal cord compression secondary to an abscess in the neck. This case report describes the findings in a 9.5-month-old heifer with an abscess of the cervical spine secondary to injection site infection. The main clinical findings were swelling on the left side of the neck, proprioceptive deficits in all limbs and generalised ataxia. The ultrasonographic examination of the swelling showed an abscess. Radiographs showed a well-defined lytic lesion in 5th cervical vertebra (C5). Postmortem examination revealed an intramuscular encapsulated abscess on the left side of the neck at the level of C5. The abscess had invaded the vertebral canal and caused marked compression of the spinal cord. Injection technique is critical for the prevention of problems such as those described in this report. Sterile hypodermic needles must be used, and the volume of drug per injection site limited to 10-15 ml in young cattle.

  19. The immediate effects of cervical spine manipulative therapy and mobilization on local skin temperature, in mechanical neck pain

    OpenAIRE

    2012-01-01

    M.Tech. Purpose: Mechanical neck pain is the most common type of cervical spine pain encountered. It is also referred to as simple or non-specific neck pain, and is common in all groups of people. Often the exact cause of the pain is unknown. Neck pain, although felt in the neck, can be caused by numerous spinal problems. Neck pain may arise due to muscular tightness in both the neck and upper back, or due to entrapment of nerves of the cervical vertebrae. Joint dysfunction in the cervical...

  20. 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.

  1. 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.

  2. No trauma of the cervical spine. Automatic headrest adjustment; Kein HWS-Trauma. Kopfstuetze automatisch naeher am Kopf

    Energy Technology Data Exchange (ETDEWEB)

    Schmuck, M.; Gaebelein, J. [Proma GmbH, Lichtenfels (Germany)

    2005-06-01

    A new headrest system developed by Proma considerably reduces the risk of injuries of the cervical spine. The idea behind it is simple and innovative: Apart from the automatic height adjustment, the headrest also has an automatic adjustment function to keep it in a position close to the head. (orig.)

  3. The accuracy of the Oculus Rift virtual reality head-mounted display during cervical spine mobility measurement.

    Science.gov (United States)

    Xu, Xu; Chen, Karen B; Lin, Jia-Hua; Radwin, Robert G

    2015-02-26

    An inertial sensor-embedded virtual reality (VR) head-mounted display, the Oculus Rift (the Rift), monitors head movement so the content displayed can be updated accordingly. While the Rift may have potential use in cervical spine biomechanics studies, its accuracy in terms of cervical spine mobility measurement has not yet been validated. In the current study, a VR environment was designed to guide participants to perform prescribed neck movements. The cervical spine kinematics was measured by both the Rift and a reference motion tracking system. Comparison of the kinematics data between the Rift and the tracking system indicated that the Rift can provide good estimates on full range of motion (from one side to the other side) during the performed task. Because of inertial sensor drifting, the unilateral range of motion (from one side to neutral posture) derived from the Rift is more erroneous. The root-mean-square errors over a 1-min task were within 10° for each rotation axis. The error analysis further indicated that the inertial sensor drifted approximately 6° at the beginning of a trial during the initialization. This needs to be addressed when using the Rift in order to more accurately measure cervical spine kinematics. It is suggested that the front cover of the Rift should be aligned against a vertical plane during its initialization.

  4. Motion generated in the unstable upper cervical spine during head tilt-chin lift and jaw thrust maneuvers.

    Science.gov (United States)

    Prasarn, Mark L; Horodyski, Marybeth; Scott, Nicole E; Konopka, Geoff; Conrad, Bryan; Rechtine, Glenn R

    2014-04-01

    Although it is essential to maintain a secure airway in a trauma patient, it is also critical to protect the potentially injured cervical spine. It has previously been suggested that the jaw thrust maneuver be used in place of the head tilt-chin lift in the suspected spine-injured patient. We sought to examine whether the jaw thrust was in fact safer to use in the setting of an unstable upper cervical spine injury. Unstable, dissociative C1-C2 injuries were surgically created in nine fresh, lightly embalmed human cadaver specimens. An electromagnetic motion analysis device was used to assess the amount of angular and linear motion with sensors placed above and below the injured segment. Measurements were recorded during execution of the two airway maneuvers. Trials were performed both with and without a cervical immobilization collar in place. There was almost twice as much angular motion in all planes when performing a head tilt-chin lift as compared with the jaw thrust, and this was statistically significant (pthrust. This was statistically significant for axial displacement and anteroposterior translation (p=.003 for both), and approached significance for mediolateral translation (p=.056). The jaw thrust maneuver results in less motion at an unstable C1-C2 injury as compared with the head tilt-chin lift maneuver. We therefore recommend the use of the jaw thrust to improve airway patency in the trauma patient with suspected cervical spine injury. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. 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

    respectively, and the CROM of 15 healthy volunteers was measured repeatedly by the CROM device. The measurement results were compared between the patients and the healthy volunteers. The loss of the patients' CROM after surgery was analyzed, and the interexaminer reliability of the CROM device was measured by the intraclass correlation coefficient (ICC). Results At the 6th month of the follow-up period after surgery, the range of motion of cervical flexion and left and right rotation among the 6 available motions of the fusion group were significantly lower than that of the non-fusion group (P<0.05), and there were significant differences between the 6 available motions of the fusion group and that of the healthy control group (P<0.05). In the fusion group, the range of motion cervical flexion and left and right rotation of the cervicooccipital fusion group were significantly lower than that of the atlantoaxial fusion group (P<0.05). The CROM of all groups became higher to some extend at the 6th month of the follow-up period, comparing with that at the 3rd month. The interexaminer ICC for 6 available motions by the CROM device was above 0.91, which showed high reliability. Conclusions The upper cervical spine fusion significantly reduces the range of cervical motion, especially the flexion and rotation function. In addition, the CROM device is a reliable measuring tool for cervical range of motion.

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

    Directory of Open Access Journals (Sweden)

    Marshall T. Holland

    2015-01-01

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

  7. Geometrical properties of the human child cervical spine with a focus on the C1 vertebra.

    Science.gov (United States)

    Yoganandan, Narayan; Pintar, Frank A; Lew, Sean M; Rao, Raj D

    2014-01-01

    Child dummies and injury criteria used in automotive crashworthiness environments are based on scaling from the adult and/or between children of different ages. Cartilage-to-bone ossification, spinal canal and joint developments of the spine, and strength attainments do not grow linearly from birth to maturity. Though this is known to medical professionals, age-based quantitative analyses are needed to accurately model the pediatric spine. The objective of this study was to quantify longitudinal growths of various regions of the first cervical vertebrae, responsible for transmitting the axial load from the base of the skull through the condyles to the neck/torso. Computed tomography (CT) images of 54 children from one day to 18 years of age were retrospectively used to determine the following geometrical properties: bilateral neurocentral synchondroses widths, the width of posterior synchondrosis, outer and inner anteroposterior and transverse diameters, spinal canal area, and depths of the anterior and posterior arches of the C1 vertebra. Both axial and sagittal CT images were used in the analysis. Sagittal images were used to quantify data for the anterior and posterior arches and axial images were used for all described cross-sectional parameters. Geometrical properties were extracted and reported for the various parameters at 6 months; one year; 18 months; and 3, 6, and 10 years of age corresponding to the dummy family ages routinely used in motor vehicle crashworthiness research and other applications. The outer transverse diameter ranged from 4.97 to 7.08 cm; outer and inner antero-posterior diameters ranged from 2.99 to 4.18 and 2.19 to 3.03 mm; and spinal canal area ranged from 4.34 to 6.68 mm(2). Other data are given in the body of the article. The growths of the first cervical vertebra quantified in terms of the above variables occurred nonlinearly with age and the degree of nonlinearity depended on the type of the geometrical parameter. Growths did not

  8. Article Volume : 3 Issue :5 Month : October (2016 ASSOCIATION BETWEEN THORACIC KYPHOSIS, HEAD POSTURE AND CERVICAL RANGE OF MOTION IN ADULTS WITH AND WITHOUT CERVICAL SPINE DYSFUNCTION

    Directory of Open Access Journals (Sweden)

    Vidhi Shah

    2016-10-01

    Full Text Available Background: Excessive Thoracic Kyphosis (TK and Forward Head Posture(FHP become more apparent in aging adults from the accumulation of remodeling in response to habitual postures. Faulty posture of the shoulders, neck, and particularly the head may contribute to the onset and perpetuation of cervical pain dysfunction syndrome. Current literature suggests that an association exists between the head posture, thoracic kyphosis and cervical range of motion in individuals with cervical spine dysfunction. Since age as well as cervical spine dysfunction may affect the above parameters, the objective of our research was to study the association between these in adults with and without cervical spine dysfunction. Methods: 50 adults with CSD and 50 adults without CSD were assessed for TK, FHP and Cervical range of motion (CROM by flexicurve method Kipnotic Index (KI, measuring cranio-vertebral angle(CVA using a lateral-view photograph(digitized of the subject and using Universal Goniometer respectively. Results: In both groups, there was increased KI (TK, lesser CVA i.e. FHP and reduced CROM when compared to normative values, however there was no statistical difference in KI and CVA between the two groups (p=0.53,0.75. Cervical extension and rotation ranges were significantly reduced in CSD adults (p=0.00,0.00,0.00. Correlation between CVA and CROM, KI and CROM and KI and CVA was not significant in adults with as well as without CSD (p=0.16-0.51,0.05-0.35,p=0.08-0.69,0.19-0.52,p=0.13,0.94 respectively. Conclusion: Correlation between FHP and CROM,TK and CROM, FHP and TK in adults with and without CSD was not significant.

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

    Energy Technology Data Exchange (ETDEWEB)

    Obenauer, S.; Alamo, L.; Herold, T.; Funke, M.; Kopka, L.; Grabbe, E. [Department of Radiology, Georg August-University Goettingen, Robert-Koch-Strasse 40, 37075 Goettingen (Germany)

    2002-08-01

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

  10. Distal bimelic amyotrophy (DBMA): Phenotypically distinct but identical on cervical spine MR imaging with brachial monomelic amyotrophy/Hirayama disease.

    Science.gov (United States)

    Preethish-Kumar, Veeramani; Nalini, Atchayaram; Singh, Ravinder-Jeet; Saini, Jitender; Prasad, Chandrajit; Polavarapu, Kiran; Thennarasu, Kandavel

    2015-01-01

    Our objective was to characterize the MR imaging features in a large and distinct series of distal bimelic amyotrophy (DBMA) from India. We utilized a retrospective and prospective study on 26 cases. Results demonstrated that upper limb distal muscle wasting and weakness was predominantly symmetrical in onset. Mean age at onset was 20.9 ± 7.0 years, mean duration 83.0 ± 102.6 months. MRI carried out in 22 patients with flexion studies showed forward displacement of posterior dura in 19 (86.4%). Crescent shaped epidural enhancement on contrast was seen in 20/24 cases (83.3%), and bilateral T2W hyperintensities of cord in17 (65.4%) - symmetrical in15 cases. Maximum hyperintensity was noted at C5-C6, C6-C7 levels. Cord atrophy was noted in 24 (92.3%) cases (most affected: C5-C6, C6-C7) - symmetrical atrophy in 21cases. Cervical spine straightening occurred in six (23.1%) cases and reversal of lordosis in 15 (57.7%). In conclusion, this study confirms that DBMA is phenotypically distinct but pathophysiologically the same as brachial monomelic amyotrophy (BMMA) on MR imaging. Typical MRI features were seen in all. It is important to differentiate this disorder from ALS, which could present at a younger age as often seen among Indians. The clinical and MR imaging features are highly suggestive that DBMA, as with BMMA/Hirayama disease, occurs due to dynamic alterations at the cervical spine level.

  11. 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

  12. 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.)

  13. Pediatric cervical spine fracture caused by an adult 3-point seatbelt.

    Science.gov (United States)

    Deutsch, Robert Jay; Badawy, Mohamed K

    2008-02-01

    The development and use of seatbelts has saved numerous lives and prevented serious injuries in the setting of automobile crashes. However, restraints designed for adults are not necessarily effective in preventing injury to small children and may actually be harmful. Here, we present a case of upper cervical spine fracture in a 5-year-old female patient caused by neck flexion over an inappropriately applied adult 3-point seatbelt during a motor vehicle collision. The American Academy of Pediatrics currently advises against the use of vehicle safety belts until the shoulder belt can be positioned across the chest with the lap belt snug across the thighs. As clinicians who care for children, it is imperative that we continue to educate parents about proper use of age-appropriate child safety restraints.

  14. [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.

  15. Kirschner Wire Migration to the Cervical Spine: A Complication of Clavicular Fixation in a Child

    Directory of Open Access Journals (Sweden)

    KK Tan

    2007-05-01

    Full Text Available We report a case of a broken K-wire migrating to the cervical spine from the right clavicle in a 9-year-old child. The initial diagnosis, fracture of the clavicle with an acromioclavicular joint dislocation, was treated by open reduction and K-wiring. One K-wire broke and migrated to the neck, posterolateral to the C6 vertebra. The K-wire was removed percutaneously under image intensif ication. Acromioclavicular joint dislocation in children is rare since the distal clavicle does not ossify until the age of 18 or 19 years meaning that almost all closed fractures of the clavicle in children can be treated non- operatively.

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

    Science.gov (United States)

    Agrawal, Deepak; Sinha, Tej Prakash; Bhoi, Sanjeev

    2015-01-01

    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. PMID:26167212

  17. 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.

  18. Sagittal balance of the cervical spine: an analysis of occipitocervical and spinopelvic interdependence, with C-7 slope as a marker of cervical and spinopelvic alignment.

    Science.gov (United States)

    Núñez-Pereira, Susan; Hitzl, Wolfgang; Bullmann, Viola; Meier, Oliver; Koller, Heiko

    2015-07-01

    Sagittal malalignment of the cervical spine has been associated with worsened postsurgical outcomes. For better operative planning of fusion and alignment restoration, improved knowledge of ideal fusion angles and interdependences between upper and lower cervical spine alignment is needed. Because spinal and spinopelvic parameters might play a role in cervical sagittal alignment, their associations should be studied in depth. The authors retrospectively analyzed digital lateral standing cervical radiographs of 145 patients (34 asymptomatic, 74 symptomatic; 37 surgically treated), including full-standing radiographs obtained in 45 of these patients. Sagittal measurements were as follows: C2-7, occiput (Oc)-C2, C1-2 Cobb angles, and C-7 slope (the angle between the horizontal line and the superior endplate of C-7), as well as T4-12 and L1-S1 Cobb angles, sacral slope, pelvic incidence, and C-7 sagittal vertical axis (SVA). A correlation analysis was performed, and linear regression models were developed. Statistical analyses revealed significant correlations between C2-7 and Oc-C2 (r = -0.4, p 0.1). Comparing cervical and spinopelvic alignment revealed a significant correlation between sacral slope and C-7 slope (r = -0.3, p = 0.04) and C2-7 (r = 0.4, p spine exist, confirming the existence of inherent compensatory mechanisms to maintain overall balance; no significant differences were found among asymptomatic, symptomatic, and surgically treated patients. The C-7 slope is a useful marker of overall sagittal alignment, acting as a link between the occipitocervical and thoracolumbar spine.

  19. Are magnetic resonance flexion views useful in evaluating the cervical spine of patients with rheumatoid arthritis?

    Energy Technology Data Exchange (ETDEWEB)

    Reijnierse, M.; Kroon, H.M.; Bloem, J.L. [Dept. of Radiology, Leiden University Medical Center (Netherlands); Breedveld, F.C. [Dept. of Rheumatology, Leiden University Medical Center, Leiden (Netherlands); Hansen, B. [Dept. of Medical Statistics, Leiden University Medical Center, Leiden (Netherlands); Pope, T.L. [Dept. of Diagnostic Radiology, Bowman Gray School of Medicine, Winston-Salem (United States)

    2000-02-01

    Objective. To determine whether MR imaging in flexion adds value relative to imaging in the neutral position with respect to displaying involvement of the subarachnoid space, brainstem and spinal cord. Design and patients. T1-weighted MR images of the cervical spine in 42 rheumatoid arthritis patients with cervical spine involvement were obtained and analyzed prospectively. We assessed changes between images obtained in the neutral position and following active flexion, especially horizontal atlantoaxial and subaxial motion, presence or absence of brainstem compression, subarachnoid space involvement at the atlantoaxial and subaxial level and the cervicomedullary angle. Vertical atlantoaxial subluxation and the amount of pannus were correlated with motion and change in subarachnoid space. Results. The flexion images showed horizontal atlantoaxial motion in 21 patients and subaxial motion in one patient. The flexion view displayed brainstem compression in only one patient. Involvement of the subarachnoid space increased at the atlantoaxial level in eight (19%) patients (P=0.004) and at the level below C2 in five (12%) patients (P=0.03). There were no patients with a normal subarachnoid space in neutral position and compression in the flexed position. The cervicomedullary angle changed significantly with flexion. Vertical atlantoaxial subluxation and the amount of pannus did not show a significant correlation with motion or subarachnoid space involvement. Conclusion. MR imaging in the flexed position shows a statistically significant narrowing of the subarachnoid space at the atlantoaxial level and below C2. Cord compression is only observed on flexion views if the subarachnoid space in neutral position is already decreased. MR imaging in the flexed position might be useful, since subarachnoid space involvement may be an indicator for the development of neurologic dysfunction. (orig.)

  20. Twente spine model: A complete and coherent dataset for musculo-skeletal modeling of the thoracic and cervical regions of the human spine.

    Science.gov (United States)

    Bayoglu, Riza; Geeraedts, Leo; Groenen, Karlijn H J; Verdonschot, Nico; Koopman, Bart; Homminga, Jasper

    2017-06-14

    Musculo-skeletal modeling could play a key role in advancing our understanding of the healthy and pathological spine, but the credibility of such models are strictly dependent on the accuracy of the anatomical data incorporated. In this study, we present a complete and coherent musculo-skeletal dataset for the thoracic and cervical regions of the human spine, obtained through detailed dissection of an embalmed male cadaver. We divided the muscles into a number of muscle-tendon elements, digitized their attachments at the bones, and measured morphological muscle parameters. In total, 225 muscle elements were measured over 39 muscles. For every muscle element, we provide the coordinates of its attachments, fiber length, tendon length, sarcomere length, optimal fiber length, pennation angle, mass, and physiological cross-sectional area together with the skeletal geometry of the cadaver. Results were consistent with similar anatomical studies. Furthermore, we report new data for several muscles such as rotatores, multifidus, levatores costarum, spinalis, semispinalis, subcostales, transversus thoracis, and intercostales muscles. This dataset complements our previous study where we presented a consistent dataset for the lumbar region of the spine (Bayoglu et al., 2017). Therefore, when used together, these datasets enable a complete and coherent dataset for the entire spine. The complete dataset will be used to develop a musculo-skeletal model for the entire human spine to study clinical and ergonomic applications. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. 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.

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

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    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.

  3. [Fracture of the cervical spine in ankylosing spondylitis. A case report].

    Science.gov (United States)

    Kaneko, Takahisa; Koyanagi, Izumi; Murakami, Tomohiro; Houkin, Kiyohiro

    2010-09-01

    We report a case of a 61-year-old man with ankylosing spondylitis who showed cervical spine fracture. The patient had fallen down on the floor and presented with severe neck pain. He was treated conservatively with a hard neck collar in an emergency hospital because of C7 body fracture without dislocation. However, the follow-up radiographs demonstrated a progressive C6-7 anterior dislocation. He was referred to our hospital 6 weeks after the trauma. The 3D-CT reconstruction imaging revealed that the fracture extended from the C7 vertebral body to the C6 lamina via the bilateral C6/7 facet joints. The patient underwent C2-Th3 posterior fixation using pedicle and lateral mass screw techniques. The postoperative course was uneventful. He was discharged without any complication at 1 month postoperatively. The radiograph 3 months after surgery showed good bone fusion. Spine fracture with ankylosing spondylitis usually shows significant instability because of the long lever-arm of the fused vertebrae at the fracture level. Solid spinal fusions such as long posterior fusion or anterior-posterior simultaneous fusion are needed in such cases.

  4. 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.

  5. Hypopharyngeal and upper esophageal ulceration after cervical spine radiotherapy concurrent with crizotinib

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    Zimmermann, Marcus H.; Beckmann, Gabriele; Flentje, Michael [University Hospital of Wuerzburg, Department of Radiation Oncology, Wuerzburg (Germany); Jung, Pius [University Hospital of Wuerzburg, Department of Pneumonology, Medical Clinic I, Wuerzburg (Germany)

    2017-07-15

    Herein, the authors describe the case of a 31-year-old female patient with primary metastatic adenocarcinoma of the lung referred for radiation therapy of newly diagnosed intramedullary spinal cord metastasis at C4/5 and an adjacent osteolytic lesion. Radiotherapy of the cervical spine level C3 to C5, including the whole vertebra, was performed with 30 Gy in 10 fractions. The patient's systemic therapy with crizotinib 250 mg twice daily was continued. After 8 fractions of radiation the patient developed increasing dysphagia. Ulceration of the hypopharynx and the upper esophagus were obvious in esophagoscopy and CT. Hospitalization for analgesia and percutaneous endoscopic gastrostomy (PEG) was required. First oral intake was possible 3 weeks after the onset of symptoms. The early onset, severity, and duration of mucositis seemed highly unusual in this case. A review of the literature failed to identify any reference to increased mucositis after radiation therapy concurrent with crizotinib, although references to such an effect with other tyrosine kinase inhibitors (TKI) were found. Nevertheless, the authors presume that a considerable risk of unexpected interactions exists. When crizotinib and radiotherapy are combined, heightened attention toward intensified reactions seems to be warranted. (orig.) [German] Die Autoren berichten ueber eine 31-jaehrige Patientin mit primaer metastasiertem Adenokarzinom der Lunge, die ihnen zur Bestrahlung einer neu aufgetretenen intraspinal-intramedullaeren Metastase auf Hoehe der Bandscheibe C 4/5 sowie einer benachbarten osteolytischen Laesion zugewiesen wurde. Es erfolgte eine Bestrahlung der Halswirbelsaeule von C 3 bis C 5 mit 30 Gy in 10 Fraktionen. Die bestehende Systemtherapie mit 250 mg Crizotinib 2-mal taeglich wurde fortgesetzt. Nach 8 Fraktionen entwickelte die Patientin eine zunehmende Dysphagie. In der Oesophagoskopie sowie computertomographisch zeigte sich eine Ulzeration des Hypopharynx und des oberen

  6. Comparison of intubation success and glottic visualization using King Vision and C-MAC videolaryngoscopes in patients with cervical spine injuries with cervical immobilization: A randomized clinical trial.

    Science.gov (United States)

    Shravanalakshmi, Dhanyasi; Bidkar, Prasanna U; Narmadalakshmi, K; Lata, Suman; Mishra, Sandeep K; Adinarayanan, S

    2017-01-01

    Glottic visualization can be difficult with cervical immobilization in patients with cervical spine injury. Indirect laryngoscopes may provide better glottic visualization in these groups of patients. Hence, we compared King Vision videolaryngoscope, C-MAC videolaryngoscope for endotracheal intubation in patients with proven/suspected cervical spine injury. After standard induction of anesthesia, 135 patients were randomized into three groups: group C (conventional C-MAC videolaryngoscope), group K (King Vision videolaryngoscope), and group D (D blade C-MAC videolaryngoscope). Cervical immobilization was maintained with Manual in line stabilization with anterior part of cervical collar removed. First pass intubation success, time for intubation, and glottic visualization (Cormack - Lehane grade and percentage of glottic opening) were noted. Intubation difficulty score (IDS) was used for grading difficulty of intubation. Five-point Likert scale was used for ease of insertion of laryngoscope. First attempt success rate were 100% (45/45), 93.3% (42/45), and 95.6% (43/45) in patients using conventional C-MAC, King Vision, and D blade C-MAC videolaryngoscopes, respectively. Time for intubation in seconds was significantly faster with conventional C-MAC videolaryngoscope (23.3 ± 4.7) compared to D blade C-MAC videolaryngoscope (26.7 ± 7.1), whereas conventional C-MAC and King Vision were comparable (24.9 ± 7.2). Good grade glottic visualization was obtained with all the three videolaryngoscopes. All the videolaryngoscopes provided good glottic visualization and first attempt success rate. Conventional C-MAC insertion was significantly easier. We conclude that all the three videolaryngoscopes can be used effectively in patients with cervical spine injury.

  7. Comparison of intubation success and glottic visualization using King Vision and C-MAC videolaryngoscopes in patients with cervical spine injuries with cervical immobilization: A randomized clinical trial

    Science.gov (United States)

    Shravanalakshmi, Dhanyasi; Bidkar, Prasanna U.; Narmadalakshmi, K.; Lata, Suman; Mishra, Sandeep K.; Adinarayanan, S.

    2017-01-01

    Background: Glottic visualization can be difficult with cervical immobilization in patients with cervical spine injury. Indirect laryngoscopes may provide better glottic visualization in these groups of patients. Hence, we compared King Vision videolaryngoscope, C-MAC videolaryngoscope for endotracheal intubation in patients with proven/suspected cervical spine injury. Methods: After standard induction of anesthesia, 135 patients were randomized into three groups: group C (conventional C-MAC videolaryngoscope), group K (King Vision videolaryngoscope), and group D (D blade C-MAC videolaryngoscope). Cervical immobilization was maintained with Manual in line stabilization with anterior part of cervical collar removed. First pass intubation success, time for intubation, and glottic visualization (Cormack – Lehane grade and percentage of glottic opening) were noted. Intubation difficulty score (IDS) was used for grading difficulty of intubation. Five-point Likert scale was used for ease of insertion of laryngoscope. Results: First attempt success rate were 100% (45/45), 93.3% (42/45), and 95.6% (43/45) in patients using conventional C-MAC, King Vision, and D blade C-MAC videolaryngoscopes, respectively. Time for intubation in seconds was significantly faster with conventional C-MAC videolaryngoscope (23.3 ± 4.7) compared to D blade C-MAC videolaryngoscope (26.7 ± 7.1), whereas conventional C-MAC and King Vision were comparable (24.9 ± 7.2). Good grade glottic visualization was obtained with all the three videolaryngoscopes. Conclusion: All the videolaryngoscopes provided good glottic visualization and first attempt success rate. Conventional C-MAC insertion was significantly easier. We conclude that all the three videolaryngoscopes can be used effectively in patients with cervical spine injury. PMID:28217398

  8. 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.

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

    Science.gov (United States)

    Hollerwöger, Dieter

    2006-05-01

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

  10. 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.

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

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

    1999-05-01

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

  12. 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.

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

    Directory of Open Access Journals (Sweden)

    Jędrzej Płocki

    2015-03-01

    Full Text Available Introduction: The problem of health risks resulting from the performance of the occupation of a dentist concerns, among other things, the cervical region of the spine. Due to the position assumed at work, this part of the spine is overloaded, and the degree of this overload depends, among other things, on the technique used by a dentist, the ergonomic conditions, patient adaptation skills, and cooperation with an assistant or assistants. Aim of the research : The objective of the study was to obtain an answer to the research questions posed: whether dentists possess knowledge concerning the principles of ergonomics; is there any relationship between the period of employment and cervical spine pain, age, technique of work, duration of performing work during the week, and pain in the neck region; and if dentists attach importance to the prophylaxis of musculoskeletal disorders. Material and methods : The study covered 52 dentists – 33 females (63.5% and 19 males (36.5%, and was conducted using an anonymous questionnaire designed by the authors, the Visual Analogue Scale (VAS, a modified pain assessment questionnaire according to Laitinen, and methods of descriptive statistics (Pearson’s χ 2 test for independence. Results : Physicians possess knowledge concerning the ergonomics of work. In addition, more than 60% of respondents possess modern, electrically adjustable equipment, and the technique of work depends on the age of the dentist. There is a relationship between cervical spine pain and the duration of performance of the occupation (p = 0.01122. According to dentists (48.1%, pain in the neck region of the spine is caused by long-lasting maintenance of a static position of the body, and kinesitherapeutic exercises alleviate these complaints in 23.1% of respondents. Conclusions : Despite the use the principles of ergonomics at work, dentists are exposed to the occurrence of pain in the neck region of the spine.

  14. 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.

  15. Risk factors for surgical site infection after posterior cervical spine surgery: an analysis of 5,441 patients from the ACS NSQIP 2005-2012.

    Science.gov (United States)

    Sebastian, Arjun; Huddleston, Paul; Kakar, Sanjeev; Habermann, Elizabeth; Wagie, Amy; Nassr, Ahmad

    2016-04-01

    The incidence of surgical site infection (SSI) following posterior cervical surgery has been reported as high as 18% in the literature. Few large studies have specifically examined posterior cervical procedures. The study aims to examine the incidence, timing, and risk factors for SSI following posterior cervical surgery. This is a retrospective cohort study of prospectively collected data in a national surgical outcomes database. The sample includes patients who underwent posterior cervical spine surgery between 2005 and 2012 identified in the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) Participant Use Data File. The 30-day rate of postoperative SSI, timing of diagnosis, and associated risk factors were determined. The ACS NSQIP was used to identify 5,441 patients who underwent posterior cervical spine surgery by Current Procedural Terminology codes from 2005 to 2012. Thirty-day readmission data were obtained for 2011-2012. The incidence and timing of SSI were determined. Multivariable logistic regression analysis was then performed to identify significant risk factors. Of the 5,441 patients identified as having undergone posterior cervical surgery, 3,724 had a posterior cervical decompression, 1,310 had a posterior cervical fusion, and 407 underwent cervical laminoplasty. Surgical site infection within 30 days was identified in 160 patients (2.94%), with 80 of those cases being superficial SSI. There was no significant difference in SSI rate among the three procedure groups. The average time for diagnosis of SSI was over 2 weeks. In 2011-2012, 36.9% of patients with SSI were readmitted within 30 days. Several significant predictors of SSI were identified in univariate analysis, including body mass index (BMI) >35, chronic steroid use, albumin 35 (odds ratio [OR]=1.78, p=.003), chronic steroid use (OR=1.73, p=.049), and operative time >197 minutes (OR=2.08, p=.005), were identified in multivariable analysis. Optimization

  16. The study on the coping with fatigue, family cohesion, adaptability in patients suffered high paraplegia caused by cervical spine fracture%颈椎骨折高位截瘫患者的应对疲惫家庭亲密度和适应性研究

    Institute of Scientific and Technical Information of China (English)

    陶伟萍; 毛巧燕; 杨建萍

    2014-01-01

    目的 探讨家庭亲密度和适应性对颈椎骨折并高位截瘫患者应对疲惫的影响.方法 采用家庭亲密度和适应性量表、简明疲惫评估量表对96例颈椎骨折并高位截瘫患者患者进行问卷调查,分成疲惫组和非疲惫组,比较两组家庭亲密度和适应性的差别,并采用pearson相关性分析和多元线性回归分析探讨家庭亲密度和适应性对应对疲惫的影响.结果 ①96例截瘫患者中,63例处于应对疲惫状态,发病率为65.63%.②疲惫组实际亲密度和实际适应性评分均显著低于非疲惫组,亲密度不满意程度和适应性不满意程度评分均显著高于非疲惫组,均差异有统计学意义(t=-2.630,-3.359,10.469,17.821,P<0.05).③应对疲惫与实际亲密度(r=-0.463,P=0.015)、实际适应性(r=-0.486,P=0.021)均显著负相关,与亲密度不满意程度(r=0.395,P=0.036)、适应性不满意程度(r=0.524,P=0.020)均显著正相关.④多元回归分析显示,实际亲密度、实际适应性、亲密度不满意程度和适应性不满意程度均为颈椎骨折并高位截瘫患者应对疲惫的影响因素.结论 家庭亲密度和适应性下降是颈椎骨折并高位截瘫患者应对疲惫的重要原因.%Objective To explore the effect of family cohesion and adaptability on coping with fatigue in patients suffered high paraplegia caused by cervical spine fracture.Methods 96 patients suffered high paraplegia caused by cervical spine fracture were questionnaired by family cohesion and adaptability scale and bricf fatiguc assessment scale after 1 week of operation.And they were divided into the fatigue group and non-fatigue group,the scores of family cohesion and adaptability were compared between the two groups,and thepearson correlation analysis and multivariate linear regression analysis were used to explore the effect of family cohesion and adaptability on coping with fatigue.Results ①65.63% (63/96) patients suffered coping with fatigue

  17. The effect of protective football equipment on alignment of the injured cervical spine. Radiographic analysis in a cadaveric model.

    Science.gov (United States)

    Palumbo, M A; Hulstyn, M J; Fadale, P D; O'Brien, T; Shall, L

    1996-01-01

    No universally accepted management protocol is available for dealing with the protective equipment worn by a neck-injured football player. The purpose of this cadaveric study was to determine the effects of the helmet and shoulder pads on the alignment of 1) the intact lower cervical spine and 2) the partially destabilized C5-6 motion segment. In Group I cadavers (N = 15), the lower cervical spine was tested in an intact condition. In Group II (N = 8), the C5-6 motion segment was tested in both an intact and a partially destabilized condition. Each cadaver was placed supine on a backboard and four lateral cervical radiographs were obtained as follows: no protective equipment, helmet only, helmet and shoulder pads, and shoulder pads only. Results for Group I showed that wearing both helmet and shoulder pads did not result in a significant change in cervical lordosis when compared with the neutral position (i.e., the no-equipment test). Cervical lordosis was significantly decreased in the helmet-only category (mean, 9.6 degrees) and significantly increased in the shoulder pads-only category (mean, 13.6 degrees). In Group II, destabilized specimens under the helmet test situation showed a significant mean increase in C5-6 forward angulation (16.5 degrees), posterior disk space height (3.8 mm), and dorsal element distraction (8.3 mm). Immobilizing the neck-injured football player with only the helmet or only the shoulder pads in place violates the principle of splinting the cervical spine in neutral alignment, according to our findings. We support the concept that removal of the helmet and shoulder pads should be an all-or-none proposition.

  18. 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.

  19. Evaluation of low-cost computer monitors for the detection of cervical spine injuries in the emergency room: an observer confidence-based study

    OpenAIRE

    Brem, H. M.; Böhner, C; A. Brenning; Gelse, K; Radkow, T.; Blanke, M.; Schlechtweg, P. M.; Neumann, G.; Wu, I Y; Bautz, W; Hennig, F. F.; Richter, H.

    2006-01-01

    Background: To compare the diagnostic value of low-cost computer monitors and a Picture Archiving and Communication System (PACS) workstation for the evaluation of cervical spine fractures in the emergency room. Methods: Two groups of readers blinded to the diagnoses (2 radiologists and 3 orthopaedic surgeons) independently assessed–digital radiographs of the cervical spine (anterior–posterior, oblique and trans-oral-dens views). The radiographs of 57 patients who arrived consecutively to ...

  20. Anterior decompression, structural bone grafting, and Caspar plate stabilization for unstable cervical spine fractures and/or dislocations.

    Science.gov (United States)

    Garvey, T A; Eismont, F J; Roberti, L J

    1992-10-01

    Fourteen patients who sustained acute cervical spine fractures and/or dislocations with associated posterior ligamentous disruption had anterior decompressions, structural bone grafting, and anterior Caspar plate stabilization. With an average 30-month follow-up, no patient has had loss of fixation. Despite criticism raised from biomechanical testing, the Caspar anterior plate system (Aesculape, Tuttlingen, Germany) may be added to structural bone grafting of unstable cervical fractures and/or dislocations, yielding an in vivo solid construct, which obviates the need for simultaneous posterior stabilization.

  1. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  3. Study of the influence of degenerative intervertebral disc changes on the deformation behavior of the cervical spine segment in flexion

    Science.gov (United States)

    Kolmakova, Tatyana V.

    2016-11-01

    The paper describes the model of the cervical spine segment (C3-C4) and the calculation results of the deformation behavior of the segment under degenerative changes of the intervertebral disc. The segment model was built based on the experimental literature data taking into account the presence of the cortical and cancellous bone tissue of vertebral bodies. The calculation results show that degenerative changes of the intervertebral disc cause the immobility of the C3 vertebra at flexion.

  4. Deceleration during 'real life' motor vehicle collisions – a sensitive predictor for the risk of sustaining a cervical spine injury?

    Directory of Open Access Journals (Sweden)

    Hartwig Erich

    2009-03-01

    Full Text Available Abstract Background The predictive value of trauma impact for the severity of whiplash injuries has mainly been investigated in sled- and crash-test studies. However, very little data exist for real-life accidents. Therefore, the predictive value of the trauma impact as assessed by the change in velocity of the car due to the collision (ΔV for the resulting cervical spine injuries were investigated in 57 cases after real-life car accidents. Methods ΔV was determined for every car and clinical findings related to the cervical spine were assessed and classified according to the Quebec Task Force (QTF. Results In our study, 32 (56% subjects did not complain about symptoms and were therefore classified as QTF grade 0; 25 (44% patients complained of neck pain: 8 (14% were classified as QTF grade I, 6 (10% as QTF grade II, and 11 (19% as QTF grade IV. Only a slight correlation (r = 0.55 was found between the reported pain and ΔV. No relevant correlation was found between ΔV and the neck disability index (r = 0.46 and between ΔV and the QTF grade (r = 0.45 for any of the collision types. There was no ΔV threshold associated with acceptable sensitivity and specificity for the prognosis of a cervical spine injury. Conclusion The results of this study indicate that ΔV is not a conclusive predictor for cervical spine injury in real-life motor vehicle accidents. This is of importance for surgeons involved in medicolegal expertise jobs as well as patients who suffer from whiplash-associated disorders (WADs after motor vehicle accidents. Trial registration The study complied with applicable German law and with the principles of the Helsinki Declaration and was approved by the institutional ethics commission.

  5. Face validity of VIS-Ed: a visualization program for teaching medical students and residents the biomechanics of cervical spine trauma.

    Science.gov (United States)

    Courteille, Olivier; Ho, Johnson; Fahlstedt, Madelen; Fors, Uno; Felländer-Tsai, Li; Hedman, Leif; Möller, Hans

    2013-01-01

    This RCT study aimed to investigate if VIS-Ed (Visualization through Imaging and Simulation - Education) had the potential to improve medical student education and specialist training in clinical diagnosis and treatment of trauma patients. The participants' general opinion was reported as high in both groups (lecture vs. virtual patient (VP)). Face validity of the VIS-Ed for cervical spine trauma was demonstrated and the VP group reported higher stimulation and engagement compared to the lecture group. No significant difference in the knowledge test between both groups could be observed, confirming our null hypothesis that VIS-Ed was on par with a lecture.

  6. 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

  7. Cervical spine injuries resulting from diving accidents in swimming pools: outcome of 34 patients.

    Science.gov (United States)

    Borius, Pierre-Yves; Gouader, Ismail; Bousquet, Philippe; Draper, Louisa; Roux, Franck-Emmanuel

    2010-04-01

    Cervical spine injuries after diving into private swimming pools can lead to dramatic consequences. We reviewed 34 patients hospitalized in our center between 1996 and 2006. Data was collected from their initial admission and from follow-up appointments. The injuries were sustained by young men in 97% (mean age 27) and the majority happened during the summer (88%). Fractures were at C5-C7 in 70%. American Spinal Injury Association class (ASIA) on admission was A for 8 patients, B for 4, C for 4, D for 1, and E for 17. There were 23 surgical spine stabilizations. Final ASIA class was A for 6 patients, B for 1, C for 3, D for 5, and E for 18. The mean duration of hospitalization was 21.3 days in our neurosurgical center (mean overall cost: 36,000 Euros/patient) plus 10.6 months in rehabilitation center for the 15 patients admitted who had an ASIA class A to C. Mean overall direct cost for a patient with class A is almost 300,000 Euros, compared to around 10,000 Euros for patients with class D and E. In addition, a profound impact on personal and professional life was seen in many cases including 11 divorces and 7 job losses. Dangerous diving into swimming pools can result in spinal injuries with drastic consequences, including permanent physical disability and a profound impact on socio-professional status. Moreover, there are significant financial costs to society. Better prevention strategies should be implemented to reduce the impact of this public health problem.

  8. Three-dimensional intervertebral range of motion in the cervical spine: Does the method of calculation matter?

    Science.gov (United States)

    Anderst, William J; Aucie, Yashar

    2017-03-01

    Intervertebral range of motion (ROM) is commonly calculated using ordered rotations or projection angles. Ordered rotations are sequence-dependent, and projection angles are dependent upon on which orientation vectors are projected. This study assessed the effect of calculation method on intervertebral ROM in the subaxial cervical spine (C3-C7) during in vivo dynamic, three-dimensional, functional movement. Biplane radiographs were collected at 30 images per second while 29 participants performed full ROM flexion/extension, axial rotation and lateral bending movements of their cervical spine. In vivo bone motion was tracked with sub-millimeter accuracy using a validated volumetric model-based tracking technique. Intervertebral rotations were calculated using six Cardan angle sequences and two projection angle combinations. Within-subject comparisons revealed significant differences in intervertebral ROM among calculation methods (all p<0.002). Group mean ROM differences were small, but significantly different among calculation methods (p<0.001). A resampling technique demonstrated that as group size increases, the differences between calculation methods decreases substantially. It is concluded that the method used to calculate intervertebral rotations of the sub-axial cervical spine can significantly affect within-subject and between group comparisons of intervertebral ROM.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  10. [Vertical development of the face and cervical spine. Diagnostic and therapeutic significance in orthodontics and maxillofacial surgery].

    Science.gov (United States)

    Salagnac, J M; Delaire, J; Mercier, J

    1999-04-01

    Vertical growth of the cervical spine, of the mandibula and the upper maxilla are normally anatomically and physiologically correlated. At a very early age the relationships are established between the cervical spine and the angle of the mandibula which is normally level with C2's antero-inferior angle. A parallelism can be noticed between the rhythms of the vertical growth of the cervical spine and the changes of the maxillary in relation to the skull. So relationships are gradually established between the palate level, the top of the odontoid, and the foramen magnum. These relationships are well objectivized on a lateral teleradiography by Delaire' analysis. Lateral teleradiography of the situation of the angle of the mandibula, in relation to the basis of the C2 body should be systematic. It provides much information concerning the growth potential of the condylar unit, and makes possible a differential diagnosis between true or false posterior vertical insufficiency (PVI) and true or false posterior vertical excess (PVE) and to recognize clinical types of skeletal class II and class III of vertical origin.

  11. A method to characterize average cervical spine ligament response based on raw data sets for implementation into injury biomechanics models.

    Science.gov (United States)

    Mattucci, Stephen F E; Cronin, Duane S

    2015-01-01

    Experimental testing on cervical spine ligaments provides important data for advanced numerical modeling and injury prediction; however, accurate characterization of individual ligament response and determination of average mechanical properties for specific ligaments has not been adequately addressed in the literature. Existing methods are limited by a number of arbitrary choices made during the curve fits that often misrepresent the characteristic shape response of the ligaments, which is important for incorporation into numerical models to produce a biofidelic response. A method was developed to represent the mechanical properties of individual ligaments using a piece-wise curve fit with first derivative continuity between adjacent regions. The method was applied to published data for cervical spine ligaments and preserved the shape response (toe, linear, and traumatic regions) up to failure, for strain rates of 0.5s(-1), 20s(-1), and 150-250s(-1), to determine the average force-displacement curves. Individual ligament coefficients of determination were 0.989 to 1.000 demonstrating excellent fit. This study produced a novel method in which a set of experimental ligament material property data exhibiting scatter was fit using a characteristic curve approach with a toe, linear, and traumatic region, as often observed in ligaments and tendons, and could be applied to other biological material data with a similar characteristic shape. The resultant average cervical spine ligament curves provide an accurate representation of the raw test data and the expected material property effects corresponding to varying deformation rates.

  12. LMA C Trach aided endotracheal intubation in simulated cases of cervical spine injury: A series of 30 cases

    Directory of Open Access Journals (Sweden)

    Deepshikha C Tripathi

    2013-01-01

    Full Text Available Background: Laryngeal mask airway (LMA C Trach is a novel device designed to intubate trachea without conventional laryngoscopy. The aim of the study was to evaluate the clinical efficacy of C trach in the simulated scenario of cervical spine injury where conventional laryngoscopy is not desirable. Methods: This prospective pilot study was carried out in 30 consenting adults of either gender, ASAPS I or II, scheduled for surgery requiring endotracheal intubation. An appropriate sized rigid cervical collar was positioned around the patient′s neck to restrict the neck movements and simulate the scenario of cervical spine injury. After induction of anesthesia, various technical aspects of C Trach facilitated endotracheal intubation, changes in hemodynamic variables, and complications were recorded. Results: Mask ventilation was easy in all the patients. Successful insertion of C Trach was achieved in 27 patients at first attempt, while 3 patients required second attempt. Majority of patients required one of the adjusting maneuvers to obtain acceptable view of glottis (POGO score >50%. Intubation success rate was 100% with 26 patients intubated at first attempt and the rest required second attempt. Mean intubation time was 69.8±27.40 sec. With experience, significant decrease in mean intubation time was observed in last 10 patients as compared to first 10 (46±15.77 sec vs. 101.3±22.91 sec. Minor mucosal injury was noted in four patients. Conclusion: LMA C Trach facilitates endotracheal intubation under direct vision and can be a useful technique in patients with cervical spine injury with cervical collar in situ.

  13. Lower cervical spine loading in frontal sled tests using inverse dynamics: potential applications for lower neck injury criteria.

    Science.gov (United States)

    Pintar, Frank A; Yoganandan, Narayan; Maiman, Dennis J

    2010-11-01

    Lower cervical spine injuries are more common in survivors of motor vehicle crashes sustaining neck trauma. Injury criteria are determined using upper neck loads in dummies although a lower neck load cell exists. Due to a paucity of lower neck data from post mortem human subject (PMHS) studies, this research was designed to determine the head-neck biomechanics with a focus on lower neck metrics and injuries. Sixteen frontal impact tests were conducted using five belted PMHS. Instrumentation consisted of a pyramid shaped nine accelerometer package on the head, tri-axial accelerometer on T1, and uniaxial accelerometer on the sled. Three-dimensional kinematics of the head-neck complex were obtained using a 20- camera high-speed motion analysis system. Testing sequence was: low (3.6 m/s), medium (6.9 m/s), repeat low, and high (15.8 m/s) velocities. Trauma evaluations were made between tests. Testing was terminated upon confirmation of injuries. Autopsy was conducted, and geometric and inertial properties of the head were determined. Using inverse dynamics, upper and lower neck loads were determined, along with head and T1 kinematics. Lower cervical injuries occurred in four specimens during the loading phase and were attributed to the flexion mechanism. Peak upper and lower neck loading magnitudes and head-neck and T1 kinematics are given for each test. Sagittal plane head center of gravity and T1 kinematic data along with upper and lower neck forces and moments, hitherto not reported in literature, may be used to determine the biofidelity responses of frontal impact dummies and establish lower neck injury criteria.

  14. Anterior cervical fusion and osteosynthetic stabilization according to Caspar: a prospective study of 41 patients with fractures and/or dislocations of the cervical spine.

    Science.gov (United States)

    Goffin, J; Plets, C; Van den Bergh, R

    1989-12-01

    Between June 1984 and April 1988, 41 patients with severe posttraumatic lesions of the cervical spine between the C2-C3 and the C7-T1 level seen consecutively were treated by an anterior cervical fusion and osteosynthetic stabilization according to Caspar. These patients were prospectively studied. Seven patients had a bilateral facet dislocation, 5 a unilateral facet dislocation, 9 an anterior subluxation, 9 an anterior compression fracture, 5 a hangman's fracture, and 6 a hyperextension injury at a lower cervical level. From a neurological point of view, there were 12 patients with an initial complete transverse lesion and 14 with an incomplete transverse lesion, and the remaining 15 patients did not have any deficit initially. Four patients died during the first 3 months after the operation. In 38 patients good anatomical position was obtained, generally by the intraoperative use of the vertebral distractor of Caspar. In all patients excellent immediate postoperative stability of the spine was obtained, although in 2 patients a second operation was necessary a few days after the first one. Postoperatively all patients were "immobilized" by a soft collar for 3 months. Four patients with an initial complete transverse lesion showed some neurological recovery in the postoperative period, and all patients with an incomplete transverse lesion improved. There were no postoperative neurological disturbances in the group of patients who were neurologically normal from the beginning. The mean postoperative hospitalization time was 13.6 days. These results were compared to the results from the literature, concerning other conservative and operative treatments for posttraumatic lesions of the cervical spine.

  15. 下颈椎单侧小关节脱位的研究进展%Current research on unilateral cervical facet dislocation of the lower cervical spine

    Institute of Scientific and Technical Information of China (English)

    江晨; 宋文慧

    2016-01-01

    单侧小关节脱位是较为常见的颈椎损伤,且以C5-6最常发生,这与其解剖及形态学特征密切相关.该损伤由屈曲和旋转暴力协同作用所致,但主要因素尚不明确.治疗分为非手术治疗和手术治疗,但仍未确定最佳的治疗方案.现在被普遍接受的方案是首先行闭合复位,再根据闭合复位成功与否及有无出现创伤性椎间盘突出决定下一步治疗.%Unilateral facet dislocation of the lower cervical spine is an important subgroup of cervical spine injuries,accounting for from 12% to 16% of all cervical spine injuries.Unilateral facet dislocation occurs the most commonly at the C5-6 level,and is closely related to the anatomic and morphometric features of the cervical facet.This injury has been attributed to combined flexion and rotation,but it remains unclear whether flexion or rotation is the component of greater importance.Its treatment includes nonoperative and operative measures but optimal treatment has not been established.It is generally accepted that a recommendable treatment protocol begins with closed reduction and proceeds depending on whether the closed reduction succeeds and traumatic disc herniation is present or not.

  16. Ossification of the posterior longitudinal ligament (OPLL) in the cervical spine. Clinical, neuroradiological and neurophysiological study on 9 cases.

    Science.gov (United States)

    Del Conte, L; Tassinari, T; Trucco, M; Serrato, O; Badino, R

    1992-12-01

    Ossification of the posterior longitudinal ligament (OPLL) in the cervical spine is considered to be uncommon in western countries, although widely known and studied in Japan. We report on 9 cases of OPLL cervical myelopathy investigated by x-ray films and cervical CT and by somatosensory evoked potentials. The patients reported spastic tetraparesis, sensory disorders of the limbs and, in one case, sphincter incontinence. Neuroradiological examinations showed that the posterior columns of the spinal cord were more affected than the roots. Our data suggest that OPLL is more frequent in the West than has so far been reported and that combined radiological and neurophysiological investigation ensures correct diagnosis and accurate assessment of the cord impairment.

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Soederman, Tomas; Shalabi, Adel; Sundin, Anders [Uppsala University Hospital, Department of Radiology, Uppsala (Sweden); Olerud, Claes; Alavi, Kamran [Uppsala University Hospital, Department of Orthopedic Surgery, Uppsala (Sweden)

    2014-09-18

    To compare CR with CT (static and dynamic) to evaluate upper spine instability and to determine if CT in flexion adds value compared to MR imaging in neutral position to assess compression of the subarachnoid space and of the spinal cord. Twenty-one consecutive patients with atlantoaxial subluxation due to rheumatoid arthritis planned for atlantoaxial fusion were included. CT and MRI were performed with the neck in the neutral position and CT also in flexion. CR in neutral position and flexion were obtained in all patients except for one subject who underwent examination in flexion and extension. CR and CT measurements of atlantoaxial subluxation correlated but were larger by CR than CT in flexion, however, the degree of vertical dislocation was similar with both techniques irrespective of the position of the neck. Cervical motion was larger at CR than at CT. The spinal cord compression was significantly worse at CT obtained in the flexed position as compared to MR imaging in the neutral position. Functional CR remains the primary imaging method but CT in the flexed position might be useful in the preoperative imaging work-up, as subarachnoid space involvement may be an indicator for the development of neurologic dysfunction. (orig.)

  19. Subacromial impingement in patients with whiplash injury to the cervical spine

    Directory of Open Access Journals (Sweden)

    Giddins Grey E

    2008-06-01