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Relationship between Northwick Park neck pain questionnaire and cervical spine MR imaging findings
The study was aimed at determining the association between the self-report of pain and disability by means of Northwick neck pain questionnaire (NPQ) and cervical spine MR imaging findings. A random sample of 251 patients, 132 men and 119 women aged 43�13�years, submitted with neck pain were investigated. Patients with previous discitis, surgery, neoplasm or hospitalized for cervical spine trauma
Estanislao Arana; Luis Mart�-Bonmat�; Ruben Montijano; Daniel Bautista; Enrique Molla; Salvador Costa
Correlation between TMD and Cervical Spine Pain and Mobility: Is the Whole Body Balance TMJ Related?
Temporomandibular dysfunction (TMD) is considered to be associated with imbalance of the whole body. This study aimed to evaluate the influence of TMD therapy on cervical spine range of movement (ROM) and reduction of spinal pain. The study group consisted of 60 patients with TMD, cervical spine pain, and limited cervical spine range of movements. Subjects were interviewed by a questionnaire about symptoms of TMD and neck pain and had also masticatory motor system physically examined (according to RDC-TMD) and analysed by JMA ultrasound device. The cervical spine motion was analysed using an MCS device. Subjects were randomly admitted to two groups, treated and control. Patients from the treated group were treated with an occlusal splint. Patients from control group were ordered to self-control parafunctional habits. Subsequent examinations were planned in both groups 3 weeks and 3 months after treatment was introduced. The results of tests performed 3 months after the beginning of occlusal splint therapy showed a significant improvement in TMJ function (P > 0.05), cervical spine ROM, and a reduction of spinal pain. The conclusion is that there is a significant association between TMD treatment and reduction of cervical spine pain, as far as improvement of cervical spine mobility. PMID:25050363
Walczynska-Dragon, Karolina; Baron, Stefan; Nitecka-Buchta, Aleksandra; Tkacz, Ewaryst
Manipulative therapy is frequently used in the management of musculoskeletal pain. A frequently reported clinical feature of this treatment is the immediacy with which it appears to initiate improvement in pain and function. A randomised, double blind, placebo controlled, repeated measures design was employed to study the initial effects of a cervical spine treatment technique in a group of 15
Bill Vicenzino; David Collins; Anthony Wright
Revision cervical spine surgery.
Principles of revision cervical spine surgery are based on adequate decompression of neural elements and mechanical stability via appropriate selection of surgical approach and constructs producing long-term stability with arthrodesis. When planning revision surgery, the surgeon must consider the cause of the underlying problem (eg, biological, mechanical), the potential for complications, and clinical outcomes that can reasonably be expected. This information should be clearly explained to the patient during the informed consent process. This article provides the spine care provider with an understanding of how to appropriately evaluate and manage the most common cervical conditions that require revision cervical spine surgery. PMID:22082635
Rihn, Jeffrey A; Harrod, Chambliss; Albert, Todd J
Hemangiopericytoma of the cervical spine
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.
Ramdasi, Raghvendra V.; Nadkarni, Trimurti D.; Goel, Naina A.
Vertebroplasty for Spine Fracture Pain
MENU Return to Web version Vertebroplasty for Spine Fracture Pain Vertebroplasty for Spine Fracture Pain More than 40 million people in the ... bones that puts them at risk for spine fractures (broken bones). Thinning of the bones can occur ...
Cervical spine: sport injuries biomechanics
An improved and detailed 3-D FE model of human cervical spine was created using digitized geometric measurement. The model was validated with the in-vivo studies of Moroney [5], Panjabi [6] and Fuller [7]. Clinical instability of the spine for two cases involving flexion and compression loading (simulating injuries in motorcycle vaulting, football and diving accidents) were analyzed. The instability was
Abraham Tchako; Ali M. Sadegh
Cervical spine injuries in American football.
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 catastrophic injury is felt to be the result of changes in the rules in the mid-1970s that prohibited the use of the head as the initial contact point when blocking and tackling. Evaluation of patients with suspected cervical spine injury includes a complete neurological examination while on the field or the sidelines. Immobilization on a hard board may also be necessary. The decision to obtain radiographs can be made on the basis of the history and physical examination. Treatment depends on severity of diagnosed injury and can range from an individualized cervical spine rehabilitation programme for a 'stinger' to cervical spine decompression and fusion for more serious bony or ligamentous injury. Still under constant debate is the decision to return to play for the athlete. PMID:19691361
Rihn, Jeffrey A; Anderson, David T; Lamb, Kathleen; Deluca, Peter F; Bata, Ahmed; Marchetto, Paul A; Neves, Nuno; Vaccaro, Alexander R
Cervical spine in Treacher Collins syndrome.
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. PMID:22627438
Pun, Amy Hoi-Ying; Clark, Bruce Eric; David, David John; Anderson, Peter John
Evaluation of pediatric cervical spine injuries
To compare historical features, clinical examination findings, and radiographic results among pediatric patients with cervical spine injury (CSI), a retrospective review of patients who were diagnosed with CSI was undertaken. Two main groups were identified: radiographically evident cervical spine injury (RESCI), and spinal cord injury without radiographic abnormality (SCIWORA). Demographic, historical, clinical, and radiographic information was obtained from patients' charts
Chris Baker; Howard Kadish; Jeff E Schunk
Diffuse idiopathic skeletal hyperostosis (DISH) is considered an underdiagnosed and mostly asymptomatic nonprimary osteoarthritis. The etiology of DISH remains unknown and the validated diagnostic criteria are absent. This condition is still recognized radiologically only. Rarely, large projecting anterior osteophytes result in esophageal impingement and distortion leading to dysphagia. We report the case of progressive dysphagia and neck pain due to DISH of the cervical spine in a 70-year-old man, which was surgically removed with excellent postoperative results and complete resolution of symptoms. Imaging studies, surgical findings, and histopathological examinations were used to support the diagnosis. The patient was successfully treated with total excision of the anterior osteophytes with no evidence of recurrence 12 months after surgery. In this report, we also discuss the clinical features and perioperative considerations in combination with a literature review. Our patient illustrates that clinicians should be aware of this rare clinical manifestation as the presenting feature of DISH in cervical spine. Surgical decompression through osteophytectomy is effective for patients who fail conservative treatment. PMID:24729695
Zhang, Chao; Ruan, Dike; He, Qing; Wen, Tianyong; Yang, Pushan
Diffuse idiopathic skeletal hyperostosis (DISH) is considered an underdiagnosed and mostly asymptomatic nonprimary osteoarthritis. The etiology of DISH remains unknown and the validated diagnostic criteria are absent. This condition is still recognized radiologically only. Rarely, large projecting anterior osteophytes result in esophageal impingement and distortion leading to dysphagia. We report the case of progressive dysphagia and neck pain due to DISH of the cervical spine in a 70-year-old man, which was surgically removed with excellent postoperative results and complete resolution of symptoms. Imaging studies, surgical findings, and histopathological examinations were used to support the diagnosis. The patient was successfully treated with total excision of the anterior osteophytes with no evidence of recurrence 12 months after surgery. In this report, we also discuss the clinical features and perioperative considerations in combination with a literature review. Our patient illustrates that clinicians should be aware of this rare clinical manifestation as the presenting feature of DISH in cervical spine. Surgical decompression through osteophytectomy is effective for patients who fail conservative treatment. PMID:24729695
Zhang, Chao; Ruan, Dike; He, Qing; Wen, Tianyong; Yang, Pushan
... the neck area, the first vertebrae of the thoracic spine, and the disk spaces in between them. The ... with you and explain what they mean. In case of an injury or other emergency, the results of a cervical spine X-ray can be available quickly. Otherwise, they' ...
Cervical myofascial pain and headache
Myofascial pain is a common cause of regional chronic pain. Myofascial trigger points can refer pain to the head and face\\u000a in the cervical region, thus contributing to cervicogenic headache. When identified properly, cervical myofascial pain is\\u000a a treatable component of headache management. This article reviews current literature on the pathophysiology, diagnosis, and\\u000a management of cervical myofascial pain.
Joanne Borg-Stein
Comparison of Three Prehospital Cervical Spine Protocols to Missed Injuries
medical services; ED, emergency department; C spine, cervical spine Western Journalmedical services (EMS) practice is to assume a potential cervical Western Journalmedical services (EMS) and emergency department (ED) personnel. Western Journal
Preoperative Embolization of Cervical Spine Tumors
Purpose: To assess the technical success rate, complications, and effect on intraoperative blood loss of preoperative transarterial embolization of cervical spine tumors. Methods: A retrospective analysis was performed on 38 patients with tumors of the cervical spine; 69 vertebrae were affected. Polyvinyl alcohol particles, coils, gelfoam particles, either alone or in combination, were used for preoperative tumor embolization. After embolization a total of 57 corporectomies with titanium basket implantation were performed. Results: In 36 of 38 patients, complete (n= 27) or partial (n= 9) embolization was achieved. In 23 patients one vertebral artery was completely occluded by coil placement, and in one patient the ipsilateral internal and external carotid arteries were occluded in addition. No neurological complications could be directly related to the embolization, but two postoperative brain stem infarctions occurred. The mean intraoperative blood loss was 2.4 L. Conclusion: Transarterial embolization of cervical spine tumors is a safe and effective procedure to facilitate extensive surgery.
Vetter, Sylvia C.; Strecker, Ernst-Peter [Department of Radiology and Nuclear Medicine, Diakonissenkrankenhaus, Diakonissenstrasse 28, D-76199 Karlsruhe (Germany); Ackermann, Ludwig W.; Harms, Juergen [Department of Orthopedic Surgery, Klinikum Karlsbad-Langensteinbach Guttmannstrasse 1, D-76307 Karlsbad (Germany)
Psychological distress in chronic craniomandibular and cervical spinal pain patients.
Recent studies to chronic pain have shown that the number of painful body areas is related to the level of psychological distress. Therefore, the first aim of this study was to analyse differences in level of psychological distress between craniomandibular pain patients with or without cervical spinal pain. In this analysis, the number of painful body areas below the cervical spine was also taken into account. The second aim was to determine psychological differences between subgroups of craniomandibular pain patients. In this study, 103 out of 250 persons with or without craniomandibular pain were included in the final analyses. Patients who suffered from both craniomandibular and cervical spinal pain showed higher levels of psychological distress, as measured with the Symptom Checklist 90 (SCL-90) than patients with local craniomandibular pain and persons without pain. Further, a positive relationship was found between the number of painful body areas below the cervical spine, as measured on a body drawing, and the SCL-90 scores. No psychological differences were found between myogenous and arthrogenous craniomandibular pain patients. In conclusion, chronic craniomandibular pain patients with a coexistent cervical spinal pain showed more psychological distress compared to patients with only a local craniomandibular pain and asymptomatic persons. PMID:11456346
Visscher, C M; Lobbezoo, F; de Boer, W; van der Meulen, M; Naeije, M
Osteochondroma of the cervical spine MR findings
We report two cases of osteochondroma in the region of the cervical spine. The magnetic resonance (MR) images well demonstrated the relationship of the tumor, the spinal cord, and adjacent soft tissue, but correct diagnosis by MR imaging was difficult in one patient due to unusual gadolinium enhancement. Computed tomography played an important role in these patients by demonstrating the
Minoru Morikawa; Yuji Numaguchi; Joseph A. Soliman
INTRODUCTION Usually, cervical pedicle screw fixation has been considered too risky for neurovascular structures. The purpose of this study was to investigate the method and efficacy of the cervical pedicle screw system for fracture-dislocation of the cervical spine because of its rigid fixation. PATIENTS AND METHODS A prospective study was conducted involving 48 patients with cervical spine fracture-dislocation who underwent cervical pedicle screw fixation surgery between January 2003 and January 2007. All patients had various degrees of cord injury, and they were classified according to the American Spinal Cord Injury Association (ASIA) Impairment Scale: 18 cases were grade A, 15 grade B, 10 grade C, and 5 grade D. RESULTS Six months after the operation, all patients had achieved solid bony fusion and stable fixation of the related segments. Thirty patients with incomplete spinal cord injury improved their ASIA Impairment Scale classification by 1 to 2 grades after the operation. Eighteen patients with complete spinal cord injury had no improvement in neural function. However, nerve root symptoms such as pain and numbness were alleviated to some extent. CONCLUSIONS The cervical pedicle screw system is an effective and reliable method for the restoration of cervical stability. Sufficient pre-operative imaging studies of the pedicles and strict screw insertion technique should be emphasised. PMID:20487593
Zhou, Feng; Zou, Jun; Gan, Minfeng; Zhu, Ruofu; Yang, Huilin
Adjacent segment disease after cervical spine fusion.
Anterior cervical diskectomy and fusion is one of the most common cervical spine procedures. Although it is usually successful in relieving the symptoms of radiculopathy and myelopathy, the subsequent development of clinically significant disk disease at levels adjacent to the fusion is a matter of concern. Adjacent segment cervical disease occurs in approximately 3% of patients; the incidence is expected to increase to more than 25% of patients within the first 10 years after the index fusion procedure. The disease is well described in the literature, and significant basic science and clinical research has been conducted. Nonetheless, the cause of the disease is a matter of debate. A combination of factors probably contributes to its development, including the increased biomechanical stress placed on the disk space adjacent to a fusion and the natural history of cervical spondylosis in patients known to have such pathology. Clinical and biomechanical data are available to support each of these claims. Symptomatic disk disease adjacent to a cervical fusion is a significant clinical problem, and, therefore, motion-sparing technology has been developed to reduce its incidence. Two cervical disk replacement systems are currently approved by the US Food and Drug Administration for the treatment of symptomatic cervical spondylosis. PMID:19385583
Rihn, Jeffrey A; Lawrence, James; Gates, Charley; Harris, Eric; Hilibrand, Alan S
Cervical Spine Surgery: An Historical Perspective
Background��Continued innovation in surgery requires a knowledge and understanding of historical advances with a recognition of successes\\u000a and failures.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes��To identify these successes and failures, we selectively reviewed historical literature on cervical spine surgery with respect\\u000a to the development of (1) surgical approaches, (2) management of degenerative disc disease, and (3) methods to treat segmental\\u000a instability.\\u000a \\u000a \\u000a \\u000a \\u000a Methods��We performed a nonsystematic
Vincenzo Denaro; Alberto Di Martino
Cervical Spine Involvement: A Rare Manifestation of Reiter's Syndrome
Spine involvement is less common in Reiter's syndrome than in other seronegative spondyloarthropathies. Also, cervical spine involvement rarely occurs in Reiter's syndrome and other spondyloarthropathies. This paper reports a rare case of Reiter's syndrome in which there was cervical spine involvement that presented clinically as an atlanto-axial rotatory subluxation. Reiter's Syndrome (RS) is one of the most common types of seronegative spondyloarthropathies (SSAs) that presents clinically with a triad of symptoms, i.e., conjunctivitis, urethritis, and arthritis. This case highlighted the importance of radiographs of the lateral cervical spine and dynamic cervical imaging for all patients who have Reiter's syndrome with cervical spine symptoms to ensure that this dangerous abnormality is not overlooked. PMID:25360183
Rastegar, Khodakaram; Ghalaenovi, Hossein; Babashahi, Ali; Shayanfar, Nasrin; Jafari, Mohammad; Jalalian, Mehrdad; Fattahi, Arash
Sheep Cervical Spine Biomechanics: a Finite Element Study
Introduction Animal models are often used to make the transition from scientific concepts to clinical applications. The sheep model has emerged as an important model in spine biomechanics. Although there are several experimental biomechanical studies of the sheep cervical spine, only a limited number of computational models have been developed. Therefore, the objective of this study was to develop and validate a C2-C7 sheep cervical spine finite element (FE) model to study the biomechanics of the normal sheep cervical spine. Methods The model was based on anatomy defined using medical images and included nonlinear material properties to capture the high flexibility and large neutral zone of the sheep cervical spine. The model was validated using comprehensive experimental flexibility testing. Ten adult sheep cervical spines, from C2-C7, were used to experimentally ascertain overall and segmental flexibility to �2 Nm in flexion-extension, lateral bending, and axial rotation. Results The ranges of motion predicted by the computational model were within one standard deviation of the respective experimental motions throughout the load cycle, with the exception of extension and lateral bending. The model over- and under predicted the peak motions in extension and lateral bending, respectively. Nevertheless, the model closely represents the range of motion and flexibility of the sheep cervical spine. Discussion This is the first multilevel model of the sheep cervical spine. The validated model affords additional biomechanical insight into the intact sheep cervical spine that cannot be easily determined experimentally. The model can be used to study various surgical techniques, instrumentation, and device placement, providing researchers and clinicians insight that is difficult, if not impossible, to gain experimentally. PMID:25328473
DeVries Watson, Nicole A; Gandhi, Anup A; Fredericks, Doug C; Smucker, Joseph D; Grosland, Nicole M
Congenital dermal sinus of the cervical spine in an adult.
Congenital dermal sinuses are epithelium-lined tracts that extend from an opening in the skin through deeper tissues. Most dorsal congenital dermal sinuses are located in the lumbosacral area; a cervical location is unusual. This report describes a 24-year-old woman who presented with neck pain of 6 months' duration. A dimple in the skin over her cervical spine and a stunted right foot (0.5 cm shorter than the left) were detected on physical assessment. Neurological examination revealed increased deep tendon reflexes in her lower extremities. Magnetic resonance imaging showed a dermal sinus extending from the dimple site to the spinal cord near the C4-C5 vertebrae. Laminectomies were performed at C3-C4 and the tract was totally excised. The patient's neck pain completely resolved and her deep tendon reflexes were normal at 12 months after surgery. Tethered spinal cord alone does not necessarily demand surgery; however, if a congenital dermal sinus is present then surgery is indicated to prevent spinal infection. Even if there are no neurological symptoms, the tract must be surgically removed and the cord must be fully released to prevent future infectious or neurological complications. PMID:18032049
Dagcinar, Adnan; Konya, Deniz; Akakin, Akin; Gercek, Arzu; Ozgen, Serdar; Pamir, Necmettin M
Occurrence of Cervical Spine Injuries During the Rugby Scrum
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
Merrick J. Wetzler; Toks Akpata; William Laughlin; Andrew S. Levy
Percutaneous vertebroplasty for multiple myeloma of the cervical spine
Introduction��Spinal involvement is a common presentation of multiple myeloma (MM); however, the cervical spine is the least common site\\u000a of myelomatous involvement. Few studies evaluate the results of percutaneous vertebroplasty (PV) in the treatment of MM of\\u000a the spine. The purpose of this series is to report on the use of PV in the treatment of MM of the cervical
Francisco Mont�Alverne; Jean-Noel Vall�e; Remy Guillevin; Evelyne Cormier; Betty Jean; Michelle Rose; Jos� Guilherme Caldas; Jacques Chiras
A delayed diagnosis of bilateral facet dislocation of the cervical spine: a case report
Objective: To review the case of a patient suffering from bilateral facet dislocation of the cervical spine. Clinical features: A 53-year-old male was involved in a car accident and was transported to the hospital. Cervical radiographs were taken at the emergency department and interpreted as normal. Four days later, he consulted a chiropractor where radiographs of the cervical spine were repeated. The examination revealed bilateral cervical facet joint dislocation at C5�C6 as well as a fracture involving the spinous process and laminae of C6. Intervention and outcome: The patient was referred to the hospital and underwent surgery. Conclusion: Patients involved in motor vehicle accidents often consult chiropractors for neck pain treatment. A high index of suspicion due to significant history and physical examination findings should guide the clinician in determining the need for reviewing the initial radiographs (if taken and available) or request repeat studies, regardless of the initial imaging status. PMID:24587496
O'Shaughnessy, Julie; Grenier, Julie-Marthe; Stern, Paula J.
Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability
The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain. The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barr�-Li�ou syndrome. When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability. Therefore, we propose that in many cases of chronic neck pain, the cause may be underlying joint instability due to capsular ligament laxity. Currently, curative treatment options for this type of cervical instability are inconclusive and inadequate. Based on clinical studies and experience with patients who have visited our chronic pain clinic with complaints of chronic neck pain, we contend that prolotherapy offers a potentially curative treatment option for chronic neck pain related to capsular ligament laxity and underlying cervical instability. PMID:25328557
Steilen, Danielle; Hauser, Ross; Woldin, Barbara; Sawyer, Sarah
Chronic neck pain: making the connection between capsular ligament laxity and cervical instability.
The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain. The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barr�-Li�ou syndrome. When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability. Therefore, we propose that in many cases of chronic neck pain, the cause may be underlying joint instability due to capsular ligament laxity. Currently, curative treatment options for this type of cervical instability are inconclusive and inadequate. Based on clinical studies and experience with patients who have visited our chronic pain clinic with complaints of chronic neck pain, we contend that prolotherapy offers a potentially curative treatment option for chronic neck pain related to capsular ligament laxity and underlying cervical instability. PMID:25328557
Steilen, Danielle; Hauser, Ross; Woldin, Barbara; Sawyer, Sarah
Symptomatic intravertebral disc herniation (Schmorl's node) in the cervical spine.
A case of a Schmorl's node in the cervical vertebra causing neck pain is reported. An inflammatory focus was found on histological examination of Schmorl's node indicating a possible mechanism of pain production. Images PMID:4083942
Lipson, S J; Fox, D A; Sosman, J L
Outpatient surgery in the cervical spine: is it safe?
Study Design?Systematic review. Study Rationale?As the length of stay after cervical spine surgery has decreased substantially, the feasibility and safety of outpatient cervical spine surgery come into question. Although minimal length of stay is a targeted metric for quality and costs for medical centers, the safety of outpatient cervical spine surgery has not been clearly defined. Objective?The objective of this article is to evaluate the safety of inpatient versus outpatient surgery in the cervical spine for adult patients with symptomatic or asymptomatic degenerative disc disease. Methods?A systematic review of the literature was undertaken for articles published through February 19, 2014. Electronic databases and the bibliographies of key articles were searched to identify comparative studies evaluating the safety of inpatient versus outpatient surgery in the cervical spine. Spinal cord stimulation, spinal injections, and diagnostic procedures were excluded. Two independent reviewers assessed the strength of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, and disagreements were resolved by consensus. Results?Five studies that met the inclusion criteria were identified. One study reported low risk of hematoma (0% of outpatients and 1.6% of inpatients). Two studies reported on mortality and both reported no deaths in either group following surgery. Dysphagia risks ranged from 0 to 10% of outpatients and 1.6 to 5% of inpatients, and infection risks ranged from 0 to 1% of outpatients and 2 to 2.8% of inpatients. One study reported that no (0) outpatients were readmitted to the hospital due to a complication, compared with four inpatients (7%). The overall strength of evidence was insufficient for all safety outcomes examined. Conclusion?Though the studies in our systematic review did not suggest an increased risk of complication with outpatient cervical spine surgery, the strength of evidence to make a recommendation was insufficient. Further study is needed to more clearly define the role of outpatient cervical spine surgery. PMID:25278884
Lee, Michael J; Kalfas, Iain; Holmer, Haley; Skelly, Andrea
Osteomyelitis of mandible as a delayed adverse event following radiation therapy has been widely reported; however, osteomyelitis of the cervical spine has rarely been reported. In this study, we reported our experience with a case of cervical spine osteomyelitis and epidural abscess after concurrent chemoradiotherapy (CCRT) for hypopharyngeal carcinoma. The case involved a 68-year old man who underwent radical CCRT after a diagnosis of stage IVb, T4bN2cM0 posterior hypopharyngeal wall carcinoma. At 7 months after completing the initial therapy, the patient complained of severe pain in the neck and both shoulders and reduced muscular strength in the extremities. A large defect was found on the mucosa of posterior hypopharyngeal wall. On cervical magnetic resonance imaging, cervical spine osteomyelitis and an epidural abscess were observed. Because antimicrobial therapy was not effective, hyperbaric oxygen therapy was administered. Abscess reduction and improvement of the mucosal defect were observed. Because cervical spine complications after CCRT can be fatal upon worsening, adequate attention must be given. PMID:24711945
Watanabe, Jun; Hashimoto, Shigehisa; Takahashi, Sugata
Federal Register 2010, 2011, 2012, 2013
...claim for VA disability benefits related to a claimant's diagnosis of a cervical spine condition. DATES: Written comments and...results of medical examination and related to the claimant's diagnosis of a cervical spine condition. VA will gather medical...
Risk Factors for Vertebral Artery Injuries in Cervical Spine Trauma
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.
Dabke, Harshad V.
Artificial total disc replacement versus fusion for the cervical spine: a systematic review
Cervical total disc replacement (CTDR) has been increasingly used as an alternative to fusion surgery in patients with pain or neurological symptoms in the cervical spine who do not respond to non-surgical treatment. A systematic literature review has been conducted to evaluate whether CTDR is more efficacious and safer than fusion or non-surgical treatment. Published evidence up to date is summarised qualitatively according to the GRADE methodology. After 2�years of follow-up, studies demonstrated statistically significant non-inferiority of CTDR versus fusion with respect to the composite outcome �overall success�. Single patient relevant endpoints such as pain, disability or quality of life improved in both groups with no superiority of CTDR. Both technologies showed similar complication rates. No evidence is available for the comparison between CTDR and non-surgical treatment. In the long run improvement of health outcomes seems to be similar in CTDR and fusion, however, the study quality is often severely limited. After both interventions, many patients still face problems. A difficulty per se is the correct diagnosis and indication for surgical interventions in the cervical spine. CTDR is no better than fusion in alleviating symptoms related to disc degeneration in the cervical spine. In the context of limited resources, a net cost comparison may be sensible. So far, CTDR is not recommended for routine use. As many trials are ongoing, re-evaluation at a later date will be required. Future research needs to address the relative effectiveness between CTDR and conservative treatment. PMID:20936484
Winkler, Roman; Mad, Philipp
Posterior fixation of the upper cervical spine: contemporary techniques.
Instrumentation in the upper cervical spine has changed considerably in the past two decades. Previous stand-alone wiring techniques have been made largely obsolete with the development of occipital segmental plating, transarticular screws, and C1 lateral mass screws, as well as a myriad of C2 fixation options, including pedicle, pars, and translaminar screws. Polyaxial screws and segmental fixation are more user-friendly than stand-alone wiring and provide a stronger construct. Awareness of the risks and benefits associated with the use of modern instrumentation and thorough familiarity with the anatomy of the upper cervical spine are essential to avoid complications and optimize outcomes. PMID:21292929
Bransford, Richard J; Lee, Michael J; Reis, Abilio
Objective. To evaluate the correlation between neurological deficits indicative of compressive myelopathy and MRI findings in a series of patients with RA and symptomatic involvement of the cervical spine. Methods. Forty-one consecutive patients with RA were studied using cervical spine MRI. Unconditional logistic regression analysis was used to identify MRI parameters of cervical spine involvement associated with the development of
J. A. Narvaez; M. Serrallonga; E. De Lama; M. de Albert; R. Mast; J. M. Nolla
Clinical manifestations of diffuse idiopathic skeletal hyperostosis of the cervical spine
Objectives: To describe the clinical manifestations and the complications of cervical spine (C-spine) involvement in diffuse idiopathic skeletal hyperostosis (DISH). Methods: Two patients, who presented with dysphagia resulting from large anterior osteophytes of the C-spine, were diagnosed as having DISH. A Medline search from 1964 to present, using the terms �diffuse idiopathic skeletal hyperostosis� and �cervical spine,� identified several clinical
Reuven Mader
Objective��The treatment of symptomatic Chiari II malformations typically involves multilevel cervical laminectomies in very young children.\\u000a These patients are at significant risk of cervical instability. The purpose of this study was to determine the incidence and\\u000a significance of cervical instability after multilevel cervical laminectomies in a cohort of patients decompressed for Chiari\\u000a II malformation.\\u000a \\u000a \\u000a \\u000a Methods��Postoperative dynamic lateral cervical spine radiographs
Fred C. Lam; Beverly J. Irwin; Kenneth J. Poskitt; Paul Steinbok
Mastoid pneumocoele with skull base and cervical spine pneumatisation.
Very uncommonly, Eustachian tube dysfunction can lead to symptomatic chronic elevation of middle ear pressure with aeration of bone and adjacent structures in the skull base and upper cervical spine, and an increased risk of fracture. We present a case demonstrating the natural history of this condition over 11 years before treatment and 10 months after treatment. PMID:24119274
Cowan, Ian A; Greig, Sam R; Bird, Philip A
Closed cervical spine trauma associated with bilateral vertebral artery injuries
Bilateral vertebral artery injuries in closed cervical spine injuries are uncommon, but early recognition and treatment are important to prevent neurological deterioration. A case of bilateral vertebral injuries in a 35-year-old motor vehicle accident victim is presented, and the current literature is reviewed.
P. Kloen; J. D. Patterson; B. I. Wintman; R. M. Ozuna; G. W. Brick
We studied 12 consecutive patients with facet joint dislocation in the cervical spine to assess the incidence, site and clinical sequelae of occlusion of the extracranial vertebral artery. Intra-arterial digital subtraction angiography was performed after the orthopaedic management of the dislocations. This demonstrated vertebral artery occlusion (one bilateral) in five of the seven patients with bilateral dislocations and in four
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
Ramadorai, Uma E; Hire, Justin M; DeVine, John G
Successful Treatment of Severe Sympathetically Maintained Pain Following Anterior Spine Surgery
Sympathetic dysfunction is one of the possible complications of anterior spine surgery; however, it has been underestimated as a cause of complications. We report two successful experiences of treating severe dysesthetic pain occurring after anterior spine surgery, by performing a sympathetic block. The first patient experienced a burning and stabbing pain in the contralateral upper extremity of approach side used in anterior cervical discectomy and fusion, and underwent a stellate ganglion block with a significant relief of his pain. The second patient complained of a cold sensation and severe unexpected pain in the lower extremity of the contralateral side after anterior lumbar interbody fusion and was treated with lumbar sympathetic block. We aimed to describe sympathetically maintained pain as one of the important causes of early postoperative pain and the treatment option chosen for these cases in detail. PMID:25289130
Woo, Jae Hee
Symptomatic Solitary Osteochondroma of the Subaxial Cervical Spine in a 52-Year-Old Patient
Osteochondromas are the most common benign tumors of the bone. They mostly arise from the appendicular skeleton and present clinically in the second or third decade of life. Ostechondromas arising from the subaxial cervical spine and presenting after the 5th decade of life are extremely rare. We report a 52-year-old male patient who presented with numbness and subjective weakness of left upper and lower limbs and neck pain, and had lobulated bony hard fixed swelling in the right lower cervical paraspinal region. Radiological images revealed a bony swelling arising from C4 and C5 lamina with a cartilaginous cap and intraspinal extension. Excision biopsy with stabilisation of the spine was performed. Histopathalogical examination of the specimen confirmed the diagnosis of osteochondroma. We conclude surgical excision of such rare tumors, including the cartilaginous cap as well as the intraspinal component can reliably produce a good clinical outcome. PMID:24596611
Amritanand, Rohit; Krishnan, Venkatesh; David, Kenny Samuel
Symptomatic solitary osteochondroma of the subaxial cervical spine in a 52-year-old patient.
Osteochondromas are the most common benign tumors of the bone. They mostly arise from the appendicular skeleton and present clinically in the second or third decade of life. Ostechondromas arising from the subaxial cervical spine and presenting after the 5th decade of life are extremely rare. We report a 52-year-old male patient who presented with numbness and subjective weakness of left upper and lower limbs and neck pain, and had lobulated bony hard fixed swelling in the right lower cervical paraspinal region. Radiological images revealed a bony swelling arising from C4 and C5 lamina with a cartilaginous cap and intraspinal extension. Excision biopsy with stabilisation of the spine was performed. Histopathalogical examination of the specimen confirmed the diagnosis of osteochondroma. We conclude surgical excision of such rare tumors, including the cartilaginous cap as well as the intraspinal component can reliably produce a good clinical outcome. PMID:24596611
Sekharappa, Vijay; Amritanand, Rohit; Krishnan, Venkatesh; David, Kenny Samuel
Spontaneous Regression after Extensive Recurrence of a Pediatric Cervical Spine Aneurysmal Bone Cyst
Aneurysmal bone cyst is a pseudotumoral lesion. Complete resection prior to selective arterial embolization seems to be the treatment of choice for the more extensive and destructive lesions. In these cases maintaining stability of the cervical spine is critical. This can be very challenging in children and adolescents in whom the axial skeleton is still growing. In this case a young girl presented with a voluminous cervical aneurysmal bone cyst encaging both vertebral arteries and spinal cord. The lesion was treated with aggressive surgical resection, followed by cervical vertebral fusion with instrumentation. After nine months the patient referred no pain and no neurological deficit. MRI scans showed an extensive local recurrence. The family of the young girl refused any other therapy and any other followup. The patients returned to our attention after five years with no pain and neurological deficit. Cervical spine radiographs and MRI scans showed a complete regression of the extensive local recurrence. In the literature, the possibility of spontaneous regression of residual part or local recurrence is reported. The case of this young girl provided the chance to attend a spontaneous regression in an extensive recurrence of aneurismal bone cyst. PMID:24707421
Lanterna, Luigi Andrea; Bosisio, Michela; Gritti, Paolo; Risso, Andrea; Signorelli, Antonio; Biroli, Francesco
Aneurysmal bone cyst is a pseudotumoral lesion. Complete resection prior to selective arterial embolization seems to be the treatment of choice for the more extensive and destructive lesions. In these cases maintaining stability of the cervical spine is critical. This can be very challenging in children and adolescents in whom the axial skeleton is still growing. In this case a young girl presented with a voluminous cervical aneurysmal bone cyst encaging both vertebral arteries and spinal cord. The lesion was treated with aggressive surgical resection, followed by cervical vertebral fusion with instrumentation. After nine months the patient referred no pain and no neurological deficit. MRI scans showed an extensive local recurrence. The family of the young girl refused any other therapy and any other followup. The patients returned to our attention after five years with no pain and neurological deficit. Cervical spine radiographs and MRI scans showed a complete regression of the extensive local recurrence. In the literature, the possibility of spontaneous regression of residual part or local recurrence is reported. The case of this young girl provided the chance to attend a spontaneous regression in an extensive recurrence of aneurismal bone cyst. PMID:24707421
Brembilla, Carlo; Lanterna, Luigi Andrea; Bosisio, Michela; Gritti, Paolo; Risso, Andrea; Signorelli, Antonio; Biroli, Francesco
Extensive cervical spine and foregut anomaly in 'serpentine syndrome'
INTRODUCTION We report an extremely rare and challenging combination of congenital anomalies. Only five similar cases have been described in the English language medical literature to date. PRESENTATION OF CASE A male infant was born at 30+5 weeks gestation by emergency caesarian section. Cervical spine rachischisis, shortened oesophagus, intrathoracic stomach, atretic duodenum and absent spleen were noted, in addition to respiratory insufficiency. Gastrointestinal re-anastomosis, particularly oesophageal lengthening, was not feasible at the initial thoracotomy. Surgical stabilization of the cervical spine was unlikely to be successful until two years of age. Asplenia predisposed the infant to sepsis from encapsulated organisms, and recurrent respiratory infections occurred. DISCUSSION A close relationship exists between the upper gastrointestinal tract and cervical spine during embryonic development. An embryonic aberration at this level could account for all the deformities present in this infant. Tethering of the embryonic cervical oesophagus to the somites in the first trimester, preventing foregut elongation, and producing ischaemia at the coeliac axis, is suggested as the aetiology. CONCLUSION This case presented a challenge to the multi-disciplinary team involved in his management and prompted extensive consultation with international experts. After considerable counseling of the parents, care was directed towards palliation. PMID:23567544
Dargan, D.; McMorrow, A.; Bourke, T.W.; McCallion, W.A.; Verner, A.M.; Lyons, J.; McConnell, R.S.; Lundy, C.T.; Eames, N.W.A.
Dedifferentiated chondrosarcoma of the cervical spine: a case report
Dedifferentiated chondrosarcoma (DDCS) is a rare and aggressive bone tumor with poor prognosis. Primary DDCS of the mobile spine is extremely rare, particularly in the cervical spine. We herein describe a first case of cervical DDCS in an 81-year-old male presenting with a slowly growing mass. Radiographs showed an expansion of the cortical contour of the C2 lamina and a soft tissue mass with punctate calcification. Magnetic resonance imaging demonstrated a lobulated lesion expanding over the entire lamina and pedicles of C2 with the tumor protuberant to the adjacent soft tissue. A complete tumor resection was performed. Histologically, the majority of the tumor was a low-grade chondrosarcoma component. However, atypical spindle cells that had proliferated in a fascicular pattern with a collagenous stroma, mimicking fibrosarcoma, were focally observed without a transitional zone, and these features confirmed that the tumor was DDCS. PMID:23375124
[Cervical spine osteochondroma presenting with torticollis and hemiparesis].
Osteochondromas are slow-growing benign bone tumors that are located frequently in the long bones. Approximately 1-4% of them occur in the spine. Solitary spinal osteochondromas may produce a wide variety of symptoms depending on their location and relationship to associated structures. We report a case of a 74-year old woman who was admitted to our hospital with complaints of progressive left hemibody weakness and cervicalgia. Neurological examination disclosed mild left-sided hemiparesis and left torticollis. Computed tomography and magnetic resonance imaging of the cervical spine revealed an expansive lesion affecting the left C3-C4 facet joint. The patient underwent a posterior C3 and C4 hemilaminectomy, complete excision of the lesion and instrumented posterior cervical fixation. Histological examination confirmed the diagnosis of osteochondroma. After surgery her symptoms improved progressively with no neurological sequels. PMID:24139102
Castro-Castro, Juli�n; Rodi�o-Pad�n, Jon; Touceda-Bravo, Alberto; Castro-Bouzas, Daniel; Pinz�n-Mill�n, Alfonso
Clustered clinical findings for diagnosis of cervical spine myelopathy
Cervical spine myelopathy (CSM) is a clinical diagnosis made with imaging confirmation. At present, most clinical tests used to identify CSM are specific and no clusters of tests have proven more beneficial than stand alone tests in guiding treatment decision making. This study endeavored to produce a cluster of predictive clinical findings for a sample of patients using a clinical diagnosis/imaging confirmation as the reference standard for cervical spine myelopathy. Data from 249 patients with various conditions associated with cervical spine dysfunction were analyzed to determine which clinical tests and measures, when clustered together, were most diagnostic for CSM. Using multivariate regression analyses and calculations for sensitivity, specificity, and positive and negative likelihood ratios, a definitive cluster was identified. Thirteen clinical findings were investigated for capacity to diagnosis CSM. Five clinical: (1) gait deviation; (2) +Hoffmann�s test; (3) inverted supinator sign; (4) +Babinski test; and (5) age >45 years, were demonstrated the capacity when clustered into one of five positive tests to rule out CSM (negative likelihood ratio?=?0.18; 95% CI?=?0.12�0.42), and when clustered into three of five positive findings to rule in CSM (positive likelihood ratio?=?30.9; 95% CI?=?5.5�181.8). This study found clustered combinations of clinical findings that could rule in and rule out CSM. These clusters may be useful in identifying patients with this complex diagnosis in similar patient populations. PMID:22131790
Cook, Chad; Brown, Christopher; Isaacs, Robert; Roman, Matthew; Davis, Samuel; Richardson, William
Brown tumor of the cervical spine: a case report and review of the literature.
Brown tumors (BT) are benign focal bone lesions that may appear in the context of primary and secondary hyperparathyroidism (HPT). Involvement of the spine is exceedingly rare. We present a case of brown tumor involving the cervical spine, the third reported in the literature. In the literature review (until August 2010), we found nine cases of spinal BT in primary HPT and 14 cases in secondary HPT. Fifteen patients (65%) had evidence of spinal cord compression. A 34-year-old woman on long-term hemodialysis, with secondary HPT, presented with a 9-month history of persistent neck pain. Radiographs of the cervical spine revealed an expansive osteolytic lesion in the posterior arch of the second cervical vertebra. MR imaging revealed an expansive mass on C2 affecting the vertebral body, odontoid process, right pedicle, laminas, and spinous process; there were no signs of spinal edema. A CT-guided needle biopsy of the lesion showed destruction of trabecular bone, infiltration of the fibroblastic cells, and abundant osteoclast-like multinucleated giant cells with hemorrhage and hemosiderin pigment, and the diagnosis of brown tumor was made. Cervical pain disappeared within a few days of parathyroidectomy, and rapid remineralization of C2 was evident within a few months. BT must always be considered in the context of hyperparathyroidism and osteolytic lesions. Vertebral BT can be particularly devastating due to medullar compression symptoms. Regression or complete disappearance of these lesions after parathyroidectomy is common, but prompt surgical decompression is necessary in case of medullar compression symptoms. PMID:20981561
Mateo, Lourdes; Massuet, Ana; Sol�, Montserrat; P�rez Andr�s, Ricard; Musulen, Eva; S�nchez Torres, M Carmen
Imaging of acute cervical spine trauma: when to obtain which modality.
The current knowledge and evidence around the merits of different imaging modalities for the evaluation of cervical spine injuries are reviewed. The National Emergency X-Radiography Use Study, Canadian Cervical Spine rule, and American College of Radiology appropriateness criteria are reviewed and summarized. The advantages and disadvantages of available imaging modalities for selected cervical spine injury patterns are also illuminated to simplify the decision making on when to use which modality. PMID:24101178
Ulbrich, Erika J; Carrino, John A; Sturzenegger, Matthias; Farshad, Mazda
The Effect of Protective Equipment on Cervical Spine Alignment in Collegiate Lacrosse Players
Background: Contact sports place athletes at risk for cervical spine injury. Protective helmets and shoulder pads worn by football and ice hockey athletes alter cervical spine alignment. The effect of helmet and shoulder pads on neck alignment in lacrosse athletes is not known.Hypothesis: Helmets and shoulder pads worn by lacrosse athletes alter cervical spine alignment.Study Design: Controlled laboratory study.Methods: Sagittal
Paul S. Sherbondy; Jay N. Hertel; Wayne J. Sebastianelli
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 shortened muscles, passive and active mobilization of the facet joints). As the patients with CD usually respond well to the appropriate therapy, cervical causes of dysphagia cannot be overlooked in patients with difficulty swallowing, including patients with disorders of the central control of swallowing. PMID:23671976
Grgi?, Vjekoslav
Carotid and Vertebral Artery Injury following Severe Head or Cervical Spine Trauma
In order to determine the frequency of neck vessel injuries, Doppler investigations were performed in 60 patients following either severe head injury (n = 29), cervical spine injury (n = 26), or combined head and cervical spine injury (n = 5). The majority of patients were referred to our hospital for early rehabilitation; before admission Doppler investigations had been performed
Oliver Rommel; Andreas Niedeggen; Martin Tegenthoff; Paul Kiwitt; Uwe B�tel; Jean-Pierre Malin
Assessment of stresses in the cervical spine caused by posture and position of the head.
Preamble. Billions of people are using cell phone devices on the planet, essentially in poor posture. The purpose of this study is to assess the forces incrementally seen by the cervical spine as the head is tilted forward, into worsening posture. This data is also necessary for cervical spine surgeons to understand in the reconstruction of the neck. PMID:25393825
Hansraj, Kenneth K
Purpose: Inadequate cervical spine X-rays delay diagnosis and treatment and add radiation exposure to trauma patients with suspected\\u000a cervical spine injury. Digital radiography (DR) with dynamic range compression (DRC) modification can improve the visualization\\u000a of abnormalities in the cervical spine X-ray. Methods: Two digital hard copy cervical spine X-rays from each of 65 trauma patients were used, both with standard
T. Janchar; D. Artz; D. Milzman; M. Freedman; Michael H. Freedman
Introduction��Recently, solitary fibrous tumors occurring in spine-related lesions have been reported. However, the destruction of vertebral\\u000a bodies by this type of tumor has not been reported.\\u000a \\u000a \\u000a \\u000a Materials and methods��A 71-year-old female presented with pain from a mass on the right side of her neck. Plain radiographs of the cervical spine\\u000a showed collapse of the C5 vertebral body and dislocation of
Koji Hashimoto; Kei Miyamoto; Hideo Hosoe; Gou Kawai; Kenta Kikuike; Kuniyasu Shimokawa; Naoki Suzuki; Masayuki Matsuo; Hirotaka Kodama; Katsuji Shimizu
The incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, oft en involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and timeliness of transfer to a controlled
Erik E. Swartz; Laura C. Decoster; Susan A. Norkus; Barry P. Boden; Kevin N. Waninger; Robb S. Rehberg
To determine if helmet removal causes a significant increase in lordosis of the cervical spine in ice hockey players, we radiographically assessed the position of the cervical spine in subjects immobilized to a standard spine backboard wearing shoulder pads both with and without a helmet. Ten adult male volunteers (ages, 18 to 28 years) with no previous history of cervical
Robert F. LaPrade; Kent A. Schnetzler; Robert J. Broxterman; Fred Wentorf; Erik Wendland; Thomas J. Gilbert
OBJECTIVE: To elucidate the relationships between the neurovascular structures and surrounding bone, which are hidden from the surgeon by soft tissue, and to aid in avoiding nerve root and vertebral artery injury in anterior cervical spine surgery. METHODS: Using six cadaveric spines, we measured important landmarks on the anterior surface of the spine, the bony housing protecting the neurovascular structures
T. Glenn Pait; James A. Killefer; Kenan I. Arnautovic
In vivo flexion/extension of the normal cervical spine.
Twenty-two women (age range 25-49 years, average 30.9 years) and twenty-two men (age range 23-42 years, average 31.6 years), all healthy and asymptomatic, underwent passive flexion/extension examinations of the cervical spine. Functional x-rays were taken and analyzed using a computer-assisted method that quantified intervertebral rotations, translations, and locations of the centers of rotation for each level C1-C2-C6-C7. The aim of the study was to establish values for these parameters for a normal population as related to age and gender. In the process, a statistically significant difference was found in the average value of rotation between male and female groups at the C5-C6 level. A new parameter, the ratio between translation and rotation, was also established and may prove useful for clinical diagnoses. This parameter has a smaller error associated with it than do pure translations and may aid the clinician by helping to account for the large variation in rotatory ranges of motion within the population. This translation/rotation ratio indicated highly significant differences in the lower segments of the cervical spine between gender groups. PMID:1919845
Dvorak, J; Panjabi, M M; Novotny, J E; Antinnes, J A
[Interbody spacers in the treatment of cervical spine disorders].
Degenerative conditions of the spine represent a group of most common lifestyle associated diseases with significant medical and important social impact. Clinical symptoms and syndromes of surgically considerable degenerative diseases of the spine mostly result from nerve root or spinal cord compression caused by a herniated intervertebral disc or a dorsal osteophyte. Therefore, the main goal of the surgical treatment is decompression of the neural structures by complete removal of the intervertebral disc and the osteophytes followed by insertion of an artificial disc spacer into the remaining space. The most frequently used procedure for treating such findings is called anterior cervical discectomy. Since its first introduction in 1950, several modifications of the original technique have been introduced. Their common feature is that removal of the degenerated intervertebral disc or the osteophytes requires stabilization of the adjacent segments by fusion. Thus, implantation of an interbody spacer results not only in intervertebral space reconstruction, but by immobilizing the adjacent vertebral bodies also in forming a firm bony bridging between them--and ultimately a solid bony block. Our paper provides a review of cervical interbody spacers in the order of their evolution from auto- and allografts, through compact materials, cages and dynamic artificial disks. Furthermore, different types of cage filling materials used for fusion augmentation are also discussed. PMID:20731309
Pataky, F; Gajdos, M; Kat'uch, V
Osteochondroma of the cervical spine: Report of two cases in preadolescent males
Although considered to be rare in the spine, osteochondromas are in fact found there as often as other benign bone tumors. Three percent of all osteochondromas occur in the spine, while forty percent of osteoblastomas are to be found there. Yet, because osteochondromas are so much more common overall than osteoblastomas, their actual occurrences in the spine can be expected to be equal. Two cases of osteochondroma of the cervical spine, one of which was diagnosed by computed tomography, are reported.
Novick, G.S.; Pavlov, H.; Bullough, P.G.
Catastrophic cervical spine injuries can lead to devastating consequences for the collision athlete. Improved understanding of these injuries can lead to identification of risk factors, early diagnosis, and effective on-field management. This article is the second in a 2-part series. The first part, published in the June 2004 issue, reviewed the current concepts regarding the epidemiology, functional anatomy, and diagnostic considerations relevant to cervical spine trauma in collision sports. In this article, the principles of on-field emergency care of the spine-injured athlete are reviewed. The authors discuss the need for effective pre-event planning, on-field evaluation and management of cervical spine injuries, and the transition of care from the playing field to the emergency room. The protocol for equipment removal, when necessary, is also reviewed. An organized, rapid approach to the management of cervical spine-injured collision athletes can help to optimize the outcomes of these catastrophic injuries. PMID:15494346
Banerjee, Rahul; Palumbo, Mark A; Fadale, Paul D
Objective: To provide certified athletic trainers, team physicians, emergency responders, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in the athlete. Background: The relative incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and the timeliness of transfer to a controlled environment for diagnosis and treatment. Recommendations: Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport, such as football, hockey, or lacrosse; and considerations in the emergency department. PMID:19478836
Swartz, Erik E; Boden, Barry P; Courson, Ronald W; Decoster, Laura C; Horodyski, MaryBeth; Norkus, Susan A; Rehberg, Robb S; Waninger, Kevin N
Leiomyosarcoma metastatic to the cervical spine causing a C6 compression fracture: A case report
Leiomyosarcoma is a rare malignant tumor derived from smooth muscle cells, which commonly metastasizes to the lungs, liver, kidney, brain and skin. The current study presents the case of a 42-year-old male who presented with progressive neck pain and numbness of the left arm. Spinal computed tomography and magnetic resonance imaging revealed osteolytic lesions of numerous vertebrae (C2, C3, C4, C5, C6, C7, T1 and T2). With regard to the C6 vertebra, total destruction of the vertebral body resulted in vertebral collapse and subsequent spinal cord compression. The patient underwent an anterior C6 corpectomy, reconstruction with a mesh cage filled with polymethyl methacrylate (PMMA) and open PMMA infusion to C5 and C7. The surgical procedure significantly alleviated the symptoms and obtained a reliable reconstruction. The clinical follow-up examination at 13 months was uneventful with the exception of mild numbness of the left hand since the surgery. To the best of our knowledge, this is the first case of leiomyosarcoma recurrence presenting in the cervical spine, and the present study provides insight into the use of a surgical technique that has rarely been used in the cervical spine. PMID:24959258
Gelfoam-induced Swallowing Difficulty after Anterior Cervical Spine Surgery.
Symptomatic diffuse idiopathic skeletal hyperostosis (DISH) is not common. Gelfoam is one of the most commonly used topical hemostatic agents. But, in the partially moistened state, air retained in its pores may result in excessive expansion on contact with liquid. The onset of swallowing difficulty after anterior cervical spine surgery due to appling gelfoam is a rare complication. A 77-year-old man with swallowing difficulty was admitted to our hospital and we diagnosed him as DISH confirmed by radiological study. After removing the DISH, patient's symptom was relieved gradually. However, on postoperative day (POD) 7, the symptom recurred but lesser than the preoperative state. We confirmed no hematoma and esophageal perforation on the operation site. We observed him closely and controlled the diet. Three months later, he had no symptom of swallowing difficulty, and was able to be back on a regular diet, including solid foods. We present a complication case of swallowing difficulty occurring by gelfoam application. PMID:24757468
Yang, Joo Chul; Kim, Tae Wan; Park, Kwan Ho
Giant cervical spine osteochondroma in an adolescent female.
Osteochondroma or osteocartolaginous exostosis is by far the most common benign bone tumour, which accounts for 35% to 50% of benign bone neoplasms and 10% to 15% of all primary bone tumours. Osteochondroma represents a developmental enchondromatous hyperplasia which leads to formation of cartilage capped bony protrusions on bony surfaces. We present a case report of a 14-year- old female, who presented to us with a hard, gradually progressing, large painless swelling, over the left side of her neck. Swelling was nontender, extending from dorsal to ventral aspect, measuring 6 x 8 cm. Therefore, we are interested in introducing our case to medical fraternity, in which a giant lower cervical spine osteochondroma was seen in an adolescent female patient. PMID:24995199
Huda, N; Julfiqar, M; Pant, Ajay; Jameel, Tariq
Giant Cervical Spine Osteochondroma in an Adolescent Female
Osteochondroma or osteocartolaginous exostosis is by far the most common benign bone tumour, which accounts for 35% to 50% of benign bone neoplasms and 10% to 15% of all primary bone tumours. Osteochondroma represents a developmental enchondromatous hyperplasia which leads to formation of cartilage capped bony protrusions on bony surfaces. We present a case report of a 14-year- old female, who presented to us with a hard, gradually progressing, large painless swelling, over the left side of her neck. Swelling was nontender, extending from dorsal to ventral aspect, measuring 6 x 8 cm. Therefore, we are interested in introducing our case to medical fraternity, in which a giant lower cervical spine osteochondroma was seen in an adolescent female patient. PMID:24995199
Huda, N.; Pant, Ajay; Jameel, Tariq
Maintenance of graft compression in the adult cervical spine.
It is generally advised that the graft inserted in adult cervical spine should be pre-loaded with a compressive force or that the screws are inserted in a divergent orientation, in order to maximise compression and the chance of graft incorporation (Truumees et al. in Spine 28:1097-1102, 2003). However, there is little evidence that a compressive force is maintained once the force applicator has been removed, or that the divergent screws enhance compression. This study compared the maintenance of applied pre-load force, across cervical spine graft, between standard anterior plating technique with pre-load and divergent screws and a novel plate technique, which allows its application prior to removal of the force applicator. Six intact adult cadaveric human cervical spines were exposed by standard surgical technique. A Casper type distracter was inserted across the disc space of interest, the disc was removed. In 14 experiments, following the disc removal, an autologous iliac crest bone graft was inserted under distraction, together with a strain gauge pressure transducer. A resting output from the transducer was recorded. The voltage output has a linear relationship with compressive force. A standardised compressive force was applied across the graft through the "Casper type" distracter/compressor (7.5 kg, torque). The pre-load compressive force was measured using a torque drill. Then two different procedures were used in order to compare the final applied strain on the bone graft. In eight experiments (procedure 1), the "Casper type" distracter/compressor was removed and a standard anterior cervical plate with four divergent screws was inserted. In six experiments (procedure 2), a novel plate design was inserted prior to removal of the distracter/compressor, which is not possible with the standard plate design. A final compressive force across the graft was measured. For the standard plate construct (procedure 1), the applied compression force is significantly greater than resting (SO/SC)--P=0.01, but the compression force is not maintained once the compressor is removed (SO/SR)--P=0.27. Final bone graft compression after plate insertion is not significantly different to the resting state (SO/SF)--P=0.16 (Wilcoxon's sign test for paired observation). Application of the plate tended to offload the graft; the final compressive force is 170+/-100% less than the resting force. None of the applied force was maintained (mean 9.5+/-8.8%). For the new plate (procedure 2), the end compressive force (SF) measured across the graft was greater than the resting force (SO) (P<0.001). Further, the novel plate application increased the compressive force on the graft by 712+/-484%. The final bone graft compression using a novel plate, which allows its application prior to removal of the force applicator, is significant (SO/SF)--P=0.01. Here, 77+/-10% of the applied pre-load was maintained. The difference between the plates is significant (P<0.001). Conclusions are as follows: (1) Applied pre-load is not maintained across a graft once the force applicator is removed. (2) Divergent screws with a plate do not compress graft and rather tend to offload it. (3) Compressive force may be maintained if the plate is applied prior to the force applicator removal. PMID:16421744
Bolger, Ciaran; Bourlion, Maurice; Leroy, Xavier; Petit, Dominique; Vanacker, Gerard; McEvoy, Linda; Nagaria, Jabir
Chiropractic management of postoperative spine pain: a report of 3 cases
Objective The purpose of this case series is to describe chiropractic care including spinal manipulation for 3 patients with postsurgical spine pain. Clinical features Three patients with postsurgical spine pain (1 cervical fusion, 1 lumbar discectomy, and 1 lumbar laminectomy) presented for chiropractic treatment at a major US medical center. Treatment included spinal manipulation and/or flexion-distraction mobilization based on patient response to joint loading strategies. Intervention and outcomes Two patients were treated with high-velocity, low-amplitude spinal manipulation; and 1 patient was treated with flexion-distraction mobilization. Treatment frequency and duration were 4 treatments over 4 weeks for case 1, 17 treatments over 7 years for case 2, and 5 treatments over 5 weeks for case 3. Subjective improvement was noted using numeric pain scores and functional changes; and upon completion, the patients reported being �satisfied� with their overall outcome. One episode of transient benign soreness was noted by 1 patient. No additional adverse events or effects were noted. Conclusion In these 3 cases, patients with postsurgical spine pain responded positively to chiropractic care. Spinal manipulation/mobilization was tolerated without significant adverse effects. PMID:24396317
Coulis, Christopher M.; Lisi, Anthony J.
A 14-year-old girl who presented with an endodermal cyst manifesting as severe neck and shoulder pain along with vesicorectal disturbances. Cervical magnetic resonance imaging showed a slightly enhanced intradural cyst at the C6-7 level in the ventral side of the spinal canal, with significant dorsal shortening and thinning of the spinal cord. Anterior corpectomy was chosen because of the dorsal effacement of the spinal cord. The cyst wall was subtotally removed to avoid damage to the normal spinal cord. After cyst removal, the iliac bone and an anterior cervical plate were used for anterior fusion. Postoperatively, her pain subsided without neurological deficits. The histological diagnosis was endodermal cyst. The cyst did not recur during a follow-up period of 18 months. Endodermal cysts are rare congenital lesions of the spine lined by endodermal epithelium. The natural history of this lesion is unclear, and the surgical strategy for the approach route and the extent of removal of the cyst wall remain controversial. We suggest that the anterior approach may allow a safer and more effective surgical route for the treatment of ventrally located endodermal cyst compared to the posterior approach. PMID:22198113
Ito, Kiyoshi; Aoyama, Tetsuro; Kiuchi, Takashi; Okada, Maki; Kanaya, Kohei; Muraoka, Hisashi; Horiuchi, Tetsuyoshi; Hongo, Kazuhiro
Primary spinal glioblastoma (GBM) is a rare spinal tumour and is considered to have poor prognosis. We describe a case of a 17-year-old adolescent boy with a cervical spine GBM presenting with neck pain and right upper limb weakness. Initial spinal MRI demonstrated a 4.5 cm lesion extending from C2 to C5 suspicious for demyelination. Despite high-dose corticosteroids, his weakness progressed resulting in quadriparesis. Subsequent laminectomy and biopsy confirmed spinal GBM. Shortly after surgery the patient continued to deteriorate and was essentially bedbound. Standard chemoradiotherapy as per the Stupp protocol, together with multimodal rehabilitation, resulted in substantial functional improvement within 6 weeks of initiation. Continued functional improvement was observed for a period of 11 months. Although an Eastern Cooperative Oncology Group (ECOG) performance score of 4 would normally preclude chemoradiotherapy, a prolonged response to treatment and return to independent function were observed. PMID:24518393
Lau, Peter Kar Han; Lee, Gabriel; Bynevelt, Michael; Nowak, Anna K
The central objective of this investigation was to focus on the development of the cervical spine observed by lateral cephalometric\\u000a radiological images of children and adolescents (6�16�years old). A sample of 26 individuals (12 girls and 14 boys) was classified\\u000a according to stages of cervical spine maturation in two subcategories: group I (initiation phase) and group II (acceleration\\u000a phase). The
Marcos Fabio Henriques dos Santos; Rodrigo Lopes de Lima; Bernardo De-Ary-Pires; M�rio Ary Pires-Neto; Ricardo de Ary-Pires
MRI of giant cell turmor of the tendon sheath in the cervical spine
The authors present a case of giant cell tumor of the tendon sheath (GCTTS) in the cervical spine, not previously described in the radiologic literature. Diagnostic imaging includes plain film radiographs, bone scintigraphy, CT, and MRI. Only one case of tenosynoviaI giant cell tumor of the cervical spine has been reported. The radiological features of this tumor are described along with a brief review of GCTTS. 6 refs., 3 figs.
Bui-Mansfield, L.T.; Youngberg, R.A.; Coughlin, W.; Choolijian, D. [Madigan Army Medical Center, Tacoma, WA (United States)] [Madigan Army Medical Center, Tacoma, WA (United States)
Introduction. To review the safety and efficacy of gadolinium in spine pain management procedures in patients at high risk for a contrast reaction and who are not suitable candidates for the use of standard non-ionic contrast. Methods. We reviewed records over a 61-month period of all image-guided spinal pain management procedures where patients had allergies making them unsuitable candidates for standard non-ionic contrast and where gadolinium was used to confirm needle tip placement prior to injection of medication. Results. Three hundred and four outpatients underwent 527 procedures. A spinal needle was used in all but 41 procedures. Gadolinium was visualized using portable C-arm fluoroscopy in vivo allowing for confirmation of needle tip location. The gadolinium dose ranged from 0.2 to 10 ml per level. The highest dose received by one patient was 15.83 ml intradiscally during a three-level discogram. Three hundred and one patients were discharged without complication or known delayed complications. One patient had documented intrathecal injection but without sequelae and 2 patients who underwent cervical procedures experienced seizures requiring admission to the intensive care unit. Both the latter patients were discharged without any further complications. Conclusion. Based on our experience we recommend using gadolinium judiciously for needle tip confirmation. We feel more confident using gadolinium in the lumbar spine and in cervical nerve blocks. Gadolinium should probably not be used as an injectate volume expander. The indications for gadolinium use in cervical needle-guided spine procedures are less clear and use of a blunt-tipped needle should be considered.
Safriel, Yair [Yale University School of Medicine, Neuroradiology Section, Department of Radiology (United States)], E-mail: email@example.com; Ang, Roberto [Center for Diagnostic Imaging (United States); Ali, Muhammed [Kaiser Permanente Woodland Hills Medical Center (United States)
\\u000a Sports with the greatest risk of spinal injury in this age group include American football, rugby, ice hockey, wrestling,\\u000a diving, skiing, cheerleading, baseball and horse riding. Disabling spinal injuries are more likely to result from cervical\\u000a spine injuries than with thoracolumbar injuries. The most common mechanism for neurological injury is axial loading on a flexed\\u000a neck. The spinal cord does
Radhesh Lalam; Victor N. Cassar-Pullicino
Four hundred sixty-seven adult victims of blunt trauma undergoing cervical spine radiography (CSR) were prospectively studied to identify any clinical parameters which would aid in the selective application of CSR. Eight persons (1.7%), six of whom were alert and two who presented comatose, sustained cervical spine injuries. In this study, persons injured in falls demonstrated a statistically significant greater risk of cervical spine injury compared to those injured in motor vehicle accidents (p = 0.001). In alert trauma victims, a statistical correlation with cervical spine injury was noted for individuals who had complaints of neck discomfort (p = 0.028) and for patients who manifested tenderness to neck palpation (p = 0.000039). No cervical spine injury was noted in any alert, not intoxicated, neurologically intact patient who had no complaints of neck discomfort upon questioning or palpation. We conclude that alert trauma victims with no complaints of neck discomfort upon questioning and with no tenderness on neck palpation need not undergo CSR. PMID:3385821
Roberge, R J; Wears, R C; Kelly, M; Evans, T C; Kenny, M A; Daffner, R D; Kremen, R; Murray, K; Cottington, E C
Background Menkes disease is an X-linked recessive disorder of copper transport caused by mutations in ATP7A, a copper-transporting ATPase. Certain radiologic findings reported in this condition overlap with those caused by child abuse. However, cervical spine defects simulating cervical spine fracture, a known result of nonaccidental pediatric trauma, have not been reported previously in this illness. Objective To assess the frequency of cervical spine anomalies in Menkes disease after discovery of an apparent C2 posterior arch defect in a child participating in a clinical trial. Materials and methods We examined cervical spine radiographs obtained in 35 children with Menkes disease enrolled in a clinical trial at the National Institutes of Health Clinical Center. Results Four of the 35 children with Menkes disease had apparent C2 posterior arch defects consistent with spondylolysis or incomplete/delayed ossification. Conclusion Defects in C2 were found in 11% of infants and young children with Menkes disease. Discovery of cervical spine defects expands the spectrum of radiologic findings associated with this condition. As with other skeletal abnormalities, this feature simulates nonaccidental trauma. In the context of Menkes disease, suspicions of child abuse should be considered cautiously and tempered by these findings to avoid unwarranted accusations. PMID:22825777
Hill, Suvimol C.; Dwyer, Andrew J.
Development and validation of a 10-year-old child ligamentous cervical spine finite element model.
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. PMID:23817769
Dong, Liqiang; Li, Guangyao; Mao, Haojie; Marek, Stanley; Yang, King H
Tertiary Syphilis in the Cervical Spine: A Case Report and Review of the Literature
As the prevalence of syphilis rises, an increase in tertiary syphilis with spinal involvement is predicted. We report what we believe to be the first case of compressive cervical spine syphilitic gummata, with central cord compression signs. We also review the relevant literature to date. The diagnosis of syphilis in the spine relies on the physician to be aware of it as part of the differential diagnosis. Treponemal laboratory tests are an important aid in establishing a diagnosis. PMID:24436850
Salem, K. M. I.; Majeed, H.; Bommireddy, R.; Klezl, Z.
Back pain in space and post-flight spine injury: Mechanisms and countermeasure development
NASA Astrophysics Data System (ADS)
During spaceflight many astronauts experience moderate to severe lumbar pain and deconditioning of paraspinal muscles. There is also a significant incidence of herniated nucleus pulposus (HNP) in astronauts post-flight being most prevalent in cervical discs. Relief of in-flight lumbar back pain is facilitated by assuming a knee-to-chest position. The pathogenesis of lumbar back pain during spaceflight is most likely discogenic and somatic referred (from the sinuvertebral nerves) due to supra-physiologic swelling of the lumbar intervertebral discs (IVDs) due to removal of gravitational compressive loads in microgravity. The knee-to-chest position may reduce lumbar back pain by redistributing stresses through compressive loading to the IVDs, possibly reducing disc volume by fluid outflow across IVD endplates. IVD stress redistribution may reduce Type IV mechanoreceptor nerve impulse propagation in the annulus fibrosus and vertebral endplate resulting in centrally mediated pain inhibition during spinal flexion. Countermeasures for lumbar back pain may include in-flight use of: (1) an axial compression harness to prevent excessive IVD expansion and spinal column elongation; (2) the use of an adjustable pulley exercise developed to prevent atrophy of spine muscle stabilisers; and (3) other exercises that provide Earth-like annular stress with low-load repetitive active spine rotation movements. The overall objective of these countermeasures is to promote IVD health and to prevent degenerative changes that may lead to HNPs post-flight. In response to "NASA's Critical Path Roadmap Risks and Questions" regarding disc injury and higher incidence of HNPs after space flight (Integrated Research Plan Gap-B4), future studies will incorporate pre- and post-flight imaging of International Space Station long-duration crew members to investigate mechanisms of lumbar back pain as well as degeneration and damage to spinal structures. Quantitative results on morphological, biochemical, metabolic, and kinematic spinal changes in the lumbar spine may aid further development of countermeasures to prevent lumbar back pain in microgravity and reduce the incidence of HNPs post-flight.
Sayson, Jojo V.; Lotz, Jeffrey; Parazynski, Scott; Hargens, Alan R.
To determine if helmet removal causes a significant increase in lordosis of the cervical spine in ice hockey players, we radiographically assessed the position of the cervical spine in subjects immobilized to a standard spine backboard wearing shoulder pads both with and without a helmet. Ten adult male volunteers (ages, 18 to 28 years) with no previous history of cervical spine injuries were fitted with an appropriately sized ice hockey helmet and shoulder pads and immobilized in a supine position to a standard spine backboard. Computerized tomographic lateral scout scans were obtained of the cervical spine for three conditions: 1) no equipment (control), 2) helmet and shoulder pads, and 3) shoulder pads only (helmet removed). With the helmet removed and the shoulder pads remaining, a significant increase in C2 to C7 lordosis was found when compared with the other two conditions. Individual segmental measurements revealed a significant increase in cervical lordosis at the C6-7 level with the helmet removed compared with the helmet and shoulder pads condition. Our results demonstrate that the removal of an ice hockey helmet from a supine player causes a significant increase in lordosis (extension) of the cervical spine. We recommend that ice hockey helmets not be removed from injured players, with rare exceptions, because doing so results in unnecessary motion of the cervical spine. PMID:11101101
Laprade, R F; Schnetzler, K A; Broxterman, R J; Wentorf, F; Gilbert, T J
Dynamic responses of the head and cervical spine to axial impact loading.
This study explores the inertial effects of the head and torso on cervical spine dynamics with the specific goal of determining whether the head mass can provide a constraining cervical spine end condition. The hypothesis was tested using a low friction impact surface and a pocketing foam impact surface. Impact orientation was also varied. Tests were conducted on whole unembalmed heads and cervical spines using a drop track system to produce impact velocities on the order of 3.2 m s-1. Data for the head impact forces and the reactions at T1 were recorded and the tests were also imaged at 1000 frames s-1. Injuries occurred 2-19 ms following head impact and prior to significant head motion. Average compressive load a failure was 1727 +/- 387 N. Decoupling was observed between the head and T1. Cervical spine loading due to head rebound constituted up to 54 +/- 16% of the total axial neck load for padded impacts and up to 38 +/- 30% of the total axial neck load for rigid impacts. Dynamic buckling was also observed; including first-order modes and transient higher-order modes which shifted the structure from a primarily compressive mode of deformation to various bending modes. These experiments demonstrate that in the absence of head pocketing, the head mass can provide sufficient constraint to cause cervical spine injury. The results also show that cervical spinal injury dynamics are complex, and that a large sample size of experimentally produced injuries will be necessary to develop comprehensive neck injury models and criteria. PMID:8850637
Nightingale, R W; McElhaney, J H; Richardson, W J; Myers, B S
Long term follow-up of diffuse idiopathic skeletal hyperostosis in the cervical spine
In eleven patients with diffuse idiopathic skeletal hyperostosis who presented with extensive ossification in the cervical spine, progression or regression of ossification during the follow-up period were measured in extent and thickness radiographically. Intervertebral range of motion was also measured and the relation between changes of ossification and intervertebral mobility was analyzed. The range of motion at the segments at
K. Suzuki; Y. Ishida; K. Ohmori
Transoral Resection of Spinal Cord Tumors and Posterior Cervical Spine Stabilization
Transoral resection of an anterior spinal cord tumor consists of three major phases: corpectomy (ie, removal of vertebral bodies), tumor resection, and duraplasty (ie, repair of the dura mater). A second surgical procedure, posterior stabilization of the occiput to the C3 vertebra, consists of an iliac crest bone graft for cervical spine fusion and the application of a rigid fixation
Phyllis G. Walton; Eve L. Broughton
Epidemiologic, pathologic, biomechanical, and cinema tographic data on head and neck injuries occurring in tackle football have been compiled since 1971 by the National Football Head and Neck Injury Registry. Pre liminary analysis performed in 1975 indicated that the majority of serious cervical spine football injuries were caused by axial loading. Based on this observation, the National Collegiate Athletic Association
Joseph S. Torg; Joseph J. Vegso; Mary Jane ONeill; Brian Sennett
Is radiography justified for the evaluation of patients presenting with cervical spine trauma?
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 radiogenic lethal cancer incidents. According to the decision model calculations, the use of CT is more favorable over the use of radiography alone or radiography with CT by a factor of 13, for low risk 20 yr old patients, to a factor of 23, for high risk patients younger than 80 yr old. The radiography/CT imaging strategy slightly outperforms plain radiography for high and moderate risk patients. Regardless of the patient age, sex, and fracture risk, the higher diagnostic accuracy obtained by the CT examination counterbalances the increase in dose compared to plain radiography or radiography followed by CT only for positive radiographs and renders CT utilization justified and the radiographic screening redundant.
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)
An evidence-based mobile decision support system for subaxial cervical spine injury treatment.
Bringing evidence to practice is a key issue in modern medicine. The key barrier to information searching is time. Clinical decision support systems (CDSS) can improve guideline adherence. Mounting evidence exists that mobile CDSS on handheld computers support physicians in delivering appropriate care to their patients. Subaxial cervical spine injuries account for almost half of spine injuries, and a majority of spinal cord injuries. A valid and reliable classification exists, including evidence-based treatment algorithms. A mobile CDSS on this topic was not yet available. We developed and tested an iPhone application based on the Subaxial Injury Classification (SLIC) and 5 evidence-based treatment algorithms for the surgical approach to subaxial cervical spine injuries. The application can be downloaded for free. Users are cordially invited to provide feedback in order to direct further development and evaluation of CDSS for traumatic lesions of the spinal column. PMID:21541200
Kubben, P L; van Santbrink, H; Cornips, E M J; Vaccaro, A R; Dvorak, M F; van Rhijn, L W; Scherpbier, A J J A; Hoogland, H
Anterior cervical discectomy and fusion (ACDF) is a commonly performed surgery for the treatment of spondylosis, radiculopathy, myelopathy, and trauma to the cervical spine. Esophageal perforation is a rare yet serious complication following ACDF with an incidence of 0.02 to 1.52%. We describe a case of a 24-year-old man who underwent ACDF and corpectomy following a motor vehicle accident who subsequently developed delayed onset esophageal perforation requiring surgical intervention. We believe that the detailed review of the surgical management of esophageal perforation following cervical spine surgery will provide a deeper understanding for the Intensivist in regards to postoperative airway management in these types of patients. Careful extubation over a soft flexible exchange catheter should take place to help reduce the risk of perforation in the event reintubation is required. PMID:24459627
Amhaz, Hassan H; Kuo, Ruth; Vaidya, Rahul; Orlewicz, Marc S
Oncogenic osteomalacia of the cervical spine: a rare case of curative resection and reconstruction.
Oncogenic osteomalacia (OO) is a rare paraneoplastic syndrome, with only 100 reported cases in the literature. The majority of OO-associated mesenchymal tumors are due to a lesion called phosphaturic mesenchymal tumor, mixed connective tissue (PMTMCT) variant. There have been only 6 reported cases of OO of the spine. With this paper the authors present a case of OO of the cervical spine in a patient who initially presented with multiple pathological fractures of unknown cause, and who eventually underwent staged C-5 spondylectomy followed by circumferential stabilization. Resection of the cervical lesion led to resolution of his hypophosphatemia and prevention of any further pathological fractures. The authors describe a rare cervical neoplasm, its treatment, and review the literature on this rare bony pathological entity. PMID:21275557
Akhter, Murtaza; Sugrue, Patrick A; Bains, Rick; Khavkin, Yevgeniy A
Brown-Sequard syndrome after blunt cervical spine trauma: clinical and radiological correlations.
The objective of this study was to describe clinical and radiological features of a series of patients presenting with Brown-Sequard syndrome after blunt spinal trauma and to determine whether a correlation exists between cervical plain films, CT, MRI and the clinical presentation and neurological outcome. A retrospective review was done of the medical records and analysis of clinical and radiological features of patients diagnosed of BSS after blunt cervical spine trauma and admitted to our hospital between 1995 and 2005. Ten patients were collected for study, three with upper- and seven with lower-cervical spine fracture. ASIA impairment scale and motor score were determined on admission and at last follow-up (6 months-9 years, mean 30 months). Patients with lower cervical spine fracture presented with laminar fracture ipsilateral to the side of cord injury in five out of six cases. T2-weighted hyperintensity was present in seven patients showing a close correlation with neurological deficit in terms of side and level but not with the severity of motor deficit. Patients with Brown-Sequard syndrome secondary to blunt cervical spine injury commonly presented T2-weighted hyperintensity in the clinically affected hemicord. A close correlation was observed between these signal changes in the MR studies and the neurologic level. Effacement of the anterior cervical subarachnoid space was present in all patients, standing as a highly sensitive but very nonspecific finding. In the present study, craniocaudal extent of T2-weighted hyperintensity of the cord failed to demonstrate a positive correlation with neurological impairment. PMID:17394028
Miranda, Pablo; Gomez, Pedro; Alday, Rafael; Kaen, Ariel; Ramos, Ana
The effect of degenerative cervical spine surgery depends on good understanding of the pathogenesis and clinical course of disease with a detailed neurological and neuroradiological examination. Surgical approach should be considered separately for each pathological substrate in order to avoid additional morbidity. The aim of our study is to present the results of treatment through analysis of large clinical series focusing on anterior surgical approach with iliac crest graft fusion without cervical plating. The retrospective analysis of 90 patients operated on Neurosurgery of CHC Zemun, from 2008 to 2011, was done. In 81 patients cervical disc herniation was found in one or two levels, and 9 patients had spinal canal stenosis with polydiscopathy. Preoperatively 50 patients had cervical myelopathy, and 40 patients had radiculopathy as dominating clinical sign. Anterior cervical approach was performed in 79 patients, and 11 patients were operated by posterior approach. The treatment outcome was as follows: good outcome 16 (16.8%) patients, improved condition 65 (72.2%), without improvement 6 (6.7%), bad outcome 3 (4.3%). The anterior cervical approach with iliac crest autologous graft fusion, and without additional cervical plating, is reliable treatment option with results comparable to reported clinical series with sintetic graft placement and anterior cervical plate stabilisation. PMID:23654008
Markovi?, M; Zivkovi?, N; Stojanovi?, D; Samardzi?, M
Reduced field-of-view DTI segmentation of cervical spine tissue.
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. PMID:23993792
Tang, Lihua; Wen, Ying; Zhou, Zhenyu; von Deneen, Karen M; Huang, Dehui; Ma, Lin
... into the pelvic area such as a cervical cap, diaphragm, or pessary Allergy to spermicides used for ... does not go away: Discharge may be gray, white or yellow in color Painful sexual intercourse Pain ...
Objective To clarify the incidence and predictive risk factors of cervical spine instabilities which may induce compression myelopathy in patients with rheumatoid arthritis (RA). Methods Three types of cervical spine instability were radiographically categorized into �moderate� and �severe� based on atlantoaxial subluxation (AAS: atlantodental interval >3 mm versus ?10 mm), vertical subluxation (VS: Ranawat value <13 mm versus ?10 mm), and subaxial subluxation (SAS: irreducible translation ?2 mm versus ?4 mm or at multiple). 228 �definite� or �classical� RA patients (140 without instability and 88 with �moderate� instability) were prospectively followed for >5 years. The endpoint incidence of �severe� instabilities and predictors for �severe� instability were determined. Results Patients with baseline �moderate� instability, including all sub-groups (AAS+ [VS? SAS?], VS+ [SAS? AAS�], and SAS+ [AAS� VS�]), developed �severe� instabilities more frequently (33.3% with AAS+, 75.0% with VS+, and 42.9% with SAS+) than those initially without instability (12.9%; p<0.003, p<0.003, and p?=?0.061, respectively). The incidence of cervical canal stenosis and/or basilar invagination was also higher in patients with initial instability (17.5% with AAS+, 37.5% with VS+, and 14.3% with SAS+) than in those without instability (7.1%; p?=?0.028, p<0.003, and p?=?0.427, respectively). Multivariable logistic regression analysis identified corticosteroid administration, Steinbrocker stage III or IV at baseline, mutilating changes at baseline, and the development of mutilans during the follow-up period correlated with the progression to �severe� instability (p<0.05). Conclusions This prospective cohort study demonstrates accelerated development of cervical spine involvement in RA patients with pre-existing instability�especially VS. Advanced peripheral erosiveness and concomitant corticosteroid treatment are indicators for poor prognosis of the cervical spine in RA. PMID:24558457
Yurube, Takashi; Sumi, Masatoshi; Nishida, Kotaro; Miyamoto, Hiroshi; Kohyama, Kozo; Matsubara, Tsukasa; Miura, Yasushi; Hirata, Hiroaki; Sugiyama, Daisuke; Doita, Minoru
Object Upper cervical spine injuries in the pediatric age group have been recognized as extremely unstable from ligamentous disruption and as potentially lethal. Few measurement norms have been published for the pediatric upper cervical spine to help diagnose this pathological state. Instead, adult measurement techniques and results are usually applied inappropriately to children. The authors propose using high-resolution reconstructed CT scans to define a range of normal for a collection of selected upper cervical spine measurements in the pediatric age group. Methods Sagittal and coronal reformatted images were obtained from thin axial CT scans obtained in 42 children (< 18 years) in a 2-month period. There were 25 boys and 17 girls. The mean age was 100.9 months (range 1-214 months). Six CT scans were obtained for nontrauma indications, and 36 were obtained as part of a trauma protocol and later cleared for cervical spine injury. Six straightforward and direct linear distances-basion-dental interval (BDI); atlantodental interval (ADI); posterior atlantodental interval (PADI); right and left lateral mass interval (LMI); right and left craniocervical interval (CCI); and prevertebral soft-tissue thickness at C-2-that minimized logistical and technical distortions were measured and recorded. Statistical analysis including interobserver agreement, age stratification, and sex differences was performed for each of the 6 measurements. Results The mean ADI was 2.25 � 0.24 mm (� SD), the mean PADI was 18.3 � 0.07 mm, the mean BDI was 7.28 � 0.10 mm, and the mean prevertebral soft tissue width at C-2 was 4.45 � 0.43 mm. The overall mean CCI was 2.38 � 0.44 mm, and the overall mean LMI was 2.91 � 0.49 mm. Linear regression analysis demonstrated statistically significant age effects for PADI (increased 0.02 mm/month), BDI (decreased 0.02 mm/month), and CCI (decreased 0.01 mm/month). Similarly significant effects were found for sex; females demonstrated on average a smaller CCI by 0.26 mm and a smaller PADI by 2.12 mm. Moderate to high interrater reliability was demonstrated across all parameters. Conclusions Age-dependent and age-independent normal CT measurements of the upper cervical spine will help to differentiate physiological and pathological states in children. The BDI appears to change significantly with age but not sex; on the other hand, the LMI and ADI appear to be age-independent measures. This preliminary study suggests acceptable levels of interrater reliability, and further expanded study will aim to validate these measurements to produce a profile of normal upper cervical spine measurements in children. PMID:25127096
Vachhrajani, Shobhan; Sen, Anish N; Satyan, Krishna; Kulkarni, Abhaya V; Birchansky, Sherri B; Jea, Andrew
Since the inception of the term Sports Medicine Athletic Trainers, Sports Physical Therapists, Paramedics, and Emergency Room Physicians have faced a number of challenges when it comes to providing care to an equipment laden athlete suspected of having a cervical spine or serious head injury. The same equipment that is designed to protect the player may significantly impede the medical team when it comes to diagnosing and treating cervical spine and head injuries. Incorrectly removing the helmet and shoulder pads from a football player with a cervical spine injury, may lead to unwanted motion of the cervical spine during removal. It is the purpose of this article to review the current concepts relating to equipment removal and to introduce a novel system for quick and easy removal of football shoulder pads called the Riddell�RipKord system. PMID:21712941
Smith, Danny; Hoogenboom, Barb
Early MRI findings in stab wound of the cervical spine: two case reports.
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. PMID:11942503
Alkan, A; Baysal, T; Saras, K; Sigirci, A; Kutlu, R
[Purpose] Muscle co-contraction is important in stabilizing the spine. The aim of this study was to compare cervical muscle co-contraction in adults with and without chronic neck pain during voluntary movements. [Subjects and Methods] Surface electromyography of three paired cervical muscles was measured in fifteen young healthy subjects and fifteen patients with chronic neck pain. The subjects performed voluntary neck movements in the sagittal and coronal plane at slow speed. The co-contraction ratio was defined as the normalized integration of the antagonistic electromyography activities divided by that of the total muscle activities. [Results] The results showed that the co-contraction ratio of patients was greater during flexion movement, lesser during extension movement, slightly greater during right lateral bending, and slightly lesser during left lateral bending compared with in the controls. [Conclusion] The results suggested that neck pain patients exhibit greater antagonistic muscle activity during flexion and dominate-side bending movements to augment spinal stability, while neuromuscular control provides relatively less protection in the opposite movements. This study helps to specify the changes of the stiffness of the cervical spine in neck pain patients and provides a useful tool and references for clinical assessment of neck disorders. PMID:24764639
Cheng, Chih-Hsiu; Cheng, Hsin-Yi Kathy; Chen, Carl Pai-Chu; Lin, Kwan-Hwa; Liu, Wen-Yu; Wang, Shwu-Fen; Hsu, Wei-Li; Chuang, Yu-Fen
Objective. Comparison of clinically observed neurologic long tract signs in a heterogeneous group of patients with rheumatoid arthritis\\u000a (RA), with morphologic abnormalities of the cervical spine as depicted on radiographs and magnetic resonance (MR) images.\\u000a Design. The patients were prospectively assigned to one of three classes on the basis of their neurologic status. Lateral cervical\\u000a spine radiographs and sagittal T1-weighted
M. Reijnierse; Johan L. Bloem; Ben A. C. Dijkmans; Herman M. Kroon; Herma C. Holscher; Bettina Hansen; Ferdinand C. Breedveld
The aim of this study was to evaluate if subjective symptoms, radiographic and especially MR parameters of cervical spine\\u000a involvement, can predict neurologic dysfunction in patients with severe rheumatoid arthritis (RA). Sequential radiographs,\\u000a MR imaging, and neurologic examination were performed yearly in 46 consecutive RA patients with symptoms indicative of cervical\\u000a spine involvement. Radiographic parameters were erosions of the dens
M. Reijnierse; B. A. C. Dijkmans; B. Hansen; T. L. Pope; H. M. Kroon; H. C. Holscher; F. C. Breedveld; J. L. Bloem
[Stress analysis of cervical spine C4-C6 under frontal impact load].
In order to check the neck response and injury during motor vehicle accidents, we developed a detailed finite element model for human cervical spine C4-C6. This model consisted of cortical bone, cancellous bone, annulus, nucleus, ligaments and articular facet, and it also set up contact in the contacting parts for simulating the movement perfectly under frontal impact. This model could be used for stress and strain distribution after the frontal impact load was applied on this model. During the process of frontal impact, the most displacement simulated data were in the interval range of experimental data. The experimental results showed that this model for the human cervical spine C4-C6 simulated the movement under the frontal impact with fidelity, and reflected the impact dynamics response on the whole. PMID:24804497
Xue, Qiang; Ding, Mei
Osteoradionecrosis (ORN) is a known entity in patients with head and neck malignancy treated by radiotherapy. Involvement of mandible (0.8-37%) and maxilla (2-11%) is quiet common but upper cervical spine involvement is rare. One needs to have a high index of suspicion for the diagnosis of ORN after radiotherapy in the head and neck region. It may mimic either metastasis or an infection and needs histopathology to make definitive diagnosis. We reported the successful treatment of a patient with ORN involving upper cervical spine by posterior decompression and stabilisation. In addition, a new technique of reaching the odontoid process from posterior aspect for biopsy has been described. PMID:24038287
Raza, Ali; Islam, Mueedul; Lakshmanan, Pal
Background\\/Purpose: Assessment of potential spine injuries is inconsistent and controversial. Subsequent morbidity includes prolonged immobilization and missed injuries. To address these issues, a multidisciplinary team was organized to design a cervical spine management\\/clearance pathway. The process, algorithm, and initial results are described. Methods: Team members consisted of pediatric surgeons, orthopedic surgeons, neurosurgeons, emergency room physicians, and trauma nurse practitioners. Nationwide
Steven L. Lee; Matthew Sena; Stephen K. Greenholz; Marti Fledderman
Ultrasound imaging of cervical spine motion for extreme acceleration environments
Neck and back pain is one of the most common musculoskeletal complaints in personnel in variable acceleration environments such as astronauts and military pilots. Ultrasound is known for dynamic imaging and diagnostic ...
Buckland, Daniel Miller
Atypical teratoid\\/rhabdoid tumor (AT\\/RT) occurring in the central nervous system is a high-grade malignant tumor, and its prognosis is poor for patients younger than 3 years of age. In this article, we present a case of infant AT\\/RT in the cervical spine and its successful treatment by intensive chemotherapy. The patient, a 1.75-year-old girl, developed an acute, progressive tetraparesis. MRI
Shunsuke Yano; Kazutoshi Hida; Hiroyuki Kobayashi; Yoshinobu Iwasaki
We studied 130 patients, aged 20 to 81 years, with symptoms of tinnitus, vertigo or dizziness. Radiological examinations\\u000a revealed degenerative changes in the cervical spines of all patients such as discopathy or osteophytes. Head and neck and\\u000a neurological examinations ruled out other symptoms apart from vertebrobasilar artery flow insufficiency. The vertebrobasilar\\u000a arteries were examined by means of a color Doppler
P. Str?k; E. Rero?; P. Maga; M. Modrzejewski; N. Szybist
Cervical spine malformation in cornelia de lange syndrome: a report of three patients.
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. PMID:24668777
Bettini, Laura Rachele; Locatelli, Laura; Mariani, Milena; Cianci, Paola; Giussani, Carlo; Canonico, Francesco; Cereda, Anna; Russo, Silvia; Gervasini, Cristina; Biondi, Andrea; Selicorni, Angelo
Introduction Interactions between the cervical spine and the stomatognathic system have been discussed in literature. The present study was conducted to investigate whether, and to what extent, orthodontically induced mandibular advancement produces changes in cervical spine posture. Furthermore, possible appliance-specific effects should be distinguished. Material and methods The cephalograms of 64 patients with skeletal class II were analysed before and after mandibular advancement. Linear and angular cephalometric parameters were identified to define the position of the atlanto-occipital and atlantoaxial joints. The total example was divided into two subgroups (comprising 32 individuals each) according to the employed appliance: activator versus bite-jump appliance (BJA). Student's t-test and analysis of covariance were used for statistical analysis. Results Overall, a significant straightening of the cervical spine was observed during the treatment. This conclusion is based on changes of Chamberlain (p?=?0.0055), CVT (p?=?0.0003), OPT (p?0.0001), Redlund-Johnell/Petersson (p?0.0001), McGregor-mC2 (p?=?0.0333) and AT-FH (p?=?0.0445). Improvements in occipitoatlantal dislocation were also observed in the total sample. Appliance-specific changes were found in the activator subgroup for a number of linear parameters (Chamberlain, McGregor, CVT, OPT, Redlund-Johnell/Petersson). In contrast, only two linear parameters (OPT and Powers ratio) revealed statistically significant changes in the BJA subgroup. Conclusions During skeletal class II treatment the position of upper cervical spine changes. In the activator subgroup the observed effects were more pronounced than those in the BJA subgroup. Further studies including a control group comprised with non-treated class II patients are needed to assess whether these effects may be caused directly by the appliances irrespective of growth. PMID:24661951
Fracture dislocation of the cervical spine: a critique of current management in the United States
The author has been asked to review the hospital records and X-rays of 12 patients from various regions of the United States who have sustained fracture dislocations of the cervical spine.In no instance was the initial care considered to be appropriate.No patient was significantly improved by treatment although only 17 per cent had apparent complete transverse cord syndromes on admission.
Bernard J Sussman
High rotation rate behavior of cervical spine segments in flexion and extension.
Numerical finite element (FE) models of the neck have been developed to simulate occupant response and predict injury during motor vehicle collisions. However, there is a paucity of data on the response of young cervical spine segments under dynamic loading in flexion and extension, which is essential for the development or validation of tissue-level FE models. This limitation was identified during the development and validation of the FE model used in this study. The purpose of this study was to measure the high rotation rate loading response of human cervical spine segments in flexion and extension, and to investigate a new tissue-level FE model of the cervical spine with the experimental data to address a limitation in available data. Four test samples at each segment level from C2-C3 to C7-T1 were dissected from eight donors and were tested to 10?deg of rotation at 1 and 500?deg/s in flexion and extension using a custom built test apparatus. There was strong evidence (p?0.05) of increased stiffness at the higher rotation rate above 4?deg of rotation in flexion and at 8?deg and 10?deg of rotation in extension. Cross-correlation software, Cora, was used to evaluate the fit between the experimental data and model predictions. The average rating was 0.771, which is considered to demonstrate a good correlation to the experimental data. PMID:25070575
Barker, Jeffrey B; Cronin, Duane S; Chandrashekar, Naveen
Cervical spine injuries continue to be a costly societal problem. Future advancements in injury prevention depend on improved physical and computational models which, in turn, are predicated on a better understanding of the responses of the neck during dynamic loading. Previous studies have shown that the tolerance of the neck is dependent on its initial position and its buckling behavior. This study uses a computational model to examine the mechanical factors influencing buckling behavior during impact to the neck. It was hypothesized that the inertial properties of the cervical spine influence the dynamics during compressive axial loading. The hypothesis was tested by performing parametric analyses of vertebral mass, mass moments of inertia, motion segment stiffness, and loading rate. Increases in vertebral mass resulted in increasingly complex kinematics and larger peak loads and impulses. Similar results were observed for increases in stiffness. Faster loading rates were associated with higher peak loads and higher-order buckling modes. The results demonstrate that mass has a great deal of influence on the buckling behavior of the neck, particularly with respect to the expression of higher-order modes. Injury types and mechanisms may be substantially altered by loading rate because inertial effects may influence whether the cervical spine fails in a compressive mode, or a bending mode. PMID:10653032
Nightingale, R W; Camacho, D L; Armstrong, A J; Robinette, J J; Myers, B S
Objective: a case is described of a spontaneously occurring cerebrospinal fluid collection in the ventral cervical spine which caused radiculopathy and spontaneous intracranial hypotension. Case: a sixty eight year old Caucasian man presented with a 2 year history of proximal upper limb weakness with a his-tory of trivial cervical trauma many years previously. Methods: the patient was investigated with blood tests for causes of peripheral neuropathy, nerve conduction and electro-myography studies, lumbar puncture and MRI of the brain and spine with contrast. Results: a cerebrospinal fluid collection was identified in the ventral cervical spinal cord causing mass effect associated with cord atrophy and there were signs of spontaneous intracranial hypotension on the MRI brain including subdural cere-brospinal fluid collections, meningeal enhancement and slumped posterior fossa. Conclusions: this is the first description of a spontaneous spinal fluid collection causing direct compression and cord sig-nal change, manifest as a motor deficit, with intracranial signs of spontaneous hypotension. Spinal imaging is recom-mended in cases of spontaneous intracranial hypotension and cerebrospinal fluid collections in the spine may rarely be a cause of radiculopathy in such cases. PMID:23407592
Zakaria, Rasheed; Wilby, Martin; Fletcher, Nicholas A
Purpose: With 54{sup o} of freedom from the skull to mandible to C7, ensuring adequate immobilization for head-and-neck radiotherapy (RT) is complex. We quantify variations in skull, mandible, and cervical spine movement between RT sessions. Methods and Materials: Twenty-three sequential head-and-neck RT patients underwent serial computed tomography. Patients underwent planned rescanning at 11, 22, and 33 fractions for a total of 93 scans. Coordinates of multiple bony elements of the skull, mandible, and cervical spine were used to calculate rotational and translational changes of bony anatomy compared with the original planning scan. Results: Mean translational and rotational variations on rescanning were negligible, but showed a wide range. Changes in scoliosis and lordosis of the cervical spine between fractions showed similar variability. There was no correlation between positional variation and fraction number and no strong correlation with weight loss or skin separation. Semi-independent rotational and translation movement of the skull in relation to the lower cervical spine was shown. Positioning variability measured by means of vector displacement was largest in the mandible and lower cervical spine. Conclusions: Although only small overall variations in position between head-and-neck RT sessions exist on average, there is significant random variation in patient positioning of the skull, mandible, and cervical spine elements. Such variation is accentuated in the mandible and lower cervical spine. These random semirigid variations in positioning of the skull and spine point to a need for improved immobilization and/or confirmation of patient positioning in RT of the head and neck.
Ahn, Peter H. [Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (United States)], E-mail: email@example.com; Ahn, Andrew I. [Albert Einstein College of Medicine of Yeshiva University, Bronx, NY (United States); Lee, C. Joe; Shen Jin; Miller, Ekeni; Lukaj, Alex; Milan, Elissa; Yaparpalvi, Ravindra; Kalnicki, Shalom; Garg, Madhur K. [Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (United States)
Summary Carrying loads on the head is a common practice in rural Zimbabwe. Headloading imposes a considerable amount of strain to the axial skeleton. The cervical spine, being the most cranial and mobile part of the vertebral column, may be susceptible to spondylosis or disc degeneration in headloading. Age as well as the effects of intrinsic factors on cervical spondylosis
M Joosab; M Torode; PVV Prasada Rao
Study Design: A randomized, double-blind, active controlled trial. Objective: To evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids in the management of chronic neck pain and upper extremity pain in patients with disc herniation and radiculitis. Summary of Background Data: Epidural injections in managing chronic neck and upper extremity pain are commonly employed interventions. However, their long-term effectiveness, indications, and medical necessity, of their use and their role in various pathologies responsible for persistent neck and upper extremity pain continue to be debated, even though, neck and upper extremity pain secondary to disc herniation and radiculitis, is described as the common indication. There is also paucity of high quality literature. Methods: One-hundred twenty patients were randomly assigned to one of 2 groups: Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL); Group II patients received 0.5% lidocaine, 4 mL, mixed with 1 mL of nonparticulate betamethasone. Primary outcome measure was ? 50 improvement in pain and function. Outcome assessments included Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), opioid intake, employment, and changes in weight. Results: Significant pain relief and functional status improvement (? 50%) was demonstrated in 72% of patients who received local anesthetic only and 68% who received local anesthetic and steroids. In the successful group of participants, significant improvement was illustrated in 77% in local anesthetic group and 82% in local anesthetic with steroid group. Conclusions: Cervical interlaminar epidural injections with or without steroids may provide significant improvement in pain and function for patients with cervical disc herniation and radiculitis. PMID:22859902
Manchikanti, Laxmaiah; Cash, Kimberly A.; Pampati, Vidyasagar; Wargo, Bradley W.; Malla, Yogesh
Airway management in cervical spine ankylosing spondylitis: Between a rock and a hard place.
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. PMID:24403620
Eipe, Naveen; Fossey, Susan; Kingwell, Stephen P
Intraoperative neural monitoring (IONM), utilizing somatosensory evoked potentials (SEP) and electromyography (EMG), was introduced to cervical spine surgery in the late 1980's. However, as SEP only provided physiological data regarding the posterior cord, new motor deficits were observed utilizing SEP alone. This prompted the development of motor evoked potential monitoring (MEP) which facilitated real-time assessment of the anterior/anterolateral spinal cord. Although all three modalities, SEP, EMG, and MEP, are routinely available for IONM of cervical spine procedures, MEP are not yet routinely employed. The purpose of this review is to emphasize that MEP should now routinely accompany SEP and EMG when performing IONM of cervical spine surgery. Interestingly, one of the most common reasons for malpractice suits involving the cervical spine, is quadriparesis/quadriplegia following a single level anterior cervical diskectomy and fusion (ACDF). Previously, typical allegations in these suits included; negligent surgery, lack of informed consent, failure to diagnose/treat, and failure to brace. Added to this list, perhaps, as the 5th most reason for a suit will be failure to monitor with MEP. This review documents the value of MEP monitoring in addition to SEP and EMG monitoring in cervical spine surgery. The addition of MEP0 should minimize major motor injuries, and more accurately and reliably detect impending anterior cord deterioration that may be missed with SEP monitoring alone. PMID:24340237
Epstein, Nancy E.
Variations in Entrance of Vertebral Artery in Korean Cervical Spine: MDCT-based Analysis
Background Knowledge of the anatomical variation of the vertebral artery has clinical importance not only for the performance of interventional or surgical procedures itself but also to ensure their safety. We conducted a study of the anatomical variation by reviewing multi-detector computed tomography (MDCT) images of the cervical spine from 460 Korean patients. Methods 16-row MDCT data from 460 patients were used in this study. We observed 920 vertebral arteries. Examination points included level of entrance of the artery into the transverse foramen of the cervical vertebra, origin site of the vertebral artery, course of a vertebral artery with aberrant entrance. Result The vertebral artery in 2 (0.2%) cases in this study entered into the transverse foramen of the 7th cervical vertebra from the left. In 45 (4.9%) cases, the vertebral artery entered into the transverse foramen of the 5th cervical vertebra. Of these, the entrance was on the right in 15 (1.6%) and on the left in 30 (3.3%). We found 17 (1.8%) cases in which the artery entered into the transverse foramen of the 4th cervical vertebra, 10 (1.1%) on the right and 7 (0.7%) on the left side. As is commonly acknowledged, the 6th cervical vertebra was the most common site of entry; the vertebral artery entered the transverse foramen of the 6th cervical vertebra in the remaining 855 (93.0%) cases, on the right in 434 (47.2%) and on the left in 421 (45.8%). Conclusions In conclusion, the possibility of an atypical course of the vertebral artery in segments V1 and V2 should be evaluated with magnetic resonance imaging (MRI) or CT images before carrying out procedures involving the anterior cervical vertebrae. PMID:25031813
Shin, Hye Young; Park, Ji Kang; Park, Sun Kyung; Jung, Gyu Seo
Purpose: To determine the incidence of pain flare after spine stereotactic body radiation therapy (SBRT) in steroid-na�ve patients and identify predictive factors. Methods and Materials: Forty-one patients were treated with spine SBRT between February 2010 and April 2012. All patients had their pain assessed at baseline, during, and for 10 days after SBRT using the Brief Pain Inventory. All pain medications were recorded daily and narcotics converted to an oral morphine equivalent dose. Pain flare was defined as a 2-point increase in worst pain score as compared with baseline with no decrease in analgesic intake, a 25% increase in analgesic intake as compared with baseline with no decrease in worst pain score, or if corticosteroids were initiated at any point during or after SBRT because of pain. Results: The median age and Karnofsky performance status were 57.5 years (range, 27-80 years) and 80 (range, 50-100), respectively. Eighteen patients were treated with 20-24 Gy in a single fraction, whereas 23 patients were treated with 24-35 Gy in 2-5 fractions. Pain flare was observed in 68.3% of patients (28 of 41), most commonly on day 1 after SBRT (29%, 8 of 28). Multivariate analysis identified a higher Karnofsky performance status (P=.02) and cervical (P=.049) or lumbar (P=.02) locations as significant predictors of pain flare. In those rescued with dexamethasone, a significant decrease in pain scores over time was subsequently observed (P<.0001). Conclusions: Pain flare is a common adverse event after spine SBRT and occurs most commonly the day after treatment completion. Patients should be appropriately consented for this adverse event.
Chiang, Andrew [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada) [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON (Canada); Zeng, Liang; Zhang, Liying; Lochray, Fiona; Korol, Renee; Loblaw, Andrew; Chow, Edward [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada)] [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Sahgal, Arjun, E-mail: firstname.lastname@example.com [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada) [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON (Canada)
Radiographic characteristics of the hand and cervical spine in fibrodysplasia ossificans progressiva
Summary Fibrodysplasia ossificans progressiva (FOP) is a disabling heritable disorder of connective tissue characterized by progressive heterotopic ossification in various extraskeletal sites. Early correct diagnosis of FOP is important to prevent additional iatrogenic harm or trauma. Congenital malformation of the great toes is a well-known diagnostic clue, but some patients show normal-appearing great toes. The thumb shortening and cervical spine abnormalities are other skeletal features often observed in FOP. This study aimed to address the quantitative assessment of these features in a cohort of patients with FOP, which potentially helps early diagnosis of FOP. Radiographs of the hand and cervical spine were retrospectively analyzed from a total of 18 FOP patients (9 males and 9 females) with an average age of 13.9 years (range 0.7�39.3 years). The elevated ratio of the second metacarpal bone to the distal phalanx of the thumb (> +1SD) was a consistent finding irrespective of the patient's age and gender. Infant FOP patients, in addition, exhibited an extremely high ratio of the second metacarpal bone to the first metacarpal bone (> +3SD). The height/depth ratio of the C5 vertebra increased in patients over 4 years of age (> +2SD). Additionally, the ratio of (height+depth) of the C5 spinous process to the C5 vertebral depth was markedly elevated in young patients (> +2SD). We quantitatively demonstrated the hand and cervical spine characteristics of FOP. These findings, which can be seen from early infancy, could be useful for early diagnosis of FOP even in patients without great toe abnormalities. PMID:25343126
Mishima, Kenichi; Kitoh, Hiroshi; Haga, Nobuhiko; Nakashima, Yasuharu; Kamizono, Junji; Katagiri, Takenobu; Susami, Takafumi; Matsushita, Masaki; Ishiguro, Naoki
This manuscript�s purpose was to establish a knowledge base of information related to stroke and the cervical spine vascular structures, from both historical and current perspectives. The scientific biomedical literatures both indexed (ie. Index Medicus, CRAC) and non-indexed literature systems were scanned and the pertinent manuscripts were annotated. Citation is by occurence in the literature so that historical trends may be viewed more easily. No analysis of the reference material is offered. Suggested however is that: 1. complications to cervical spine manipulation are being recognized and reported with increasing frequency, 2. a cause and effect relationship between stroke and cervical spine manipulation has not been established, 3. a screening mechanism that is valid, reliable and reasonable needs to be established.
Gotlib, Allan C.; Thiel, Haymo
MR and CT image fusion of the cervical spine: a noninvasive alternative to CT-myelography
NASA Astrophysics Data System (ADS)
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.
Hu, Yangqiu; Mirza, Sohail K.; Jarvik, Jeffrey G.; Heagerty, Patrick J.; Haynor, David R.
Cervical radicular pain: the role of interlaminar and transforaminal epidural injections.
Chronic neck pain and cervical radicular pain are relatively common in the adult population. Treatment for chronic radicular pain recalcitrant to conservative management includes surgical management as well as interventional techniques with epidural injections utilizing either an interlaminar approach or transforaminal approach. Although there have been multiple systematic reviews and randomized clinical trials of cervical interlaminar epidural injections, the literature is sparse in reference to cervical transforaminal epidural injections. Overall, there is good evidence for the effectiveness of cervical interlaminar epidural injections in managing cervical disc herniation and fair evidence in managing central spinal stenosis and postsurgery syndrome. The evidence is poor, however, for cervical transforaminal epidural injections. Complications with cervical interlaminar epidural injections are rare, but more commonly occur with transforaminal epidural injections and can be fatal. Emerging concepts in pain include further randomized trials; proper placebo design; focus on control design (either active control or placebo control); and appropriate methodologic quality assessment and evidence synthesis. PMID:24338702
Manchikanti, Laxmaiah; Falco, Frank J E; Diwan, Sudhir; Hirsch, Joshua A; Smith, Howard S
Effect of occipitocervical fusion with screw-rod system for upper cervical spine tumor
Background Craniospinal junction tumors are rare but severe lesions. Surgical stabilization has been established to be an ideal treatment for upper cervical tumor pathology. The purpose of this study was to evaluate the effect of a screw-rod system for occipitocervical fusion. Methods A total of 24 cases with C1 and C2 cervical tumor underwent occipitocervical fusion with Vertex screw-rod internal fixation from January 2005 to December 2012. Preoperative X-ray and MRI examinations were performed on all patients before the operation, after the operation, and during last follow-up. The JOA score was used to assess neurological function pre and postoperatively. Results All the patients were followed up for 6 to 42 months with an average of 24 months. The result of X-ray showed that bony fusion was successful in 18 patients at 3 months and 6 patients at 6 months of follow-ups. There was no deterioration of spinal cord injury. The JOA Scores of neurological function increased significantly. Conclusion The screw-rod system offers strong fixation and good fusion for occipitocervical fusion. It is an effective and reliable method for reconstruction of upper cervical spine tumor. PMID:24884456
Outcome of posttraumatic fibromyalgia: A 3-year follow-up of 78 cases of cervical spine injuries
Objective: To assess the outcome of fibromyalgia syndrome (FMS) after cervical spine injury. Methods: Seventy-eight of 102 (77%) patients with neck injury were recruited 3 years after the original study in 1996. Twenty of the original 22 patients with FMS were available for reevaluation in 1999. A count of 18 tender points was conducted by thumb palpation, and tenderness thresholds
Lily Neumann; Vladimir Zeldets; Arkady Bolotin; Dan Buskila
Vertebral pain in helicopter pilots
NASA Technical Reports Server (NTRS)
Pathological forms of spinal pain engendered by piloting helicopters were clinically studied. Lumbalgia and pathology of the dorsal and cervical spine are discussed along with their clinical and radiological signs and origins.
Auffret, R.; Delahaye, R. P.; Metges, P. J.; VICENS
NASA Astrophysics Data System (ADS)
The computed radiography images of 100 randomly selected traumatic cervical spine series were evaluated. The studies were reviewed on the laser printed hardcopy and 2K monitor soft copy images. In addition to the cervical vertebrae, the cervico-thoracic vertebral body interface must be recognized for a lateral c-spine image to be acceptable. The level of visualization of the spine was on average, 1/2 vertebral body better on the monitor than the hardcopy image. In 8% of cases, this improve visualization allowed clearance of the lateral cervical spine thereby expediting patient care in this critical area. This presentation will cover the quality of images and techniques to improve the success rate for clearing the cervical spine.
Leckie, Robert G.; Sheehy, Monet R.; Cade, Lawrence; Goeringer, Fred; Meyers, Chris A.; Parker, James E.; Smith, Donald V.; Freedman, Matthew T.
OBJECTIVE: To study how the cervical spine is assessed before discontinuation of cervical spine immobilisation in unconscious trauma patients in intensive care units. DESIGN: Telephone interview of consultants responsible for adult intensive care units. SETTING: All 25 intensive care units in the South and West region that admit victims of major trauma. MAIN OUTCOME MEASURES: The clinical and radiological basis on which the decision is made to stop cervical spine immobilisation in unconscious patients with trauma. RESULTS: In 19 units cervical spine immobilisation was stopped in unconscious patients on the basis of radiology alone, and six units combined radiology with clinical examination after the patient had regained consciousness. Sixteen units relied on a normal lateral radiological view of the cervical spine alone, five required a normal lateral and anteroposterior view, and four required a normal lateral, anteroposterior, and open mouth peg view. CONCLUSIONS: There are inconsistencies in the clinical and radiological approach to assessing the cervical spine in unconscious patients with trauma before the removal of immobilisation precautions. There is an overreliance on the lateral cervical spine view alone, which has been shown to be insensitive in this setting. PMID:9180066
Gupta, K. J.; Clancy, M.
Abstract Objective To demonstrate the benefits of reducing forward head posture and restoring the cervical lordosis as a novel approach to treating a patient with mechanical thoracic pain. Clinical Features The patient had thoracolumbar junction pain bilaterally that failed to respond to previous sessions of spinal manipulative therapy. Treatment included both manipulative and rehabilitative procedures designed to correct the forward head posture and cervical kyphosis. Treatment progress was quantified on pre and post lateral cervical radio-graphs. Intervention and Outcome The treatment plan was 30 sessions over an 8-week period that included spinal manipulative therapy, used in concert with a new headweight device applied immediately after the manipulation was performed at each session. The patient was also instructed on the performance of certain rehabilitative procedures to be performed in the home setting. The patient experienced significant symptomatic relief after the 3rd week of care. The cervical lordosis was restored by 144% and the forward head posture was decreased by 56% at the end of the trial period. Conclusion Restoration of the cervical curve and reduction of forward head posture appears to have beneficial effects beyond the cervical spine. The addition of active rehabilitative procedures seems to enhance the effectiveness of spinal manipulative therapy in the correction of forward head posture and cervical kyphosis. PMID:19674570
Morningstar, Mark
Aneurysmal bone cysts (ABCs) of the cervical spine are rare occurrences accounting for about 2% of all cases. Having a propensity to develop in the pediatric population, it generally involves the posterior elements with occasional extension to the facets and body of one vertebral level. Surgical treatment of high cervical ABC in pediatric patients is challenging. Where as complete tumor resection should be attempted for the best chance for cure, spinal fusion should be added to correct the defects created by resection to minimize the risk of postoperative instability. This paper presents a multi-level giant expansile ABC of the high cervical spine involving all three spinal columns in a 13-year-old girl and discuss the surgical management. Surgical treatment in this patient included complete tumor excision and circumferential fusion in two stages without any neurovascular injury. The safety and efficacy of this method, especially in the pediatric population is discussed in view of pertinent literature.
Mishra, Sudhansu Sekhar; Panigrahi, Souvagya; Das, Deepak
CT scanning is an important tool in the evaluation of trauma patients. We review a case involving a trauma patient in which a cervical spine computed tomography (CT) artifact affected decision-making by physicians. The CT artifact mimicked bilateral dislocated facets (51-B1.1). On the basis of CT findings, the patient was transferred to a different hospital for evaluation. Discrepancy between the primary CT scan and patient physical exam prompted secondary CT scans and X-ray evaluation; neither of these studies showed osseous abnormalities. This case reinforces the necessity for physicians to formulate their diagnosis based upon multiple areas of information including physical examination, plain x-ray and subsequent advanced imaging, rather than relying solely on advanced imaging. PMID:25352931
Coats, Aaron C; Nies, Matthew S; Rispler, David
Secondary hydrocephalus communicans after traumatic upper cervical spine injuries with leakage of cerebrospinal fluid is a rare and hardly described complication. A case of a 75-year-old woman sustained a type II dens axis without other injuries, especially without evidence of a hydrocephalus in the primary CT scan. Dorsal atlanto-axial fusion was performed. Postoperative drainage was prolonged and positive for ?2-transferrin. Wound revision with an attempt to seal the leakage was not successful. Secondary CT scans of the brain were performed due to neurological deterioration and showed a hydrocephalus with typical EEG findings. No anatomical reason for a circulative obstruction was found in the CT scan. After application of a ventriculo-peritoneal shunt the neurological status improved and the patient could be discharged to neurological rehabilitation. PMID:22752831
Mica, Ladislav; Neuhaus, Valentin; Poschmann, Enrico; Konu-Leblebicioglu, Dilek; Schwarz, Urs; Wanner, Guido A; Werner, Clement ML; Simmen, Hans-Peter
Primary Leptomeningeal Melanoma of the Cervical Spine Mimicking a Meningioma--A Case Report
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. PMID:25083399
Marx, Sascha; Fleck, Steffen K.; Manwaring, Jotham; Vogelgesang, Silke; Langner, Soenke; Schroeder, Henry W.S.
The purpose of this study was to determine the use of manipulation and mobilisation by the Chartered Physiotherapists (CMPT) in Manipulative Therapy Ireland and to describe adverse effects associated with the use of these techniques. A 44 item postal survey was sent to all 259 members of the CPMT (response rate 49%, n=127). All 127 respondents used non-High Velocity Thrust Techniques (HVTT) and 27% (n=34) used HVTT. Nine percent (n=12) used HVTT on the upper cervical spine. Twenty six percent (n=33) reported an adverse effect in the previous 2 years. The adverse effects were associated with the use of HVTT (4%, n=5), non-HVTT (20%, n=26) and cervical traction (2%, n=2). The most serious adverse effects were associated with non-HVTT and included 1 drop attack, 1 fainting episode and 1 Transient Ischemic Attack (TIA) 4 days post treatment. Fifty three percent (n=18) of HVTT users and 40% (n=44) of non-HVTT users reported carrying out a vertebrobasilar insufficiency (VBI) assessment. The study shows that VBI assessment may not detect every patient at risk of adverse effects. Large scale studies to investigate the risk of serious adverse reactions are needed. A system of reporting adverse effects on a routine basis could be considered. PMID:19632881
Sweeney, Aoife; Doody, Catherine
Objective A general orientation along the cervical spine could be estimated by external landmarks, and it was useful, quick and less exposable to radiation, but, sometimes it gave reference confusion of target cervical level. The authors reviewed the corresponding between the neck external landmarks and cervical levels. Methods Totally 1,031 cervical lateral radiographs of different patients were reviewed in single university hospital. Its compositions were 534 of males and 497 females; 86 of second decades (10-19 years-old), 169 of third decades, 159 of fourth decades, 209 of fifth decades, 275 of sixth decades, and 133 of more than seventh decades (>60 years-old). Reference external landmarks (mandible, hyoid bone, thyroid cartilage, and cricothyroid membrane) with compounding factors were reviewed. Results The reference levels of cervical landmarks were C2.13 with mandible angle, C3.54 with hyoid bone, C5.12 with thyroid cartilage, and C6.01 with cricothyroid membrane. The reference levels of cervical landmarks were differently observed by sex, age, and somatometric measurement (height) accordingly mandible angle from C1 to C3, hyoid bone from disc level of C2 and C3 to C5, thyroid cartilage from disc level of C3 and C4 to C7, and cricothyroid membrane from C4 to disc level of C7 and T1. Conclusion Surface landmarks only provide general reference points, but not correspond to exact levels of the cervical spine. Intraoperative fluoroscopy ensures a more precise placement to the targeted cervical level.
Oh, Chang Hyun; Ji, Gyu Yeul; Hyun, Dongkeun; Choi, Chun Gil; Lim, Hyun Kyoung; Jang, A Reum
Background Several tests have been suggested to assess the isometric endurance of the cervical flexor (NFME) and extensors (NEE) muscles. This study proposes to determine whether neck flexors endurance is related to extensor endurance, and whether cervical muscle endurance is related to disability, pain amount and pain stage in subjects with neck pain. Methods Thirty subjects (18 women, 12 men, mean?�?SD age: 43?�?12�years) complaining of neck pain filled out the Visual Analogue Scale (VAS) and the Neck Pain and Disability Scale-Italian version (NPDS-I). They also completed the timed endurance tests for the cervical muscles. Results The mean endurance was 246.7?�?150�seconds for the NEE test, and 44.9?�?25.3�seconds for the NMFE test. A significant correlation was found between the results of these two tests (r?=?0.52, p?=?0.003). A positive relationship was also found between VAS and NPDS-I (r?=?0.549, p?=?0.002). The endurance rates were similar for acute/subacute and chronic subjects, whereas males demonstrated significantly higher values compared to females in NFME test. Conclusions These findings suggest that neck flexors and extensors endurance are correlated and that the cervical endurance is not significantly altered by the duration of symptoms in subjects with neck pain. PMID:24581272
Shoulder-arm pain from cervical bands and scalene muscle anomalies
Fourteen patients were identified with (1) pain and sensory changes in a brachial plexus distribution, (2) aggravation of pain with use of the affected extremity, and (3) pain on palpation over the brachial plexus. All patients had minimal or no intrinsic hand muscle atrophy. Only one patient had cervical ribs. Nerve conduction studies were normal, and electromyography (EMG) showed mild
Jeffrey E. Liu; Albert J. Tahmoush; David B. Roos; Robert J. Schwartzman
Spine Journal Twenty-five years with the biopsychosocial model of low back pain -is it time to
nowadays take psychological and social factors into account when studying low back pain. This mightSpine Journal Twenty-five years with the biopsychosocial model of low back pain - is it time to celebrate? A report from the Twelfth International Forum for Primary Care Research on Low Back Pain
Royal Holloway, University of London
We report a case of 73-year-old man with massive hyperostosis of the cervical spine associated with diffuse idiopathic skeletal\\u000a hyperostosis (DISH), resulting in dysphagia, hoarseness and acute respiratory insufficiency. An emergency operation was performed,\\u000a which involved excision of osteophytes at the level of C6�C7, compressing the trachea against enlarged sternoclavicular joints,\\u000a also affected by DISH. Approximately 3�years later, the patient
Rok Vengust; Ren� Mihali?; Matja� Turel
Cervical spine injuries resulting from diving accidents in swimming pools: outcome of 34 patients
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. PMID:19956985
Gouader, Ismail; Bousquet, Philippe; Draper, Louisa; Roux, Franck-Emmanuel
Postnatal progression of bone disease in the cervical spines of mucopolysaccharidosis I dogs
Introduction Mucopolysaccharidosis I (MPS I) is a lysosomal storage disorder characterized by deficient ?-L-iduronidase activity leading to accumulation of poorly degraded dermatan and heparan sulfate glycosaminoglycans (GAGs). MPS I is associated with significant cervical spine disease, including vertebral dysplasia, odontoid hypoplasia, and accelerated disc degeneration, leading to spinal cord compression and kypho-scoliosis. The objective of this study was to establish the nature and rate of progression of cervical vertebral bone disease in MPS I using a canine model. Methods C2 vertebrae were obtained post-mortem from normal and MPS I dogs at 3, 6 and 12 months-of-age. Morphometric parameters and mineral density for the vertebral trabecular bone and odontoid process were determined using micro-computed tomography. Vertebrae were then processed for paraffin histology, and cartilage area in both the vertebral epiphyses and odontoid process were quantified. Results Vertebral bodies of MPS I dogs had lower trabecular bone volume/total volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N) and bone mineral density (BMD) than normals at all ages. For MPS I dogs, BV/TV, Tb.Th and BMD plateaued after 6 months-of-age. The odontoid process appeared morphologically abnormal for MPS I dogs at 6 and 12 months-of-age, although BV/TV and TMD were not significantly different from normals. MPS I dogs had significantly more cartilage in the vertebral epiphyses at both 3 and 6 months-of-age. At 12 months-of-age, epiphyseal growth plates in normal dogs were absent, but in MPS I dogs they persisted. Conclusions In this study we report reduced trabecular bone content and mineralization, and delayed cartilage to bone conversion in MPS I dogs from 3 months-of-age, which may increase vertebral fracture risk and contribute to progressive deformity. The abnormalities of the odontoid process we describe likely contribute to increased incidence of atlanto-axial subluxation observed clinically. Therapeutic strategies that enhance bone formation may decrease incidence of spine disease in MPS I patients. PMID:23563357
Chiaro, Joseph A; Baron, Matthew D; del Alcazar, Chelsea; O'Donnell, Patricia; Shore, Eileen M; Elliott, Dawn M; Ponder, Katherine P; Haskins, Mark E; Smith, Lachlan J
The Efficacy of Pulsed Radiofrequency Treatment of Cervical Radicular Pain Patients
Objective Cervical radicular pain is defined as pain arising in the arm caused by irritation of a cervical spinal nerve or its roots. Although many treatment modalities are described in the literature, the available evidence for efficacy is not sufficient to allow definitive conclusions. The goal of this study was to establish the benefits and prognostic factors of pulsed radiofrequency (PRF) on the adjacent cervical dorsal root ganglia (DRG) of cervical radicular pain patients. Methods A retrospective study of PRF treatment of patients with cervical radicular pain was carried out. Two times diagnostic block of cervical DRG were performed before PRF. PRF was applied for 2 minutes at a setting of 2 Hz and 45 V by two times on the same targets, with the end point being an electrode tip temperature 42?. Numerical rating scale (NRS) score was evaluated post-treatment 2 week, 1 month, 3 months and 6 months, which were compared with pretreatment value. A successful outcome was defined that NRS change was improved more than 50% at 6 months. Results The mean age was 54 years. The success rate was 68%(15/22) after six months of follow-up. PRF induced complications were not observed. Between success and failure group, we do not find any positive outcome prognostic factor. Interestingly, PRF treatment on foraminal stenosis is better outcome than herniated cervical disc. Conclusion PRF on adjacent cervical DRG is effective and safe treatment option for cervical radicular pain patients. However, more long-term follow up and larger patients are needed to establish effectiveness PRF treatment on cervical radicular pain patients.
Yoon, Young Moon; Lee, Seung Jun; Choi, Chan Young; Sohn, Moon Jun; Lee, Chae Heuck
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. PMID:23956717
Tripathi, Deepshikha C.; Jha, Pramila S.; Trivedi, Lopa P.; Doshi, Shilpa M.; Modia, Brijesh
Cervical spine rotation is used by manual therapists as a premanipulative vertebrobasilar insufficiency (VBI) test to identify patients at risk of developing VBI post-manipulation. Investigations of the effect of rotation on vertebral artery blood flow have yielded conflicting results, the validity of the test being debated. It was the aim of this study, therefore, to investigate the effects of cervical
Jeanette Mitchell; David Keene; Craig Dyson; Lyndsay Harvey; Christopher Pruvey; Rita Phillips
Pelvic Incidence and Lumbar Spine Instability Correlations in Patients with Chronic Low Back Pain
Purpose Many factors such as lumbar instability and spinopelvic alignment are associated with low back pain. Our purpose was to analyze the pelvic incidence - one of spinopelvic alignment parameters- and spine instability correlations in patients with chronic low back pain. Methods Fifty-two patients suffering from chronic low back pain entered this case control study. Lateral spine radiography was taken from patients. pelvic incidence and L3, L4 and L5�s vertebral body width were measured for all patients, and lumbar instability was evaluated in 3 different levels: L5-S1, L4-L5 and L3-L4. Results Thirty-two patients having lumbar instability formed group A and 20 patients without lumbar spine instability allocated to group B. Average age, mean weight, height, body mass index and mean vertebral width of both groups did not differ meaningfully. Pelvic incidence�s mean amounts set to 53.9 in group B and 57.7 in group A without any significant difference; but pelvic incidence was significantly lower in patients with lumbar instability of L5-S1 origin (P=0.01). Conclusions Overall, pelvic incidence did not differ between two groups. However, separate evaluation of each level revealed lumbar instability of L5-S1 segment to be associated with lower pelvic incidence. PMID:23342229
Golbakhsh, Mohammad-Reza; Hamidi, Majid Attar; Hassanmirzaei, Bahar
Prevalence of joint-related pain in the extremities and spine in five groups of top athletes
Purpose��Joint-related pain conditions from the spine and extremities are common among top athletes. The frequency of back pain has,\\u000a however, been studied in more detail, and the frequency of low-back pain in top athletes in different high-load sports has\\u000a been reported to be as high as 85%. Sport-related pain from different joints in the extremities is, however, infrequently\\u000a reported on
Pall Jonasson; Klas Halldin; Jon Karlsson; Olof Thoreson; Jonas Hvannberg; Leif Sw�rd; Adad Baranto
Study Design A prospective radiographic study of cervical spine with congenital monosegment fusion. Purpose To evaluate the effect of cervical synostosis on adjacent segments and the vertebral morphology. Overview of Literature There are numerous clinical studies of adjacent segment disease (ASD) after monosegment surgical fusion. However, there was no report on ASD in the cervical spine with congenital monosegment synostosis. Methods Radiograms of 52 patients, aged 5 to 90 years, with congenital monosegment synostosis (CMS) between C2 and C6, who complained of neck/shoulder discomfort or pain were studied. 51 were normally aligned and one was kyphotically aligned. Results Spondylosis was not found in the patients below 35 years of age. Only 12 out of 24 patients with normally aligned C2-3 synostosis had spondylosis in 19 more caudal segments, and only one at C3-4. A patient with kyphotic C2-3 had spondylolysis at C3-4. In 8 patients with C3-4 synostosis, spondylosis was found in only 9 caudal segments (4 at C4-5, 4 at C5-6, and 1 at C6-7). The caudate C4-5 disc was the most liable to degenerate in comparison with other caudate segments. Caudal corporal flaring and inwaisting of the synostotic vertebra were the features that were the most evident. In 2 of 9 C4-5 and 7 out of 10 C5-6 synostosis patients, spondylosis was found at the two adjacent cephalad and caudate segments, respectively. Only corporal inwaisting without flaring was found. In all cases, spondylosis was confined to the adjacent segments. More advanced spondylosis was found in the immediate caudal segment than the cephalad one. Conclusions It is concluded that spondylosis at the mobile segments in a synostotic spine is thought to be a fusion-related pathology rather than solely age-related disc degeneration. Those data suggested that CMS definitely precipitated the disc degeneration in the adjacent segments. PMID:25346814
Moon, Myung-Sang; Yoon, Min-Geun; Seo, Young Hoon; Lee, Bong-Jin; Moon, Hanlim; Kim, Sung-Sim
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, p<0.05 for all comparisons). These results provide new insights to develop prevention, recognition, and treatment strategies for compressive cervical spine injuries with lateral eccentricities. PMID:24411098
Van Toen, C; Melnyk, A D; Street, J; Oxland, T R; Cripton, P A
Introduction The frequency of vertebrobasilar ischemia in patients with cervical spine trauma had been regarded as low in many published papers. However, some case reports have described cervical spine injury associated with blunt vertebral artery injury. Many aspects of the management of vertebral artery injuries still remain controversial, including the screening criteria, the diagnostic modality, and the optimal treatment for various lesions. The case of a patient who had a brain infarction due to recanalization of his occluded vertebral artery following open reduction of cervical spinal dislocation is presented here. Case presentation A 41-year-old Asian man presented with C4 to C5 distractive flexion injury manifesting with quadriplegia and anesthesia below his C3 cord level (including phrenic nerve paralysis), and bowel and bladder dysfunction. Magnetic resonance angiography and computed tomography angiography showed left extracranial vertebral artery occlusion and patent contralateral vertebral artery. He was observed without antiplatelet and/or anticoagulation therapy, and underwent surgery (open reduction and internal fusion of C4 to C5, and tracheostomy) 8 hours after the injury. After surgery, supraspinal symptoms such as left horizontal nystagmus and left homonymous hemianopsia led to cranial computed tomography and magnetic resonance imaging, which showed left-side cerebellar infarction in his posterior inferior cerebellar artery territory and right-side posterior cerebral artery infarction. Magnetic resonance angiography and computed tomography angiography demonstrated patent bilateral vertebral artery (but hypoplastic right vertebral artery) and occluded right posterior cerebral artery. His injured vertebral artery was treated conservatively, which did not cause any other ischemic complications. Conclusions The management of asymptomatic vertebral artery injury is controversial with several treatment options available, including observation alone, antiplatelet therapy, anticoagulation therapy, or invasive intervention. Although there are some reports in which management with observation alone is described as safe, we should pay serious attention to the vertebral artery injury caused by cervical spine trauma. PMID:25316102
Muscle energy technique is an established osteopathic manipulative intervention often used to treat somatic dysfunctions of the spine. There are little objective data to demonstrate its efficacy, however. To determine the efficacy of this osteopathic manipulative technique, the authors compared active cervical range of motion among asymptomatic young and middle-aged adults (n=18) before and after this treatment protocol, comparing those results against matched control subjects (n=14) who received sham manipulative treatment. Range of motion was measured in three planes (flexion/extension, lateral bending, rotation) on all subjects (N=32) using a motion-analysis system. Multiplanar gross cervical motion restrictions were diagnosed in this asymptomatic population. In the treatment group, cervical long restrictor muscles were treated with the muscle energy technique in the sagittal, frontal, and horizontal planes. The control group had relative restrictions addressed by means of a sham manipulative treatment protocol in which the barriers to motion were not challenged therapeutically. The muscle energy technique produced a significant increase in overall regional cervical range of motion in the treatment group (approximately 4 degrees) when compared with control subjects (P<.001). Significant differences were also observed in the magnitude of change in the three planes of movement (rotation, P<.002; lateral bending, P<.01), with flexion/extension being the least affected (P=.2). These data demonstrate that the application of the muscle energy technique can produce acute increases in the active cervical range of motion in asymptomatic subjects. PMID:16585381
Burns, Denise K; Wells, Michael R
Laminectomy has been regarded as a standard treatment for multi-level cervical stenosis. Concern for complications such as kyphosis has limited the indication of multi-level laminectomy; hence it is often augmented with an instrumented fusion. Laminoplasty has emerged as a motion preserving alternative. The purpose of this study was to compare the multidirectional flexibility of the cervical spine in response to a plate-only open door laminoplasty, double door laminoplasty, and laminectomy using a computational model. A validated three-dimensional finite element model of a specimen-specific intact cervical spine (C2-T1) was modified to simulate each surgical procedure at levels C3-C6. An additional goal of this work was to compare the instrumented computational model to our multi-specimen experimental findings to ensure similar trends in response to the surgical procedures. Model predictions indicate that mobility was retained following open and double door laminoplasty with a 5.4% and 20% increase in flexion, respectively, compared to the intact state. Laminectomy resulted in 57% increase in flexion as compared to the intact state, creating a concern for eventual kyphosis - a known risk/complication of multi-level laminectomy in the absence of fusion. Increased disc stresses were observed at the altered and adjacent segments post-laminectomy in flexion. PMID:25328475
Kode, Swathi; Kallemeyn, Nicole A; Smucker, Joseph D; Fredericks, Douglas C; Grosland, Nicole M
BACKGROUND: Thoracic spine pain (TSP) is experienced across the lifespan by healthy individuals and is a common presentation in primary healthcare clinical practice. However, the epidemiological characteristics of TSP are not well documented compared to neck and low back pain. A rigorous evaluation of the prevalence, incidence, correlates and risk factors needs to be undertaken in order for epidemiologic data
Andrew M Briggs; Anne J Smith; Leon M Straker; Peter Bragge
Cervical spine (CS) magnetic resonance imaging (MRI) and collar use may prevent quadriplegia, yet create brain injury. We developed a computer model to assess the effect of CS management strategies on outcomes in comatose, blunt trauma patients with extremity movement and a negative CS CT scan. Strategies include early collar removal (ECR), ECR & MRI, late collar removal (LCR), and LCR & MRI. MRI risks include hypoxia, hypotension, increased intracranial pressure (?ICP), and ventilator-associated pneumonia (VAP). LCR risks include ?ICP, VAP, and delirium. Model elements include Quadriplegia and Primary, Secondary, LCR, and MRI Brain Injury. The Monte Carlo simulation determines health outcomes (Functional Survival versus Quadriplegia, Severe Brain Disability, or Dead). Utility values are Functional Survival 0.90, Quadriplegia 0.20, Severe Brain Disability 0.10, and Dead 0.00. Years of life expectancy are Functional Survival 39.5, Quadriplegia 20.0, Severe Brain Disability 20.0, and Dead 0.0. Unstable CS rate 2.5%: Functional Survival/1,000: Unstable Patients: ECR 384, LCR 350, LCR & MRI 332, ECR & MRI 331; High-Risk Patients: ECR 161, LCR 151, LCR & MRI 140, ECR & MRI 153; Stable Patients: ECR 596, LCR 587, LCR & MRI 573, ECR & MRI 595. Quality-Adjusted Life Months for Unstable, High-Risk, and Stable Patients are greater with ECR; Stable Patient ECR and ECR & MRI are similar. Unstable CS rate 0.5%: Functional Survival/1000: Unstable Patients: ECR 394, LCR 352, LCR & MRI 332, ECR & MRI 332; High-Risk Patients: ECR 164, LCR 151, LCR & MRI 140, ECR & MRI 152; Stable Patients: ECR 611, LCR 592, LCR & MRI 576, ECR & MRI 598. Quality-Adjusted Life Months for Unstable, High-Risk, and Stable Patients are greater with ECR. LCR and MRI brain injury results in losses of functional survivorship that exceed those from quadriplegia. Model results suggest that early collar removal without cervical spine MRI is a reasonable, and likely the preferable, cervical spine management strategy for comatose, blunt trauma patients with extremity movement and a negative cervical spine CT scan. PMID:21083417
Dunham, C Michael; Carter, Kimbroe J; Castro, Frank; Erickson, Barbara
Importance of precise positioning for proton beam therapy in the base of skull and cervical spine.
Using proton beam therapy, high doses have been delivered to chordomas and chondrosarcomas of the base of skull and cervical spine. Dose inhomogeneity to the tumors has been accepted in order to maintain normal tissue tolerances, and detailed attention to patient immobilization and to precise positioning has minimized the margins necessary to ensure these dose constraints. This study examined the contribution of precise positioning to the better dose localization achieved in these treatments. Three patients whose tumors represented different anatomic geometries were studied. Treatment plans were developed which treated as much of the tumor as possible to 74 Cobalt-Gray-Equivalent (CGE) while maintaining the central brain stem and central spinal cord at less than or equal to 48 CGE, the surface of the brain stem, surface of the spinal cord, and optic structures at less than or equal to 60 CGE, and the temporal lobes at less than or equal to 5% likelihood of complication using a biophysical model of normal tissue complication probability. Two positioning accuracies were assumed: 3 mm and 10 mm. Both proton beam plans and 10 MV X ray beam plans were developed with these assumptions and dose constraints. In all cases with the same positioning uncertainties, the proton beam plans delivered more dose to a larger percentage of the tumor volume and the estimated tumor control probability was higher than with the X ray plans. However, without precise positioning both the proton plans and the X ray plans deteriorated, with a 12% to 25% decrease in estimated tumor control probability. In all but one case, the difference between protons with good positioning and poor positioning was greater than the difference between protons and X rays, both with good positioning. Hence in treating these tumors, which are in close proximity to critical normal tissues, attention to immobilization and precise positioning is essential. With good positioning, proton beam therapy permits higher doses to significantly more of the tumor in these sites than do X rays. PMID:1651308
Tatsuzaki, H; Urie, M M
Cervical epidural steroid injections for the treatment of cervical spinal (neck) pain.
Cervical epidural steroid injections (CESI) are an accepted treatment for neck pain with a radicular component, and may be accomplished by using either transforaminal (CTFESI) or interlaminar (CILESI) approaches. CESIs are routinely performed using real-time fluoroscopic-guidance in conjunction with the injection of water soluble, iodine-based contrast media to enhance visualization of intravascular injections. Digital subtraction angiography (DSA) imaging is an adjuvant to fluoroscopic methods for visualizing blood vessels while performing spinal injections. However, as with any neuraxial procedure, various complications associated with CESIs have been reported. Complications are directly associated with the technical procedures of CESIs. Particulate steroids may have a prolonged duration of action but non-particulate steroids are safer for CESIs. Blunt-beveled needles are less likely than sharp-beveled needles to penetrate blood vessels to cause bleeding complications during CTFESI procedures. Small doses of local anesthetics appear to be safe and assist in identifying intravascular injections previously overlooked by conventional techniques. PMID:23315021
Candido, Kenneth D; Knezevic, Nebojsa 'nick'
Several anterior and posterior methods are today available for stabilization of the cervical spine. Factors such as level and degree of instability, method of decompression, bone quality, length of fixation and safety factors influence the choice of method for a particular patient. The use of laminar hooks in the cervical spine has been restricted by fear of cord compression with the potential of tetraplegia. The aim of the present study was to assess the safety and determine the anatomical relation between hooks inserted in the cervical spinal canal and the dura and spinal cord. Thirteen cadavers from seven women and six men with no evidence of cervical spine disorder were included. The mean age was 81.3 years (range 65-101 years). The cervical spine was instrumented with cervical Compact Cotrel Dubousset hooks and rods. The effect of the hook on the dura was studied by myelography in nine cadavers. The deformation of the dural sac was quantified by measurement of the maximal width of the indentation of the contrast column at each level. A CT myelography scan was obtained in three cadavers. The ratio between the distance of maximal hook intrusion into the spinal canal and the canal diameter in the direction of the hook was calculated. The relation between inserted hooks and the spinal cord and dura was documented in a fresh cadaver studied with CT myelography. A hemilaminectomy was performed at all levels in three cadavers with direct visual inspection and photography of the hook sites before and after excision of the dura. A dural deformation of 2 mm or less, as observed by myelography, was found at four out of 77 (5%) hook sites. The deformation was caused by a supralaminar hook at C3, C6 and C7 and by an infralaminar hook at C6. The mean hook intrusion in the spinal canal, as observed on CT, was 27% (range 8-43) of the canal diameter. On visual inspection, 14 out of 18 hooks were in contact with the dura. After removal of the dura, two out of the 18 hooks in the same cadaver were in contact with the spinal cord. However, no deformation of the cord was observed. To our knowledge this is the first study systematically documenting the relation between hooks and the spinal cord in cadavers. In 95% of the hooks no deformation of the dural sac was observed and there was no evidence of spinal cord deformation. From an anatomical point of view, laminar hook instrumentation can be considered a safe procedure. The study shows, however, that hooks inserted in the cervical spine have a close anatomical relationship with the neuraxis, and at stenotic levels the use of other techniques is therefore recommended. PMID:11563621
Fagerstr�m, T; Hedlund, R; Bancel, P; Robert, R; Dupas, B
Spine day 2012: spinal pain in Swiss school children- epidemiology and risk factors
Background The key to a better understanding of the immense problem of spinal pain seems to be to investigate its development in adolescents. Based on the data of Spine Day 2012 (an annual action day where Swiss school children were examined by chiropractors on a voluntary basis for back problems), the aim of the present study was to gain systematic epidemiologic data on adolescent spinal pain in Switzerland and to explore risk factors per gender and per spinal area. Method Data (questionnaires and physical examinations) of 836 school children were descriptively analyzed for prevalence, recurrence and severity of spinal pain. Of those, 434 data sets were included in risk factor analysis. Using logistic regression analysis, psycho-social parameters (presence of parental back pain, parental smoking, media consumption, type of school bag) and physical parameters (trunk symmetry, posture, mobility, coordination, BMI) were analyzed per gender and per spinal area. Results Prevalence of spinal pain was higher for female gender in all areas apart from the neck. With age, a steep increase in prevalence was observed for low back pain (LBP) and for multiple pain sites. The increasing impact of spinal pain on quality of life with age was reflected in an increase in recurrence, but not in severity of spinal pain. Besides age and gender, parental back pain (Odds ratio (OR)=3.26, p=0.011) and trunk asymmetry (OR=3.36, p=0.027) emerged as risk factors for spinal pain in girls. Parental smoking seemed to increase the risk for both genders (boys: OR=2.39, p=0.020; girls: OR=2.19, p=0.051). Risk factor analysis per spinal area resulted in trunk asymmetry as risk factor for LBP (OR=3.15, p=0.015), while parental smoking increased the risk for thoracic spinal pain (TSP) (OR=2.83, p=0.036) and neck pain (OR=2.23, p=0.038). The risk for TSP was further enhanced by a higher BMI (OR=1.15, p=0.027). Conclusion This study supports the view of adolescent spinal pain as a bio-psycho-social problem that should be investigated per spinal area, age and gender. The role of trunk asymmetry and passive smoking as risk factors as well as the association between BMI and TSP should be further investigated, preferably in prospective studies. PMID:24094041
Background Previous data using T1-weighted MRI demonstrated neck muscle fat infiltration (MFI) in patients with poor functional recovery following whiplash. Such findings do not occur in those with milder symptoms of whiplash, chronic non-traumatic neck pain or healthy controls, suggesting traumatic factors play a role. Muscle degeneration could potentially represent a quantifiable marker of poor recovery, but the temporal constraints of running a T1-weighted sequence and performing the subsequent analysis for muscle fat may be a barrier for clinical translation. The purpose of this preliminary study was to evaluate, quantify and compare MFI for the cervical multifidus muscles with T1-weighted imaging and a more rapid quantitative 3D multi-echo gradient echo (GRE) Dixon based method in healthy subjects. Methods 5 asymptomatic participants with no history of neck pain underwent cervical spine MRI with a Siemens 3 Tesla system. The muscle and fat signal intensities on axial spin-echo T1-weighted images were quantitatively classified for the cervical multifidii from C3-C7, bilaterally. Additional axial GRE Dixon based data for fat and water quantification were used for comparison via paired t-tests. Inter-tester reliability for fat and water measures with GRE images were examined using 1) Pearson�s Intra-class correlation coefficient 2) Bland-Altman Plots and 3) Lin�s-Concordance Coefficient. P?0.05 was used to indicate significance. Results Total mean (SD) MFI (C3-C7) for the multifidii obtained with T1-weighted imaging and GRE were 18.4% (3.3) (range 14-22%) and 18.8% (2.9) (range 15-22%), respectively. The Pearson correlation coefficients for inter-tester reliability on the GRE sequences for the C3-C7 multifidii ranged from .83 - .99, indicating high levels of agreement with segmental MFI measures. Bland-Altman Plots revealed all data points were within 2 SDs and concordance was established between 2-blinded raters, suggesting good agreement between two raters measuring fat and water with GRE imaging. Conclusions Results of this preliminary study demonstrate reliability between 2 raters of varying experience for MRI analysis of MFI with 3D GRE MRI. The quantification of MFI for healthy cervical musculature is comparable to T1-weighted images. Inclusion of larger samples of symptomatic data and histological comparison with the reference standard biopsy is warranted. PMID:24020963
Patients with cervical spine instability and limited range of motion are challenge to anesthesiologists. It is important to consider alternatetive methods for securing the airway while maintaining neutral position and minimizing neck motion, because these patients are at increased risk for tracheal intubation failure and neurologic injury during airway management or position change. We experienced two cases that patients had cervical spine instability and severe limited range of motion due to the fusion of the entire cervical spine. One patient was a 6-year-old girl weighing 12.7 kg and had Klippel-Feil syndrome with Arnold-Chiari malformation, the other was a 24-year-old female weighing 31 kg and had juvenile rheumatoid arthritis. We successfully performed the intubation by using the fiberoptic intubation though a laryngeal mask airway in these two cases. PMID:22474556
Lee, Jae Jin; Lee, Mi Kyoung; Kong, Myoung Hoon; Kim, Kyong Jong; Lee, Jea Yeun
Investigation of the effect of GaAs laser therapy on cervical myofascial pain syndrome
Low-energy laser therapy has been applied in several rheumatoid and soft tissue disorders with varying rates of success. The objective of our study was to investigate the effect of laser therapy on cervical myofascial pain syndrome with a placebo-controlled double-blind prospective study model. It was performed with a total of 53 patients (35 females and 18 males) with cervical myofascial
Lale Altan; Umit Bing�l; Mehtap Ayka�; Merih Yurtkuran
Analysis of surgical management of 113 patients (92 in the acute period of the injury and 21 in the late period) with closed injury to the cervical segment of the spine and spinal cord made it possible to elaborate strict indications for and determine the volume of anterior decompression of the spinal cord. The principal indication for operation through an anterior approach in the acute period of injury to the cervical spine is anterior compression of the spinal cord caused by different factors identified by detailed X-ray examination including methods of contrast study (warm venospondylography, pneumomyelography, discography, vertebral angiography). In 34 patients the spinal cord was examined by the microsurgical method with removal of the responsible factors. With the use of this method, lethality reduced to 4.3% and the conduction functions of the spinal cord were restored in 72.8% of the patients in the acute period and in two thirds of the patients operated on in the late period. PMID:6353828
Aranovich, V L; Belov, V G
Summary An intubating laryngeal mask airway (ILMA) facilitates tracheal intubation with the neck in neutral position, which is similar to the neck position maintained by a rigid cervical collar. However, a cervical collar virtually obliterates neck movement, even the small movements that normally facilitate airway insertion. We therefore tested the hypothesis that the ILMA facilitates tracheal intubation even in patients wearing a rigid cervical collar. In 50 cervical spine surgery patients with a rigid Philadelphia collar in place and 50 general surgery patients under general anaesthesia, we performed blind tracheal intubation via an ILMA. The time required for intubation, intubation success rate, and numbers and type of adjusting manoeuvres employed were recorded. Inter-incisor distance was significantly smaller (4.1 [0.8] cm vs. 4.6 [0.7] cm, mean [SD], P<0.01) and Mallampati scores were significantly greater (P<0.001) in the collared patients. ILMA insertion took longer (30 [25] vs. 22 [6] seconds), more patients required 2 insertion attempts (15 vs. 3; P<0.005), and ventilation adequacy with ILMA was worse (P<0.05) in collared patients. However, there were no significant differences between the collared and control patients in terms of total time required for intubation (60 [41] vs. 50 [30] seconds), number of intubation attempts, overall intubation success rate (96 vs. 98%), or the incidence of intubation complications. Blind intubation through an ILMA is thus a reasonable strategy for controlling the airway in patients who are immobilized with a rigid cervical collar, especially when urgency precludes a fiberoptic approach. PMID:15321932
Komatsu, Ryu; Nagata, Osamu; Kamata, Kotoe; Yamagata, Katsuyuki; Sessler, Daniel I.; Ozaki, Makoto
Background: To determine whether patients who become quadriplegic following cervical spine surgery are adequately compensated by our present medico-legal system. The outcomes of malpractice suits obtained from Verdict Search (East Islip, NY, USA), a medico-legal journal, were evaluated over a 20-year period. Although the present malpractice system generously rewards many quadriplegic patients with substantial settlements/ Plaintiffs' verdicts, a subset receive lesser reimbursements (verdicts/settlements], while others with defense verdicts receive no compensatory damages. Methods: Utilizing Verdict Search, 54 cases involving quadriplegia following cervical spine surgery were reviewed for a 20-year interval (1988�2008). The reason(s) for the suit, the defendants, the legal outcome, and the time to outcome were identified. Operations included 25 anterior cervical procedures, 22 posterior cervical operations, 1 circumferential cervical procedure, and 6 cases in which the cervical operations were not defined. Results: The four most prominent legal allegations for suits included negligent surgery (47 cases), lack of informed consent (23 cases), failure to diagnose/treat (33 cases), and failure to brace (15 cases). Forty-four of the 54 suits included spine surgeons. There were 19 Plaintiffs' verdicts (average US $5.9 million, range US $540,000-US $18.4 million), and 20 settlements (average US $2.8 million, range US $66,500-US $12.0 million). Fifteen quadriplegic patients with defense verdicts received no compensatory damages. The average time to verdicts/settlements was 4.3 years. Conclusions: For 54 patients who were quadriplegic following cervical spine surgery, 15 (28%) with defense verdicts received no compensatory damages. Under a No-Fault system, quadriplegic patients would qualify for a �reasonable� level of compensation over a �shorter� time frame. PMID:20657685
Compressive myelopathy of the cervical spine in Komodo dragons (Varanus komodoensis).
Cervical subluxation and compressive myelopathy appears to be a cause of morbidity and mortality in captive Komodo dragons (Varanus komodoensis). Four cases of cervical subluxation resulting in nerve root compression or spinal cord compression were identified. Three were presumptively induced by trauma, and one had an unknown inciting cause. Two dragons exhibited signs of chronic instability. Cervical vertebrae affected included C1-C4. Clinical signs on presentation included ataxia, ambulatory paraparesis or tetraparesis to tetraplegia, depression to stupor, cervical scoliosis, and anorexia. Antemortem diagnosis of compression was only confirmed with magnetic resonance imaging or computed tomography. Treatment ranged from supportive care to attempted surgical decompression. All dragons died or were euthanatized, at 4 days to 12 mo postpresentation. Studies to define normal vertebral anatomy in the species are necessary to determine whether the pathology is linked to cervical malformation, resulting in ligament laxity, subsequent instability, and subluxation. PMID:19368265
Zimmerman, Dawn M; Douglass, Michael; Sutherland-Smith, Meg; Aguilar, Roberto; Schaftenaar, Willem; Shores, Andy
Federal Register 2010, 2011, 2012, 2013
...Spine) Conditions Disability Benefits Questionnaire) Activity Under OMB Review AGENCY: Veterans Benefits Administration, Department...announces that the Veterans Benefits Administration (VBA), Department...PRA submission describes the nature of the information...
A transverse skin incision for anterior cervical spine surgery gives an excellent cosmetic result but is not extensile, thus accuracy of incision placement is essential. We describe a new, fast and inexpensive method of accurate transverse skin incision placement that does not rely on anatomical landmarks or intraoperative fluoroscopy. A ratio, determined by measurements from a lateral cervical spine radiograph, was applied to measurements on the patients' neck to determine the site for incision. The use of a ratio was designed to remove any inaccuracies related to X-ray magnification differences. A retrospective review of 54 consecutive anterior cervical spine procedures undertaken with this technique was performed. The operative level ranged from C2-C3 to C7-T1, the most common being C5-C6. Post-operative radiographic measurement of the incision site (marked by skin clips) demonstrated a mean distance of 5 mm (range 1-8 mm) from the centre of the skin clips to the predetermined ideal midpoint for each individual. In no case was it necessary to radically extend or to make a separate incision. The technique described is an accurate method of determining the level of transverse skin incision placement for cervical spine surgery that reduces intra-operative fluoroscopy time, radiation dose and expense. PMID:22705137
Leonard, Michael; Kennedy, Cian; Heneghan, Helen; Cabe, John Mc
Painful cervical lymphadenopathy: An unusual presentation of chikungunya
Chikungunya is an arboviral disease transmitted by Aedes mosquito that represents a major public health burden worldwide including India. The disease presents as sudden onset of high-grade fever, severe arthralgias, and rash. Here, we describe a case of a patient who presented with cervical lymphadenopathy, fever, and myalgia and later was diagnosed as chikungunya. Lymphadenopathy has been described before as a less common symptom of chikungunya. But this is probably, the first case of chikungunya with cervical lymphadenopathy as a presenting feature. PMID:24600579
Keny, Mukundraj S; Pereira, Ian A; deSa, Sunita B; Gomes, Edwin J
... a spine care professional. As a multidisciplinary spine organization, NASS members are MDs, DOs and PhDs in 22 spine-related specialties, including orthopedics, neurosurgery, physiatry, pain management and other disciplines. Nurse practitioners, physician�s assistants, chiropractors, ...
Anterior cervical discectomy and arthrodesis has come to represent standard of care for patients with persistent radicular and/or myelopathic symptoms that have failed to improve with conservative treatments. One potential complication of the procedure is the accelerated degeneration of the vertebrae and the intervertebral discs adjacent to the level fused and the effects of fusion on those levels. The concern that fusion may be a contributing factor to accelerated adjacent segment degeneration led to increased interest in cervical disc replacement after anterior decompressive surgery. Several studies analyzing the short-term outcomes of the disc replacement procedure have been published since then, and the pros and cons of both procedures continue to remain a topic of debate among the scientific community. The analysis of published literature and our own experience has convinced us that the overall longer-term clinical outcomes after anterior cervical discectomy and fusion (ACDF) and total disc replacement (TDR) in the general patient population are not significantly different in terms of symptomatic improvement, neurological improvement, and restoration to better quality of life. Age of the patients and number of affected levels may impact the outcomes and hence determine the choice of optimum procedure. To definitely compare the incidence of adjacent segment disease after these procedures, multi-institutional studies with predetermined and unanimously agreed upon clinical and radiological criteria should be undertaken and the results analyzed in an unbiased fashion. Until that time, it is reasonable to assume that ACDF as well as cervical TDR are both safe and effective procedures that may have outcome benefits in specific patient subgroups based upon demographics and clinical/radiological parameters at the time of surgery. PMID:24353966
Jawahar, Ajay; Nunley, Pierce
Study Design In vivo validation during functional loading. Objective To determine the accuracy and repeatability of a model-based tracking technique that combines subject-specific CT models and high-speed biplane X-ray images to measure three-dimensional (3D) in vivo cervical spine motion. Summary of Background Data Accurate 3D spine motion is difficult to obtain in vivo during physiological loading due to the inability to directly attach measurement equipment to individual vertebrae. Previous measurement systems were limited by two-dimensional (2D) results and/or their need for manual identification of anatomical landmarks, precipitating unreliable and inaccurate results. All previous techniques lack the ability to capture true 3D motion during dynamic functional loading. Methods Three subjects had 1.0 mm diameter tantalum beads implanted into their fused and adjacent vertebrae during ACDF surgery. High resolution CT scans were obtained following surgery and used to create subject-specific 3D models of each cervical vertebra. Biplane X-rays were collected at 30 frames per second while the subjects performed flexion/extension and axial rotation movements six months after surgery. Individual bone motion, intervertebral kinematics, and arthrokinematics derived from dynamic RSA served as a gold standard to evaluate the accuracy of the model-based tracking technique. Results Individual bones were tracked with an average precision of 0.19 mm and 0.33 mm in non-fused and fused bones, respectively. Precision in measuring 3D joint kinematics in fused and adjacent segments averaged 0.4 mm for translations and 1.1� for rotations, while anterior and posterior disc height above and below the fusion were measured with a precision ranging between 0.2 mm and 0.4 mm. The variability in 3D joint kinematics associated with tracking the same trial repeatedly was 0.02 mm in translation and 0.06� in rotation. Conclusions 3D cervical spine motion can be precisely measured in vivo with sub-millimeter accuracy during functional loading without the need for bead implantation. Fusion instrumentation did not diminish the accuracy of kinematic and arthrokinematic results. The semi-automated model-based tracking technique has excellent repeatability. PMID:21372650
Anderst, William J; Baillargeon, Emma; Donaldson, William F; Lee, Joon Y; Kang, James D
Background:?Aneurysmal bone cysts are rare occurrences in the cervical spine. Surgical treatment in pediatric patients is a challenge. Complete tumor resection offers the best chance for cure. Description:?Diagnosis and surgical management of an expansile aneurysmal bone cyst of the cervical spine involving all three spinal columns in a 10-year-old boy. Results:?Surgical treatment included tumor excision and circumferential fusion, and produced no neurological or vascular sequelae. This approach minimizes the risk of recurrence and the possibility of postoperative spinal instability. Conclusion:?Spinal instability is preferably addressed with reconstruction and stabilization. Cervical aneurismal bone cyst lesions are ideally treated with complete resection to minimize the chance of recurrence. In pediatric cases, defects created by resection should be corrected by fusion to minimize the risk of postoperative instability and growth abnormality. PMID:23526912
Gurjar, Hitesh Kumar; Sarkari, Avijit; Chandra, P. Sarat
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. PMID:24843330
Bharti, Neerja; Arora, Suman; Panda, Nidhi B
A study of 90 patients was undertaken to compare intubation success rates of using either ILMA, C-Trach or McCoy laryngoscope in patients with simulated cervical spine injury. Insertion and intubation success rates, time taken to achieve intubation, airway complications and haemodynamic parameters were recorded. Insertion of ILMA and C-Trach was successful at the first attempt in all patients. Intubation success rates were higher in the C-Trach (100%) and McCoy (100%) groups than in the ILMA (87%) group. Total intubation time was significantly longer in the ILMA (63 s, SD 36.5) group than in the C-Trach (41 s, SD 15.8) and McCoy (30 s, SD 7.4) groups (p < 0.05, p < 0.05, respectively). There were no significant differences in haemodynamic parameters among the groups at any time. PMID:16792615
Bilgin, H; Bozkurt, M
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 degrees 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. PMID:12136331
Obenauer, S; Alamo, L; Herold, T; Funke, M; Kopka, L; Grabbe, E
Cervical fascia: a terminological pain in the neck.
Although understanding the cervical fascia and its arrangement is an important part of anatomical, surgical and radiological training, it is inconsistently described in textbooks, which makes its study challenging and interdisciplinary communication confusing. This review examines the recommended textbooks for trainees of these disciplines in order to identify areas of agreement and controversy. Not only were the terms used variably between texts, but also key aspects of the anatomical descriptions associated with similar terms differed, contributing further to the confusion. PMID:22985295
Guidera, Alice K; Dawes, Patrick J D; Stringer, Mark D
To evaluate immediate effects of two different modes of acupuncture on motion-related pain and cervical spine mobility in chronic neck pain patients compared to a sham procedure. Thirty-six patients with chronic neck pain and limited cervical spine mobility participated in a prospective, randomized, double-blind, sham-controlled crossover trial. Every patient was treated once with needle acupuncture at distant points, dry needling
Dominik Irnich; Nicolas Behrens; Jochen M Gleditsch; Wolfram St�r; Martin A Schreiber; Peter Sch�ps; Andrew J Vickers; Antje Beyer
Purpose��To describe the presentation and management of complete upper airway obstruction with life threatening arterial oxygen desaturation\\u000a that occurred during attempted awake fibreoptic intubation in two patients presenting with unstable C-spine injury.\\u000a \\u000a \\u000a \\u000a Clinical Feature��Complete upper airway obstruction occurred during awake fibreoptic intubation of two men (ASA II; 68 & 55 yr old) presenting\\u000a with unstable C-spine fractures. In both cases,
Glenn McGuire; Hossam El-Beheiry
Background. The incidence of spine metastasis is expected to increase as the population ages, and so is the number of palliative spinal procedures. Minimally invasive procedures are attractive options in that they offer the theoretical advantage of less morbidity. Purpose. The purpose of our study was to evaluate whether minimally invasive posterior spinal instrumentation provided significant pain relief and improved function. Study Design. We compared pre- and postoperative pain scores as well as ambulatory status in a population of patients suffering from oncologic conditions in the spine. Patient Sample. A consecutive series of patients with spine tumors treated minimally invasively with stabilization were reviewed. Outcome Measures. Visual analog pain scale as well as pre- and postoperative ambulatory status were used as outcome measures. Methods. Twenty-four patients who underwent minimally invasive posterior spinal instrumentation for metastasis were retrospectively reviewed. Results. Seven (29%) patients were unable to ambulate secondary to pain and instability prior to surgery. All patients were ambulating within 2 to 3 days after having surgery (P = 0.01). The mean visual analog scale value for the preoperative patients was 2.8, and the mean postoperative value was 1.0 (P = 0.001). Conclusion. Minimally invasive posterior spinal instrumentation significantly improved pain and ambulatory status in this series. PMID:22312498
Schwab, Joseph H.; Gasbarrini, Alessandro; Cappuccio, Michele; Boriani, Luca; De Iure, Federico; Colangeli, Simone; Boriani, Stefano
Background Menopause would seem to exist as a period of accelerated changes for women and their upper torso mechanics. Whether these anthropometric changes reflect changes in pain states remains unclear. Plausible mechanisms of pain exist for the independent and combined effect of increasing breast size and thoracic kyphosis. Bra fit has the potential to change when the anthropometric measures (chest circumference and bust circumference) used to determine bra size change, such as postmenopausally. Identifying an association between breast size, thoracic kyphosis and thoracic spine pain in postmenopausal women and identifying the relevance of bra fit to this association may be of importance to the future management and education of post-menopausal women presenting clinically with thoracic spine pain. Methods A cross-sectional study design. Fifty-one postmenopausal bra-wearing women were recruited. Measures included breast size (Triumph International), thoracic kyphosis (flexible curve), bra fitted (Y/N) and pain (Short Form McGill Pain Questionnaire) and tenderness on palpation (posteroanterior pressure testing). These measures were collected in one session at a physiotherapy clinic. Results The majority of the women in this study were overweight or obese and wearing an incorrect sized bra. Pain was significantly related to breast size, body weight and BMI at mid thoracic levels (T7-8). In contrast self-reported thoracic pain was not correlated with age or index of kyphosis (thoracic kyphosis). Women with thoracic pain were no more likely to have their bra professionally fitted whereas women with a higher BMI and larger breasts were more likely to have their bra professionally fitted. Conclusion The findings of this study show that larger breasts and increased BMI are associated with thoracic pain in postmenopausal women. This is unrelated to thoracic kyphosis. Increasing breast size and how a bra is worn may have biomechanical implications for the loaded thoracic spine and surrounding musculature. Post-menopause women present with a spectrum of anthropometrical changes that have the potential to contribute to altered biomechanics and affect pain states in the thoracic spine. PMID:23816160
There is a gap between in vitro and clinical studies concerning performance of spinal disc prosthesis. Retrieval studies may help to bridge this gap by providing more detailed information about motion characteristics, wear properties and osseous integration. Here, we report on the radiographic, mechanical, histological properties of a cervical spine segment treated with a cervical spine disc prosthesis (Prodisc C, Synthes Spine, Paoli, USA) for 3�months. A 48-year-old male received the device due to symptomatic degenerative disc disease within C5�C6. The patient recovered completely from his symptoms. Twelve weeks later, he died from a subarachnoid hemorrhage. During routine autopsy, C3�T1 was removed with all attached muscles and ligaments and subjected to plain X-rays and computed tomography, three dimensional flexibility tests, shear test as well as histological and electronic microscopic investigations. We detected radiolucencies mainly at the cranial interface between bone and implant. The flexibility of the segment under pure bending moments of �2.5�Nm applied in flexion/extension, axial rotation and lateral bending was preserved, with, however, reduced lateral bending and enlarged neutral zone compared to the adjacent segments C4�C5, and C6�C7. Stepwise increase of loading in flexion/extension up to �9.5�Nm did not result in segmental destruction. A postero-anterior force of 146�N was necessary to detach the lower half of the prosthesis from the vertebra. At the polyethylene (PE) core, signs of wear were observed compared to an unused core using electronic microscopy. Metal and PE debris without signs of severe inflammatory reaction was found within the surrounding soft tissue shell of the segment. A thin layer of soft connective tissue covered the major part of the implant endplate. Despite the limits of such a case report, the results show: that such implants are able to preserve at least a certain degree of segmental flexibility, that direct bone implant contact is probably rare, and that debris may be found after 12�weeks. PMID:17242873
Kettler, Annette; Drumm, Joerg; Nabhan, Abdullah; Steudel, Wolf Ingo; Claes, Lutz; Wilke, Hans Joachim
[The effect of the instability of cervical spine on the hemodynamics in the vertebrobasilar system].
256 patients with cephalgia were examined. The main cephalgia cause was a cervical instability. We showed importance of extended examinations for cephalgia pathogenesis. We estimated cerebral circulation by ultrasound (cerebral blood flow registration) methods. We found an intact blood flow in both vascular systems (arterial and venous) in 19.9% cases. Cervical instability more 3 mm vertebra dislocation was not always a cause of vertebral discirculation. Quite often a vertebra dislocation under 3 mm was a result of vertebra-basilar disordes. PMID:24730044
Grinenko, E A; Kul'chikov, A E; Musin, R S; Morozov, S G
Chronic neck pain and masticatory dysfunction
Chronic nonspecific neck pain is a common problem in rheumatology and may resist conventional treatment. Pathophysiological links exist between the cervical spine and masticatory system. Occlusal disorders may cause neck pain and may respond to dental treatment. The estimated prevalence of occlusal disorders is about 45%, with half the cases being due to functional factors. Minor repeated masticatory dysfunction (MD)
Jean-Fran�ois Catanzariti; Thierry Debuse; Bernard Duquesnoy
BACKGROUND AND PURPOSE: The incidence of blunt traumatic vertebral artery dissec- tion\\/thrombosis varies widely in published trauma series and is associated with spinal trauma. The purpose of this study was to determine the frequency of traumatic vertebral artery thrombosis (VAT) in cervically injured patients by using routine MR angiography (MRA) and MR imaging and identify associations with the severity of
Philip J. Torina; Adam E. Flanders; John A. Carrino; Anthony S. Burns; David P. Friedman; James S. Harrop; Alexander R. Vacarro
Background The risk associated with cervical manipulation is controversial. Research in this area is widely variable but as yet the risk is not easily quantifiable. This presents a problem when informing the patient of risks when seeking consent and information may be withheld due to the fear of patient withdrawal from care. As yet, there is a lack of research into the frequency of risk disclosure and consequent withdrawal from manipulative treatment as a result. This study seeks to investigate the reality of this and to obtain insight into the attitudes of chiropractors towards informed consent and disclosure. Methods Questionnaires were posted to 200 UK chiropractors randomly selected from the register of the General Chiropractic Council. Results A response rate of 46% (n = 92) was achieved. Thirty-three per cent (n = 30) respondents were female and the mean number of years in practice was 10. Eighty-eight per cent considered explanation of the risks associated with any recommended treatment important when obtaining informed consent. However, only 45% indicated they always discuss this with patients in need of cervical manipulation. When asked whether they believed discussing the possibility of a serious adverse reaction to cervical manipulation could increase patient anxiety to the extent there was a strong possibility the patient would refuse treatment, 46% said they believed this could happen. Nonetheless, 80% said they believed they had a moral/ethical obligation to disclose risk associated with cervical manipulation despite these concerns. The estimated number of withdrawals throughout respondents' time in practice was estimated at 1 patient withdrawal for every 2 years in practice. Conclusion The withdrawal rate from cervical manipulation as a direct consequence of the disclosure of associated serious risks appears unfounded. However, notwithstanding legal obligations, reluctance to disclose risk due to fear of increasing patient anxiety still remains, despite acknowledgement of moral and ethical responsibility. PMID:20977721
We report the case of a 43-year-old woman referred for evaluation of worsening gait. Her initial evaluation led to a diagnosis of a Charcot spine and 2 spinal stabilization surgeries. Because no clear cause for the Charcot spine could be determined from the patient's history or initial evaluation, an extensive diagnostic work-up was undertaken, which ultimately led to a diagnosis of congenital insensitivity to pain with anhydrosis (CIPA). This diagnosis was known and confirmed by the patient's parents but was unknown to the patient and her treating physicians. Unique to this case is not only the significant medical implications and the value of the re-diagnosis and confirmation of this rare condition, but also the rarer occurrence of a Charcot spine in a person with CIPA. PMID:18295639
Sliwa, James A; Rippe, David; Do, Van
Prevalence and Risk Factors of Recurrent Cervical Pain Syndrome in a Working Population
The prevalence and risk factors of recurrent cervical pain syndrome (CPS) was studied in 990 workers examined while undergoing their systematic annual visit of occupational medicine. A prevalence rate of 10.2% was obtained. Using a tree-structured logistic regression analysis, a strong association between age, sex, previous head trauma, extension of the neck and strenuous muscular activity during work, and the
Jean Fran�ois Dartigues; Patrick Henry; Emmanuel Puymirat; Daniel Commenges; Philippe Peytour; Mich�le Gagnon
Managing cervical lymphadenitis-a total pain in the neck!
Patients presenting with cervical lymphadenitis are a complex and common occurrence in a general pediatric practice. Although Staphylococcus aureus (often methicillin-resistant S. aureus [MRSA]) and Streptococcus pyogenes predominate as causative pathogens, the next most common pathogens, Bartonella, atypical mycobacterium, and mononucleosis, also must be considered early on. The best way to diagnose and manage these cases initially is to proceed methodically, with detailed history and physical examination, initial streptococcal mono rapid tests, serial office visits, and complete blood counts. In nonviral cases, an empiric oral antibiotic trial is usually prescribed as early as possible to cover for MRSA or Bartonella. Very tender or reddened lymph nodes larger than 5 cm that are unresponsive and worsening may likely require inpatient parenteral antibiotics and sometimes surgical removal. The practitioner must also realize that submandibular and supraclavicular node locations are highly suggestive of atypical mycombacterium and cancer, respectively. [Pediatr Ann. 2014;43(10):390-396.]. PMID:25290125
Block, Stan L
Acute Hydrocephalus as a Complication of Cervical Spine Fracture and Dislocation: A Case Report
Hydrocephalus is a well-known complication of head injury, but an uncommon complication of a spinal lesion. Here, we present a rare case of acute obstructive hydrocephalus secondary to a cervical fracture and dislocation. A 60-year-old female patient was transferred to the emergency department with quadriplegia and respiratory difficulty. Imaging studies showed a cervical fracture and dislocation at the C3-4 level. She required intubation and mechanical ventilation. Twenty-four hours after admission, her mental status had deteriorated and both pupils were dilated. Computed tomography of the brain showed acute hydrocephalus; therefore, extraventricular drainage (EVD) was performed. After the EVD, her mental status recovered and she became alert, but she remained quadriplegic and dependent on the ventilator. Two months after injury, she died because of respiratory failure caused by pneumonia. PMID:25110487
Chung, Yoon Young; Ju, Chang Il; Kim, Dong Min
Background: The selection, neurodiagnostic evaluation, and surgical management of patients with cervical ossification of the posterior longitudinal ligament (OPLL) remain controversial. Whether for prophylaxis or treatment, the decision to perform anterior vs. posterior vs. circumferential cervical OPLL surgery is complex. MR and CT Documentation of OPLL: Together, MR and CT cervical studies best document the full extent of OPLL. While MR provides the optimal soft-tissue overview (e.g. hyperintense signals reflecting edema/myelomalacia in the cord), CT's directly demonstrate the ossification of OPLL often �missed� by MR (e.g. documents the single or double layer signs of dural penetration. Patient Selection: Patients with mild myelopathy/cord compression rarely require surgery, while those with moderate/severe myelopathy/cord compression often warrant anterior, posterior, or circumferential approaches. Operative Approaches: Anterior corpectomies/fusions, warranted in patients with OPLL and kyphosis/loss of lordosis, also increase the risks of cerebrospinal fluid (CSF) leaks (e.g. single/double layer sign), and vascular injuries (e.g. carotid, vertebral). Alternatively, with an adequate lordosis, posterior procedures (e.g. often with fusions), may provide adequate multilevel decompression while minimizing risk of anterior surgery. Occasionally, combined pathologies may warrant circumferential approaches. Anesthetic and Intraoperative Monitoring Protocols: The utility of awake nasotracheal fiberoptic intubation/awake positioning, intraoperative somatosensory/motor evoked potential, and electromyographic monitoring, and the requirement for total intravenous anesthesia (TIVA) for OPLL surgery is also discussed. Conclusion: Anterior, posterior, or circumferential surgery may be warranted to treat patients with cervical OPLL, and must be based on careful patient selection, and both MR and CT documentation of the full extent of OPLL. PMID:24843818
Epstein, Nancy E.
Accurate measurement of the coupled intervertebral motions is helpful for understanding the etiology and diagnosis of relevant diseases, and for assessing the subsequent treatment. No study has reported the in vivo, dynamic and three-dimensional (3D) intervertebral motion of the cervical spine during active axial rotation (AR) and lateral bending (LB) in the sitting position. The current study fills the gap by measuring the coupled intervertebral motions of the subaxial cervical spine in ten asymptomatic young adults in an upright sitting position during active head LB and AR using a volumetric model-based 2D-to-3D registration method via biplane fluoroscopy. Subject-specific models of the individual vertebrae were derived from each subject's CT data and were registered to the fluoroscopic images for determining the 3D poses of the subaxial vertebrae that were used to obtain the intervertebral kinematics. The averaged ranges of motion to one side (ROM) during AR at C3/C4, C4/C5, C5/C6, and C6/C7 were 4.2�, 4.6�, 3.0� and 1.3�, respectively. The corresponding values were 6.4�, 5.2�, 6.1� and 6.1� during LB. Intervertebral LB (ILB) played an important role in both AR and LB tasks of the cervical spine, experiencing greater ROM than intervertebral AR (IAR) (ratio of coupled motion (IAR/ILB): 0.23-0.75 in LB, 0.34-0.95 in AR). Compared to the AR task, the ranges of ILB during the LB task were significantly greater at C5/6 (p=0.008) and C6/7 (p=0.001) but the range of IAR was significantly smaller at C4/5 (p=0.02), leading to significantly smaller ratios of coupled motions at C4/5 (p=0.0013), C5/6 (p<0.001) and C6/7 (p=0.0037). The observed coupling characteristics of the intervertebral kinematics were different from those in previous studies under discrete static conditions in a supine position without weight-bearing, suggesting that the testing conditions likely affect the kinematics of the subaxial cervical spine. While C1 and C2 were not included owing to technical limitations, the current results nonetheless provide baseline data of the intervertebral motion of the subaxial cervical spine in asymptomatic young subjects under physiological conditions, which may be helpful for further investigations into spine biomechanics. PMID:25218506
Lin, Cheng-Chung; Lu, Tung-Wu; Wang, Ting-Ming; Hsu, Chao-Yu; Hsu, Shih-Jung; Shih, Ting-Fang
Background In anterior cervical spine surgery a retractor is obligatory to approach the spine. Previous studies showed an increase of endotracheal tube cuff pressure after placement of a retractor. It is known that high endotracheal tube cuff pressure increases the incidence of postoperative dysphagia, hoarseness, and sore throat. However, until now no evidence supports the fact whether adjusting the endotracheal tube cuff pressure during anterior cervical spine surgery will prevent this comorbidity. We present the design of a randomized controlled trial to determine whether adjusting endotracheal tube cuff pressure after placement of a retractor during anterior cervical spine surgery will prevent postoperative dysphagia. Methods/design 177 patients (aged 18�90�years) scheduled for anterior cervical spine surgery on 1 or more levels will be included. After intubation, endotracheal tube cuff pressure is manually inflated to 20�mm Hg in all patients. Patients will be randomized into two groups. In the control group endotracheal tube cuff pressure is not adjusted after retractor placement. In the intervention group endotracheal tube cuff pressure after retractor placement is maintained at 20�mm Hg and air is withdrawn when cuff pressure exceeds 20�mm Hg. Endotracheal tube cuff pressure is measured after intubation, before and after placement and removal of the retractor. Again air is inflated if cuff pressure sets below 20�mmHg after removal of the retractor. The primary outcome measure is postoperative dysphagia. Other outcome measures are postoperative hoarseness, postoperative sore throat, degree of dysphagia, length of hospital stay, and pneumonia. The study is a single centre double blind randomized trial in which patients and research nurses will be kept blinded for the allocated treatment during the follow-up period of 2�months. Discussion Postoperative dysphagia occurs frequently after anterior cervical spine surgery. This may be related to high endotracheal tube cuff pressure. Whether adaptation and maintaining the pressure after placement of the retractor will decrease the incidence of dysphagia, has to be determined by this trial. Trial registration Netherlands Trial Register (NTR) 3542: http://www.trialregister.nl. PMID:24067111
A case of symptomatic cervical perineural (Tarlov) cyst: clinical manifestation and management
Perineural (Tarlov) cysts are most often found in the sacral region and are rare in the cervical spine. Although they are\\u000a usually asymptomatic, a small number of those at the lumbosacral level have been known to produce localized or radicular pain.\\u000a Few reports are available on symptomatic perineural cysts in the cervical spine and it has not been discussed how
Keewon Kim; Se Woong Chun; Sun G. Chung
Pain assessment during conscious sedation for cervical cancer high-dose-rate brachytherapy
Background This observational study set out to evaluate the effectiveness of conscious sedation anesthesia for pain control during high-dose-rate (hdr) brachytherapy using a ring-and-tandem applicator system for patients with cervical cancer. Methods At the time of initiation of the hdr cervical cancer brachytherapy program at our institution, patients received a detailed symptom assessment during the procedures. Brachytherapy was carried out using a Smit sleeve, together with a ring-and-tandem applicator. Midazolam and an opioid�hydromorphone, morphine, or fentanyl�were the main agents used to achieve conscious sedation. Results From January 2009 to October 2010, 20 patients (median age: 45 years) underwent 57 procedures. All patients received chemoradiation with curative intent. The median duration of the procedures was 1.4 hours, and no significant cardiovascular events were noted. The total dose of intravenous midazolam used ranged from 0.5 mg to 8.5 mg (median: 2.5 mg). The total dose of intravenous morphine equivalent used ranged from 2.5 mg to 60 mg (median: 8 mg). The mean and median pain scores during the procedures were 1.4 and 1.1 respectively. Brief moments of moderate to severe incidental pain were noted at the time of certain events during the procedure�specifically during insertion of the ring-and-tandem applicator. The maximal pain score during the entire procedure ranged from 0 to 10 (median: 4.7). The period of recovery from conscious sedation was relatively brief (median discharge time: 1 hour). Conclusions We were able to demonstrate that patients undergoing hdr brachytherapy for cervical cancer can achieve good pain control with conscious sedation. PMID:23904769
Bhanabhai, H.; Samant, R.; E, C.; Grenier, L.; Lowry, S.
[Purpose] The purpose of this study was to examine whether Nordic walking exercise can relieve low back pain and change the spine shape in elderly women. [Subjects] Sixteen elderly women with chronic low back pain from N University in Chungcheong-do, South Korea, were enrolled. [Methods] The participants were asked to walk in an upright posture, with the head upright and looking forward. The Nordic poles were held close to the body. When a foot was moved forward, the arm on the other side lifted the Nordic pole and moved it forward. The participants were using the Nordic pole when walked on the track with their arms lifted above their shoulders. The type of shoes worn during walking was not considered. [Results] One-way analysis of variance was used to determine the presence of significant differences between the measures of spine deformation and VAS. [Conclusion] Chronic low back pain, a complaint often received from elderly women, was reduced by pole-induced power walking reduction on the balance of the spine and back of this important exercise program is presented as a guideline.
Park, Hoo-Sung; Lee, Sung-No; Sung, Dong-Hun; Choi, Hwan-Seok; Kwon, Tae Dong; Park, Gi Duck
Objective To describe whether negative affect and sleep impairment are associated with the clinical effect of epidural steroid injections (ESIs) for low back pain. Design Observational study; patients were evaluated before ESI and 1 and 3 months after ESI. Setting Spine center and related treatment sites. Participants Participants (N=158) seeking treatment for low back pain with or without radiculopathy. Intervention ESI for low back pain with or without radiculopathy. Main Outcome Measures We assessed the dependent (global pain severity for back and leg pain, pain behavior, pain interference) and independent variables (depression, sleep disturbance, and covariates of back pain response) with the Patient-Reported Outcome Measurement Information System (PROMIS) and legacy measures. Outcome was assessed cross-sectionally using multiple regression and longitudinally with path analysis. Results After 1 month, sleep disturbance was the only predictor for the global ratings of improvement in back pain (R2=16.8%) and leg pain (R2=11.4%). The proportions of variance explained by sleep disturbance and negative affect for all dependent variables were greater at 3 months than 1 month. Mediation analysis was significant for negative affect for the 3-month outcomes on PROMIS pain behavior (?=.87, P<.01) and pain interference (?=.37, P<.01). There was no evidence of mediation by sleep disturbance for any outcome. Conclusions Negative affect and sleep disturbance are associated with worse outcomes after ESI. Further research is needed to determine if treatment of negative affect and sleep disturbance prior to or concurrently with ESI will improve outcomes. PMID:24060493
Karp, Jordan F.; Yu, Lan; Friedly, Janna; Amtmann, Dagmar; Pilkonis, Paul A.
Evaluation of cervical spine posture after functional therapy with FR-2: a longitudinal study.
The authors compared postural changes produced in 20 Caucasian female children treated with the Frankel Functional Regulator appliance (FR-2) (Frankel Industries, Morangis Cedex, France) using cephalometric tracings and comparing the tracings to 20 untreated Class II controls from the University of Chieti. Each patient in the study group was treated for exactly two years by the same operator using the FR-2 appliance and a standardized design and clinical technique, including prefunctional orthodontics where indicated. The average starting age was 8.4 yrs. (SD+/-2.1). At the end of the therapy, the average age was 10.3 yrs. (SD+/-2.4). Two teleradiographs were made of each patient: the first one at the beginning of treatment and the second one after six months. The radiographs were taken with the subjects standing in the ortho-position with no ear rods in the cephalostat; mirror position was carried out. In order to detect errors due to landmark identification, duplicate measurements were made using ten radiographs, and the error variance was calculated using Dahlberg's formula. Thirty-seven variables were studied. The cervical lordosis angle (CVT/EVT) was significantly higher in the study group as compared to the control group (p<0.05) at the end of treatment, probably due to a significant backward inclination of the upper segment of the cervical column (OPTNer and CVTNer) in the treated group (p<0.001 and p<0.01) from pre- to posttreatment. There was no significant change in the lower segment of the cervical column inclination (EVT/Ver). The changes resulted in a weak association in the multiple regression model to an increasing of maxillary base length and mandibular protrusion (R2=0.272; p<0.05). Other variables in the multiple regression were not significant. PMID:15727322
Tecco, Simona; Farronato, Giampietro; Salini, Vincenzo; Di Meo, Silvio; Filippi, Maria R; Festa, Felice; D'Attilio, Michele
Two spinal cord lesions in a patient with ankylosing spondylitis and cervical spine injury.
A patient with ankylosing spondylitis sustained C3-C4 vertebral subluxation and C4-C5 myelopathy after a hyperextension trauma. Autopsy showed that several segments below the main cervical cord lesion at the fractured site, there was a second spinal cord lesion at the T1 vertebral level with no corresponding local bony or ligamentous damage. The thoracic cord lesion was probably secondary to traction of the upper thoracic cord, where the blood supply is poor, in a narrow and rigid spinal canal at the moment of extreme hyperextension. PMID:6681663
Foo, D; Bignami, A; Rossier, A B
We investigated the incidence of anomalies in the vertebral arteries and Circle of Willis with three-dimensional CT angiography in 55 consecutive patients who had undergone an instrumented posterior fusion of the cervical spine. We recorded any peri-operative and post-operative complications. The frequency of congenital anomalies was 30.9%, abnormal vertebral artery blood flow was 58.2% and vertebral artery dominance 40%. The posterior communicating artery was occluded on one side in 41.8% of patients and bilaterally in 38.2%. Variations in the vertebral arteries and Circle of Willis were not significantly related to the presence or absence of posterior communicating arteries. Importantly, 18.2% of patients showed characteristic variations in the Circle of Willis with unilateral vertebral artery stenosis or a dominant vertebral artery, indicating that injury may cause lethal complications. One patient had post-operative cerebellar symptoms due to intra-operative injury of the vertebral artery, and one underwent a different surgical procedure because of insufficient collateral circulation. Pre-operative assessment of the vertebral arteries and Circle of Willis is essential if a posterior spinal fusion with instrumentation is to be carried out safely. PMID:24692624
Nagahama, K; Sudo, H; Abumi, K; Ito, M; Takahata, M; Hiratsuka, S; Kuroki, K; Iwasaki, N
Background While chronic neck pain is a common problem in the adult population, with a typical 12-month prevalence of 30%�50%, there is a lack of consensus regarding its causes and treatment. Despite limited evidence, cervical epidural injections are one of the commonly performed nonsurgical interventions in the management of chronic neck pain. Methods A randomized, double-blind, active, controlled trial was conducted to evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of chronic neck pain with or without upper extremity pain in patients without disc herniation, radiculitis, or facet joint pain. Results One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint pain by means of controlled diagnostic medial branch blocks were randomly assigned to one of two treatment groups, ie, injection of local anesthetic only (group 1) or local anesthetic mixed with nonparticulate betamethasone (group 2). The primary outcome of significant pain relief and improvement in functional status (?50%) was demonstrated in 72% of group 1 and 68% of group 2. The overall average number of procedures per year was 3.6 in both groups with an average total relief per year of 37�39 weeks in the successful group over a period of 52 weeks. Conclusion Cervical interlaminar epidural injections of local anesthetic with or without steroids may be effective in patients with chronic function-limiting discogenic or axial pain. PMID:22826642
Manchikanti, Laxmaiah; Cash, Kimberly A; Pampati, Vidyasagar; Malla, Yogesh
Cervical Spondylotic Myelopathy presenting as mechanical neck pain: a case report.
Cervical Spondylotic Myelopathy (CSM) is the most common type of myelopathy in adults over 55 years of age. In the early stages symptoms may include local neck pain and stiffness that might mimic the presentation of non-specific mechanical neck pain (NSMNP). The patient was a 79 year old male, who complained of eight weeks of neck pain. He had been referred for physiotherapy by his family physician with a diagnosis of NSMNP. Initial presentation was consistent with the referral, but further assessment by the physiotherapist revealed findings suggestive of CSM. He was referred for an urgent cervical MRI scan, which revealed myelomalacic changes at C3/4 due to spondylotic changes. The patient was unsuitable for manual therapy intervention and was referred to a spinal orthopaedic surgeon who performed a posterior decompression and stabilisation at C3-C5, 2 months after the initial presentation. This case report highlights the importance of considering CSM in adults over 55 years of age presenting with NSMNP, particularly as the prevalence of both increases with age. It demonstrates the need for health professionals to carry out detailed examination where CSM may be a potential differential diagnosis. Outcomes are less favourable for patients over the age of 70, therefore an urgent surgical opinion was required for this patient. Deterioration of symptoms whilst he awaited surgery demonstrates how missed diagnosis may lead to possible long term spinal cord damage, with potential medico-legal concerns for the therapist. PMID:24815593
Smith, Benjamin E; Diver, Claire J; Taylor, Alan J
Cervical spondylotic myelopathy (CSM) is the commonest cause of spinal cord impairment worldwide and despite surgical treatment, it is commonly associated with chronic neuropathic pain and neurological impairment. Based on data suggesting a key role of sodium and glutamate mediated cellular injury in models of spinal cord compression, we examined whether riluzole, a sodium channel/glutamate blocker, could improve neurobehavioral outcomes in a rat model of CSM. To produce chronic progressive compression of the cervical spinal cord, we used an established model of graded mechanical cord compromise developed in our laboratory. The chronic (8weeks) mechanical compression of the cervical spinal cord resulted in persistent mechanical allodynia and thermal hyperalgesia at 8weeks. Moreover, we found increased expression of phosphorylated NR1 and NR2B in the dorsal horns as well as astrogliosis and increased microglia expression in the dorsal horns after mechanical compression. Following daily systemic administration for 7weeks after the induction of compression, riluzole (8mg/kg) significantly attenuated forelimb and hindlimb mechanical allodynia and alleviated thermal hyperalgesia in the tail. Importantly, riluzole led to a decrease in swing phase duration, an increase in hind leg swing speed and an increase paw intensity in gait analysis. Riluzole also decreased the number of phosphorylated NR1 and phosphorylated NR2B positive cells in the dorsal horns and the microglia activation in the dorsal horns. Together, our results indicate that systemic riluzole administration during chronic cervical spinal cord compression is effective at protecting spinal cord tissue, preserving neurobehavioral function and alleviating neuropathic pain, possibly by decreasing NMDA receptor phosphorylation in astrocytes and by eliminating microglia activation. As such, riluzole represents a promising clinical treatment for CSM. PMID:24184328
Moon, Eun Su; Karadimas, Spyridon K; Yu, Wen-Ru; Austin, James W; Fehlings, Michael G
DepoDur, an extended-release epidural morphine, has been used effectively for postoperative pain control following many orthopaedic and general surgery procedures and has provided prolonged analgesia when compared with Duramorph. The goal of this article was to compare the safety and analgesic efficacy of DepoDur versus Duramorph after lumbar spine surgery. A prospective, randomized, double-blind clinical study was completed at a single extended-stay ambulatory surgery center. All patients over 18 undergoing posterior lumbar spine fusions were considered for the study. Sixty patients were randomly assigned to a control or treatment group. The control group received DepoDur before surgery, while the treatment group received Duramorph. Although results show no significant differences between the two groups in postoperative visual analog pain scale scores, use of pain medication, and adverse events, subjects receiving DepoDur were less likely to receive Naloxone and oxygen supplementation, experience nausea or fever, and were more likely to experience hypotension. DepoDur proved to be safe and effective, offering similar prolonged analgesic activity when compared with Duramorph. PMID:24641892
Vineyard, Joseph C; Toohey, John S; Neidre, Arvo; Fogel, Guy; Joyner, Robert
Background: Grafting choices available for performing anterior cervical diskectomy/fusion (ACDF) procedures have become a major concern for spinal surgeons, and their institutions. The �gold standard�, iliac crest autograft, may still be the best and least expensive grafting option; it deserves to be reassessed along with the pros, cons, and costs for alternative grafts/spacers. Methods: Although single or multilevel ACDF have utilized iliac crest autograft for decades, the implant industry now offers multiple alternative grafting and spacer devices; (allografts, cages, polyether-etherketone (PEEK) amongst others). While most studies have focused on fusion rates and clinical outcomes following ACDF, few have analyzed the �value-added� of these various constructs (e.g. safety/efficacy, risks/complications, costs). Results: The majority of studies document 95%-100% fusion rates when iliac crest autograft is utilized to perform single level ACDF (X-ray or CT confirmed at 6-12 postoperative months). Although many allograft studies similarly quote 90%-100% fusion rates (X-ray alone confirmed at 6-12 postoperative months), a recent �post hoc analysis of data from a prospective multicenter trial� (Riew KD et. al., CSRS Abstract Dec. 2011; unpublished) revealed a much higher delayed fusion rate using allografts at one year 55.7%, 2 years 87%, and four years 92%. Conclusion: Iliac crest autograft utilized for single or multilevel ACDF is associated with the highest fusion, lowest complication rates, and significantly lower costs compared with allograft, cages, PEEK, or other grafts. As spinal surgeons and institutions become more cost conscious, we will have to account for the �value added� of these increasingly expensive graft constructs. PMID:22905321
Epstein, Nancy E.
[Purpose] This study investigated the effect of the spacing of backpack shoulder straps on cervical muscle activity, acromion and scapular position, and upper trapezius (UT) pain. [Subjects] Fourteen males aged 20-32?years, were recruited. [Methods] We measured the MPS (midcervical paraspinal) activity, acromial angle, scapular distance, and UT pain after gait carrying a backpack with different shoulder strap spacings. [Results] The MPS, scapular inferior distance, and UT pressure pain threshold was significantly decreased and the acromion angle was significantly increased when carrying a backpack with wide shoulder straps compared to narrow shoulder straps. [Conclusion] A backpack with wide shoulder straps may cause scapular depression syndrome and chronic UT pain. PMID:24259829
Kim, Min-Hee; Yoo, Won-Gyu
Background: There is sparse literature that provides evidence of cervical and shoulder postural alignment of 15 to 17-year-old adolescents and that analyzes sex differences. Objectives: To characterize the postural alignment of the head and shoulder in the sagittal plane of 15 to 17-year-old Portuguese adolescents in natural erect standing and explore the relationships between three postural angles and presence of neck and shoulder pain. Method: This cross-sectional study was conducted in two secondary schools in Portugal. 275 adolescent students (153 females and 122 males) aged 15 to 17 were evaluated. Sagittal head, cervical, and shoulder angles were measured with photogrammetry and PAS software. The American Shoulder and Elbow Surgeons Shoulder Assessment (ASES) was used to assess shoulder pain, whereas neck pain was self-reported with a single question. Results: Mean values of sagittal head, cervical, and shoulder angles were 17.2�5.7, 47.4�5.2, and 51.4�8.5�, respectively. 68% of the participants revealed protraction of the head, whereas 58% of them had protraction of the shoulder. The boys showed a significantly higher mean cervical angle, and adolescents with neck pain revealed lower mean cervical angle than adolescents without neck pain. 53% of the girls self-reported regular neck pain, contrasting with 19% of the boys. Conclusions: This data shows that forward head and protracted shoulder are common postural disorders in adolescents, especially in girls. Neck pain is prevalent in adolescents, especially girls, and it is associated with forward head posture. PMID:25054381
Ruivo, Rodrigo M.; Pezarat-Correia, Pedro; Carita, Ana I.
Objective The purpose of this pilot study was to collect preliminary information for a study to determine the immediate effects of a single unilateral chiropractic manipulation to the lower cervical spine on handgrip strength and free-throw accuracy in asymptomatic male recreational basketball players. Methods For this study, 24 asymptomatic male recreational right-handed basketball players (age = 26.3 � 9.2 years, height = 1.81 � 0.07 m, body mass = 82.6 � 10.4 kg [mean � SD]) underwent baseline dominant handgrip isometric strength and free-throw accuracy testing in an indoor basketball court. They were then equally randomized to receive either (1) diversified left lower cervical spine chiropractic manipulative therapy (CMT) at C5/C6 or (2) placebo CMT at C5/C6 using an Activator adjusting instrument on zero force setting. Participants then underwent posttesting of isometric handgrip strength and free-throw accuracy. A paired-samples t test was used to make within-group pre to post comparisons and between-group pre to post comparisons. Results No statistically significant difference was shown between either of the 2 basketball performance variables measured in either group. Isometric handgrip strength marginally improved by 0.7 kg (mean) in the CMT group (P = .710). Free-throw accuracy increased by 13.2% in the CMT group (P = .058). The placebo CMT group performed the same or more poorly during their second test session. Conclusions The results of this preliminary study showed that a single lower cervical spine manipulation did not significantly impact basketball performance for this group of healthy asymptomatic participants. A slight increase in free-throw percentage was seen, which deserves further investigation. This pilot study demonstrates that a larger study to evaluate if CMT affects handgrip strength and free-throw accuracy is feasible. PMID:24396315
Humphries, Kelley M.; Ward, John; Coats, Jesse; Nobert, Jeannique; Amonette, William; Dyess, Stephen
NASA Astrophysics Data System (ADS)
MRI velocimetry (also known as phase-contrast MRI) is a powerful tool for quantification of cerebrospinal fluid (CSF) flow in various regions of the brain and craniospinal junction and has been accepted as a diagnostic tool to assist with the diagnosis of certain conditions such as hydrocephalus and chiari malformations. Cerebrospinal fluid is continually produced in the ventricles of the brain, flows through the ventricular system and then out and around the brain and spinal cord and is reabsorbed over the convexity of the brain. Any disease process which either impedes the normal pattern of flow or restricts the area where flow occurs can change the pattern of these waveforms with the direction and velocity of flow being determined by the pressure transmitted from the pulsation of the heart and circulation of blood within the central nervous system. Therefore, we hypothesized that phase-contrast MRI could eventually be used as a diagnostic aid in determining the degree of spinal cord compression following injury to the cervical or thoracic spine. In this study, we examined CSF flow in 3 normal subjects and 2 subjects with non-acute injuries in the cervical spine using Cine phasecontrast MRI. CSF flow analysis was performed using an in-house developed software. The flow waveform was calculated in both normal subjects (n=3) as well as subjects with spinal cord injury in the cervical spine (n=2). The bulk flow at C2 was measured to be 0.30 +/- 0.05 cc, at 5 cm distal to C2, it was 0.19+/- 0.07 cc, and at 10 cm distal to C2, it was 0.17+/- 0.05 cc. These results were in good agreement with previously published results. In patients with spinal cord injury, at the site of injury in the cervical spine, bulk flow was found to be 0.08 +/- 0.12 cc, at 5 cm proximal to the site of injury it was found to be 0.18 +/- 0.07 cc, and at 5 cm distal to the site of injury, it was found to be 0.12 +/- 0.01 cc.
Negahdar, MJ; Shakeri, M.; McDowell, E.; Wells, J.; Vitaz, T.; Harkema, S.; Amini, A.
Chronic At- and Below-Level Pain after Moderate Unilateral Cervical Spinal Cord Contusion in Rats
Abstract Chronic neuropathic pain is a significant consequence of spinal cord injury (SCI) that is associated with evoked pain, including allodynia and/or hyperalgesia. Allodynia is defined as a painful response to normally innocuous stimuli, and hyperalgesia occurs when there is an amplified pain response to normally noxious stimuli. We describe a model of a unilateral cervical level (C5) contusion injury where sensory recovery was assessed weekly for 6 weeks in 32 adult, female, Sprague-Dawley rats. Bilateral thermal hyperalgesia and tactile allodynia are detectable in the fore- and hindpaws as early as 7 days post-injury (dpi) and persist for at least 42 days. Paw withdrawal latency in response to a noxious thermal stimulus significantly intra-animal pre-operative values. Change in paw withdrawal latency plateaued at 21?dpi. Interestingly, bilateral forepaw allodynia develops in fewer than 40% of rats as measured by von Frey monofilament testing. Similar results occur in the hindpaws, where bilateral allodynia occurs in 46% of rats with SCI. The contralesional forepaw and both hindpaws of rats showed a slight increase in paw withdrawal threshold to tactile stimuli acutely after SCI, corresponding to ipsilesional forelimb motor deficits that resolve over time. That there is no difference among allodynic and non-allodynic groups in overall spared tissue or specifically of the dorsal column or ventrolateral white matter where ascending sensory tracts reside suggests that SCI-induced pain does not depend solely on the size or extent of the lesion, but that other mechanisms are in play. These observations provide a valid model system for future testing of therapeutic interventions to prevent the onset or to reduce the debilitating effects of chronic neuropathic pain after SCI. PMID:23216008
Wade, Rodel E.; Houle, John D.
Reliability of a measure of total lumbar spine range of motion in individuals with low back pain.
Measuring lumbar spine range of motion (ROM) using multiple movements is impractical for clinical research, because finding statistically significant effects requires a large proportion of subjects to present with the same impairment. The purpose of this study was to develop a single measure representing the total available lumbar ROM. Twenty participants with low back pain performed three series of eight lumbar spine movements, in each of two sessions. For each series, an ellipse and a cubic spline were fit to the end-range positions, measured based on the position of the twelfth thoracic vertebra in the transverse plane of the sacrum. The area of each shape provides a measure of the total available ROM, whereas their center reflects the movements' symmetry. Using generalizability theory, the index of dependability for the area and anterior-posterior center position was found to be 0.90, but was slightly lower for the mediolateral center position. Slightly better values were achieved using the spline-fitting approach. Further analysis also indicated that excellent reliability, and acceptable minimal detectable change values, would be achieved with a single testing session. These data indicate that the proposed measure provides a reliable and easily interpretable measure of total lumbar spine ROM. PMID:23270840
Al Zoubi, Fadi M; Preuss, Richard A
Cervical radiculopathy is typically characterized by neurologic symptoms that are traced to disturbances of discrete spinal nerve root(s) due to inflammatory or mechanical etiologies. Here we present three patients diagnosed with cervical radiculopathy, whose directional preference only surfaced after either a cervical transforaminal or intralaminar nerve root epidural steroid injection. This retrospective observational case series describes three men who presented with cervical radiculopathy with 7-9/10 neck pain, neck disability index (NDI) ranging between 44% and 90%, and an irreducible derangement upon McKenzie mechanical diagnosis and therapy (MMDT) evaluation. These patients demonstrated weaknesses, sensory changes, and/or decreased reflexes in the C5, C6, or C7 distributions. They each underwent a cervical transforaminal or intralaminar epidural injections at one or two levels, which uncovered their directional preference and facilitated further conservative treatment. These three patients experienced drastic improvements with each postinjection physical therapy session. They demonstrated decreased pain scores, centralization of pain, and a decreasing NDI trends throughout their treatments. They were all discharged with stable 0-3/10 pain severity after four physical therapy sessions and NDI scores of 0%. These cases suggest an interplay between inflammatory and mechanical contributors to spine-mediated pain and the treatment challenge this presents. Dissecting the components of spine pain can be challenging; however, delivery of skilled multidisciplinary care in an algorithmic fashion may be beneficial and provide the future framework for the management of cervical radiculopathy and other spine-related conditions. PMID:23113937
Desai, Mehul J; Padmanabhan, Girish; Simbasivan, Ajai; Kamanga-Sollo, Gladys G; Dharmappa, Ajay
Background Pain from cervical spondylosis (CS) may result from degenerative spinal canal stenosis (cervical spondylotic myelopathy (CSM)) or lateral recesses compromise, leading to nerve root compression (cervical spondylotic radiculopathy (CSR)). Pregabalin was shown to be effective in randomized, placebo-controlled trials for post-herpetic neuralgia and diabetic neuropathy. We evaluate its efficacy in CS with underlying CSR or CSM in a prospective study comprising Asian patients for the first time. Methods Patients with CS and CSR or CSM (clinical, MRI, or electrophysiological evidence) presenting with neuropathic pain were recruited. We excluded patients with diabetes, underlying neurological disease or who were previously on antiepileptics. Pregabalin 75 mg bd was administered for 4 weeks, after which dosage was increased to 150 mg bd for another 4 weeks if the visual analog scale (VAS) was not reduced by 50%. In addition, we monitored the short form McGill pain questionnaire (SFMPQ) at baseline, 4 weeks and 8 weeks. Mood changes were monitored using the hospital anxiety and depression score (HADS) with an identical timeline. Results We recruited 50 patients, of which 23 completed the trial. Of the 27 who withdrew, 12 (44%) were for somnolence. Thirteen patients� (54%) dosages remained at 75 mg and 11 patients� (46%) dosages were escalated to 150 mg bd. There were significantly reducing trends from baseline for VAS (ANOVA, F(1, 21) = 25.4, P < 0.0005), SFMPQ (sensory) (F(1, 22) = 11.2, P = 0.003), and SFMPQ (affective) (F(1, 21) = 10.9, P = 0.008). For VAS, there was significant reduction at 4 weeks (P = 0.001) and 8 weeks (P < 0.0005) compared to baseline. For SFMPQ (sensory), there was significant reduction at 4 weeks (P = 0.01) and 8 weeks (P = 0.006) in scores compared to baselines. For SFMPQ (affective), there was significant reduction at 4 weeks (P = 0.04) and 8 weeks (P = 0.008) in scores compared to baseline. No significant anxiety (F(1, 4) = 1.3, P = 0.32) or depression (F(1, 4) = 0.06, P = 0.82) changes were observed in the HADS. Conclusion Pregabalin is efficacious in alleviation of pain symptoms related to CSR as a first-line single agent, evaluated by quantitative severity and other experiential scales. No significant mood changes reported in other studies were demonstrated. Somnolence was commonest adverse effect leading to high dropout rates, occurring early even at the lowest dose. The findings suggest the need for further studies of efficacy at lower dosages, particularly in the Asian population. PMID:24400034
Lo, Yew Long; Cheong, Priscilia Woon Ting; George, Jane Mary; Tan, Seang Beng; Yue, Wai Mun; Guo, Chang Ming; Fook-Chong, Stephanie
Although a variety of biomechanical laboratory investigations and radiological studies have highlighted the potential problems associated with total lumbar disc replacement (TDR), no previous study has performed a systematic clinical failure analysis. The aim of this study was to identify the post-operative pain sources, establish the incidence of post-operative pain patterns and investigate the effect on post-operative outcome with the help of fluoroscopically guided spine infiltrations in patients from an ongoing prospective study with ProDisc II. Patients who reported unsatisfactory results at any of the FU-examinations received fluoroscopically guided spine infiltrations as part of a semi-invasive diagnostic and conservative treatment program. Pain sources were identified in patients with reproducible (?2�) significant (50�75%) or highly significant (75�100%) pain relief. Results were correlated with outcome parameters visual analogue scale (VAS), Oswestry disability index (ODI) and the subjective patient satisfaction rate. From a total of 175 operated patients with a mean follow-up (FU) of 29.3�months (range 12.2�74.9�months), n�=�342 infiltrations were performed in n�=�58 patients (33.1%) overall. Facet joint pain, predominantly at the index level (86.4%), was identified in n�=�22 patients (12.6%). The sacroiliac joint was a similarly frequent cause of post-operative pain (n�=�21, 12.0%). Pain from both structures influenced all outcome parameters negatively (P�<�0.05). Patients with an early onset of pain (?6�months) were 2�5� higher at risk of developing persisting complaints and unsatisfactory outcome at later FU-stages in comparison to the entire study cohort (P�<�0.05). The level of TDR significantly influenced post-operative outcome. Best results were achieved for the TDRs above the lumbosacral junction at L4/5 (incidence of posterior joint pain 14.8%). Inferior outcome and a significantly higher incidence of posterior joint pain were observed for TDR at L5/S1 (21.6%) and bisegmental TDR at L4/5/S1 (33.3%), respectively. Lumbar facet and/or ISJ-pain are a frequent and currently underestimated source of post-operative pain and the most common reasons for unsatisfactory results following TDR. Further failure-analysis studies are required and adequate salvage treatment options need to be established with respect to the underlying pathology of post-operative pain. The question as to whether or not TDR will reduce the incidence of posterior joint pain, which has been previously attributed to lumbar fusion procedures, remains unanswered. Additional studies will have to investigate whether TDR compromises the index-segment in an attempt to avoid adjacent segment degeneration. PMID:17972116
Korge, Andreas; Grochulla, Frank; Mehren, Christoph
Although a variety of biomechanical laboratory investigations and radiological studies have highlighted the potential problems associated with total lumbar disc replacement (TDR), no previous study has performed a systematic clinical failure analysis. The aim of this study was to identify the post-operative pain sources, establish the incidence of post-operative pain patterns and investigate the effect on post-operative outcome with the help of fluoroscopically guided spine infiltrations in patients from an ongoing prospective study with ProDisc II. Patients who reported unsatisfactory results at any of the FU-examinations received fluoroscopically guided spine infiltrations as part of a semi-invasive diagnostic and conservative treatment program. Pain sources were identified in patients with reproducible (> or =2x) significant (50-75%) or highly significant (75-100%) pain relief. Results were correlated with outcome parameters visual analogue scale (VAS), Oswestry disability index (ODI) and the subjective patient satisfaction rate. From a total of 175 operated patients with a mean follow-up (FU) of 29.3 months (range 12.2-74.9 months), n = 342 infiltrations were performed in n = 58 patients (33.1%) overall. Facet joint pain, predominantly at the index level (86.4%), was identified in n = 22 patients (12.6%). The sacroiliac joint was a similarly frequent cause of post-operative pain (n = 21, 12.0%). Pain from both structures influenced all outcome parameters negatively (P < 0.05). Patients with an early onset of pain (< or =6 months) were 2-5x higher at risk of developing persisting complaints and unsatisfactory outcome at later FU-stages in comparison to the entire study cohort (P < 0.05). The level of TDR significantly influenced post-operative outcome. Best results were achieved for the TDRs above the lumbosacral junction at L4/5 (incidence of posterior joint pain 14.8%). Inferior outcome and a significantly higher incidence of posterior joint pain were observed for TDR at L5/S1 (21.6%) and bisegmental TDR at L4/5/S1 (33.3%), respectively. Lumbar facet and/or ISJ-pain are a frequent and currently underestimated source of post-operative pain and the most common reasons for unsatisfactory results following TDR. Further failure-analysis studies are required and adequate salvage treatment options need to be established with respect to the underlying pathology of post-operative pain. The question as to whether or not TDR will reduce the incidence of posterior joint pain, which has been previously attributed to lumbar fusion procedures, remains unanswered. Additional studies will have to investigate whether TDR compromises the index-segment in an attempt to avoid adjacent segment degeneration. PMID:17972116
Siepe, Christoph J; Korge, Andreas; Grochulla, Frank; Mehren, Christoph; Mayer, H Michael
Paroxysmal neuralgic upper cervical pain attacks: the lower syndrome of cluster headache.
We present a group of seven patients with a lower syndrome (LS) of cluster headache (CH). Seventy-three newly diagnosed patients with CH were subjected to a 9 years follow-up study; 66 patients were classified as upper syndrome (US) and only seven patients (9.5%) as LS. We focus on the characteristics of this group of seven patients with LS and compare them with existing literature. The seven cases with LS illustrate the wider spectrum of clinical manifestations that can occur in CH, namely infraortibal symptoms or these outside the territory of the trigeminal branches such as the upper cervical region or the craniocervical margin. The duration of the attacks can last more than 180 min. The attacks show a circadian/circannual regularity and a stereotypic pattern of symptoms in most of the patients. The severity and duration of the attacks may increase over the years. The neck pain can overshadow all the other symptoms of CH. Because of the regularity of the attacks at particular times of day or night in some patients, even abortive therapy can be used as prevention when taken some hours before the suspected attack. We hypothesize that some patients with LS may represent an anatomical-functional variant of a primary chronic neurovascular pain disorder originating from the central nervous system, with possible involvement of the hypothalamus and the trigeminovascular (TV) system, with inputs from the cervical roots C(0)-C(2). Clinicians should consider CH when pain attacks are located outside the orbitotemporal regions, but fulfil the other diagnostic criteria for CH and should try ergotamine, oxygen, sumatriptan, verapamil, steroids or even combinations in these patients. PMID:16621239
Verslegers, W R G; Pickut, B A; De Deyn, P P
Compressive, invasive referred pain to the shoulder.
The painful shoulder can be the presenting complaint of a wide variety of local, as well as systemic, problems. Compression of the brachial plexus or occlusion of the subclavian vessels caused by narrowing of the thoracic outlet is best diagnosed by a thorough history and physical examination, and by performing the appropriate test maneuvers. Patients who do not respond to an exercise program to strengthen the shoulder girdle may require surgical excision of the first rib to enlarge the thoracic outlet. Referred pain in the shoulder originating from the cervical spine or peripheral nerves can be determined by cervical spine roentgenograms and nerve conduction tests. Neoplasms and parenchymal disease of the lung, and infections of the pleural and subdiaphragmatic areas can refer pain to the shoulder through the phrenic nerve. For those patients with persistent shoulder pain and no discernible musculoskeletal abnormalities who do not respond to standard therapeutic measures, another source of the shoulder pain should be sought. PMID:6825346
Brown, C
Background It has been found that significantly different clinical outcomes occur in trauma patients with different mechanisms of injury. Ground level falls (GLF) are usually considered �minor trauma� with less injury occurred in general. However, it is not uncommon that geriatric trauma patients sustain cervical spine (C-spine) fractures with other associated injuries due to GLF or less. The aim of this study is to determine the injury patterns and the roles of clinical risk factors in these geriatric trauma patients. Methods Data were reviewed from the institutional trauma registry of our local level 1 trauma center. All patients had sustained C-spine fracture(s). Basic clinical characteristics, the distribution of C-spine fracture(s), and mechanism of injury in geriatric patients (65 years or older) were compared with those less than 65 years old. Furthermore, different clinical variables including age, gender, Glasgow coma scale (GCS), blood alcohol level, and co-existing injuries were analyzed by multivariate logistic regression in geriatric trauma patients due to GLF and internally validated by random bootstrapping technique. Results From 2006 - 2010, a total of 12,805 trauma patients were included in trauma registry, of which 726 (5.67%) had sustained C-spine fracture(s). Among all C-spine fracture patients, 19.15% (139/726) were geriatric patients. Of these geriatric patients 27.34% (38/139) and 53.96% (75/139) had C1 and C2 fractures compared with 13.63% (80/587) and 21.98% (129/587) in young trauma patients (P < 0.001). Of geriatric trauma patients 13.67% (19/139) and 18.71% (26/139) had C6 and C7 fractures compared with 32.03% (188/587) and 41.40% (243/587) in younger ones separately (P < 0.001). Furthermore, 53.96% (75/139) geriatric patients had sustained C-spine fractures due to GLF with more upper C-spine fractures (C1 and C2). Only 3.2% of those had positive blood alcohol levels compared with 52.9% of younger patients (P < 0.001). In addition, 6.34% of geriatric patients due to GLF had intracranial pathology (ICP) which was one of the most common co-injuries with C-spine fractures. Logistic regression analysis showed the adjusted odds ratios of 1.17 (age) and 91.57 (male) in geriatric GLF patients to predict this co-injury pattern of C-spine fracture and ICP. Conclusion Geriatric patients tend to sustain more upper C-spine fractures than non-geriatric patients regardless of the mechanisms. GLF or less not only can cause isolated C-spines fracture(s) but also lead to other significant injuries with ICP as the most common one in geriatric patients. Advanced age and male are two risk factors that can predict this co-injury pattern. In addition, it seems that alcohol plays no role in the cause of GLF in geriatric trauma patients. PMID:23519239
Wang, Hao; Coppola, Marco; Robinson, Richard D.; Scribner, James T.; Vithalani, Veer; de Moor, Carrie E.; Gandhi, Raj R.; Burton, Mandy; Delaney, Kathleen A.
Background Neck pain caused by cervical spondylosis has become a common health problem worldwide among >40-year-old adults. Acupuncture intervention is one of the most popular treatment measures for this disorder. However, evidence for its efficacy in relieving neck pain and recovering neck physiological function has not been established in randomized, placebo-controlled trials. The primary aim of this trial is to assess the efficacy and safety of active acupuncture compared with sham acupuncture intervention for neck pain caused by cervical spondylosis. Methods/Design We will conduct a randomized, double-blind, parallel-group, placebo-controlled trial comparing active acupuncture with placebo (sham acupuncture). A total of 456 patients with neck pain caused by cervical spondylosis who meet the eligibility criteria from outpatient clinics of the Second People�s Hospital of Fujian Province and the Affiliated Rehabilitation Hospital, Fujian University of Traditional Chinese Medicine will be recruited and randomized into an active acupuncture or sham acupuncture group. The participants will undergo treatment sessions with either active or sham acupuncture intervention five times a week for 2 weeks. Evaluation by blinded assessors at baseline and at intervention for 1 and 2 weeks will include demographic characteristics, validated questionnaires (Northwick Park Neck Pain Questionnaire (NPQ) scale, Short-Form 36 (SF-36) scale, and McGill pain scale), examination of neck physiological function, and adverse events. All included patients will be followed up and investigated for relapse of neck pain at 4, 8, and 12 weeks after intervention. Discussion This paper describes the rationale and design of a randomized double-blind, placebo-controlled trial that aims to determine the efficacy and safety of acupuncture intervention for neck pain caused by cervical spondylosis. The primary outcomes are changes in the NPQ score and neck physiological function. Secondary outcome measures include quality of life, adverse events, and relapse of neck pain. If successful, this project will provide evidence of the efficacy and safety of acupuncture for neck pain caused by cervical spondylosis. Trial registration Chinese Clinical Trial Registry: ChiCTR-TRC-12002206. Registration date: 11 May 2012. PMID:23800342
A detailed three-dimensional solid model of the full cervical spine (C1-C7 levels) and the finite element analysis method were used to investigate the extent of changes in various biomechanical properties brought about when surgical methods are used to treat condition(s) caused by or are a sequela of disc degeneration disease at the C5-C6 level. The surgical methods simulated were anterior cervical discectomy and fusion, with interbody fusion achieved using a notional brick-shaped graft only; anterior cervical discectomy alone; percutaneous nucleotomy; and three variants of nucleus replacement. The control case was a model of an intact, healthy, adult spine. Each of these seven models was subjected to (1) flexion moment, extension moment, left lateral bending moment, right lateral bending moment, clockwise-acting axial rotation moment, and counterclockwise-acting axial rotation moment, with a compression pre-load applied simultaneously with each of these loadings and (2) an axial compression force (applied as a uniform pressure) only. For each combination of model and applied loading, the maximum von Mises stress and the maximum strain energy density were determined for tissues at the treated level, at one level above the treated level, and at one level below the treated level and (2) the total principal rotation angles at each of the intersegmental positions of the entire model. In addition, for each of the study cases, we obtained the longitudinal displacement of each of the models when subjected to the axial compression force only. We found markedly fewer changes (relative to the results when the intact, healthy spine model was used) in each of the above-mentioned biomechanical parameters above a specified threshold in the case of the simulated percutaneous nucleotomy and simulated nucleus replacement models, on one hand, compared to the simulated fusion and simulated discectomy models, on the other. This finding is in consonance with the evolving clinical practice of using minimally invasive surgical methods for treating problem(s) such as soft cervical disc herniations. PMID:20211575
Li, Yuan; Lewis, Gladius
Effect of laser acupuncture versus traditional acupuncture in neck pain of cervical spondylosis
NASA Astrophysics Data System (ADS)
This prospective cohort study aimed to compare the efficiency of laser versus traditional acupuncture in treating cervical spondylosis (CS) pain. Forty female patients were randomized into two equal groups that received 3 sessions / week for 4 weeks. Group A received needle acupuncture therapy with electrical stimulation for 20 min at standard acupoints, ear points and Ashi point on the average 3 points. Group B received low level laser therapy (LLLT) acupuncture at the same acupoints. The results demonstrated that tenderness disappeared in 65% of patients in group A and 75% of patients in group B with improved percentage of 85.5% and 89.2%. Pain on VAS related to direction of motion at 6 directions was improved in all cases where with improvement percentage 76.45% and 85.88%. Pain on VAS at rest was improved in all patients with improvement percentage of 80.41% and 84.28%. NDIQ score improved in all patients with improvement percentage of 69.78% and 73.77%. Follow up of VAS after 6 months from the last session revealed persistent improvement in 55% of patients of group A vs 80% of patients of group B. Mean serum TNF-? was decreased in 85% of patients of group A vs 95% of patients of group B where serum beta endorphins was increased in all patients. It is concluded that both modes of treatment for CS gave improvement regarding pain intensity, disability and quality of life being more evident in LLLT followed for 6 months supported with improved serum TNF? and beta endorphin.
El-Kharbotly, Ahmed M.; El-Gendy, Alyaa A.; Mohammed, Mouchira A.; El-Masry, Manal R.; Daoud, Eitedal M.; Hassan, Nagwa; Abdel-Wahab, Khaled G.; Helmy, Ghada; Mostafa, Taymour
To compare profiles of subjects with and without cervical dystonia (CD)-associated pain, to evaluate the contribution of pain and the motor component of CD on quality of life, and to compare the initial botulinum toxin treatment paradigm between pain groups, baseline data were used from the CD Patient Registry for Observation of OnabotulinumtoxinA Efficacy (CD PROBE), a multicenter, prospective, observational registry designed to capture real-world practices and outcomes for onabotulinumtoxinA CD treatment. Subjects were divided into no/mild pain [Pain Numeric Rating Scale (PNRS) score 0-3] and moderate/severe pain groups (PNRS score 4-10). Descriptive and differential statistics were utilized to compare groups. 1,037 subjects completed the first treatment session, reported baseline botulinum toxin status, and completed baseline PNRS. Those with no/mild pain were significantly older at baseline. Those subjects with moderate/severe pain had higher Toronto Western Spasmodic Torticollis Rating Scale Severity (17.7���5.1 vs. 16.2���5.6, p�<�0.0001) and Disability (12.7���6.1 vs. 7.5���5.6, p�<�0.0001). CD subjects with moderate/severe pain received a higher mean dose (177.3���82.9 vs. 158.0���67.1�U, p�=�0.0001) of onabotulinumtoxinA and were injected in more muscles (4.1���1.4 vs. 3.7���1.2, p�<�0.0001) at initial treatment. CD PROBE clearly demonstrates the frequency of pain in CD and substantiates its importance when determining an optimal treatment paradigm. Future analyses of CD PROBE will further our understanding of the treatment patterns and outcomes related to onabotulinumtoxinA therapy for this disabling condition. PMID:24752807
Charles, P David; Adler, Charles H; Stacy, Mark; Comella, Cynthia; Jankovic, Joseph; Manack Adams, Aubrey; Schwartz, Marc; Brin, Mitchell F
Pain regulation and health-related quality of life after thoracolumbar fractures of the spine
Fractures of the thoracolumbar spine rank among the severest injuries of the human skeleton. Especially in younger patients\\u000a they often result from high-energy accidents. Recently, a shift in paradigm towards more aggressive treatment strategies including\\u000a anterior procedures could be observed. However, so far only few data exist reflecting the quality of life (QoL) after such\\u000a injuries. The aim of this
Daniel Briem; Aryan Behechtnejad; Alexander Ouchmaev; Matthias Morfeld; Karin Schermelleh-Engel; Michael Amling; Johannes M. Rueger
Development of the young spine questionnaire
Background Back pain in children is common and early onset of back pain has been shown to increase the risk of back pain significantly in adulthood. Consequently, preventive efforts must be targeted the young population but research relating to spinal problems in this age group is scarce. Focus has primarily been on the working age population, and therefore specific questionnaires to measure spinal pain and its consequences, specifically aimed at children and adolescents are absent. The purpose of this study was to develop a questionnaire for schoolchildren filling this gap. Methods The Young Spine Questionnaire (YSQ) was developed in three phases � a conceptualisation, development and testing phase. The conceptualisation phase followed the Wilson and Cleary model and included questions regarding spinal prevalence estimates, pain frequency and intensity, activity restrictions, care seeking behaviour and influence of parental back trouble. Items from existing questionnaires and the �Revised Faces Pain Scale� (rFPS) were included during the development phase. The testing phase consisted of a mixed quantitative and qualitative iterative method carried out in two pilot tests using 4th grade children and focusing on assessment of spinal area location and item validity. Results The testing phase resulted in omission of the pain drawings and the questions and answer categories were simplified in several questions. Agreement between the questionnaire prevalence estimates and the interviews ranged between 83.7% (cervical pain today) and 97.9% (thoracic pain today). To improve the understanding of the spinal boundaries we added bony landmarks to the spinal drawings after pilot test I. This resulted in an improved sense of spinal boundary location in pilot test II. Correlations between the rFPS and the interview pain score ranged between 0.67 (cervical spine) and 0.79 (lumbar spine). Conclusions The Young Spine Questionnaire contains questions that assess spinal pain and its consequences. The items have been tested for content understanding and agreement between questionnaire scores and interview findings among target respondents. These preliminary results suggest that the YSQ is feasible, has content validity and is a well understood questionnaire to be used in studies of children aged 9 to 11 years. PMID:23758965
Background The one year prevalence of thoracic back pain has been estimated as 17% compared to 64% for neck pain and 67% for low back pain. At present only one randomised controlled trial has been performed assessing the efficacy of spinal manipulative therapy (SMT) for thoracic spine pain. In addition no high quality trials have been performed to test the efficacy and effectiveness of Graston Technique� (GT), a soft tissue massage therapy using hand-held stainless steel instruments. The objective of this trial is to determine the efficacy of SMT and GT compared to a placebo for the treatment of non specific thoracic spine pain. Methods Eighty four eligible people with non specific thoracic pain mid back pain of six weeks or more will be randomised to one of three groups, either SMT, GT, or a placebo (de-tuned ultrasound). Each group will receive up to 10 supervised treatment sessions at the Murdoch University Chiropractic student clinic over a 4-week period. Treatment outcomes will be measured at baseline, one week after their first treatment, upon completion of the 4-week intervention period and at three, six and twelve months post randomisation. Outcome measures will include the Oswestry Back Pain Disability Index and the Visual Analogue Scale (VAS). Intention to treat analysis will be utilised in the statistical analysis of any group treatment effects. Trial Registration This trial was registered with the Australia and New Zealand Clinical Trials Registry on the 7th February 2008. Trial number: ACTRN12608000070336 PMID:18959807
Crothers, Amy; Walker, Bruce; French, Simon D
Despite the findings that peak anterior shear load is highly correlated with low-back pain reporting, very little research has been conducted to determine how vertebral shear injury potential is influenced. The current study quantified the combined effects of vertebral joint compression and flexion/extension postural deviation from neutral on ultimate shear failure. Ninety-six porcine cervical specimens (48C3-C4, 48C5-C6) were tested. Each specimen was randomly assigned to one of twelve combinations of compressive force (15%, 30%, 45%, or 60% of predicted compressive failure force) and flexion/extension postural deviation (extended, neutral, or flexed). Vertebral joint shear failure was induced by applying posterior shear displacement of the caudal vertebra at a constant rate of 0.15 mm/s. Throughout shear failure tests, vertebral joint kinematics were measured using an optoelectronic camera and a series of infrared light emitting diodes while shear force was measured from load cells rigidly interfaced in series with linear actuators that applied the shear displacement. Measurements of shear stiffness, ultimate force, displacement, and energy stored were made from the force-displacement data. Compressive force and postural deviation demonstrated main effects without a statistically significant interaction for any of the measurements. Shear failure force increased by 11.1% for each 15% increment in compressive force (p<0.05). Postural deviation from neutral impacted ultimate shear failure force by a 12.8% increase with extension (p<0.05) and a 13.2% decrease with flexion (p<0.05). Displacement at ultimate failure was not significantly altered by either compressive force or postural deviation. These results demonstrate that shear failure force may be governed by changes in facet articulation, either by postural deviation or by reducing vertebral joint height through compression that alter the moment arm length between the center of facet contact pressure and the pars interarticularis location. However, objective evidence of this alteration currently does not exist. Both compression and flexion/extension postural deviation should be equally considered while assessing shear injury potential. PMID:22196209
Howarth, Samuel J; Callaghan, Jack P
Background In Western Europe, low back pain has the greatest burden of all diseases. When back pain persists, different medical specialists are involved and a lack of consensus exists among these specialists for medical decision-making in Chronic Low Back Pain (CLBP). Objective To develop a decision tool for secondary or tertiary spine care specialists to decide which patients with CLBP should be seen by a spine surgeon or by other non-surgical medical specialists. Methods A Delphi study was performed to identify indicators predicting the outcome of interventions. In the preparatory stage evidence from international guidelines and literature were summarized. Eligible studies were reviews and longitudinal studies. Inclusion criteria: surgical or non-surgical interventions and persistence of complaints, CLBP-patients aged 18�65 years, reported baseline measures of predictive indicators, and one or more reported outcomes had to assess functional status, quality of life, pain intensity, employment status or a composite score. Subsequently, a three-round Delphi procedure, to reach consensus on candidate indicators, was performed among a multidisciplinary panel of 29 CLBP-professionals (>five years CLBP-experience). The pre-set threshold for general agreement was ?70%. The final indicator set was used to develop a clinical decision tool. Results A draft list with 53 candidate indicators (38 with conclusive evidence and 15 with inconclusive evidence) was included for the Delphi study. Consensus was reached to include 47 indicators. A first version of the decision tool was developed, consisting of a web-based screening questionnaire and a provisional decision algorithm. Conclusions This is the first clinical decision tool based on current scientific evidence and formal multidisciplinary consensus that helps referring the patient for consultation to a spine surgeon or a non-surgical spine care specialist. We expect that this tool considerably helps in clinical decision-making spine care, thereby improving efficient use of scarce sources and the outcomes of spinal interventions. PMID:25133645
van Hooff, Miranda L.; van Loon, Jan; van Limbeek, Jacques; de Kleuver, Marinus
Background Persons with low back pain fail to show the same transition as healthy individuals from in-phase to anti-phase rotation of the thorax and pelvis as walking speed increases. The purpose of this study was to determine if the relative phase of the thorax and pelvis during walking was a reliable (within day test-retest) and valid measure for persons with thoracic pain. Methods The time series motion of the spine over C7, T8 and sacrum were measured at five treadmill walking speeds (0.67, 0.89, 1.12, 1.34, 1.56�m/s) in 19 persons with thoracic spine pain and 19 healthy control subjects. After a 20�minute rest, all tests were repeated. The average relative phases of the transverse plane rotation between C7-T8, C7-sacrum and T8-sacrum during a one-minute walk were calculated. The standard error of measurement (SEM) and the intra-class correlation coefficient (ICC) were used to estimate test-retest reliability. Three-way repeated measures analyses of variance were performed to determine the influence of group, walking speed and session on the relative phases. Results The minimum transverse plane motion amplitudes, across all participants and speeds, for the C7-T8, C7-sacrum, and T8-sacrum were 2.9, 5.1 and 2.8 degrees, respectively. The C7-T8 relative phase changed little with speed. The C7-sacrum and T8-sacrum relative phases showed increases as subjects walked faster, but both groups had similar patterns of change. Only the C7-T8 relative phase at 0.67 and 0.89�m/s exhibited good reliability (ICC?>?0.80, SEM 4.2-5.7, no significant time effects) for both groups. The C7-T8 and T8-sacrum relative phases demonstrated significant group by speed effects. Conclusions The C7-T8 relative phase showed reasonable reliability and some discrimination between groups, but changes in response to walking speed were small. The T8-sacrum relative phase showed some discriminative ability, but reliability was not adequate. PMID:24321275
Leprotic cervical spondylodiscitis.
Leprosy is a chronic infectious disease caused by the Mycobacterium leprae that leads to leprotic neuropathy involving the peripheral nerve and several characteristic skin lesions. Skeletal involvement can occur in peripheral joints, such as the wrist and the ankle. However, there is no report of an axial leprotic lesion involving the spine or paraspinal soft tissue. The authors report the first case of a leprotic cervical lesion involving the axial skeletal system. A 48-year-old male presented with neck pain and severe pain in the right suprascapular area and left arm. Preoperative MRI of the cervical spine revealed signal changes in the prevertebral soft tissue at the level of the C3, 4, 5 vertebral bodies. There were a lower signal intensity on T1-weighted image and high signal intensity on T2WI of the bone marrow at the level of the C5 and C6 vertebral bodies, and a C5/6 segmental ossification of the posterior longitudinal ligament. There were herniated cervical disc on the left C5/6 with C6 root and the right side of C6/7 with a C7 root compression. He was previously diagnosed with leprosy when he was 14 years old and received treatment intermittently over the course of 7 years. But patient did not disclose his past history. Surgical intervention was conducted using an anterior cervical approach. An incision was made in the anterior longitudinal ligament at C5/6, and a pinkish gray friable gelatinous material was observed on the C5/6 disc and on the anterior lower one-third surface of the C5 vertebral body. Specimens were obtained and subjected to pathological evaluation and microbiological culture. After C5/6 and C6/7 discectomies, nerve root decompression and autologous iliac bone grafting were performed at the C5/6 and C6/7 levels. The C5-6-7 vertebrae were fixed with an Atlantis cervical locking plate and a screw system. The pathological report indicated chronic inflammation with heavy plasma cell infiltration on the specimen. We sent the specimens to the Institute of Hansen's Disease, and polymerase chain reaction for leprosy tested positive. After surgery, his pain disappeared and he was given a prescription for antileprotic drugs. The authors describe the first case of leprotic cervical spondylodiscitis that was operatively treated in a 48-year-old patient with known leprosy history since his 14 years old. PMID:20372941
Kim, Sang Jin; Lee, Tae Hoon; Shin, Jun Jae; Chae, Gue Tae
Objective To assess the efficacy of soft, semirigid and hard cervical collars to immobilize the neck in a destabilized cadaver model. Design This is a laboratory experiment. Setting The anatomy research lab of McMaster University. Patients None. Fresh cadavers from elderly patients suffering terminal medical illness and free of cervical structural disease were studied. Interventions Destabilizing discoligamentous lesions of the neck were created in the cadavers. Radiographs were taken in maximum displacement in the prone, decubitus and side-bending positions, first unsupported and then with soft, semirigid and hard collars applied. Displacements in angulation and translation were measured from the radiographs. Outcome measures Radiographic displacement under gravity load. Results In all cases there was no effective limitation of pathological displacement, and in many cases displacement was increased after collar application. Conclusions Cervical collars do not effectively support the unstable neck, and may be ineffective in preventing pathological displacements. PMID:15362326
Bednar, Drew A.
Correlation between the ossification of nuchal ligament and clinical cervical disorders.
This is a correlation analysis between severity of the ossification of the nuchal ligament (ONL) and clinical cervical disorders including neck dysfunction, cervical malalignment, and morphologic changes of the cervical neural foramen (CNF). The clinical effects of ONL on active range of motion (AROM) of neck, cervical radiculopathy, abnormal cervical curvature, and the degree of CNF stenosis in patients with painful neck stiffness are investigated. Studies have investigated the predisposing factors to cervical dysfunction and degenerative disorders; however, few studies have examined the influence of the ONL on neck function and cervical spine. A total of 31 participants with painful neck stiffness were recruited. They accepted measurement of cervical AROM and serial cervical radiographs at anterior-posterior view, lateral view, and bilateral oblique views. Parameters of radiographs measurement included cervical lordotic curve, and cross-sectional areas (CSA) of the ONL and CNF (C2-C3, C4-C5, C5-C6, and C6-C7 levels). The ratio of CSA of the lower CNF (C4-C5, C5-C6, C6-C7) to CSA of the upper CNF (C2-C3) was used as a CNF stenosis ratio. The correlations of ONL size, neck symptoms, cervical AROM, lordotic curve, and CNF stenosis ratio were analyzed. More than half of all patients were positive in cervical root signs and prone to have larger ONL. Neck AROM of all participants was significantly below normal average in all directions, and a moderate negative association was found between the ONL CSA and AROM in flexion-extension. Most patients had moderate loss of cervical lordotic curve despite there being no significant correlation between ONL CSA and cervical curvature. Moreover, CNF stenosis ratio significantly negatively correlated with ONL CSA. Patients with larger ONL had more severe cervical radiculopathy, more stiffness in flexion-extension direction, more complex degenerative change of spine, and worse CNF stenosis. PMID:23089319
Tsai, Yu-Lin; Weng, Ming-Cheng; Chen, Tien-Wen; Hsieh, Yi-Lun; Chen, Chia-Hsin; Chen, Chia-Shin; Huang, Mao-Hsiung
Biomechanics of the flexion of spine
NASA Astrophysics Data System (ADS)
Low back pain is a common problem and it involves different kinds of injury to the spine. In this article the forces and torques experienced by the spine are examined in order to understand, and possibly avoid, low back pain.
Hobbs, H. K.; Aurora, T. S.
Giant anterior cervical osteophyte leading to Dysphagia.
Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis(DISH). Large osteophytes can produce otolaryngological symptoms such as dysphagia, dysphonia, and foreign body sensation. We describe a DISH patient with giant anterior cervical osteophyte causing chronic dysphagia and dysphonia. A 56-year-old man presented with increasing dysphagia, dysphonia, neck pain and neck stiffness. Physical examination of the neck showed a non-tender and hard mass on the left side at the level of C4-5. Radiography showed extensive ossification of anterior longitudinal ligament along the left anterolateral aspect of vertebral bodies from C2 to T1. The ossification was espe cially prominent at the level of C4-5 and linear breakage was noted at same level. Esophagogram revealed a filling defect along the pharynx and lateral displacement of the esophagus. Giant anterior cervical osteophyte was removed through the leftsided anterolateral cervical approach to the spine. Anterior cervical interbody fusion at C4-5 was followed by posterior cervical fixation using lateral mass screws from C3 to C6. After surgery, dysphagia and dysphonia improved immediately. One year later, cervical CT showed bone fusion at C4-5 bodies and no recurrence of osteophyte. DISH is a common cause of anterior cervical osteophyte leading to progressive dysphagia. Keeping this clinical entity in the differential diagnosis is important in patients with progressive neck stiffness, dysphagia or dysphonia. And surgical treatment of symptomatic anterior cervical osteophyte due to DISH should be considered with a solid fusion procedure preventing postoperative instability or osteophyte progress. PMID:24757489
Hwang, Jin Seop; Chough, Chung Kee; Joo, Won Il
Background context: Fortunately, catastrophic cervical spinal cord injuries are relatively uncommon during athletic participation. Stinger and transient quadriplegia\\/paresis are more frequent injuries that have a wide spectrum of clinical severity and disabilities. Although the diagnosis of these injuries may not be clinically difficult, the treatment and decision about when or if the athlete may return to play after such an
Alexander R. Vaccaro; Gregg R. Klein; Michael Ciccoti; William L. Pfaff; Mark J. R. Moulton; Alan J. Hilibrand; Bob Watkins
Prospective controlled intervention study. To evaluate a specific segmental muscle training program of the lumbar spine in\\u000a order to prevent and reduce low back pain in young female teamgym gymnasts. Teamgym is a team sport comprising three events:\\u000a trampette, tumbling and floor programme. In a recent study, it was found that teamgym gymnasts practice and compete despite\\u000a suffering from back
M. L. Harringe; J. S. Nordgren; I. Arvidsson; S. Werner
The authors report a rare case of primary disseminated intradural malignant peripheral nerve sheath tumor (MPNST) of the spine in a 5-year-old child without neurofibromatosis type I (NF-I). This child presented with abdominal pain and gait disturbance. MRI revealed a large intradural extramedullary tumor at C4�5 with dissemination to the thoracic spine, cauda equina and leptomeninges. Following a 2-level cervical
Roukoz B. Chamoun; William E. Whitehead; Robert C. Dauser; Thomas G. Luerssen; M. Fatih Okcu; Adekunle M. Adesina; Andrew Jea
Abstract Objective To describe a novel approach to correcting cervical hyperlordosis and forward head posture in the treatment of mid-thoracic pain using specific rehabilitative equipment Clinical Features A 27-yr-old male patient had a chief complaint of intense, episodic mid-thoracic pain. A posture examination revealed several abnormalities, including apparent thoracic humping or buckling, along with significantly rounded shoulders. Radiological study resulted in a finding of a 52� cervical lordosis and forward head posture (FHP) validated by 2 separate measurements. Intervention and Outcome Treatment included 10 visits in 24 days, consisting of spinal manipulative therapy (SMT) combined with a 4-lb headweight device and a figure-8 clavicle brace, followed by positional traction on an intersegmental traction table. Specific instructions for home care were provided to the patient. Post-trial radiographs showed a reduced cervical lordosis of 40� and a reduction in FHP of 12mm, according to 1 of the 2 FHP measurements. An incidental improvement was also recorded for the lumbar lordosis. Patient symptoms were alleviated by the end of the trial period. Conclusion This comprehensive approach appeared to correct specific posture abnormalities seen on x-ray, and had an apparent positive effect on the patient's chief complaint. Each procedure in this treatment method needs to be tested separately to determine which procedures had the greatest effect. PMID:19674605
Morningstar, Mark W.
Animals are becoming more and more common as in vivo models for the human spine. Especially the sheep cervical spine is stated to be of good comparability and usefulness in the evaluation of in vivo radiological, biomechanical and histological behaviour of new bone replacement materials, implants and cages for cervical spine interbody fusion. In preceding biomechanical in vitro examinations human cervical spine specimens were tested after fusion with either a cubical stand-alone interbody fusion cage manufactured from a new porous TiO2/glass composite (Ecopore) or polymethylmethacrylate (PMMA) after discectomy. Following our first experience with the use of the new material and its influence on the primary stability after in vitro application we carried out fusions of 20 sheep cervical spines levels with either PMMA or an Ecopore-cage, and performed radiological examinations during the following 2-4 months. In this second part of the study we intended the biomechanical evaluation of the spine segments with reference to the previously determined morphological findings, like subsidence of the implants, significant increase of the kyphosis angle and degree of the bony fusion along with the interpretation of the results. 20 sheep cervical spines segments with either PMMA- or Ecopore-fusion in the levels C2/3 and C4/5 were tested, in comparison to 10 native corresponding sheep cervical spine segments. Non-destructive biomechanical testing was performed, including flexion/extension, lateral bending and axial rotation using a spine testing apparatus. Three-dimensional range of motion (ROM) was evaluated using an ultrasound measurement system. In the native spine segments C2/3 and C4/5 the ROM increased in cranio-caudal direction particulary in flexion/extension, less pronounced in lateral flexion and axial rotation (p < 0.05). The overall ROM of both tested segments was greatest in lateral flexion, reduced to 52% in flexion/extension and to 16% in axial rotation. After 2 months C2/3- and C4/5-segments with PMMA-fusion and C2/3-segments with Ecopore-interposition showed decrease of ROM in lateral flexion in comparison to the native segments, indicating increasing stiffening. However, after 4 months all operated segments, independent from level or implanted material, were stiffer than the comparable native segments. The decrease of the ROM correlated with the radiological-morphological degree of fusion. Our evaluation of the new porous TiO2/glass composite as interbody fusion cage has shown satisfactory radiological results as well as distinct biomechanical stability and fusion of the segments after 4 months in comparison to PMMA. After histological analysis of the bone-biomaterial-interface, further examinations of this biomaterial previous to an application as alternative to other customary cages in humans are necessary. PMID:15884708
Korinth, M C; Hero, T; Pandorf, T; Zell, D
Animals are becoming more and more common as in vitro and in vivo models for the human spine. Especially the sheep cervical spine is stated to be of good comparability and usefulness in the evaluation of in vivo radiological, biomechanical and histological behaviour of new bone replacement materials, implants and cages for cervical spine interbody fusion. In preceding biomechanical in vitro examination human cervical spine specimens were tested after fusion with either a cubical stand-alone interbody fusion cage manufactured from a new porous TiO/glass composite (Ecopore) or polymethyl-methacrylate (PMMA) after discectomy. First experience with the use of the new material and its influence on the primary stability after in vitro application were gained. After fusion of 10 sheep cervical spines in the levels C2/3 and C4/5 in each case with PMMA and with an Ecopore-cage, radiologic as well as computertomographic examinations were performed postoperatively and every 4 weeks during the following 2 and 4 months, respectively. Apart from establishing our animal model, we analysed the radiological changes and the degree of bony fusion of the operated segments during the course. In addition we performed measurements of the corresponding disc space heights (DSH) and intervertebral angles (IVA) for comparison among each other, during the course and with the initial values. Immediately after placement of both implants in the disc spaces the mean DSH and IVA increased (34.8% and 53.9%, respectively). During the following months DSH decreased to a greater extent in the Ecopore-segments than in the PMMA-segments, even to a value below the initial value (p>0.05). Similarly, the IVA decreased in both groups in the postoperative time lapse, but more distinct in the Ecopore-segments (p<0.05). These changes in terms of a subsidence of the implants, were confirmed morphologically in the radiological examination in the course. The radiologically evaluated fusion, i.e. bony bridging of the operated segments, was more pronounced after implantation of an Ecopore-cage (83%), than after PMMA interposition (50%), but did not gain statistical significance. In this first in vivo examination of our new porous ceramic bone replacement material we showed its application in the spondylodesis model of the sheep cervical spine. Distinct radiological changes regarding evident subsidence and detectable fusion of the segments, operated on with the new biomaterial, were seen. We demonstrated the radiological changes of the fused segments during several months and analysed them morphologically, before the biomechanical evaluation will be presented in a subsequent publication. PMID:15655929
Korinth, M C; Hero, T; Mahnken, A H; Ragoss, C; Scherer, K
To define the prognostic factors for local control and overall survival among 100 consecutive patients with chordoma of the base of skull or upper cervical spine treated by fractionated irradiation combining proton and photon beams. Between December 1993 and August 2002, 100 patients (median age: 53 years [8 - 85], M/F sex ratio: 3/2) were treated by a combination of high-energy photons and protons. The proton component was delivered at the Centre de Protonth�rapie d'Orsay (CPO) by a 201 MeV beam. The median total dose delivered to the tumor volume was 67 GyECo. With a median follow-up of 31 months [range: 0 - 87], 25 tumours relapsed locally. The 2- and 4-year local control rates were 86.3% (+/-3.9%) and 53.8% (+/-7.5%), respectively. According to multivariate analysis, at least 95% of the tumor volume encompassed by the 95% isodose (p = 0.048; RR: 3.4 95%CI [1.01 - 11.8]) and a minimal dose delivered into the tumor volume <56 GyECo (p = 0.042; RR: 2.3 95%CI [1.03 - 5.2]) were independent prognostic factors of local control. Ten patients died. The 2- and 5-year overall survival rates were 94.3% (+/-2.5%) and 80.5% (+/-7.2%), respectively. According to multivariate analysis, local tumor control (p = 0.005; RR: 21 95%CI [2.2 - 200]) was a prognostic factor of overall survival. For chordomas of the base of the skull and upper cervical spine treated by surgery and irradiation combining photons and protons, the quality of irradiation, reflected by homogeneity of the dose into the tumor volume, is a major factor of local control. Close attention must be paid to minimize the underdosed areas close to critical organs. The role of surgical resection remains paramount, and a trial of dose escalation would have to consider an increase in the dose to critical organs, especially as current results indicate the low toxicity of this treatment. PMID:16227160
No�l, Georges; Feuvret, Loic; Calugaru, Valentin; Dhermain, Frederic; Mammar, Hamid; Haie-M�der, Christine; Ponvert, Dominique; Hasboun, Dominique; Ferrand, R�gis; Nauraye, Catherine; Boisserie, Gilbert; Beaudr�, Anne; Gaboriaud, Genevi�ve; Mazal, Alexandre; Habrand, Jean-Louis; Mazeron, Jean-Jacques
Cervical stenosis (CS) and multiple sclerosis (MS) are two common conditions with distinctive pathophysiology but overlapping clinical manifestations. The uncertainty involved in attributing worsening symptoms to CS in patients with MS due to extremely high prevalence of asymptomatic radiological CS makes treatment decisions challenging. A retrospective review was performed analyzing the medical records of all patients with confirmed diagnosis of MS who had coexistent CS and underwent surgery for cervical radiculopathy/myeloradiculopathy. Eighteen patients with coexistent CS and MS who had undergone cervical spine decompression and fusion were identified. There were six men and 12 women with an average age of 52.7years (range 40-72years). Pre-operative symptoms included progressive myelopathy (14 patients), neck pain (seven patients), radiculopathy (five patients), and bladder dysfunction (seven patients). Thirteen of the 14 patients (92.9%) with myelopathy showed either improvement (4/14, 28.6%) or stabilization (9/14, 64.3%) in their symptoms with neck pain and radiculopathy improving in 100% and 80% of patients, respectively. None of the seven patients with urinary dysfunction had improvement in urinary symptoms after surgery. To conclude, cervical spine decompression and fusion can improve or stabilize myelopathy, and significantly relieve neck pain and radiculopathy in the majority of patients with coexistent CS and MS. Urinary dysfunctions appear unlikely to improve after surgery. The low rate of surgical complications in our cohort demonstrates that cervical spine surgery can be safely performed in carefully selected patients with concomitant CS and MS with a good clinical outcome and also eliminate CS as a confounding factor in the long-term management of MS patients. PMID:25088960
Tan, Lee A; Kasliwal, Manish K; Muth, Christopher C; Stefoski, Dusan; Traynelis, Vincent C
Objectives To assess the clinical effectiveness of surgical stabilisation (spinal fusion) compared with intensive rehabilitation for patients with chronic low back pain. Design Multicentre randomised controlled trial. Setting 15 secondary care orthopaedic and rehabilitation centres across the United Kingdom. Participants 349 participants aged 18-55 with chronic low back pain of at least one year's duration who were considered candidates for
Jeremy Fairbank; Helen Frost; James Wilson-MacDonald; Ly-Mee Yu; Karen Barker
Objective The offset connector can allow medial and lateral variability and facilitate intralaminar screw incorporation into the construct. The aim of this study was to compare the biomechanical characteristics of C7 intralaminar screw constructs with and without offset connector using a three dimensional finite element model of a C6-7 cervical spine segment. Methods Finite element models representing C7 intralaminar screw constructs with and without the offset connector were developed. Range of motion (ROM) and maximum von Mises stresses in the vertebra for the two techniques were compared under pure moments in flexion, extension, lateral bending and axial rotation. Results ROM for intralaminar screw construct with offset connector was less than the construct without the offset connector in the three principal directions. The maximum von Misses stress was observed in the C7 vertebra around the pedicle in both constructs. Maximum von Mises stress in the construct without offset connector was found to be 12-30% higher than the corresponding stresses in the construct with offset connector in the three principal directions. Conclusion This study demonstrated that the intralaminar screw fixation with offset connector is better than the construct without offset connector in terms of biomechanical stability. Construct with the offset connector reduces the ROM of C6-7 segment more significantly compared to the construct without the offset connector and causes lower stresses around the C7 pedicle-vertebral body complex. PMID:24003366
Qasim, Muhammad; Natarajan, Raghu N.; An, Howard S.
Clearance of cervical spine (CS) precautions in the neurologically altered blunt trauma patient can be difficult. Physical examination is not reliable, and although computed tomography (CT) may reveal no evidence of fracture, it is generally believed to be an inferior modality for assessing ligamentous and cord injuries. However, magnetic resonance imaging (MRI) is expensive and may be risky in critically ill patients. Conversely, prolonged rigid collar use is associated with pressure ulceration and other complications. Multidetector CT raises the possibility of clearing CS on the basis of CT alone. We performed a retrospective review at our Level I trauma center of all blunt trauma patients with Glasgow Coma Scale Score 14 or less who underwent both CT and MRI CS with negative CT. One hundred fourteen patients met inclusion criteria, of which 23 had MRI findings. Seven (6%) of these had neurologic deficits and/or a change in management on the basis of MRI findings. Although use of the single-slice scanner was significantly associated with MRI findings (odds ratio, 2.62; P=0.023), no significant clinical risk factors were identified. Patients with MRI findings were heterogeneous in terms of age, mechanism, and Injury Severity Score. We conclude that CS MRI continues play a vital role in the workup of neurologically altered patients. PMID:23025962
Kaiser, Meghann L; Whealon, Matthew D; Barrios, Cristobal; Kong, Allen P; Lekawa, Michael E; Dolich, Matthew O
Thoracic spine manipulation has been shown to be effective for the management of neck pain. The purpose of this study was to investigate the immediate effect of a T3�T4 spinal thrust manipulation on autonomic nervous system activity in subjects with chronic cervical pain. An additional aim was to determine if the manipulation resulted in an immediate pain relief in patients with chronic neck pain when compared to a placebo intervention. One hundred subjects with chronic neck pain were randomly assigned to receive either a thoracic thrust manipulation or a placebo intervention. The Friedman�s test was used to evaluate the change in pupil diameter within both groups. The Wilcoxen signed-ranks test was used to explore pupil changes over time and to make paired comparisons of the pupil change between the groups. The Mann�Whitney U test was used to compare the change in pain perception for the chronic cervical pain group subjects receiving either the thrust manipulation or the placebo intervention. The results demonstrated that manipulation did not result in a change in sympathetic activity. Additionally, there was no significant difference in the subject�s pain perception (P?=?0.961) when comparing the effects of the thrust manipulation to the placebo intervention within this group of subjects with chronic neck pain. The clinical impression of this study is that manipulation of the thoracic spine may not be effective in immediately reducing pain in patients with chronic neck pain. PMID:22131791
Sillevis, Rob; Cleland, Joshua; Hellman, Madeleine; Beekhuizen, Kristina
Cerebrospinal fluid (CSF) dynamics in the spinal subarachnoid space (SSS) have been thought to play an important pathophysiological role in syringomyelia, Chiari I malformation (CM), and a role in intrathecal drug delivery. Yet, the impact that fine anatomical structures, including nerve roots and denticulate ligaments (NRDL), have on SSS CSF dynamics is not clear. In the present study we assessed the impact of NRDL on CSF dynamics in the cervical SSS. The 3D geometry of the cervical SSS was reconstructed based on manual segmentation of MRI images of a healthy volunteer and a patient with CM. Idealized NRDL were designed and added to each of the geometries based on in vivo measurments in the literature and confirmation by a neuroanatomist. CFD simulations were performed for the healthy and patient case with and without NRDL included. Our results showed that the NRDL had an important impact on CSF dynamics in terms of velocity field and flow patterns. However, pressure distribution was not altered greatly although the NRDL cases required a larger pressure gradient to maintain the same flow. Also, the NRDL did not alter CSF dynamics to a great degree in the SSS from the foramen magnum to the C1 level for the healthy subject and CM patient with mild tonsillar herniation (?6 mm). Overall, the NRDL increased fluid mixing phenomena and resulted in a more complex flow field. Comparison of the streamlines of CSF flow revealed that the presence of NRDL lead to the formation of vortical structures and remarkably increased the local mixing of the CSF throughout the SSS. PMID:24710111
Heidari Pahlavian, Soroush; Yiallourou, Theresia; Tubbs, R. Shane; Bunck, Alexander C.; Loth, Francis; Goodin, Mark; Raisee, Mehrdad; Martin, Bryn A.
Cerebrospinal fluid (CSF) dynamics in the spinal subarachnoid space (SSS) have been thought to play an important pathophysiological role in syringomyelia, Chiari I malformation (CM), and a role in intrathecal drug delivery. Yet, the impact that fine anatomical structures, including nerve roots and denticulate ligaments (NRDL), have on SSS CSF dynamics is not clear. In the present study we assessed the impact of NRDL on CSF dynamics in the cervical SSS. The 3D geometry of the cervical SSS was reconstructed based on manual segmentation of MRI images of a healthy volunteer and a patient with CM. Idealized NRDL were designed and added to each of the geometries based on in vivo measurments in the literature and confirmation by a neuroanatomist. CFD simulations were performed for the healthy and patient case with and without NRDL included. Our results showed that the NRDL had an important impact on CSF dynamics in terms of velocity field and flow patterns. However, pressure distribution was not altered greatly although the NRDL cases required a larger pressure gradient to maintain the same flow. Also, the NRDL did not alter CSF dynamics to a great degree in the SSS from the foramen magnum to the C1 level for the healthy subject and CM patient with mild tonsillar herniation (? 6 mm). Overall, the NRDL increased fluid mixing phenomena and resulted in a more complex flow field. Comparison of the streamlines of CSF flow revealed that the presence of NRDL lead to the formation of vortical structures and remarkably increased the local mixing of the CSF throughout the SSS. PMID:24710111
Heidari Pahlavian, Soroush; Yiallourou, Theresia; Tubbs, R Shane; Bunck, Alexander C; Loth, Francis; Goodin, Mark; Raisee, Mehrdad; Martin, Bryn A
Osteoblastoma of the spine. A review of 75 cases.
Clinical and radiologic features of 75 cases of osteoblastoma of the spine were reviewed. In addition to pain, which was the most frequent complaint, 18 patients demonstrated objective neurologic deficit, while scoliosis was observed in 17 patients. Aspirin yielded pain relief in 13 patients. Pathologic fracture was not encountered. The radiologic and histologic characteristics of osteoblastoma of the spine are indistinguishable from those arising in other sites. The typical lesion exhibited a well-defined, geographic margin with a sclerotic, frequently lobulated border. Approximately one half of the cases were predominantly lucent, the remainder displaying varying degrees of matrix mineralization. Distribution of the osteoblastomas through the spinal axis was as follows: cervical-29, thoracic-16, lumbar-17, sacral-13. Other significant findings included posterior element involvement in 73 of 75 cases, and a striking male to female ratio of 2.5 to 1. PMID:2149206
Nemoto, O; Moser, R P; Van Dam, B E; Aoki, J; Gilkey, F W
Background: The etiology of adjacent-segment disease following cervical spine arthrodesis remains controversial. The objective of the current study was to evaluate cervical intervertebral range of motion during dynamic flexion-extension in patients who had undergone a single-level arthrodesis and in asymptomatic control subjects. Methods: Ten patients who had undergone a single-level (C5/C6) anterior arthrodesis and twenty asymptomatic control subjects performed continuous full range-of-motion flexion-extension while biplane radiographs were collected at thirty images per second. A previously validated tracking process determined three-dimensional vertebral position on each pair of radiographs with submillimeter accuracy. Six-degrees-of-freedom kinematics between adjacent vertebrae were calculated throughout the entire flexion-extension movement cycle over multiple trials for each participant. Cervical kinematics were also calculated from images collected during static full flexion and static full extension. Results: The C4/C5 motion segment moved through a larger extension range of motion and a smaller flexion range of motion in the subjects with the arthrodesis than in the controls. The extension difference between the arthrodesis and control groups was 3.8� (95% CI [confidence interval], 0.9� to 6.6�; p = 0.011) and the flexion difference was ?2.9� (95% CI, ?5.3� to ?0.5�; p = 0.019). Adjacent-segment posterior translation was greater in the arthrodesis group than in the controls, with a C4/C5 difference of 0.8 mm (95% CI, 0.0 to 1.6 mm) and a C6/C7 difference of 0.4 mm (95% CI, 0.0 to 0.8 mm; p = 0.016). Translation range of motion and rotation range of motion were consistently larger when measured on images collected during dynamic functional movement as opposed to images collected at static full flexion or full extension. The upper 95% CI limit for anterior-posterior translation range of motion was 3.45 mm at C3/C4 and C4/C5, but only 2.3 mm at C6/C7. Conclusions: C5/C6 arthrodesis does not affect the total range of motion in adjacent vertebral segments, but it does alter the distribution of adjacent-segment motion toward more extension and less flexion superior to the arthrodesis and more posterior translation superior and inferior to the arthrodesis during in vivo functional loading. Range of motion measured from static full-flexion and full-extension images underestimates dynamic range of motion. Clinical evaluation of excessive anterior-posterior translation should take into account the cervical vertebral level. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. PMID:23515984
Anderst, William J.; Lee, Joon Y.; Donaldson, William F.; Kang, James D.
Fracture of the First Cervical Vertebra in a High School Football Player: A Case Report
Objective: To present the case of a high school football player with a burst fracture of the ring of C1 resulting from a �spearing� tackle. Background: Cervical spine fractures are rare in collision sports, but their potentially grave consequences mean that they must be given special attention. Spearing was banned by the National Collegiate Athletic Association and the National Federation of High School Athletic Associations in 1976, and the number of cervical spine fractures in high school and college football players has fallen dramatically. However, cervical spine fractures do still occur, and they present a diagnostic challenge to sports medicine professionals. Differential Diagnosis: Cervical sprain. Treatment: Treatment consists of halo-vest immobilization. Surgical fusion may be necessary for unstable C1-C2 fractures, although initial halo-vest treatment is usually attempted. Uniqueness: A 17-year-old defensive back attempted to make a tackle with his head lowered. He was struck on the superolateral aspect of the helmet by the opposing running back. He remained in the game for another play, but then left the field under his own power, complaining of neck stiffness and headache. Physical examination revealed upper trapezius and occiput tenderness, bilateral cervical muscle spasm, and pain at all extremes of voluntary cervical movement. He was alert and oriented, with a normal neurologic examination. Treatment with ice was attempted but was discontinued due to increased pain and stiffness. Heat resulted in decreased pain and stiffness, but his symptoms persisted, and he was trans- ported to the emergency room. Plain radiographs were read as negative, but a CT scan demonstrated a burst fracture of Cl. He was treated with halo-vest immobilization for 8 weeks and a rigid cervical collar for 8 additional weeks. Physical therapy was then initiated, and normal cervical range of motion and strength were restored within 6 weeks. The athlete competed in track 6 months after the injury and continues to play recreational sports without difficulty. At clinical follow-up 8 months after injury, he had full, painless cervical range of motion and a normal neurologic examination. Conclusions: A potentially devastating cervical spine injury can present insidiously, without dramatic signs or symptoms. Therefore, sports medicine professionals must retain a high index of suspicion when evaluating athletes with cervical spine complaints. ImagesFig 1.Fig 2. PMID:16558448
Trupiano, Tim P.; Sampson, Michelle L.; Weise, Marc W.
Background: The aim of this work is to present a novel decompression technique that approaches cervical spine posteriorly, but through minimal invasive method using tubular retractor avoiding detachment of posterior musculature. Methods: Six patients underwent minimally invasive posterior cervical decompression using the tubular retractor system and surgical microscope. Minimally invasive access to the posterior cervical spine was performed with exposure through a paramedian muscle-splitting approach. With the assistance of a specialized tubular retraction system and deep soft tissue expansion mechanism, multilevel posterior cervical decompression could be accomplished. This approach also allows safe docking of the retractor system on the lateral mass, thus avoiding the cervical spinal canal during exposure. A standard operating microscope was used with �10 magnification and 400 mm focal length. The hospital charts, magnetic resonance imaging studies, and follow-up records of all the patients were reviewed. Outcome was assessed by neurological status and visual analog scale (VAS) for neck and arm pain. Results: There was no significant complication related to operation. The follow-up time was 4-12 months (mean, 9 months). Muscle weakness improved in all patients; sensory deficits resolved in four patients and improved in two patients. Analysis of the mean VAS for radicular pain and VAS for neck pain showed significant improvement. Conclusions: The preliminary experiences with good clinical outcome seem to promise that this minimally invasive technique is a valid alternative option for the treatment of cervical spondylotic myelopathy. PMID:24778922
Hur, Jung-Woo; Kim, Jin-Sung; Shin, Myeong-Hoon; Ryu, Kyeong-Sik
Accurate measurement of intervertebral kinematics of the cervical spine can support the diagnosis of widespread diseases related to neck pain, such as chronic whiplash dysfunction, arthritis, and segmental degeneration. The natural inaccessibility of the spine, its complex anatomy, and the small range of motion only permit concise measurement in vivo. Low dose X-ray fluoroscopy allows time-continuous screening of cervical spine during patient's spontaneous motion. To obtain accurate motion measurements, each vertebra was tracked by means of image processing along a sequence of radiographic images. To obtain a time-continuous representation of motion and to reduce noise in the experimental data, smoothing spline interpolation was used. Estimation of intervertebral motion for cervical segments was obtained by processing patient's fluoroscopic sequence; intervertebral angle and displacement and the instantaneous centre of rotation were computed. The RMS value of fitting errors resulted in about 0.2 degree for rotation and 0.2?mm for displacements. PMID:24288523
Bifulco, Paolo; Cesarelli, Mario; Romano, Maria; Sansone, Mario
Is there a relationship between head posture and craniomandibular pain?
An often-suggested factor in the aetiology of craniomandibular disorders (CMD) is an anteroposition of the head. However, the results of clinical studies to the relationship between CMD and head posture are contradictory. Therefore, the first aim of this study was to determine differences in head posture between well-defined CMD pain patients with or without a painful cervical spine disorder and healthy controls. The second aim was to determine differences in head posture between myogenous and arthrogenous CMD pain patients and controls. Two hundred and fifty persons entered the study. From each person, a standardized oral history was taken and blind physical examinations of the masticatory system and of the neck were performed. The participants were only included into one of the subgroups when the presence or absence of their symptoms was confirmed by the results of the physical examination. Head posture was quantified using lateral photographs and a lateral radiograph of the head and the cervical spine. After correction for age and gender effects, no difference in head posture was found between any of the patient and non-patient groups (P > 0.27). Therefore, this study does not support the suggestion that painful craniomandibular disorders, with or without a painful cervical spine disorder, are related to head posture. PMID:12453255
Visscher, C M; De Boer, W; Lobbezoo, F; Habets, L L M H; Naeije, M
Background Neck pain is one of the chief symptoms of cervical spondylosis (CS). Acupuncture is a well-accepted and widely used complementary therapy for the management of neck pain caused by CS. In this paper, we present a randomized controlled trial protocol evaluating the use of acupuncture for CS neck pain, comparing the effects of the optimized acupuncture therapy in real practice compared with sham and shallow acupuncture. Methods/Design This trial uses a multicentre, parallel-group, randomized, sham acupuncture and shallow acupuncture, controlled single-blind design. Nine hospitals are involved as trial centres. 945 patients who meet inclusion criteria are randomly assigned to receive optimized acupuncture therapy, sham acupuncture or shallow acupuncture by a computerized central randomization system. The interventions past for 4 weeks with eight to ten treatments in total. The group allocations and interventions are concealed to patients and statisticians. The Northwick Park Neck Pain Questionnaire (NPQ) is used as the primary outcome measure, and the McGill Pain Questionnaire (MPQ) and The Short Form (36) Health Survey (SF-36) are applied as secondary outcome measures. The evaluation is performed at baseline, at the end of the intervention, and at the end of the first month and the third month during follow-up. The statistical analyses will include baseline data comparison and repeated measures of analysis of variance (ANOVA) for primary and secondary outcomes of group and time differences. Adverse events (AEs) will be reported if they occur. Discussion This trial is a multicentre randomized control trial (RCT) on the efficacy of acupuncture for CS neck pain and has a large sample size and central randomization in China. It will strictly follow the CONSORT statement and STRICTA extension guideline to report high-quality study results. By setting the control groups as sham and shallow acupuncture, this study attempts to reveal the effects of real acupuncture versus placebo or non-classic acupuncture treatment and evaluate whether classic Chinese medical acupuncture is effective on CS neck pain. This study will provide evidence for the effects of acupuncture on CS neck pain. Trial Registration Chinese Clinical Trial Registry: ChiCTR-TRC-00000184. PMID:22776567
In this study we examined whether results from a clinical test of passive mobility of soft tissue structures in the upper cervical spine, corresponded with signs of physical injuries, as judged by magnetic resonance imaging (MRI). Results were based on examinations of 122 study participants, 92 with and 30 without a diagnosis of whiplash-associated disorder, type 2. The structures considered were the alar and the transverse ligaments, and the tectorial and the posterior atlanto-occipital membranes. Ordinary and weighted kappa coefficients were used as a measure of agreement, whereas McNemar's test was used for evaluating differences in rating. The clinical classification and the MRI examination both comprised four response categories (grades 0-3), with 0 representing a normal structure, and 3 indicating a structure with pronounced abnormality. In our sample, an abnormal clinical test reflected a hyper- rather than hypo-mobility. Considering all four-response categories, the kappa coefficient indicated moderate agreement (range 0.45-0.60) between the clinical and the MRI classification. The results for the membranes appeared somewhat better than for the ligaments. When there was disagreement, the classifications obtained by the clinical test were significantly lower than the MRI grading, but mainly within one grade difference. When combining grade 0-1 (normal) and 2-3 (abnormal), the agreement improved considerably (range 0.70-0.90). Although results from the clinical test seem to be slightly more conservative than the MRI assessment, we believe that a clinical test can serve as valuable clinical tool in the assessment of WAD patients. However, further validity- and reliability studies are needed. PMID:17936054
Kaale, Bertel Rune; Krakenes, Jostein; Albrektsen, Grethe; Wester, Knut
Object Single-level anterior cervical discectomy and fusion (ACDF) is an established surgical treatment for cervical myelopathy. Within 10 years of undergoing ACDF, 19.2% of patients develop symptomatic adjacent-level degeneration. Performing ACDF adjacent to prior fusion requires exposure and removal of previously placed hardware, which may increase the risk of adverse outcomes. Zero-profile cervical implants combine an interbody spacer with an anterior plate into a single device that does not extend beyond the intervertebral disc space, potentially obviating the need to remove prior hardware. This study compared the biomechanical stability and adjacent-level range of motion (ROM) following placement of a zero-profile device (ZPD) adjacent to a single-level ACDF against a standard 2-level ACDF. Methods In this in vitro biomechanical cadaveric study, multidirectional flexibility testing was performed by a robotic spine system that simulates flexion-extension, lateral bending, and axial rotation by applying a continuous pure moment load. Testing conditions were as follows: 1) intact, 2) C5-6 ACDF, 3) C4-5 ZPD supraadjacent to simulated fusion at C5-6, and 4) 2-level ACDF (C4-6). The sequence of the latter 2 test conditions was randomized. An unconstrained pure moment of 1.5 Nm with a 40-N simulated head weight load was applied to the intact condition first in all 3 planes of motion and then using the hybrid test protocol, overall intact kinematics were replicated subsequently for each surgical test condition. Intersegmental rotations were measured optoelectronically. Mean segmental ROM for operated levels and adjacent levels was recorded and normalized to the intact condition and expressed as a percent change from intact. A repeated-measures ANOVA was used to analyze the ROM between test conditions with a 95% level of significance. Results No statistically significant differences in immediate construct stability were found between construct Patterns 3 and 4, in all planes of motion (p > 0.05). At the operated level, C4-5, the zero-profile construct showed greater decreases in axial rotation (-45% vs -36%) and lateral bending (-55% vs -38%), whereas the 2-level ACDF showed greater decreases in flexion-extension (-40% vs -34%). These differences were marginal and not statistically significant. Adjacent-level motion was nearly equivalent, with minor differences in flexion-extension. Conclusions When treating degeneration adjacent to a single-level ACDF, a zero-profile implant showed stabilizing potential at the operated level statistically similar to that of the standard revision with a 2-level plate. Revision for adjacent-level disease is common, and using a ZPD in this setting should be investigated clinically because it may be a faster, safer alternative. PMID:25170655
Healy, Andrew T; Sundar, Swetha J; Cardenas, Raul J; Mageswaran, Prasath; Benzel, Edward C; Mroz, Thomas E; Francis, Todd B
Cervical Perineural Cyst Masquerading as a Cervical Spinal Tumor
Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor. PMID:24761204
Joshi, Vijay P; Zanwar, Atul; Karande, Anuradha
Cervical perineural cyst masquerading as a cervical spinal tumor.
Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor. PMID:24761204
Joshi, Vijay P; Zanwar, Atul; Karande, Anuradha; Agrawal, Amit
A case of symptomatic cervical perineural (Tarlov) cyst: clinical manifestation and management.
Perineural (Tarlov) cysts are most often found in the sacral region and are rare in the cervical spine. Although they are usually asymptomatic, a small number of those at the lumbosacral level have been known to produce localized or radicular pain. Few reports are available on symptomatic perineural cysts in the cervical spine and it has not been discussed how they should be managed. We present here a case of cervical perineural cysts with persistent radicular pain where the pain was adequately managed with repetitive transforaminal epidural steroid injection (TFESI). The patient had experienced intractable pain in the posterior neck and left upper extremity for more than 7�years. The nature of the pain was cramping and a tingling sensation, which was aggravated in the supine position. Magnetic resonance imaging revealed a perineural cyst in the neural foramen of left C7 root. The patient underwent three repetitive TFESIs targeted at the root. Each injection provided incremental relief, which lasted more than 6�months. Follow-up image revealed shrinkage of the cyst. This case illustrates in detail the clinical manifestation of a rare symptomatic perineural cyst in the cervical region and to our knowledge is the first to report the beneficial effect of repetitive TFESI. PMID:21830055
Kim, Keewon; Chun, Se Woong; Chung, Sun G
Background Cervical spine manipulation (CSM) is a commonly utilized intervention, but its use remains controversial. Purpose To retrospectively analyze all available documented case reports in the literature describing patients who had experienced severe adverse events (AEs) after receiving CSM to determine if the CSM was used appropriately, and if these types of AEs could have been prevented using sound clinical reasoning on the part of the clinician. Data sources PubMed and the Cumulative Index to Nursing and Allied Health were systematically searched for case reports between 1950 and 2010 of AEs following CSM. Study selection Case reports were included if they were peer-reviewed; published between 1950 and 2010; case reports or case series; and had CSM as an intervention. Articles were excluded if the AE occurred without CSM (e.g. spontaneous); they were systematic or literature reviews. Data extracted from each case report included: gender; age; who performed the CSM and why; presence of contraindications; the number of manipulation interventions performed; initial symptoms experienced after the CSM; and type of resultant AE. Data synthesis Based on the information gathered, CSMs were categorized as appropriate or inappropriate, and AEs were categorized as preventable, unpreventable, or unknown. Chi-square analysis with an alpha level of 0.05 was used to determine if there was a difference in proportion between six categories: appropriate/preventable, appropriate/unpreventable, appropriate/unknown, inappropriate/preventable, inappropriate/unpreventable, and inappropriate/unknown. Results One hundred thirty four cases, reported in 93 case reports, were reviewed. There was no significant difference in proportions between appropriateness and preventability, P?=?.46. Of the 134 cases, 60 (44.8%) were categorized as preventable, 14 (10.4%) were unpreventable and 60 (44.8%) were categorized as �unknown�. CSM was performed appropriately in 80.6% of cases. Death resulted in 5.2% (n?=?7) of the cases, mostly caused by arterial dissection. Limitations There may have been discrepancies between what was reported in the cases and what actually occurred, since physicians dealing with the effects of the AE, rather than the clinician performing the CSM, published many of the cases. Conclusions This review showed that, if all contraindications and red flags were ruled out, there was potential for a clinician to prevent 44.8% of AEs associated with CSM. Additionally, 10.4% of the events were unpreventable, suggesting some inherent risk associated with CSM even after a thorough exam and proper clinical reasoning. PMID:23633885
Puentedura, Emilio J; March, Jessica; Anders, Joe; Perez, Amber; Landers, Merrill R; Wallmann, Harvey W; Cleland, Joshua A
The superficial cervical plexus block (SCPB) is utilized in pediatric patients to perform certain surgical procedures, but there is no evidence supporting its use in hemodialysis catheter placement. We evaluated the analgesic effectiveness, intraoperative complications, and patient satisfaction associated with SCPB for pediatric patients in renal failure undergoing emergent dialysis catheterization. A total of 52 patients ranging from 1 to 17 years old that required emergent dialysis catheter placement and received SCPB were included in this study. During the catheterization, intraoperative pain scores, requirement for additional analgesia, catheterization access site, and intraoperative complications were recorded. The Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) was used to determine pain ratings during skin puncture with the needle, skin dilatation, and securing the catheter with stitches. The patients had an average age of 8.46?�?5.3 years. The preferred catheterization entry site was through right internal jugular vein, which was achieved in 80.7% of patients. However, 19.3% of patients required access through the right subclavian vein. The average mCHEOPS score during skin puncture was 1.4?�?0.5, and the mean mCHEOPS score was 2.3?�?0.6 for skin dilatation. Finally, the average mCHEOPS score while securing the catheter with stitches was 1.3?�?0.4. No patient required fentanyl for additional analgesia. No intraoperative complications occurred. The benefits gained from using SCPB performed by an experienced anesthesiologist for hemodialysis catheter placement include providing sufficient analgesia and optimal surgical conditions while avoiding the complications associated with general anesthesia for pediatric patients with renal failure. PMID:24708342
Ciftci, Taner; Daskaya, Hayrettin; Y?ld?r?m, Mehmet B; S�ylemez, Haluk
Charcot Spine and Parkinson's Disease
Charcot spine is rare condition whose association with Parkinson's disease (PD) has not been reported yet. The authors reported the cases of two patients with PD who developed Charcot spine. Both patients presented with a history of back pain and bilateral radicular leg pain. They had complete clinical and radiological assessment. Lumbar spine was involved in both patients. Clinical features and response to treatment were described. In the first case, circumferential fusion and stabilization were performed on the dislocated vertebral levels. A solid and stable fusion of the spine was obtained with satisfactory clinical outcome. Surgical treatment has been recommended to the other patient. In both cases, no other neurological etiology was found to account for Charcot spine. In conclusion, Charcot spine is associated with several neurological affections but has not previously been reported in association with Parkinson's disease. PMID:25165591
Loriaut, Philippe; Rozenberg, Sylvie; Boyer, Patrick; Dallaudiere, Benjamin; Khiami, Frederic; Sariali, Elhadi; Pascal-Moussellard, Hugues
Background Office workers spend a long period of time behind a computer during working hours. The relation between the posture of sitting during work with computer and neck pain is still debatable. Even though some researchers claim a significant difference in head posture between patients with neck pain and pain-free participants, the FHP (forward head posture) has not always been associated with neck pain in literature. So, the purpose of this study was to discover the relationship between neck pain and improper posture in the head, cervicothoracic spine and shoulders. Methods: This was a cross-sectional study to explore the relationships between neck pains, sagittal postures of cervical and thoracic spine and shoulders among office workers in two positions, straight looking forward and working position. 46 subjects without neck pain and 55 subjects with neck pain were evaluated using a photographic method. Thoracic and cervical postures were measured by the HT (High Thoracic), CV (Craniovertebral) angles respectively. Shoulder�s posture was evaluated in the sagittal plane by the acromion protrusion. Results: HT and CV angles were positively correlated with the presence of neck pain only in working position (p< 0.05). In straight looking forward position there was no significant difference between the two groups statistically (p>0.05). The difference of shoulder protrusion between symptomatic and asymptomatic groups was not significant. Conclusion: FHP and thoracic kyphosis were accompanied with neck pain. But shoulder posture was not correlated with neck pain.
Nejati, Parisa; Lotfian, Sara; Moezy, Azar; Moezy, Azar; Nejati, Mina
A total 71 male athletes (weight lifters, wrestlers, orienteers, and ice-hockey players) and 21 non-athletes were randomly selected, for a baseline MRI study. After 15 years all the participants at baseline were invited to take part in a follow-up examination, including a questionnaire on back pain and a follow-up MRI examination. Thirty-two athletes and all non-athletes had disc height reduction at one or several disc levels. Disc degeneration was found in more than 90% of the athletes and deterioration had occurred in 88% of the athletes, with the highest frequency in weight lifters and ice-hockey players. 78% of the athletes and 38% of the non-athletes reported previous or present history of back pain at baseline and 71 and 75%, respectively at follow-up. There was no statistically significant correlation between back pain and MRI changes. In conclusion, athletes in sports with severe or moderate demands on the back run a high risk of developing disc degeneration and other abnormalities of the spine on MRI and they report high frequency of back pain. The study confirmed our hypothesis, i.e. that most of the spinal abnormalities in athletes seem to occur during the growth spurt, since the majority of the abnormalities demonstrated at follow-up MRI after the sports career were present already at baseline. The abnormalities found at young age deteriorated to a varying degree during the 15-year follow-up, probably due to a combination of continued high load sporting activities and normal ageing. Preventive measures should be considered to avoid the development of these injuries in young athletes. PMID:19305975
Baranto, Adad; Hellstr�m, Mikael; Cederlund, C-G; Nyman, Rickard; Sw�rd, Leif
Injuries of the cervical spine.
There has been a world-wide increase in serious neck injuries. Better understanding of the altered physiology of spinal man, and the employment of the appropriate supportive measures, has led to a lessening in morbidity. These general measures and the indications for surgery are discussed. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 PMID:6691691
McSweeney, T.
Although a variety of biomechanical laboratory investigations and radiological studies have highlighted the potential problems\\u000a associated with total lumbar disc replacement (TDR), no previous study has performed a systematic clinical failure analysis.\\u000a The aim of this study was to identify the post-operative pain sources, establish the incidence of post-operative pain patterns\\u000a and investigate the effect on post-operative outcome with the
Christoph J. Siepe; Andreas Korge; Frank Grochulla; Christoph Mehren; H. Michael Mayer
Background To improve residual pain management in acute cervical radiculopathy treated with NSAIDs, the feasibility of early and repeated low-dose interscalene brachial plexus block (IS-BPB) needs to be assessed. Methods This was a prospective study on patients receiving NSAIDs (loxoprofen) for cervical radiculopathy of ? 2-week onset. Pain was assessed using the visual analogue scale (VAS). A low-dose ultrasonography (USG)-guided IS-BPB (dexamethasone [1.65 mg; 0.5 ml] and mepivacaine [1%; 3.0 ml]) was performed at baseline and weekly thereafter for 4 weeks in an outpatient setting for the intervention group. All patients were evaluated using a visual satisfaction score (VSS) at week 4. Patients with baseline VAS scores < 70 (mild to moderate pain; MM group) and ? 70 (severe pain; SE group) were compared to the controls receiving NSAIDs. Results A total of 316 IS-BPBs were performed in the intervention group. There was a significant difference in the decline in the VAS from week 0 to week 3 in the MM and SE groups (P < 0.05); however, from week 3 to week 4, the therapeutic effect exhibited no significant difference. Thirteen patients at week 2 (15.5%; MM: 27.7%; SE: 0%), 43 at week 3 (51.2%; MM: 83.0%; SE: 10.8%), and 47 at week 4 (56.0%; MM: 85.1%; SE: 18.9%) achieved a VAS score of ? 20. Patient satisfaction was high, and the decrease in VAS scores in both groups was significant (P < 0.05) compared to the controls. Conclusions Weekly, low-dose, USG-guided IS-BPB can be implemented for early pain relief in acute cervical radiculopathy, with high patient satisfaction. PMID:24748940
Mitoro, Mari; Kuzumoto, Naoya
Objective The purpose of this study was to evaluate the efficacy of manipulative and manual therapy treatments with regard to pain perception and neck mobility in patients with tension-type headache. Methods A randomized clinical trial was conducted on 84 adults diagnosed with tension-type headache. Eighty-four subjects were enrolled in this study: 68 women and 16 men. Mean age was 39.76 years, ranging from 18 to 65 years. A total of 57.1% were diagnosed with chronic tension-type headache and 42.9% with tension-type headache. Participants were divided into 3 treatment groups (manual therapy, manipulative therapy, a combination of manual and manipulative therapy) and a control group. Four treatment sessions were administered during 4 weeks, with posttreatment assessment and follow-up at 1 month. Cervical ranges of motion pain perception, and frequency and intensity of headaches were assessed. Results All 3 treatment groups showed significant improvements in the different dimensions of pain perception. Manual therapy and manipulative treatment improved some cervical ranges of motion. Headache frequency was reduced with manipulative treatment (P < .008). Combined treatment reported improvement after the treatment (P < .000) and at follow-up (P < .002). Pain intensity improved after the treatment and at follow-up with manipulative therapy (P < .01) and combined treatment (P < .01). Conclusions Both treatments, administered both separately and combined together, showed efficacy for patients with tension-type headache with regard to pain perception. As for cervical ranges of motion, treatments produced greater effect when separately administered. PMID:24711779
Gemma V., Espi-Lopez; Antonia, Gomez-Conesa
The spine, in athletes is a relatively frequent origin of problems. Chronic spine problems are much more common compared to acute injuries. Chronic injuries to the spine most often occur in low-contact sports like gymnastics and are most commonly the result of overuse. Acute injuries are more common in high-speed and full contact sports and are traumatic in origin. Injuries to the spinal cord can be devastating but are fortunately very uncommon. Although imaging of the spine appears to be straightforward, any radiologist will acknowledge that the optimal imaging strategy is often unclear due to several reasons. For the cervical spine much has improved since the NEXUS and CCR studies appeared in which clear rules were defined when to image the C-spine in acute trauma situations. For the thoracic and lumbar spines such rules are not defined. Although conventional imaging has long been the primary imaging modality of choice there is ample evidence that this should be abandoned in favor of multidetector CT for the C-spine. This is reflected in the ACR criteria in which conventional imaging of tile C-spine in trauma is rated as the least appropriate imaging method. However, this is not true in children and adolescents although a strict age criterion is not defined. It is also not true for injuries to the thoracic and lumbar spine in which conventional imaging still plays a large role as primary imaging modality followed by evaluation by CT in trauma situations. The role for MRI in acute situations is increasing especially with the increasing use of the TLICS system to classify injuries of the thoracic and lumbar spine in which the evaluation of the integrity of the posterior ligamentous structures is included. For the evaluation of chronic complaints, the roles of CT and MRI are basically reversed in which MRI will become the prime imaging modality of choice after conventional imaging after which CT can be reserved for a selected patient group. The merit of the different imaging modalities will be discussed together with a spectrum of acute and chronic injuries often encountered in the spine in athletes. PMID:24896742
de Jonge, Milko C; Kramer, Josef
NASA Technical Reports Server (NTRS)
In high-performance aircraft, the need for total environmental awareness coupled with high-g loading (often with abrupt onset) creates a predilection for cervical spine injury while the pilot is performing routine movements within the cockpit. In this study, the prevalence and severity of cervical spine injury are assessed via a modified cross-sectional survey of pilots of multiple aircraft types (T-38 and F-14, F-16, and F/A-18 fighters). Ninety-five surveys were administered, with 58 full responses. Fifty percent of all pilots reported in-flight or immediate post-flight spine-based pain, and 90% of fighter pilots reported at least one event, most commonly (> 90%) occurring during high-g (> 5 g) turns of the aircraft with the head deviated from the anatomical neutral position. Pre-flight stretching was not associated with a statistically significant reduction in neck pain episodes in this evaluation, whereas a regular weight training program in the F/A-18 group approached a significant reduction (mean = 2.492; p < 0.064). Different cockpit ergonomics may vary the predisposition to cervical injury from airframe to airframe. Several strategies for prevention are possible from both an aircraft design and a preventive medicine standpoint. Countermeasure strategies against spine injury in pilots of high-performance aircraft require additional research, so that future aircraft will not be limited by the human in control.
Jones, J. A.; Hart, S. F.; Baskin, D. S.; Effenhauser, R.; Johnson, S. L.; Novas, M. A.; Jennings, R.; Davis, J.
Context: Surgery for the rheumatoid cervical spine has been shown to stabilize the unstable spine; arrest/improve the progression of neurological deficit, help neck pain, and possibly decelerate the degenerative disease process. Operative intervention for the rheumatoid spine has significantly changed over the last 30 years. Aims: The purpose of this study was to review all cases of cervical rheumatoid spine requiring surgical intervention in a single unit over the last 30 years. Materials and Methods: A prospectively-maintained spine database was retrospectively searched for all cases of rheumatoid spine, leading to a review of indications, imaging, Ranawat and Myelopathy Disability Index measures, surgical morbidity, and survival curve analysis. Results: A total of 224 cases were identified between 1981 and 2011. Dividing the data into three time-epochs, there has been a significant increase in the ratio of segment-saving Goel-Harms C1-C2: Occipitocervical fixation (OCF) surgery and survival has increased between 1981 and 2011 from 30% to 51%. Patients undergoing C1-C2 fixation were comparatively less myelopathic and in a better Ranawat class preoperatively, but postoperative outcome measures were well-preserved with favorable mortality rates over mean 39.6 months of follow-up. However, 11% of cases required OCF at mean 28 months post-C1-C2 fixation, largely due to instrumentation failure (80%). Conclusion: We present the largest series of surgically managed rheumatoid spines, revealing comparative data on OCF and C1-C2 fixation. Although survival has improved over the last 30 years, there have been changes in medical, surgical and perioperative management over that period of time too confounding the interpretation; however, the analysis presented suggests that rheumatoid patients presenting early in the disease process may benefit from C1 to C2 fixation, albeit with a proportion requiring OCF at a later time. PMID:25013346
Bhatia, Robin; Haliasos, Nikolas; Vergara, Pierluigi; Anderson, Caroline; Casey, Adrian
The aim of this study was to evaluate spatial organization of hyperactive microglial cells in trigeminal spinal subnucleus caudalis (Vc) and upper cervical spinal cord (C1), and to clarify the involvement in mechanisms underlying orofacial secondary hyperalgesia following infraorbital nerve injury. We found that the head-withdrawal threshold to non-noxious mechanical stimulation of the maxillary whisker pad skin was significantly reduced in chronic constriction injury of the infraorbital nerve (ION-CCI) rats from day 1 to day 14 after ION-CCI. On day 3 after ION-CCI, mechanical allodynia was obvious in the orofacial skin areas innervated by the 1st and 3rd branches of the trigeminal nerve as well as the 2nd branch area. Hyperactive microglial cells in Vc and C1 were observed on days 3 and 7 after ION-CCI. On day 3 after ION-CCI, a large number of phosphorylated extracellular signal-regulated kinase (pERK)-immunoreactive (IR) cells were observed in Vc and C1. Many hyperactive microglial cells were also distributed over a wide area of Vc and C1 innervated by the trigeminal nerve. The intraperitoneal administration of minocycline significantly reduced the activation of microglial cells and the number of pERK-IR cells in Vc and C1, and also significantly attenuated the development of mechanical allodynia. Furthermore, enhanced background activity and mechanical evoked responses of Vc wide dynamic range neurons in ION-CCI rats were significantly reversed following minocycline administration. These findings suggest that activation of microglial cells over a wide area of Vc and C1 is involved in the enhancement of Vc and C1 neuronal excitability in the early period after ION-CCI, resulting in the neuropathic pain in orofacial areas innervated by the injured as well as uninjured nerves. PMID:22459040
Shibuta, Kazuo; Suzuki, Ikuko; Shinoda, Masamichi; Tsuboi, Yoshiyuki; Honda, Kuniya; Shimizu, Noriyoshi; Sessle, Barry J; Iwata, Koichi
Purpose?The purpose of this report is to describe the clinical course of a patient who had a primary complaint of isolated right lateral thigh pain 3 years prior that was nonresponsive to conservative measures. Hypoesthesia in the lateral side of the right forearm, deltoid and biceps, as well as triceps paresis, was also diagnosed. Results?Immediately after surgery, the patient reported substantial improvement in his right thigh symptoms. The signs and symptoms associated with the right C6 and C7 radiculopathy did improve. Conclusion?Although the presentation described in this case is somewhat unique, the eventual myelopathic signs and symptoms were not. It was these myelopathic signs and symptoms that led to cervical magnetic resonance imaging, the diagnosis of cervical cord compressive myelopathy, and surgical management. PMID:24303344
Akhavan-Sigari, R; Rohde, V; Alaid, A
Cervical spine immobilisation can make direct laryngoscopy difficult, which might lead to airway complications. This randomised control trial compared the time to successful intubation using either the Macintosh laryngoscope or the McGrath(�) Series 5 videolaryngoscope in 128 patients who had cervical immobilisation applied. Intubation difficulty score, Cormack & Lehane laryngoscopic view, intubation failures, changes in cardiovascular variables and the incidence of any complications were recorded. The mean (SD) successful intubation time with the Macintosh laryngoscope was significantly shorter compared with the McGrath laryngoscope, 50.0 (32.6)�s vs 82.7 (80.0)�s, respectively (p�=�0.0003), despite the McGrath laryngoscope's having a lower intubation difficulty score and a superior glottic view. There were five McGrath laryngoscope intubation failures, three owing to difficulty in passing the tracheal tube and two to equipment malfunction. Equipment malfunction is a major concern as a reliable intubating device is vital when faced with an airway crisis. PMID:25087907
Ilyas, S; Symons, J; Bradley, W P L; Segal, R; Taylor, H; Lee, K; Balkin, M; Bain, C; Ng, I
Background Neck pain caused by cervical spondylosis (CS) has become one of the most common health problems around the world. Electroacupuncture (EA) has been employed to relieve CS neck pain, but there is limited clinical evidence for its effectiveness. Methods/Design This study consists of a randomized controlled trial (RCT) with two parallel arms: an acupuncture group and an EA group. Both groups will receive acupuncture at Jing-jiaji points for 30�minutes each time, for five sessions per week for a total of 20 sessions during this four-week period. In addition, the EA group will be connected with EA apparatus. The following outcome measurements will be used in examination of subjects: the Northwick Park Neck Pain Questionnaire (NPQ), McGill Pain Questionnaire (MPQ), and Short-Form 36 (SF-36) scale. All these outcomes will be examined at the start of the study, at the end of the second week, at four weeks after randomization, and one and three months after treatment cessation respectively. Discussion This study aims to assess the efficacy of EA, compared with acupuncture intervention at Jing-jiaji points for the CS neck pain. Trial registration Chinese Clinical Trials Register: ChiCTR-TRC-13003422. PMID:24168460
The present study was designed to estimate the influence of various modalities of therapeutic exercises on the static component of the motor stereotype in 200 patients presenting with cervical myofascial pain syndrome. The study was performed with the use of computed optical topography. The course of therapeutic exercises included 10 sessions of the total duration of 14 days. It is concluded based on the data obtained in this study that remedial gymnastics based on the understanding of the internal body model ("body scheme") with the use of static symmetric exercises is 2.7 times as effective as the traditional approach. PMID:24665596
Mel'nikova, E Iu; Khodasevich, L S; Poliakova, A V; Bartashevich, V V
Cervical chordoma. A case report and differential diagnosis.
Chordomas are rare and aggressive tumors derived from notochordal remnants, usually arising in the axial skeleton. The most frequently reported anatomic distribution of chordoma is 50% sacral, 35% spheno-occipital and 15% spinal. We describe the case of an elderly lady presenting with progressive dysphagia, headache and neck pain. We found an expansile mass extending from C1 to C3. While running the diagnostic plan we considered a variety of lesions possibly involving the cervical spine. Biopsy revealed the mass was a chordoma. PMID:24028912
Conforti, R; Taglialatela, G; Rinaldi, F; Quaranta, E; Cirillo, M; Paolisso, G
Objective The purpose of this case series is to describe findings for patients with bladder pain syndrome (BPS) or interstitial cystitis (IC) who responded positively under chiropractic care. Clinical Features Eight cases were selected retrospectively reviewed from 2 independent chiropractic clinics in Scotland. Cases were selected if patients reported bladder dysfunction problems and responded positively to chiropractic care. The cases in this report describe the range of patients affected by this condition. Each patient was treated using chiropractic methods that were specific to the individual case. Intervention and Outcomes The patients selected for this case series showed positive response to chiropractic care over various lengths of time and numbers of treatments. Some of the chiropractic patients who had chronic spinal conditions had reoccurrence of bladder symptoms during an exacerbation of mechanical spinal problems. Conclusion This case series highlights that bladder and urinary problems may be associated with spinal dysfunction for some patients. PMID:23843758
Cashley, Mark A.P.; Cashley, Marie A.
Background This study evaluates the outcome and complications of decompressive cervical Laminectomy and lateral mass screw fixation in 110 cases treated for variable cervical spine pathologies that included; degenerative disease, trauma, neoplasms, metabolic-inflammatory disorders and congenital anomalies. Methods A retrospective review of total 785 lateral mass screws were placed in patients ages 16-68 years (40 females and 70 males). All cases were performed with a polyaxial screw-rod construct and screws were placed by using Anderson-Sekhon trajectory. Most patients had 12-14-mm length and 3.5 mm diameter screws placed for subaxial and 28-30 for C1 lateral mass. Screw location was assessed by post operative plain x-ray and computed tomography can (CT), besides that; the facet joint, nerve root foramen and foramen transversarium violation were also appraised. Results No patients experienced neural or vascular injury as a result of screw position. Only one patient needed screw repositioning. Six patients experienced superficial wound infection. Fifteen patients had pain around the shoulder of C5 distribution that subsided over the time. No patients developed screw pullouts or symptomatic adjacent segment disease within the period of follow up. Conclusion decompressive cervical spine laminectomy and Lateral mass screw stabilization is a technique that can be used for a variety of cervical spine pathologies with safety and efficiency. PMID:21595968
Subacute Cervical Myelopathy in a Child with Cerebral Palsy
A 12-year-old girl with a spastic dystonic tetraparesis due to cerebral palsy showed a subacute cervical myelopathy. X-ray films of the cervical spine demonstrated a subluxation of C4 on C5. Myelography and computerized tomography of the cervical spine performed under general anesthesia demonstrated only a minimal rotation of C3 with respect to C4 and a rather narrow cervical canal. In
L. Angelini; G. Broggi; N. Nardocci; M. Savoiardo
Cerebrospinal fluid (CSF) dynamics in the cervical spinal subarachnoid space (SSS) have been thought to be important to help diagnose and assess craniospinal disorders such as Chiari I malformation (CM). In this study we obtained time-resolved three directional velocity encoded phase-contrast MRI (4D PC MRI) in three healthy volunteers and four CM patients and compared the 4D PC MRI measurements to subject-specific 3D computational fluid dynamics (CFD) simulations. The CFD simulations considered the geometry to be rigid-walled and did not include small anatomical structures such as nerve roots, denticulate ligaments and arachnoid trabeculae. Results were compared at nine axial planes along the cervical SSS in terms of peak CSF velocities in both the cranial and caudal direction and visual interpretation of thru-plane velocity profiles. 4D PC MRI peak CSF velocities were consistently greater than the CFD peak velocities and these differences were more pronounced in CM patients than in healthy subjects. In the upper cervical SSS of CM patients the 4D PC MRI quantified stronger fluid jets than the CFD. Visual interpretation of the 4D PC MRI thru-plane velocity profiles showed greater pulsatile movement of CSF in the anterior SSS in comparison to the posterior and reduction in local CSF velocities near nerve roots. CFD velocity profiles were relatively uniform around the spinal cord for all subjects. This study represents the first comparison of 4D PC MRI measurements to CFD of CSF flow in the cervical SSS. The results highlight the utility of 4D PC MRI for evaluation of complex CSF dynamics and the need for improvement of CFD methodology. Future studies are needed to investigate whether integration of fine anatomical structures and gross motion of the brain and/or spinal cord into the computational model will lead to a better agreement between the two techniques. PMID:23284970
Yiallourou, Theresia I; Kr�ger, Jan Robert; Stergiopulos, Nikolaos; Maintz, David; Martin, Bryn A; Bunck, Alexander C
Back Pain and Emotional Distress
North American Spine Society Public Education Series Back Pain and Emotional Distress Common Reactions to Back Pain Four out of five adults will experience an episode of significant back pain sometime during ...
Cervical motion segment replacement
When symptoms bring to light a cervical spine degenerative disc process that requires surgical intervention, a symptom relieving procedure such as decompression, followed by functional restoration, arthroplasty, offers the benefit of prophylaxis of accelerated spondylosis at the operated level. In addition, by altering the biomechanical stress factors at adjacent levels, theoretically it should offer prophylactic benefit at these levels as
Vincent E. Bryan Jr; J Goffin; A Casey; P Kehr; K Liebig; C Logroscino; F Van Calenbergh; J van Loon; Universitaire Ziekenhuizen
Study Design Case-control. Objective To characterize the motion path of the instant center of rotation (ICR) at each cervical motion segment from C2 to C7 during dynamic flexion-extension in asymptomatic subjects. To compare asymptomatic and single-level arthrodesis patient ICR paths. Summary of Background Data The ICR has been proposed as an alternative to range of motion (ROM) for evaluating the quality of spine movement and for identifying abnormal midrange kinematics. The motion path of the ICR during dynamic motion has not been reported. Methods 20 asymptomatic controls, 12 C5/C6 and 5 C6/C7 arthrodesis patients performed full ROM flexion-extension while biplane radiographs were collected at 30 Hz. A previously validated tracking process determined three-dimensional vertebral position with sub-millimeter accuracy. The finite helical axis method was used to calculate the ICR between adjacent vertebrae. A linear mixed-model analysis identified differences in the ICR path among motion segments and between controls and arthrodesis patients. Results From C2/C3 to C6/C7, the mean ICR location moved superior for each successive motion segment (p < .001). The AP change in ICR location per degree of flexion-extension decreased from the C2/C3 motion segment to the C6/C7 motion segment (p < .001). Asymptomatic subject variability (95% CI) in the ICR location averaged �1.2 mm in the SI direction and �1.9 mm in the AP direction over all motion segments and flexion-extension angles. Asymptomatic and arthrodesis groups were not significantly different in terms of average ICR position (all p ? .091) or in terms of the change in ICR location per degree of flexion-extension (all p ? .249). Conclusions To replicate asymptomatic in vivo cervical motion, disc replacements should account for level-specific differences in the location and motion path of ICR. Single-level anterior arthrodesis does not appear to affect cervical motion quality during flexion-extension. PMID:23429677
Anderst, William; Baillargeon, Emma; Donaldson, William; Lee, Joon; Kang, James
Abstract The cervical facet joint and its capsule have been reported to be injured during whiplash scenarios and are a common source of chronic neck pain from whiplash. Both the metabotropic glutamate receptor 5 (mGluR5) and the excitatory amino acid carrier 1 (EAAC1) have pivotal roles in chronic pain. In this study, spinal mGluR5 and EAAC1 were quantified following painful facet joint distraction in a rat model of facet-mediated painful loading and were evaluated for their correlation with the severity of capsule loading. Rats underwent either a dynamic C6/C7 joint distraction simulating loading experienced during whiplash (distraction; n?=?12) or no distraction (sham; n?=?6) to serve as control. The severity of capsular loading was quantified using strain metrics, and mechanical allodynia was assessed after surgery. Spinal cord tissue was harvested at day 7 and the expression of mGluR5 and EAAC1 were quantified using Western blot analysis. Mechanical allodynia following distraction was significantly (p?0.001) higher than sham. Spinal expression of mGluR5 was also significantly (p?0.05) greater following distraction relative to sham. However, spinal EAAC1 was significantly (p?=?0.0003) reduced compared to sham. Further, spinal mGluR5 expression was significantly positively correlated to capsule strain (p?0.02) and mechanical allodynia (p?0.02). Spinal EAAC1 expression was significantly negatively related to one of the strain metrics (p?0.003) and mechanical allodynia at day 7 (p?=?0.03). These results suggest that the spinal glutamatergic system may potentiate the persistent behavioral hypersensitivity that is produced following dynamic whiplash-like joint loading; chronic whiplash pain may be alleviated by blocking mGluR5 expression and/or enhancing glutamate transport through the neuronal transporter EAAC1. PMID:19772459
Dong, Ling
Chronic neck pain and masticatory dysfunction.
Chronic nonspecific neck pain is a common problem in rheumatology and may resist conventional treatment. Pathophysiological links exist between the cervical spine and masticatory system. Occlusal disorders may cause neck pain and may respond to dental treatment. The estimated prevalence of occlusal disorders is about 45%, with half the cases being due to functional factors. Minor repeated masticatory dysfunction (MD) with craniocervical asymmetry is the most common clinical picture. The pain is usually located in the suboccipital region and refractory to conventional treatment. The time pattern may be suggestive, with nocturnal arousals or triggering by temporomandibular movements. MD should be strongly suspected in patients with at least two of the following: history of treated or untreated MD, unilateral temporomandibular joint pain and clicking, lateral deviation during mouth opening, and limitation of mouth opening (less than three fingerbreadths). Rheumatologists should consider MD among causes of neck pain, most notably in patients with abnormal craniocervical posture, signs linking the neck pain to mastication, and clinical manifestations of MD. Evidence suggesting that MD may cause neck pain has been published. However, studies are needed to determine whether treatment of MD can relieve neck pain. PMID:16226475
Catanzariti, Jean-Fran�ois; Debuse, Thierry; Duquesnoy, Bernard
Rosai-dorfman disease in thoracic spine: a rare case of compression fracture.
Sinus histiocytosis with massive lymphadenopathy known as Rosai-Dorfman disease is characterized by painless bilateral cervical lymphadenopathy. Extranodal manifestations are uncommon and spinal involvement is rare. A 15-year-old man presented with intermittent midthoracic back pain only. He had no specific findings on neurologic examinations, hematologic and biochemical laboratory tests. Radiological examination of thoracic spine revealed collapse of T6 vertebrae with thoracic kyphosis and osteolytic lesion of T12 vertebra body. He underwent a removal of bone tumor, anterior reconstruction with mesh and pedicle screw fixation via posterior approach for pathologic confirmation and stabilization. Histopathologic study of the lesion revealed focal infiltration of large histiocytes showing emperipolesis. Immunochemistry stain of histiocytes was positive for CD68 and S-100 but negative for CD1a. This report presents a rare case and literature review of extranodal Rosai-dorfman disease in thoracic spine. PMID:25346769
Kim, Do Young; Park, Ji Hye; Shin, Dong Ah; Yi, Seung; Ha, Yoon; Yoon, Do Heum; Kim, Keung Nyun
Rosai-Dorfman Disease in Thoracic Spine: A Rare Case of Compression Fracture
Sinus histiocytosis with massive lymphadenopathy known as Rosai-Dorfman disease is characterized by painless bilateral cervical lymphadenopathy. Extranodal manifestations are uncommon and spinal involvement is rare. A 15-year-old man presented with intermittent midthoracic back pain only. He had no specific findings on neurologic examinations, hematologic and biochemical laboratory tests. Radiological examination of thoracic spine revealed collapse of T6 vertebrae with thoracic kyphosis and osteolytic lesion of T12 vertebra body. He underwent a removal of bone tumor, anterior reconstruction with mesh and pedicle screw fixation via posterior approach for pathologic confirmation and stabilization. Histopathologic study of the lesion revealed focal infiltration of large histiocytes showing emperipolesis. Immunochemistry stain of histiocytes was positive for CD68 and S-100 but negative for CD1a. This report presents a rare case and literature review of extranodal Rosai-dorfman disease in thoracic spine. PMID:25346769
Kim, Do Young; Park, Ji Hye; Shin, Dong Ah; Yi, Seung; Ha, Yoon; Yoon, Do Heum; Kim, Keung Nyun
Neck pain is common in violin students during a musical performance. The purpose of this study was to compare electromyographic (EMG) activity in superficial neck muscles with neck motion when playing the violin as well as neck range of motion (ROM) at rest, between violin students with and without neck pain. Nine violin students with neck pain and nine age- and gender-matched subjects without neck pain were recruited. Muscle activity of the bilateral upper trapezius, sternocleidomastoid, and superficial cervical extensor muscles was measured using surface EMG. Kinematic data on neck motion while playing and active neck ROM were also measured using a three-dimensional motion analysis system. Independent t-tests were used to compare EMG activity with kinematic data between groups. These analyses revealed that while playing, both the angle of left lateral bending and leftward rotation of the cervical spine were significantly greater in the neck pain group than among those without neck pain. Similarly, EMG activity of the left upper trapezius, both cervical extensors, and both sternocleidomastoid muscles were significantly greater in the neck pain group. The active ROM of left axial rotation was significantly lower in the neck pain group. These results suggest that an asymmetric playing posture and the associated increased muscle activity as well as decreased neck axial rotation may contribute to neck pain in violin students. PMID:23247874
Park, Kyue-nam; Kwon, Oh-yun; Ha, Sung-min; Kim, Su-jung; Choi, Hyun-jung; Weon, Jong-hyuck
Elevated peak inspiratory airway pressure (PIP) can occur during general anesthesia and is usually easily rectified. In rare circumstances it can lead to potentially fatal conditions such as tension pneumothorax. We report on a 77-year-old male patient admitted for a cervical laminoplasty. The preoperative chest radiograph showed normal findings and there was no medical history of allergy or underlying airway inflammation. Anesthesia induction and maintenance progressed uneventfully. However, 5 minutes after prophylactic antibiotic administration, PIP suddenly increased and blood pressure dropped. The operation was abandoned and the patient was moved to a supine position to perform chest radiography. Cardiac arrest occurred, and cardiopulmonary resuscitation was performed. The radiograph showed bilateral tension pneumothorax. Needle aspiration was immediately performed, and chest tubes were inserted. Ventilation rapidly improved and the vital signs normalized. The patient was discharged without sequelae on postoperative day 36. PMID:21716569
Lee, Jae-Young; Kim, Joung Uk; An, Eun-Hye; Song, Eun
Invasive stimulation of the motor (precentral) cortex using surgically implanted epidural electrodes is indicated for the treatment of neuropathic pain that is refractory to medical treatment. Controlled trials have demonstrated the efficacy of epidural motor cortex stimulation (MCS), but MCS outcome remains variable and validated criteria for selecting good candidates for implantation are lacking. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive approach that could be used as a preoperative tool to predict MCS outcome and also could serve as a therapeutic procedure in itself to treat pain disorders. This requires repeated rTMS sessions and a maintenance protocol. Other studies have also demonstrated the efficacy of transcranial direct current stimulation (tDCS) in relieving chronic pain syndromes. The most studied target is the precentral cortex, but other targets, such as the prefrontal and parietal cortices, could be of interest. The analgesic effects of cortical stimulation relate to the activation of various circuits modulating neural activities in remote structures, such as the thalamus, limbic cortex, insula, or descending inhibitory controls. In addition to the treatment of refractory neuropathic pain by epidural MCS, new developments of this type of strategy are ongoing, for other types of pain syndrome and stimulation techniques. PMID:24112914
Lefaucheur, Jean-Pascal
Minimally Invasive Cervical Foraminotomy and Decompression of Stenosis
\\u000a Many types of degenerative cervical spine disease can be treated with well-established posterior decompressive procedures.1�4 Even as anterior cervical procedures have gained prominence, posterior cervical laminoforaminotomy still provides symptomatic\\u000a relief in 92�97% of patients with radiculopathy from foraminal stenosis or lateral herniated discs.3, 5 Similarly, posterior cervical decompression for cervical stenosis achieves neurological improvement in 62.5�83% of myelopathic\\u000a patients undergoing
John E. O�Toole; Kurt M. Eichholz; Richard G. Fessler
Artificial Discs for Lumbar and Cervical Degenerative Disc Disease -Update
Executive Summary Objective To assess the safety and efficacy of artificial disc replacement (ADR) technology for degenerative disc disease (DDD). Clinical Need Degenerative disc disease is the term used to describe the deterioration of 1 or more intervertebral discs of the spine. The prevalence of DDD is roughly described in proportion to age such that 40% of people aged 40 years have DDD, increasing to 80% among those aged 80 years or older. Low back pain is a common symptom of lumbar DDD; neck and arm pain are common symptoms of cervical DDD. Nonsurgical treatments can be used to relieve pain and minimize disability associated with DDD. However, it is estimated that about 10% to 20% of people with lumbar DDD and up to 30% with cervical DDD will be unresponsive to nonsurgical treatments. In these cases, surgical treatment is considered. Spinal fusion (arthrodesis) is the process of fusing or joining 2 bones and is considered the surgical gold standard for DDD. Artificial disc replacement is the replacement of the degenerated intervertebral disc with an artificial disc in people with DDD of the lumbar or cervical spine that has been unresponsive to nonsurgical treatments for at least 6 months. Unlike spinal fusion, ADR preserves movement of the spine, which is thought to reduce or prevent the development of adjacent segment degeneration. Additionally, a bone graft is not required for ADR, and this alleviates complications, including bone graft donor site pain and pseudoarthrosis. It is estimated that about 5% of patients who require surgery for DDD will be candidates for ADR. Review Strategy The Medical Advisory Secretariat conducted a computerized search of the literature published between 2003 and September 2005 to answer the following questions: What is the effectiveness of ADR in people with DDD of the lumbar or cervical regions of the spine compared with spinal fusion surgery? Does an artificial disc reduce the incidence of adjacent segment degeneration (ASD) compared with spinal fusion? What is the rate of major complications (device failure, reoperation) with artificial discs compared with surgical spinal fusion? One reviewer evaluated the internal validity of the primary studies using the criteria outlined in the Cochrane Musculoskeletal Injuries Group Quality Assessment Tool. The quality of concealment allocation was rated as: A, clearly yes; B, unclear; or C, clearly no. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the overall quality of the body of evidence (defined as 1 or more studies) supporting the research questions explored in this systematic review. A random effects model meta-analysis was conducted when data were available from 2 or more randomized controlled trials (RCTs) and when there was no statistical and or clinical heterogeneity among studies. Bayesian analyses were undertaken to do the following: Examine the influence of missing data on clinical success rates; Compute the probability that artificial discs were superior to spinal fusion (on the basis of clinical success rates); Examine whether the results were sensitive to the choice of noninferiority margin. Summary of Findings The literature search yielded 140 citations. Of these, 1 Cochrane systematic review, 1 RCT, and 10 case series were included in this review. Unpublished data from an RCT reported in the grey literature were obtained from the manufacturer of the device. The search also yielded 8 health technology assessments evaluating ADR that are also included in this review. Six of the 8 health technology assessments concluded that there is insufficient evidence to support the use of either lumbar or cervical ADR. The results of the remaining 2 assessments (one each for lumbar and cervical ADR) led to a National Institute for Clinical Excellence guidance document supporting the safety and effectiveness of lumbar and cervical ADR with the proviso that an ongoing audit of all clinical outcomes be undertaken owing to a lack of long-term outcome data from clinical trials. Regard
Low back pain is one of the most common health problems globally, having significant impact on individuals, community, and health care system. Lumbar Spine Surgery (LSS) is usually considered a treatment of low back pain ...
Kanaan, Saddam
Introduction?Microendoscopic techniques through a unilateral paramedian approach or muscle-preserving techniques using a microscope have been reported as minimally invasive spinal decompression procedures for the cervical spine. In this study, we developed a novel technique, cervical microendoscopic interlaminar decompression (CMID) through a midline approach, for treating cervical compression myelopathy. Methods?A total of 29 consecutive patients with single- or two-level cervical compression myelopathy were reviewed. For the single-level cases (e.g., C5-C6), a midline skin incision, ? 2 cm in length, was made at the spinal level to be decompressed (C5-C6) under fluoroscopic guidance. The nuchal ligament was longitudinally cut, and tips of the spinous processes (C5 and C6) were exposed. A 16-mm tubular retractor was inserted between the tips of the C5 and C6 spinous processes. A dome-like laminectomy of C5, partial laminectomy of the upper part of C6, and flavectomy were performed. For the two-level cases (e.g., C4-C5 and C5-C6), the decompression procedure was completed by splitting the spinous process (C5). Pre- and postoperative neurologic status was evaluated using the Japanese Orthopedic Association (JOA) score. Neck and arm pain was also evaluated using a numerical rating scale (NRS). Results?Overall, 10 patients underwent single-level decompression, and 19 patients underwent two-level decompression. The average age was 67 years (range: 40-83 years), and the mean follow-up period was 11 months (range: 4-14 months). The average pre- and postoperative JOA scores were 10.2 and 13.5, with a mean recovery rate of 49%. The mean preoperative and postoperative NRS scores were 3.5 and 1.5 for neck pain and 4.6 and 2.9 for arm pain, respectively. One patient showed transient mild weakness of the leg that recovered neurologically within a few weeks. No other postoperative complications were observed. Conclusion?This procedure revealed good short-term surgical results. This technique has advantages including (1) a symmetrical orientation of the surgical field, (2) an intermuscular incision that minimizes blood loss and muscle trauma, and (3) the ability to safely complete the decompression procedure without retracting the cervical spinal cord compared with the unilateral approach. Although long-term surgical results are required, this technique is not only safe but also minimally invasive as a treatment for cervical compression myelopathy. PMID:24819630
Oshima, Yasushi; Takeshita, Katsushi; Inanami, Hirohiko; Takano, Yuichi; Koga, Hisashi; Iwahori, Tomoyuki; Baba, Satoshi; Tanaka, Sakae
Pathophysiology and Biomechanics of the Aging Spine
Aging of the spine is characterized by two parallel but independent processes: the reduction of bone mineral density and the development of degenerative changes. The combination of degeneration and bone mass reduction contribute, to a different degree, to the development of a variety of lesions. This results in a number of painful and often debilitating disorders. The present review constitutes a synopsis of the pathophysiological processes that take place in the aging spine as well as of the consequences these changes have on the biomechanics of the spine. The authors hope to present a thorough yet brief overview of the process of aging of the human spine. PMID:21966338
Papadakis, Michael; Sapkas, Georgios; Papadopoulos, Elias C; Katonis, Pavlos
Pott's Spine: Diagnostic Imaging Modalities and Technology Advancements.
Spinal tuberculosis (TB) or Pott's spine is the commonest extrapulmonary manifestation of TB. It spreads through hematogenous route. Clinically, it presents with constitutional symptoms, back pain, tenderness, paraplegia or paraparesis, and kyphotic or scoliotic deformities. Pott's spine accounts for 2% of all cases of TB, 15% of extrapulmonary, and 50% of skeletal TB. The paradiscal, central, anterior subligamentous, and neural arch are the common vertebral lesions. Thoracic vertebrae are commonly affected followed by lumbar and cervical vertebrae. Plain radiographs are usually the initial investigation in spinal TB. For a radiolucent lesion to be apparent on a plain radiograph there should be 30% of bone mineral loss. Computed tomographic scanning provides much better bony detail of irregular lytic lesions, sclerosis, disc collapse, and disruption of bone circumference than plain radiograph. Magnetic resonance imaging (MRI) is the best diagnostic modality for Pott's spine and is more sensitive than other modalities. MRI frequently demonstrates disc collapse/destruction, cold abscess, vertebral wedging/collapse, marrow edema, and spinal deformities. Ultrasound and computed tomographic guided needle aspiration or biopsy is the technique for early histopathological diagnosis. Recently, the coexistence of human immunodeficiency virus infections and TB has been increased globally. In recent years, diffusion-weighted MRI (DW-MRI) and apparent diffusion coefficient values in combination with MRI are used to some extent in the diagnosis of spinal TB. We have reviewed related literature through internet. The terms searched on Google scholar and PubMed are TB, extrapulmonary TB, skeletal TB, spinal TB, Pott's spine, Pott's paraplegia, MRI, and computed tomography (CT). PMID:24020048
Ansari, Sajid; Amanullah, Md Farid; Ahmad, Kaleem; Rauniyar, Raj Kumar
Pott's Spine: Diagnostic Imaging Modalities and Technology Advancements
Spinal tuberculosis (TB) or Pott's spine is the commonest extrapulmonary manifestation of TB. It spreads through hematogenous route. Clinically, it presents with constitutional symptoms, back pain, tenderness, paraplegia or paraparesis, and kyphotic or scoliotic deformities. Pott's spine accounts for 2% of all cases of TB, 15% of extrapulmonary, and 50% of skeletal TB. The paradiscal, central, anterior subligamentous, and neural arch are the common vertebral lesions. Thoracic vertebrae are commonly affected followed by lumbar and cervical vertebrae. Plain radiographs are usually the initial investigation in spinal TB. For a radiolucent lesion to be apparent on a plain radiograph there should be 30% of bone mineral loss. Computed tomographic scanning provides much better bony detail of irregular lytic lesions, sclerosis, disc collapse, and disruption of bone circumference than plain radiograph. Magnetic resonance imaging (MRI) is the best diagnostic modality for Pott's spine and is more sensitive than other modalities. MRI frequently demonstrates disc collapse/destruction, cold abscess, vertebral wedging/collapse, marrow edema, and spinal deformities. Ultrasound and computed tomographic guided needle aspiration or biopsy is the technique for early histopathological diagnosis. Recently, the coexistence of human immunodeficiency virus infections and TB has been increased globally. In recent years, diffusion-weighted MRI (DW-MRI) and apparent diffusion coefficient values in combination with MRI are used to some extent in the diagnosis of spinal TB. We have reviewed related literature through internet. The terms searched on Google scholar and PubMed are TB, extrapulmonary TB, skeletal TB, spinal TB, Pott's spine, Pott's paraplegia, MRI, and computed tomography (CT). PMID:24020048
Ansari, Sajid; Amanullah, Md. Farid; Ahmad, Kaleem; Rauniyar, Raj Kumar
Single level cervical arthroplasty with the Discocerv prosthesis: a preliminary report.
The authors conducted a prospective nonrandomised study about a new cervical disc prosthesis: the Discocerv Cervidisc Evolution. Fourteen patients (10 men and 4 women) were treated at a single mobile level, between July 2006 and November 2008. Their mean age was 40.8 years (range 31-56), and the mean clinical follow-up period was 12.8 months (range 9-18). Diagnosis was disc herniation (n = 12) and stenosis (n = 2). The VAS for neck pain, the VAS for radiating pain and the Neck Disability Index decreased significantly at last followup (p <0.05). According to Odom's criteria 81.6% of the patients had a good or excellent outcome. The range of movement of the cervical spine as a whole and of the treated functional segmental unit were preserved at final follow-up, which suggests that the disc prosthesis might prevent osteoarthritis at adjacent levels. The neutral sagittal alignment of the cervical spine as a whole and of the functional spinal unit showed kyphosis shortly after surgery, but lordosis was practically restored at final follow-up. PMID:21667735
Enan, Ahmed; Abu-Hegazy, Mohammad; Abo-Hegy, Mohamed; Al-Kerdany, Ashraf
Cervical motion segment replacement.
When symptoms bring to light a cervical spine degenerative disc process that requires surgical intervention, a symptom relieving procedure such as decompression, followed by functional restoration, arthroplasty, offers the benefit of prophylaxis of accelerated spondylosis at the operated level. In addition, by altering the biomechanical stress factors at adjacent levels, theoretically it should offer prophylactic benefit at these levels as well. The design requirements for a cervical disc prosthesis, the importance of precision instrumentation, and technique are described. Mechanical testing, animal testing, the study design for the EU clinical study, and the operative technique are discussed. The clinical 1- and 2-year data to date are presented. PMID:12384728
Bryan, Vincent E
An intradural cervical chordoma mimicking schwannoma
Abstract: Chordoma is a relatively rare tumor originating from the embryonic remnants of the notochord. This is an aggressive, slow growing and invasive tumor. It occurs mostly at the two ends of neuroaxis which is more frequent in the sacrococcygeal region. Chordoma in vertebral column is very rare. This tumor is extradural in origin and compresses neural tissues and makes the patient symptomatic. This tumor found extremely rare in the spinal region as an intradural tumor. The present study reports a rare case of intradural chordoma tumor as well as its clinical manifestations and treatment options. Case: The patient was a 50-year-old female presented with 9 months history of progressively worsening neck pain, cervical spine chordoma resembling neurinoma and right arm numbness. Physical examination showed no weakness in her limbs, but she had upward plantar reflex and mild hyperreflexia. In a magnetic resonance imaging (MRI) scan of the cervical spine there was an ill-defined enhancing mass in the posterior aspect of C2-C3 body caused cord compression more severe in right side as well as foraminal scalloping. The patient underwent surgery and after midline posterior cervical incision and paravertebral muscle stripping a laminectomy was performed from C1 through C4 using a high speed drill. Needle biopsy revealed chordoma on frozen section and all of accessible parts of tumor were excised. The gross and microscopic histopathological appearance was consistent with chordoma. Chordomas are malignant tumors that arise from remains of embryonic notochord. These ectopic rests of notochord termed �ecchordosis physaliphora �can be found in approximately 2% of autopsies. These are aggressive, slow growing, locally invasive and destructive tumors those occur in the midline of neuroaxis. They generally thought to account for 2% to 4% of all primary bone neoplasms and 1% to 4% malignant bone neoplasms. They are the most frequent primary malignant spinal tumors after plasmacytomas. The incidence has been estimated to be 0.51 cases per million. The most common location is sacrococcygeal region followed by the clivus. These two locations account for approximately 90% of chordomas. Of the tumors that do not arise in the sacrum or clivus, half occur in the cervical region, with the remainder found in the lumbar or thoracic region, in descending order of frequency. Cervical spine chordomas account for 6% of all cases. Distal metastasis most often occurs in young patients, those with sacrococcygeal or vertebral tumors, and those with atypical histological features. These tumors usually spread to contiguous anatomical structures, but they may be found in distant sites (skin, musculoskeletal system, brain, and other internal organs). Seeding of the tumor has also been reported, and the likely mechanism seems to be tumor cell of contamination during the surgical procedures. The usual radiological findings in chordomas of spine are destructive or lytic lesions with occasional sclerotic changes. They tend to lie anterolateral, rather than dorsal towards the cord, and reportedly known to invade the dura. The midline location, destructive nature, soft tissue mass formation and calcification are the radiological hallmarks of chordomas. Computed Tomography (CT) scan is the best imaging modality to delineate areas of osteolytic, osteosclerotic, or mixed areas of bone destruction.Chordoma is usually known as a hypovascular tumor which grows in a lobulated manner. Septal enhancement which reflects a lobulated growth pattern is seen in both CT and MRI and even in gross examination. Other epidural tumors include neurinoma, neurofibroma, meningioma, neuroblastoma, hemangioma, lymphoma and metastases. Their differentiation from chordoma may be difficult due to the same enhancement pattern on CT and MRI. A dumbbell-shaped chordoma is a rare pathogenic condition. The dumbbell shape is a characteristic finding of neurinomas in spine but in spinal neurinomas extention to transverse foramina has not yet been reported. Although our case mimicked a
Samadian, Mohammad; Shafizad, Misagh
Acute Myelopathy Caused by a Cervical Synovial Cyst
Synovial cysts of the cervical spine, although they occur infrequently, may cause acute radiculopathy or myelopathy. Here, we report a case of a cervical synovial cyst presenting as acute myelopathy after manual stretching. A 68-year-old man presented with gait disturbance, decreased touch senses, and increased sensitivity to pain below T12 level. These symptoms developed after manual stretching 3 days prior. Computed tomography scanning and magnetic resonance imaging revealed a 1-cm, small multilocular cystic lesion in the spinal canal with cord compression at the C7-T1 level. We performed a left partial laminectomy of C7 and T1 using a posterior approach and completely removed the cystic mass. Histological examination of the resected mass revealed fibrous tissue fragments with amorphous materials and granulation tissue compatible with a synovial cyst. The patient's symptoms resolved after surgery. We describe a case of acute myelopathy caused by a cervical synovial cyst that was treated by surgical excision. Although cervical synovial cysts are often associated with degenerative facet joints, clinicians should be aware of the possibility that these cysts can cause acute neurologic symptoms.
Kim, Dong Shin; Cho, Yong Jun; Kang, Suk Hyung
Modic Degenerative Marrow Changes in the Thoracic Spine : A Single Center Experience
Objective The purposes of this study were to evaluate the prevalence, types, and locations of Modic changes (MCs) in the thoracic spine in a large number of subjects, and to investigate the relation between the distributions of MCs and disc herniations (DHs) in the thoracic spine. Methods Two experienced musculoskeletal radiologists assessed the presence of MCs and DHs by consensus in the thoracic MRIs of 144 patients with non-specific back pain. Patient ages ranged from 22 to 88 years (mean=53.3�14.66 years), and 72 were female (50%). The prevalence, distribution, relation of MCs and DHs was recorded. Results MC was observed in 8 of the 144 patients (5.6%) and 10 of 1728 segments (0.58%). The most common MC was type II. Of the 8 patients exhibiting MC, 6 had type II (75.0%), and 2 had mixed MCs (type I/II or type II/III). MCs were distributed mainly at the mid-thoracic level (from T5/6 to T9/10). DH was detected in 18 patients (12.5%), 36 of 1728 segments (2.1%). Of the 10 segments exhibiting MC, 5 had DHs at the same level (50.0%). Accordingly, DH was strongly associated with MC (p=0.000). Conclusion A low prevalence of MC was observed in the thoracic spine, and type II MC predominated. The low prevalence of MC in the thoracic spine suggests that it was caused by a relative lack of mobility as compared with the cervical and lumbar spines. And DHs were found to be strongly associated with MCs even in the thoracic spine. PMID:24044078
Lee, Jae Meen; Nam, Kyoung Hyup; Lee, In Sook; Park, Se Kyung; Choi, Byung Kwan
Background�� Although many patients with cervical spine metastases are treated surgically, it is unknown whether certain subsets achieve\\u000a better pain relief and improvement of neurologic function.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes�� (1) Does tumor removal with reconstruction improve the neurologic status? (2) Is any subset of patients more likely to have\\u000a neurological recovery from palliative surgery? (3) What is the rate of surgery-related complications?
Vincenzo Denaro; Alberto Di Martino; Rocco Papalia; Luca Denaro
Development and application of a non invasive image matching method to study spine biomechanics
Research on spine biomechanics is critical to understand pathology such as degenerative changes and low back pain. However, current study on in-vivo spine biomechanics is limited by the complex anatomy and invasive ...
Wang, Shaobai
The medical literature continues to fail to support the use of lumbar epidural injections for long-term relief of chronic back pain without radiculopathy. There is limited support for the use of lumbar epidural injections for shortterm relief in selected patients with chronic back pain. Lumbar intraarticular facet injections are not recommended for the treatment of chronic lower-back pain. The literature does suggest the use of lumbar medial nerve blocks for short-term relief of facet-mediated chronic lower-back pain without radiculopathy. Lumbar medial nerve ablation is suggested for 3-6 months of relief for chronic lower-back pain without radiculopathy. Diagnostic medial nerve blocks by the double-injection technique with an 80% improvement threshold are an option to predict a favorable response to medial nerve ablation for facet-mediated chronic lower-back pain without radiculopathy, but there is no evidence to support the use of diagnostic medial nerve blocks to predict the outcomes in these same patients with lumbar fusion. There is insufficient evidence to support or refute the use of trigger point injections for chronic lowerback pain without radiculopathy. PMID:24980590
Watters, William C; Resnick, Daniel K; Eck, Jason C; Ghogawala, Zoher; Mummaneni, Praveen V; Dailey, Andrew T; Choudhri, Tanvir F; Sharan, Alok; Groff, Michael W; Wang, Jeffrey C; Dhall, Sanjay S; Kaiser, Michael G
BACKGROUND: Physicians in Canadian emergency departments (EDs) annually treat 185,000 alert and stable trauma victims who are at risk for cervical spine (C-spine) injury. However, only 0.9% of these patients have suffered a cervical spine fracture. Current use of radiography is not efficient. The Canadian C-Spine Rule is designed to allow physicians to be more selective and accurate in ordering
Ian G Stiell; Jeremy Grimshaw; George A Wells; Doug Coyle; Howard J Lesiuk; Brian H Rowe; Robert J Brison; Michael John Schull; Jacques Lee; Catherine M Clement
A longitudinal study was conducted to observe persons with neck pain after motor vehicle collisions. The aims were to reveal the prospective development of cervical kinaesthesia and to investigate the association between the test results and self-reported pain and disabilities. Two different cervical kinaesthetic tests, the Fly test and the Head-Neck Relocation test, measured movement control and the relocation accuracy of the cervical spine, respectively. Self-assessment measures included pain intensity (VAS), neck pain and disability (NDI), fear of re-injury (TAMPA) and psychological distress (GHQ-28). Seventy-four subjects entered the study, but 47 were eligible, as they participated in all 4 measurements at 1, 3, 6 and 12 months post-collision. According to the performances on the two kinaesthetic tests, the subjects could be classified into improvement and non-improvement groups, respectively. The result revealed, for the first time, two different courses of deficient cervical kinaesthesia. About half of the participants showed significant deteriorating performances in both kinaesthetic tests throughout the year (p�<�0.002), while the other half improved their performances (p�<�0.02). Generally, the relationships between the kinaesthetic tests and the self-assessment scores were not significant, irrespective of the performances on the two kinaesthetic tests. Accordingly, the results of the questionnaires correlated poorly or weakly with the kinaesthetic test results at all assessment points. The need for developing a new questionnaire, capturing the symptoms prevalent in patients with neck pain and cervical sensorimotor impairments is urgent. What determines the two different kinaesthetic courses need to be scrutinised in future research. PMID:21955671
Oddsdottir, Gudny Lilja; Kristjansson, Eythor
Schmorl nodes represent displacement of intervertebral disc tissue into the vertebral body and have been considered as an asymptomatic incidental radiological finding on plain radiographs, computed tomography and magnetic resonance imaging (MRI). Although uncommon, acute symptomatic Schmorl nodes causing severe back pain do occur. We report here an unusual case of acute painful Schmorl node in a young healthy woman, with no previous trauma, presenting with a sudden significant localized back pain within hours accompanied by characteristic findings on a MRI scan. We reviewed all reports of symptomatic Schmorl nodes known in the literature, focusing mainly on MRI findings, and recent treatment options. PMID:23741552
Ohana, Nissim; Abu-Ghanem, Yasmin; Kittani, Mohamed; Shelef, Ilan
Schmorl nodes represent displacement of intervertebral disc tissue into the vertebral body and have been considered as an asymptomatic incidental radiological finding on plain radiographs, computed tomography and magnetic resonance imaging (MRI). Although uncommon, acute symptomatic Schmorl nodes causing severe back pain do occur. We report here an unusual case of acute painful Schmorl node in a young healthy woman, with no previous trauma, presenting with a sudden significant localized back pain within hours accompanied by characteristic findings on a MRI scan. We reviewed all reports of symptomatic Schmorl nodes known in the literature, focusing mainly on MRI findings, and recent treatment options. PMID:23741552
Abu-Ghanem, Sara; Ohana, Nissim; Abu-Ghanem, Yasmin; Kittani, Mohamed; Shelef, Ilan
CAT scan - thoracic spine; Computed axial tomography scan - thoracic spine; Computed tomography scan - thoracic spine; CT scan - ... remove iodine out of the body. Those with kidney disease or diabetes may need to receive extra fluids ...
... lumbar spine; Computed axial tomography scan - lumbar spine; Computed tomography scan - lumbar spine; CT - lower back ... 2008:chap 2. Shaw AS, Dixon AK. Multidetector computed tomography. In: Adam A, Dixon AK, eds. Grainger & Allison's ...
Oblique Corpectomy to Manage Cervical Myeloradiculopathy
Background. The authors describe a lateral approach to the cervical spine for the management of spondylotic myeloradiculopathy. The rationale for this approach and surgical technique are discussed, as well as the advantages, disadvantages, complications, and pitfalls based on the author's experience over the last two decades. Methods. Spondylotic myelo-radiculopathy may be treated via a lateral approach to the cervical spine when there is predominant anterior compression associated with either spine straightening or kyphosis, but without vertebral instability. Results. By using a lateral approach, the lateral aspect of the cervical spine and the vertebral artery are easily reached and visualized. Furthermore, the lateral part of the affected intervertebral disc(s), uncovertebral joint(s), vertebral body(ies), and posterior longitudinal ligament can be removed as needed to decompress nerve root(s) and/or the spinal cord. Conclusion. Multilevel cervical oblique corpectomy and/or lateral foraminotomy allow wide decompression of nervous structures, while maintaining optimal stability and physiological motion of the cervical spine. PMID:22028964
Salvatore, Chibbaro; Orphee, Makiese; Damien, Bresson; Alisha, Reiss; Pavel, Poczos; Bernard, George
Ergonomic determinants of back pain in physiotherapists involved in paediatric neurorehabilitation.
Background. Work-related musculoskeletal disorders in physiotherapists working with children are due to the failure to apply the principles of ergonomics in their daily practice, which is often caused by the necessity of working in forced positions. Health hazards are even bigger because of the disproportion of body weight and height between the patient and the therapist. The aim of the study was to evaluate positions of the spine at work among physiotherapists involved in child neurorehabilitation and their impact on the occurrence of back pain. Material and methods. The study enrolled 84 physiotherapists between the ages of 28-55 years involved in child neurorehabilitation whose seniority in the profession ranged from 2 to 33 years. The physiotherapists were interviewed about their work and its negative consequences. The 6-degree Jackson and Moskowitz scale was used to determine the level of pain intensity. Three-dimensional positions of the spine were recorded under natural working conditions using a SonoSens Monitor 8 ultrasonic measuring system. The recorded data was compared with the so-called "profile for ergonomic operation of the spine". The idea behind the study was to find the relation between pain intensity, duration and location on the one hand, and working positions of the spine and other data from the interview on the other. The statistical analysis was based on Spearman's rank correlation coefficient, analysis of variance with single classification, post hoc analysis (Tukey test) and the chi-square test (%2). The level of statistical significance was established at p < 0.05. Results. All subjects reported 1-4� pain. The intensity of pain increased with age, profession seniority, duration of the history of pain and duration of a sense of fatigue persisting after work. Pain intensity correlated with the length of time the spine was placed in unergonomic positions - especially in excessive lateral flexion in the thoracic segment and rotation in the cervical, thoracic and lumbar segments. Conclusions. 1. Positions of the spine in physiotherapists involved in neurorehabilitation of children are unergonomic and back pain is common in these therapists. 2 There is a correlation between working techniques and the prevalence of pain in physiotherapists. PMID:25404630
Czupryna, Krzysztof; Nowotny-Czupryna, Olga; Nowotny, Janusz
Background Individuals with chronic low back pain (CLBP) have altered activations patterns of the anterior trunk musculature when performing the abdominal hollowing man�uvre (attempt to pull umbilicus inward and upward towards the spine). There is a subgroup of individuals with CLBP who have high neurocognitive and sensory motor deficits with associated primitive reflexes (PR). The objective of the study was to determine if orienting the head and extremities to positions, which mimic PR patterns would alter anterior trunk musculature activation during the hollowing manoeuvre. Methods This study compared surface electromyography (EMG) of bilateral rectus abdominis (RA), external oblique (EO), and internal obliques (IO) of 11 individuals with CLBP and evident PR to 9 healthy controls during the hollowing manoeuvre in seven positions of the upper quarter. Results Using magnitude based inferences it was likely (>75%) that controls had a higher ratio of left IO:RA activation with supine (cervical neutral), asymmetrical tonic neck reflex (ATNR) left and right, right cervical rotation and cervical extension positions. A higher ratio of right IO:RA was detected in the cervical neutral and ATNR left position for the control group. The CLBP group were more likely to show higher activation of the left RA in the cervical neutral, ATNR left and right, right cervical rotation and cervical flexion positions as well as in the cervical neutral and cervical flexion position for the right RA. Conclusions Individuals with CLBP and PR manifested altered activation patterns during the hollowing maneuver compared to healthy controls and that altering cervical and upper extremity position can diminish the group differences. Altered cervical and limb positions can change the activation levels of the IO and EO in both groups. PMID:24558971
Cervical Exercise: The Backbone of Spine Treatment
... position with very little effort, while resting. By lying on your back with as thin a pillow ... Selecting Exercises... continued Supine retraction (Figure 3): While lying on your back with your head in neutral ...
Cervical Spine Immobilization Device for Emergency Response
's back, causing a variety of problems, such as tissue ischemia and ulcers [3]. The pressure exerted of the head. The noncompliant nature of the backboard can create localized pressure points on the patient by the c-collar on the carotid arteries can lead to raised intracranial pressure [4]. Most importantly
[Inicidental finding: patient with cervical spine trauma].
An ossification of the posterior longitudinal ligament, often presenting asymptomatically, can cause a symptomatic myelopathy after trauma. Keeping this entity in mind in daily clinical routine will help in making the correct diagnosis and in administering the corresponding therapy. PMID:22337517
Schmidt, M; Ab�cherli, C; Niemann, T
Objectives It remains to be determined whether the benefits of botulinum toxin type A (BoNT-A) on cervical dystonia (CD) motor symptoms extend to improvements in patient's quality of life (QoL). This analysis of a large, multicentre study was conducted with the aim of investigating changes in QoL and functioning among de novo patients receiving 500?U BoNT-A (abobotulinumtoxinA; Dysport) for the treatment of the two most frequent forms of CD, predominantly torticollis and laterocollis. Design A prospective, open-label study of Dysport (500?U; Ipsen Biopharm Ltd) administered according to a defined intramuscular injection algorithm. Setting German and Austrian outpatient clinics. Participants 516 male and female patients (aged ?18?years) with de novo CD. The majority of patients had torticollis (78.1%). 35 patients had concomitant depression (MedDRA-defined). Main outcome measures Change from baseline to weeks 4 and 12 in Craniocervical Dystonia Questionnaire (CDQ-24) total and subscale scores, patient diary items (�day-to-day capacities and activities�, �pain� and �duration of pain�) and global assessment of pain. Results Significant improvements were observed in CDQ-24 total and subscale scores at week 4 and were sustained up to week 12 (p<0.001). Changes in CDQ-24 scores did not significantly differ between the torticollis and laterocollis groups or between patients with or without depression. There were also significant reductions in patient diary item scores for activities of daily living, pain and pain duration at weeks 4 and 12 (p<0.001). Pain relief (less or no pain) was reported by 66% and 74.1% of patients at weeks 4 and 12, respectively. Changes in pain parameters demonstrated a positive relationship with change in Tsui score. Conclusions After standardised open-label treatment with Dysport 500?U, improvements in QoL and pain intensity up to 12?weeks in patients with CD were observed. PMID:23604344
Hefter, H; Benecke, R; Erbguth, F; Jost, W; Reichel, G; Wissel, J
In this discussion, we hope to advance a clinical approach to low back pain that is more in line with our modern understanding\\u000a of neuropathic pain. We review the current understanding of normal and pathologic neuroanatomy of the lumbar spine and then\\u000a outline how pathology in the different structures can lead to neuropathic pain and cause common pain patterns seen
Joseph F. Audette; Emmanuel Emenike; Alec L. Meleger
A cross-sectional epidemiological study via personal interviews was performed regarding low back pain and its related clinical aspects in a Hungarian sample of 10,000 people. Joining the international campaign of the "Bone and Joint Decade", our aim was to give data on low back pain prevalence and to explore the underlying possible clinical conditions in a Central European adult and adolescent population. Ten thousand people aged 14-65, selected randomly by the Hungarian central office of statistics from three counties of the south-western Hungarian region, were surveyed using a special questionnaire focusing on low back pain and other degenerative spinal symptoms. People with low back pain complaints and written consent were asked to participate in a further clinical investigation, where radiological and clinical assessment was performed. A total of 4,389 persons (44.1%) reported low back pain in the last month at the time of the survey. Work absenteeism due to low back pain affected 2,140 persons (21.5%). A total of 292 people (2.9%) had already undergone spinal surgery. Upon request 682 people came for a clinical follow-up, where thorough physical examination and radiological analysis was performed and results were statistically interpreted. The Oswestry disability index (ODI) in the examined group of patients averaged 35.1%; radiological degenerative signs were observed in 392/682 (57.5%). Individuals with signs of radiological degeneration had a statistically significant higher ODI value, age, and a higher, yet not significantly increased BMI value than radiographically negative patients (p?0.05). Co-existence of hip and knee osteoarthritis was also investigated. Higher osteoarthritis prevalence was found in individuals with radiographic signs of spinal degeneration. Details of the survey and clinical investigations are discussed. PMID:19997731
Horv�th, G�bor; Koroknai, Gabriella; Acs, Barnab�s; Than, P�ter; Ill�s, Tam�s
Neutral spine control exercises in rehabilitation after lumbar spine fusion.
Lumbar spine fusion (LSF) has been reported to change the biomechanics of the spine and therefore the rehabilitation after LSF is important. In this study, the effect of selected neutral spine control exercises on activation of trunk muscles after LSF was evaluated. Muscle activity was measured by surface electromyography of the rectus abdominis, external oblique, longissimus, and multifidus muscles during 6 exercises in 22 LSF patients (mean age = 59 years; age range = 25-84 years; 50% women). Muscle activity concurrent with trunk flexion and extension during maximal voluntary isometric contraction (MVIC) was used as a reference value. Pain during the effort was assessed with a visual analog scale (VAS). The highest activity in the rectus abdominis muscles was measured during bilateral shoulder extension (51% of MVIC), and in the external oblique, it occurred during unilateral shoulder horizontal adduction (48% of MVIC) and unilateral hip extension (46% of MVIC) exercises. The highest activation of the multifidus and longissimus muscles (60-104%) was measured during bilateral shoulder flexion and modified Roman chair exercises. The mean (SD) self-reported back pain VAS scores during exercises varied from 3 (7) to 16 (26). Neutral spine control exercises activate trunk muscles and cause minimal pain and are therefore feasible exercises for home-based training to improve muscle endurance and postural control after LSF. In addition, the level of muscle activity during bilateral shoulder flexion and modified Roman chair exercises was over 60% of MVIC, justifying their use in training for strength of the trunk extensor muscles. PMID:24343327
Tarnanen, Sami P; Neva, Marko H; H�kkinen, Keijo; Kankaanp��, Markku; Ylinen, Jari; Kraemer, William J; Newton, Robert U; H�kkinen, Arja
What is cervical dysplasia? Cervical dysplasia is abnormal cell growth on the surface lining of the cervix. With proper follow-up and treatment, ... cancer. Who is most likely to have cervical dysplasia? Although cervical dysplasia is most common in women ...
This case report describes the diagnosis and management of a 43-year-old female patient who had sustained an injury to her neck in a motor-vehicle accident two years earlier. The major symptoms described by the patient included headache and neck pain, but history and examination also revealed signs and symptoms potentially indicative of cervical artery compromise. Physical therapy management initially consisted of soft tissue and non-thrust joint manipulation of the lower cervical and thoracic spine, specific exercise prescription, and superficial heat. Cervical vascular compromise was re-evaluated by way of the sustained extension-rotation test. When at the fifth visit this test no longer produced symptoms potentially indicative of vascular compromise, upper cervical diagnosis and management consisting of soft tissue and non-thrust joint manipulation was added. A positive outcome was achieved both at the impairment level and with regard to limitations in activities, the latter including increased performance at work, a return to previous reading activities, improved length and quality of sleep, and greater comfort while driving. At discharge, the patient reported only occasional pain and mild limitations in activities. This report describes the positive outcomes in a patient with chronic whiplash syndrome; however, its main emphasis lies in the discussion and critical evaluation of clinical reasoning in the presence of diagnostic uncertainty with regard to cervical artery compromise. PMID:19066653
Graziano, David L.; Nitsch, Wanda; Huijbregts, Peter A.
Study Design A cross-sectional study. Purpose This study aimed to clarify the characteristics of coping strategies for dysesthesia in preoperative patients with compressive cervical myelopathy. Overview of Literature Cognitive behavioral therapy is effective for patients with chronic pain in terms of modifying their negative behavior. To effectively perform cognitive behavioral therapy, it is necessary to assess coping strategies because of their important roles in health-related quality of life. Methods Sixty-one preoperative patients with compressive cervical myelopathy (men, 39; women, 22; 61.0�11.6 years) participated. Coping strategies for dysesthesia (coping strategies questionnaire) and subjective symptoms (numerical rating scale for dysesthesia intensity and Japanese Orthopaedic Association cervical myelopathy evaluation questionnaire) were investigated. Results There were moderately significant correlations among the subcategory scores of the coping strategies questionnaire (Spearman's rank correlation coefficient [rs]?0.69, p<0.05); the praying/hoping and catastrophizing scores were significantly correlated with the numerical rating scale score of dysesthesia (both; rs=0.34, p<0.01); there were no correlations between the coping strategy scores and the cervical spine function and upper and lower extremity motor function scores of the Japanese Orthopaedic Association cervical myelopathy evaluation questionnaire; and there were no significant associations between the coping strategy scores and age, sex, and symptom duration. Conclusions Various combinations of coping strategies for dysesthesia were selected in patients with compressive cervical myelopathy, and frequency of use of the coping strategies was not related to the perceived severity of cervical myelopathy or demographic factors.
Unusual Clinical Presentations of Cervical or Lumbar Dorsal Ramus Syndrome
Objective Patients with cervical (CDRS) or lumbar dorsal ramus syndrome (LDRS) are characterized by neck or low back pain with referred pain to upper or lower extremities. However, we experienced some CDRS or LDRS patients with unusual motor or bladder symptoms. We analyzed and reviewed literatures on the unusual symptoms identified in patients with CDRS or LDRS. Methods This study included patients with unusual symptoms and no disorders of spine and central nervous system, a total of 206 CDRS/LDRS patients over the past 3 years. We diagnosed by using double diagnostic blocks for medial branches of dorsal rami of cervical or lumbar spine with 1% lidocaine or 0.5% bupivacaine for each block with an interval of more than 1 week between the blocks. Greater than 80% reduction of the symptoms, including unusual symptoms, was considered as a positive response. The patients with a positive response were treated with radiofrequencyneurotomy. Results The number of patients diagnosed with CDRS and LDRS was 86 and 120, respectively. Nine patients (10.5%) in the CDRS group had unusual symptoms, including 4 patients with motor weakness of the arm, 3 patients with tremors, and rotatory torticollis in 2 patients. Ten patients (8.3%) in the LDRS group showed unusual symptoms, including 7 patients with motor weakness of leg, 2 patients with leg tremor, and urinary incontinence in 1 patient. All the unusual symptoms combined with CDRS or LDRS were resolved after treatment. Conclusion It seems that the clinical presentationssuch as motor weakness, tremor, urinary incontinence without any other etiologic origin need to be checked for unusual symptoms of CDRS or LDRS. PMID:25110484
Kim, Shin Jae; Ko, Myeong Jin; Lee, Young Seok; Kim, Young Baeg; Chung, Chan
Whiplash causes increased laxity of cervical capsular ligament
Background Previous clinical studies have identified the cervical facet joint, including the capsular ligaments, as sources of pain in whiplash patients. The goal of this study was to determine whether whiplash caused increased capsular ligament laxity by applying quasi-static loading to whiplash-exposed and control capsular ligaments. Methods A total of 66 capsular ligament specimens (C2/3 to C7/T1) were prepared from 12 cervical spines (6 whiplash-exposed and 6 control). The whiplash-exposed spines had been previously rear impacted at a maximum peak T1 horizontal acceleration of 8 g. Capsular ligaments were elongated at 1 mm/s in increments of 0.05 mm until a tensile force of 5 N was achieved and subsequently returned to neutral position. Four pre-conditioning cycles were performed and data from the load phase of the fifth cycle were used for subsequent analyses. Ligament elongation was computed at tensile forces of 0, 0.25, 0.5, 0.75, 1.0, 2.5, and 5.0 N. Two factor, non-repeated measures ANOVA (P<0.05) was performed to determine significant differences in the average ligament elongation at tensile forces of 0 and 5 N between the whiplash-exposed and control groups and between spinal levels. Findings Average elongation of the whiplash-exposed capsular ligaments was significantly greater than that of the control ligaments at tensile forces of 0 and 5 N. No significant differences between spinal levels were observed. Interpretation Capsular ligament injuries, in the form of increased laxity, may be one component perpetuating chronic pain and clinical instability in whiplash patients. PMID:17959284
Ivancic, Paul C.; Ito, Shigeki; Tominaga, Yasuhiro; Rubin, Wolfgang; Coe, Marcus P.; Ndu, Anthony B.; Carlson, Erik J.; Panjabi, Manohar M.
Congenital Insensitivity to Pain: A Case Report and Review of the Literature
Congenital insensitivity to pain (CIP) is a rare autosomal recessive genetic disease caused by mutations in the SCN9A gene. We report a patient with the clinical features consistent with CIP in whom we detected a novel homozygous G2755T mutation in exon 15 of this gene. Routine electrophysiological studies are typically normal in patients with CIP. In our patient, these studies were abnormal and could represent the consequences of secondary complications of cervical and lumbosacral spine disease and associated severe Charcot's joints. PMID:25309764
Oberoi, Kinsi; Grewal, Raji P.
Background contextThe impact of lumbar spinal surgery is commonly evaluated with three patient-reported outcome measures: Oswestry Disability Index (ODI), the physical component summary (PCS) of the Short Form of the Medical Outcomes Study (SF-36), and pain scales. A minimum clinically important difference (MCID) is a threshold used to measure the effect of clinical treatments. Variable threshold values have been proposed
Anne G. Copay; Steven D. Glassman; Brian R. Subach; Sigurd Berven; Thomas C. Schuler; Leah Y. Carreon
A total 71 male athletes (weight lifters, wrestlers, orienteers, and ice-hockey players) and 21 non-athletes were randomly\\u000a selected, for a baseline MRI study. After 15�years all the participants at baseline were invited to take part in a follow-up\\u000a examination, including a questionnaire on back pain and a follow-up MRI examination. Thirty-two athletes and all non-athletes\\u000a had disc height reduction at
Adad Baranto; Mikael Hellstr�m; C.-G. Cederlund; Rickard Nyman; Leif Sw�rd
Neck and shoulder pains are presenting or incidental symptoms in a large variety of conditions. There may be similarities in the anatomicophysiological mechanism of pain production and in the clinical picture in many of these conditions. Many of the vague and refractory cases of neck and shoulder pain and of migraine may be due to cervical disc disease. Scalenus anticus syndrome and cardiac disease can be diagnosed or differentiated from cervical disc syndrome only by thorough investigation. Proper treatment of neck and shoulder pain is dependent upon correct diagnosis through complete history, physical examination and laboratory tests, as described in this presentation. PMID:18131684
Fields, Albert; Hoesley, John
Spine-related disability following combat injury.
Spine-related disability for military personnel injured in combat is not known. The goal of this study was to characterize spine-related disability in a cohort of soldiers wounded in recent military operations. The authors reviewed the U.S. Army Physical Evaluation Board database medical discharge records of 450 wounded soldiers for long-term disability causing a medical discharge from active duty service. Fourteen percent of the cohort had at least one spine-related disability resulting in medical discharge from the military. For the 54 unfitting conditions attributed to back pain, 33% had no precipitating injury. Eighteen soldiers had a spinal cord injury, 10 of which were complete. The average percent disability for back pain was 11%, and the average disability for a spinal cord injury was 77%. Twenty-one percent of the soldiers with spine-related disability also had disability attributed to psychological conditions. Spine-related disability is common after combat injury, though not all spine disability is directly related to an actual injury. Spinal cord injury with persistent neurological dysfunction results in higher permanent disability. PMID:25153811
Rivera, Jessica C; Anderson, Edward R; Jenne, Joel W; Topp, Raymond F
Outcome after limited posterior surgery for thoracic and lumbar spine metastases
The efficacy of �limited posterior surgery� for metastases in the thoracic and lumbar spine was studied prospectively in 51 patients (32 men and 19 women, mean age 64 years). The most common primary tumors were prostate, breast, and renal carcinoma, 37 patients had metastases in the thoracic spine and 14 in the lumbar spine. Indications for surgery were severe pain
B. J�nsson; L. Sj�str�m; C. Olerud; I. Andr�asson; J. Bring; W. Rauschning
Objectives: Neck pain can be evaluated with passive intervertebral motion (PIVM). No study has evaluated the reliability of three-dimensional (3D) segmental PIVM testing of the cervical spine in symptomatic subjects in a functional, seated position. The purpose of this study was to evaluate inter-rater reliability of such 3D PIVM technique for pain provocation, hypomobility, and end-feel detection. Methods: Subjects (n?=?63), age 44�15�6 years, neck pain 3�4�1�6 cm with visual analog scale, were evaluated by two of three raters with varied manual therapy education and experience. To perform the test, the rater passively invoked side-bending motion at each cervical joint from C2�C3 to C6�C7, allowing segmental synkinetic rotation and extension to occur. Each joint was assessed for hypomobility, hard end-feel, and pain provocation. Kappa statistics were used to determine the inter-rater reliability for each variable for joints C2�C3 through C6�C7 for both the most painful and least painful sides. Results: Percent agreements for pain provocation, hypomobility, and end-feel ranged 65�83%, 62�84%, and 68�87%, respectively. Kappa values for pain provocation, hypomobility, and end-feel on the most painful side were fair to moderate (0�29�0�53, 0�21�0�48, and 0�25�0�50, respectively), and on the least painful side were fair to substantial (0�43�0�65, 0�33�0�58, and 0�28�0�60, respectively). Discussion: This is the first investigation to assess reliability of 3D cervical segmental testing in sitting and to assess reliability of end-feel. The seated 3D PIVM test has sufficient clinical reliability for use in patients with cervicalgia for the assessment of hypomobility, end-feel, and pain provocation. PMID:23904752
Manning, Dana M; Dedrick, Gregory S; Sizer, Phillip S; Brismee, Jean-Michel
Major spinal surgery is associated with severe postoperative pain and stress response, bowel dysfunction, and a potential for chronic pain development. Epidural analgesia has been shown to be advantageous compared to intravenous analgesia alone. The aim of the study was to investigate whether postoperative addition of epidural levobupivacaine to intravenous opioid analgesia offers advantage over intravenous opioid analgesia alone. Eighty-one patients scheduled for spinal fusion were enrolled in the study and randomized into two groups. Postoperatively, group A received 0.125% epidural levobupivacaine and group B received saline. Both groups also received intravenous piritramide as a rescue analgesic. Pain intensity, rescue analgesic consumption, blood glucose, cholesterol and cortisol levels, postoperative blood loss, paresthesia, time to first postoperative defecation, and length of hospital stay were recorded. Sixty-eight patients completed the study. The visual analog scale score (mean 2 vs. 4, p = 0.01), consumption ofpiritramide (25 mg vs. 51.5 mg, p = 0.01) and metamizole (1400 vs. 1875 mg, p < 0.01), incidence of nausea (6% vs. 28% p = 0.02) and blood loss (450 mL vs. 650 mL, p < 0.05) were significantly lower in group A. Bowel recovery and first postoperative defecation also occurred earlier in group A (6% vs. 45%, p < 0.01). Blood cortisol, glucose and cholesterol levels and the incidence of paresthesia did not differ between the groups. In conclusion, after spinal fusion, postoperative epidural administration of levobupivacaine provides better analgesia and fewer side effects with no impact on stress response. PMID:25163233
Servicl-Kuchler, Darja; Maldini, Branka; Borgeat, Alain; Bili?, Nada; Kosak, Robert; Mavcic, Blaz; Novak-Jankovic, Vesna
Adult idiopathic scoliosis: the tethered spine.
This article reports on an observational and treatment study using three case histories to describe common patterns of muscle and fascial asymmetry in adults with idiopathic scoliosis (IS) who have significant scoliotic curvatures that were not surgically corrected and who have chronic pain. Rather than being located in the paraspinal muscles, the myofascial trigger points (TrPs) apparently responsible for the pain were located at some distance from the spine, yet referred pain to locations throughout the thoracolumbar spine. Asymmetries in these muscles appear to tether the spine in such a way that they contribute to scoliotic curvatures. Evaluation also showed that each of these individuals had major ligamentous laxity and this may also have contributed to development of scoliotic curvatures. Treatment focused on release of TrPs found to refer pain into the spine, release of related fascia, and correction of related joint dysfunction. Treatment resulted in substantial relief of longstanding chronic pain. Treatment thus validated the diagnostic hypothesis that myofascial and fascial asymmetries were to some extent responsible for pain in adults with significant scoliotic curvatures. Treatment of these patterns of TrPs and muscle and fascial asymmetries and related joint dysfunction was also effective in relieving pain in each of these individuals after they were injured in auto accidents. Treatment of myofascial TrPs and asymmetrical fascial tension along with treatment of accompanying joint dysfunction is proposed as an effective approach to treating both chronic and acute pain in adults with scoliosis that has not been surgically corrected. PMID:24411157
Whyte Ferguson, Lucy
Cervical myelo-radiculopathy in athetoid cerebral palsy
Cervical myelopathy complicating athetoid cerebral palsy has not been adequately highlighted in the literature. We report two cases of patients with athetoid cerebral palsy and long histories of involuntary movements who developed cervical myelo-radiculopathy. Dystonic athetoid neck movements may cause excessive axial neck rotation as well as flexion and extension movements of the spine. These repetitive exaggerated movements may result
Y. Mikawa; R. Watanabe; J. Shikata
Thoracic vertebral osteomyelitis following catfish spine impalement.
Although rare, thoracic osteomyelitis can occur when toxins from a catfish spine impalement to the hand spread via the blood. This article describes diagnosis and management of this condition in a man who required hospitalization for debilitating back pain that developed 3 weeks after the initial injury. PMID:25343428
Sateren-Zoller, Elizabeth; Sharma, Manish S; Tin, Thiha; Cannella, Dominic M; Chyatte, Douglas
Biomechanics of the Flexion of Spine.
ERIC Educational Resources Information Center
The forces and torques experienced by the spine are examined to understand, and possibly avoid, low back pain. The structure, degrees of freedom, forces and torques when lifting objects, an experimental study, and other factors affecting the back are discussed. (KR)
Hobbs, Harry K.; Aurora, T. S.
Cervical dysplasia refers to abnormal changes in the cells on the surface of the cervix . The cervix is the ... Cervical dysplasia can develop at any age, but is most often seen in women ages 25 to 35. Most ...
... the place where a baby grows during pregnancy. Cervical cancer is caused by a virus called HPV. The ... for a long time, or have HIV infection. Cervical cancer may not cause any symptoms at first. Later, ...
Cancer - cervix ... Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United ... of the routine use of Pap smears . Cervical cancer starts in the cells on the surface of ...
Treatment of cervical vertebral (C1) metastasis of lung cancer with radiotherapy: A case report
The present study discusses a patient with C1 vertebral metastasis from adenocarcinoma of the left lung. The patient was a 31-year-old female suffering from neck pain who was referred by her physician. Magnetic resonance imaging revealed osteolytic destruction of the C1 vertebra. Chest and computed tomographic scans revealed lung carcinoma changes involving the left lung. A biopsy confirmed adenocarcinoma of the left lung. Abnormal activity was present in the cervical spine (C1) region in a radionuclide bone scan. The patient was then referred to an oncologist. The spine was stabilized with a rigid collar and a course of radiation therapy and pain medication was initiated immediately. At the 9-month follow-up examination, there was no evidence of progression on the MRI scans and the main neck symptoms had disappeared. At present, the overall survival (OS) time is 11 months. Patients complaining of new onset back or neck pain should be assumed to have vertebral metastasis until proven otherwise. Trivial trauma should be taken seriously in these cases and investigated with appropriate clinical, laboratory and imaging examinations. PMID:23599751
The authors present 2 cases involving patients who presented with myelopathy. Magnetic resonance imaging of the cervical spine showed spinal cord signal changes on T2-weighted images without any spinal cord compression. Flexion-extension plain radiographs of the spine showed no instability. Dynamic MR imaging of the cervical spine, however, showed spinal cord compression on extension. Compression of the spinal cord was caused by dynamic anulus bulging and ligamentum flavum buckling. This report emphasizes the need for dynamic MR imaging of the cervical spine for evaluating spinal cord changes on neutral position MR imaging before further workup for other causes such as demyelinating disease. PMID:19441996
Guppy, Kern H; Hawk, Mark; Chakrabarti, Indro; Banerjee, Amit
[The spine and horseback riding].
115 horseback riders have undergone clinical and radiologic examinations of the spine. A minimum of 10 years' riding was required. Depending on intensity of training and number of riding hours, the subjects were divided into three groups: roughriders, sport riders and hobby riders. It was striking that of the bare half of cases (51) suffering from lower back, only 8 (about 15%) had had medical treatment and actually been disabled. Moreover, 47% of the riders with lower back pain were painfree in the saddle, i.e. when riding. No causal connection was found between riding and a higher incidence of osteochondrosis in some parts of the vertebral column. In roughriders and partly in sports riders an increased stress on the spine due to prolonged intensive training cannot be ruled out if the higher incidence of pathologic X-ray findings and low back pain in this group is taken into consideration. On the other hand, other factors such as deficiencies and hard work in the past may, especially in roughriders with a rural background, also be responsible. A higher incidence of spondylolisthesis than in the normal population was not found. It is important that riders should possess a strong back and gluteal muscular system in order to avoid early painful spinal decompensation, especially in cases with degenerative alteration and static form anomalies of the spinal column. PMID:1240657
H�rdegen, K M
Application of magnetic resonance imaging in cervical spondylotic myelopathy.
Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction and is caused by static or dynamic repeated compression of the spinal cord resulting from degenerative arthritis of the cervical spine and some biological injuries to the cervical spine. The T2 signal change on conventional magnetic resonance imaging (MRI) is most commonly associated with neurological deficits. Diffusion tensor imaging and MR spectroscopy show altered microstructure and biochemistry that reflect patient-specific pathogenesis and can be used to predict neurological outcome and response to intervention. Functional MRI can help to assess the neurological functional recovery after decompression surgery for CSM. PMID:25349665
Zhang, Chuan; Das, Sushant K; Yang, Dong-Jun; Yang, Han-Feng
Application of magnetic resonance imaging in cervical spondylotic myelopathy
Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction and is caused by static or dynamic repeated compression of the spinal cord resulting from degenerative arthritis of the cervical spine and some biological injuries to the cervical spine. The T2 signal change on conventional magnetic resonance imaging (MRI) is most commonly associated with neurological deficits. Diffusion tensor imaging and MR spectroscopy show altered microstructure and biochemistry that reflect patient-specific pathogenesis and can be used to predict neurological outcome and response to intervention. Functional MRI can help to assess the neurological functional recovery after decompression surgery for CSM. PMID:25349665
Zhang, Chuan; Das, Sushant K; Yang, Dong-Jun; Yang, Han-Feng
The early results of anterior cervical intervertebral disc excision and fusion (Cloward operation) together with removal of associated arthritic bone spurs pressing on nerves and spinal cord give promise of relief of pain and muscle weakness in patients who have this form of cervical osteoarthritis. Eighty-five per cent of a group of patients with neurologic pain caused by compression of this kind were relieved by this operation. The approach to the cervical vertebrae is made by an incision into the front of the neck and the diseased disc and arthritic spurs are removed by drilling a half-inch hole into the edges of the vertebrae. The remaining fragments of disc are curetted away. The hole is plugged with a bone dowel. The patients had less pain and a more rapid convalescence than with the usual posterior laminectomy for chronic disc disease. ImagesFigure 1(a).Figure 2. PMID:14436128
Rand, Robert W.; Crandall, Paul H.
Surgical treatment of cervical osteoarthritis.
The early results of anterior cervical intervertebral disc excision and fusion (Cloward operation) together with removal of associated arthritic bone spurs pressing on nerves and spinal cord give promise of relief of pain and muscle weakness in patients who have this form of cervical osteoarthritis.Eighty-five per cent of a group of patients with neurologic pain caused by compression of this kind were relieved by this operation. The approach to the cervical vertebrae is made by an incision into the front of the neck and the diseased disc and arthritic spurs are removed by drilling a half-inch hole into the edges of the vertebrae. The remaining fragments of disc are curetted away. The hole is plugged with a bone dowel. The patients had less pain and a more rapid convalescence than with the usual posterior laminectomy for chronic disc disease. PMID:14436128
Surgical treatment of multiple spine metastases from gastrinoma
Study design:?Case report. Clinical question:?To report successful surgical therapy for spinal cord compression in a patient with spinal metastases from a pancreatic gastrinoma. Methods:?A 43-year-old man presented three times within 4 years with cervical and upper thoracic spinal cord compression because of metastatic gastrinoma. He had two previous spine metastases to the lower thoracic and lumbar spine, a T11 compressive lesion which required a T9L1 fusion, and an L4 lesion that was treated with chemotherapy and stereotactic radiation. The compression was relieved each time by surgery. Results:?The patient underwent three surgeries in 4 years: (1) debulking and removal of the rib head on the left at T3, and debulking of the tumor at T3 with hemilaminectomy and spinal cord decompression with internal fixation from T1�T5 using posterolateral instrumented fusion and allograft; (2) anterior C7 corpectomy with placement of a cage from C7�T1 with both anterior and posterior fusion of C2C7; and (3) T1�T3 laminectomy, T1�T3 exploration of wound, revision of hardware, T1�T3 removal of spinal tumor, and T3 bilateral transpedicular circumferential decompression. The patient is alive and regained the ability to walk 8 years after initial diagnosis, despite the appearance of spinal metastases 1 year after the diagnosis of liver metastases. Conclusion:?Surgery for spinal cord compression in patients with metastatic neuroendocrine tumors can be effective in relieving radicular pain, weakness and numbness, and while not curative can greatly improve quality of life. PMID:23230405
Crabtree, Kelli L.; Anderson, Karen K.; Haynes, Neal G.; Arnold, Paul M.
Epidural Injections for Spinal Pain
... An epidural injection is delivered into the epidural space of the spine to provide temporary or prolonged relief from pain or inflammation. The epidural space is located outside the dural membrane. Steroids, anesthetics ...
Nonlinear switching dynamics in surface electromyography of the spine
This paper develops a switching dynamics model of the surface Electromyographic (sEMG) signal generated during a condition in which the mechanical attachment of the spinal dura to the cervical vertebra creates an unstable nonlinear feedback coupling between the biomechanics of the spine and the central nervous system (CNS). The sEMG signal recorded on the paraspinal muscles during this condition reveals
P. Lohsoonthorn; E. Jonckheere
Effectiveness of acupuncture in cervical dystonia
This case describes the successful addition of acupuncture to treat a patient with cervical dystonia previously managed with Botox (botulinum toxin) injections. This resulted in reduced pain and muscle spasm relief and to the authors' knowledge is the first case to be reported using this treatment combination. The patient was diagnosed with the idiopathic variant of cervical dystonia and had
Ravindran Deepak; Hans Mathew; Mathew Koshy
[Neuropathic pain due to herpes zoster infection with atypical localization].
Acute herpes zoster infection appears in the situation of depression of immune system and reactivation of varicella zoster virus which causes small pox. Pain and maculopapular lesion accompany clinical symptoms. Various pharmacological and invasive methods can be used for treatment. Efficient therapy is important for prevention of postherpetic neuralgia and cure of acute pain and dermatological lesions. A 55 years old, 160 cm height and 65 kg weight female patient with complaints of severe pain, sensation of burning, tingling at the right hand and forearm was admitted to our pain department. The patient who was diagnosed as cervical hernia at an other medical center had a normal physical servical spine examination. Patient history and physical examination findings with acute herpes zoster infection was considered. Right stellate ganglion blockade for diagnosis and treatment was performed because of regressed and atypically located lesions and a visual analog scale score of 10. VAS score decreased 50% at 9th min after block, VAS score at 2nd hour was 2. Antiviral, gabapentin, and tricyclic antidepressant treatment was started after stellat ganglion blockade and patient was discharged. After 3 months complaints dissapeared and drug doses were discreased and stopped. In conclusion we think that stellate ganglion blockade can be useful in diagnosis, acute pain control, improving patient comfort and compatibility to drug therapy in atypically located herpes zoster. PMID:24264553
Sa??r, �zlem; �zaslan, Sabri; Meri�, Y�cel; Arslan, ?smail; K�ro?lu, Ahmet
Spining Spining TV Spining 10:30 a 11:15 Pilates Mar 11:00 Spining TV Spining TV Spining 11:00 a 11:30 Aiguagim Atenea 11:00 a 11:30 Body Pump 30' Sala Polivalent 11:15 a 12:00 Estiraments Estiraments Pilates Estiraments Pilates Sala Polivalent 11:30 a 12:00 Aiguatono Atenea 11:45 a 12:30 FAMILY ZUMBA Sala Polivalent
Geffner, Hector
Objective The purpose of this case report is to describe chiropractic management of a patient with a C6/C7 left posteromedial disk herniation with foraminal narrowing and concomitant neurological compromise in the form of left upper extremity radiating pain and hypoesthesia/anesthesia using Cox flexion-distraction technique. Clinical Features A 64-year-old man presented to a chiropractic clinic with complaints of neck/left shoulder pain and hypoesthesia/anesthesia into the palmar side of his left hand. Magnetic resonance images of the cervical spine revealed a left posteromedial C6/C7 disk herniation along with foraminal narrowing. In addition, there were other levels of degeneration, most noted at the C3/C4 spinal level, which also had significant left-sided foraminal narrowing. Intervention and Outcome Treatment included Cox flexion-distraction protocols aimed to reduce nerve root compression along with supportive physiological therapeutic interventions to aid with pain reduction and functional improvement. The patient was treated a total of 10 times over a course of 4 weeks. The patient reported being pain-free and fully functional 8 months following the conclusion of care. Conclusion This case study demonstrated the use of Cox flexion-distraction for treatment of a patient with a cervical disk herniation, foraminal narrowing, and associated radiating pain and radiculopathy in the left upper extremity. PMID:22654692
Manison, Allen M.
This is the second of a three part series describing the clinical issues surrounding the radiographic assessment of the working definition of hypermobility. Described are the two major forms of hypermobility, namely generalized and segmental. Each form is reviewed and supported with available documentation. A case report is presented which highlights the clinical aspects of segmented hypermobility. ImagesFigure 1Figure 2
McGregor, Marion; Mior, Silvano A
Biomechanical analysis of the anterior cervical fusion.
This paper presents a biomechanical analysis of the cervical C5-C6 functional spine unit before and after the anterior cervical discectomy and fusion. The aim of this work is to study the influence of the medical procedure and its instrumentation on range of motion and stress distribution. First, a three-dimensional finite element model of the lower cervical spine is obtained from computed tomography images using a pipeline of image processing, geometric modelling and mesh generation software. Then, a finite element study of parameters' influence on motion and a stress analysis at physiological and different post-operative scenarios were made for the basic movements of the cervical spine. It was confirmed that the results were very sensitive to intervertebral disc properties. The insertion of an anterior cervical plate influenced the stress distribution at the vertebral level as well as in the bone graft. Additionally, stress values in the graft decreased when it is used together with a cage. PMID:21806410
Fernandes, P C; Fernandes, P R; Folgado, J O; Levy Melancia, J
Cervical cancer is a disease in which cancer develops in the tissues of the cervix. The Cancer Genome Atlas is studying the two main types of cervical cancer. Squamous cell carcinoma develops in the thin, flat, squamous cells that line the vagina. Adenocarcinoma arises in the glandular cells in the vagina that secrete mucus. Risk factors for cervical cancer include smoking and human papillomavirus (HPV) infection. In the future, the HPV vaccine will lower the infection rate.
Background��Various reports support the use of cervical spine (c-spine) CT over conventional radiography in screening of c-spine injury.\\u000a Interest now exists in diagnostic radiation-induced morbidity.\\u000a \\u000a \\u000a \\u000a Objective��To estimate excess relative risk for developing cancer from c-spine high-resolution CT radiation exposure.\\u000a \\u000a \\u000a \\u000a Materials and methods��We conducted a retrospective review of children evaluated for c-spine injury using CT. The study population was divided into
Ricardo R. Jimenez; Michael A. DeGuzman; Shelly Shiran; Andrew Karrellas; Robert L. Lorenzo
Laparoscopic Fertility Sparing Management of Cervical Cancer
Fertility can be preserved after conservative cervical surgery. We report on a 29-year-old woman who was obese, para 0, and diagnosed with cervical insufficiency at the first trimester of current pregnancy due to a previous trachelectomy. She underwent laparoscopic transabdominal cervical cerclage (LTCC) for cervical cancer. The surgery was successful and she was discharged two days later. The patient underwent a caesarean section at 38 weeks of gestation. Laparoscopic surgery is a minimally invasive approach associated with less pain and faster recovery, feasible even in obese women. PMID:24696772
Facchini, Chiara; Rapacchia, Giuseppina; Montanari, Giulia; Casadio, Paolo; Pilu, Gianluigi; Seracchioli, Renato
Laparoscopic fertility sparing management of cervical cancer.
Fertility can be preserved after conservative cervical surgery. We report on a 29-year-old woman who was obese, para 0, and diagnosed with cervical insufficiency at the first trimester of current pregnancy due to a previous trachelectomy. She underwent laparoscopic transabdominal cervical cerclage (LTCC) for cervical cancer. The surgery was successful and she was discharged two days later. The patient underwent a caesarean section at 38 weeks of gestation. Laparoscopic surgery is a minimally invasive approach associated with less pain and faster recovery, feasible even in obese women. PMID:24696772
Facchini, Chiara; Rapacchia, Giuseppina; Montanari, Giulia; Casadio, Paolo; Pilu, Gianluigi; Seracchioli, Renato
Our aim was to compare the differences in the prevalence and the anatomical localization of referred pain areas of active trigger points (TrPs) between women with myofascial temporomandibular disorder (TMD) or fibromyalgia (FMS). Twenty women (age 46 � 8 years) with TMD and 20 (age 48 � 6 years) with FMS were recruited from specialized clinic. Bilateral temporalis, masseter, sternocleidomastoid, upper trapezius, and suboccipital muscles were examined for TrPs. TrPs were identified by palpation and considered active when the pain reproduced familiar pain symptom experienced by the patient. The referred pain areas were drawn on anatomical maps, digitalized and also measured. A new analysis technique based on a center of gravity (COG) method was used to quantitative estimate of the localization of the TrP referred pain areas. Women with FMS exhibited larger areas of usual pain symptoms than women with myofascial TMD (P < 0.001). The COG coordinates of the usual pain on the frontal and posterior pain maps were located more superior in TMD than in FMS. The number of active TrPs was significantly higher in TMD (mean � SD 6 � 1) than in FMS (4 � 1) (P = 0.002). Women with TMD exhibited more active TrPs in the temporalis and masseter muscles than FMS (P < 0.01). Women with FMS had larger referred pain areas than those with TMD for sternocleidomastoid and suboccipital muscles (P < 0.001). Significant differences within COG coordinates of TrP referred pain areas were found in TMD, the referred pain was more pronounced in the orofacial region, whereas the referred pain in FMS was more pronounced in the cervical spine. This study showed that the referred pain elicited from active TrPs shared similar patterns as usual pain symptoms in women with TMD or FMS, but that distinct differences in TrP prevalence and location of the referred pain areas could be observed. Differences in location of referred pain areas may help clinicians to determine the most relevant TrPs for each pain syndrome in spite of overlaps in pain areas. PMID:22935970
Alonso-Blanco, Cristina; Fern�ndez-de-Las-Pe�as, C�sar; de-la-Llave-Rinc�n, Ana Isabel; Zarco-Moreno, Pedro; Gal�n-Del-R�o, Fernando; Svensson, Peter
In the past decade, major progress has been made in our understanding of fibromyalgia syndrome (FMS). Various triggers have been implicated as contributing to symptom development in FMS when genetically susceptible individuals are challenged. A substantial amount of data points towards the association between trauma and chronic widespread pain/fibromyalgia syndrome (CWP/FMS). There is abundant data suggesting that the pathogenesis of CWP/FMS might be related to cervical spine injury. Furthermore, several persistent local pain conditions may progress to CWP/FMS. These conditions may share a common pathogenic mechanism namely, central sensitisation. Physical trauma and emotional trauma co-exist in many traumatic events and may interact in the pathogenesis of CWP/FMS. PMID:22094196
Buskila, Dan; Mader, Reuven
Anterior inferior iliac spine apophyseal avulsion fracture.
A case of anterior inferior iliac spine (AIIS) apophyseal avulsion fracture caused while playing football is reported. A 16-year-old amateur football player felt severe pain in his left groin while kicking the ball during training. There was point tenderness over the anterior inferior iliac spine (AIIS). Avulsion fracture of AIIS was considered clinically. Radiographs confirmed the diagnosis. He was treated with a conservative rehabilitation program. He is still an active football player. Avulsion fractures follow violent or explosive muscular contractions against a fixed resistance, sudden deceleration, or stretching of the involved muscle or as a result of a direct trauma. This injury usually occurs with an extension moment to the hip joint, with the knee flexed, and it is commonly seen in sports that involve kicking. AIIS avulsion fractures should be a diagnostic consideration in patients with pain in the groin who are involved in activities requiring high-level forces of flexion of the hip. PMID:12735624
Yildiz, Cemil; Aydin, Taner; Yildiz, Yavuz; Kalyon, Tunc Alp; Basbozkurt, Mustafa
Scoliosis is defined as a lateral deviation of the spine from the normal plumb line. Commonly, there is a rotational component\\u000a and deviation also in the sagittal plane (kyphosis or hyperlordosis). When scoliosis presents in adults, it is often painful.\\u000a In contrast, back pain in a child is considered rare, and serious underlying pathology should be excluded, particularly since\\u000a idiopathic
Alun Davies; Asif Saifuddin
Risk of cervical injuries in mixed martial arts
Background: Mixed martial arts have rapidly succeeded boxing as the world's most popular full contact sport, and the incidence of injury is recognised to be high. Objective: To assess qualitatively and quantitatively the potential risk for participants to sustain cervical spine and associated soft tissue injuries. Methods: Four commonly performed manoeuvres with possible risks to the cervical spine were analysed with respect to their kinematics, and biomechanical models were constructed. Results: Motion analysis of two manoeuvres revealed strong correlations with rear end motor vehicle impact injuries, and kinematics of the remaining two suggested a strong risk of injury. Mathematical models of the biomechanics showed that the forces involved are of the same order as those involved in whiplash injuries and of the same magnitude as compression injuries of the cervical spine. Conclusions: This study shows that there is a significant risk of whiplash injuries in this sport, and there are no safety regulations to address these concerns. PMID:15976168
Kochhar, T; Back, D; Mann, B; Skinner, J
Brown-s�quard syndrome caused by a cervical synovial cyst.
Synovial cysts are recognized as an uncommon cause of radicular and myelopathic symptoms. They are most frequently found in the lumbar region. The cervical spine or cervicothoracic junction is a rare location for a degenerative intraspinal synovial cyst as compared with the lumbar spine. At given cervical spinal levels, synovial cysts probably share clinical features with disc herniation and stenosis. However, the pathogenesis of synovial cysts remains still controversial. Here, we report a rare case of a synovial cyst in the lower cervical spine presented as Brown-S�quard syndrome and include a brief review of the literature. To the best of our knowledge, no previous report has been issued in the English literature on a synovial cyst presenting with Brown-S�quard syndrome. Neurologic function recovered completely after complete removal of the cyst and expansive laminoplasty. PMID:25024827
Kim, Seok Won; Ju, Chang Il; Kim, Hyeun Sung; Kim, Yun Sung
Evidence has shown that upper limb muscles peripheral to the cervical spine, such as the biceps brachii, can demonstrate functional deficits in the presence of chronic neck pain. However, few studies have examined how neck pain can affect the fatigability of upper limb muscles; therefore we were motivated to investigate the effects of acutely induced neuropathic neck pain on the fatigability of the biceps brachii muscle during isometric contraction to exhaustion. Topical capsaicin was used to induce neck pain in 11 healthy male participants. Surface EMG signals were recorded from the biceps brachii during an isometric elbow flexion fatigue task in which participants held a weight equivalent to 30% of their MVC until exhaustion. Two experimental sessions, one placebo and one capsaicin, were conducted separated by two days. EMG mean power frequency and average normalized activation values were calculated over the course of the fatigue task. In the presence of pain, there was no statistically significant effect on EMG parameters during fatigue of the biceps brachii. These results demonstrate that acutely induced neuropathic neck pain does not affect the fatigability, under the tested conditions, of the biceps brachii. PMID:24718930
Hung, Laurie Y; Maracle, Emmalee; Srbely, John Z; Brown S, H M
The authors report on the surgical management of an extensive lesion of the upper cervical spine that required an uncommon transmandibular approach to facilitate exposure, resection, and stabilization in a pediatric patient. A 6-year-old boy with a large aneurysmal bone cyst of the C-2 vertebra presented with progressive weakness and right-sided neck pain. The lesion extended laterally into the soft tissue of the neck, inferiorly to C-4, and posteriorly around the spinal cord. A transmandibular osteotomy was performed to provide adequate exposure for complete resection of the mass and anterior C1-3 instrumentation and fusion. Subsequently, the patient underwent occiput to C-4 posterior instrumentation and fusion. The patient tolerated the operation well and had regained all function at 3 and 11 months' follow-up. No neurological complications or problems of speech, swallowing, or respiration occurred. Even in pediatric patients, the transmandibular approach for the treatment of upper cervical spine lesions is an effective method of maximizing exposure for complex lesions requiring resection and stabilization. PMID:24702619
McDowell, Michael M; Hanft, Simon J; Greenberg, Sophie A; Rahmati, Rahmatullah; Carrao, Vincent; Eisig, Sidney; Anderson, Richard C E
This book contain 15 selections. Some of the titles are: Effects of age on the appearance of magnetic resonance images of the spine; Potential for image analysis in quantitative magnetic resonance imaging of the aging spine; Potential of x-ray diffraction computed tomography for discriminating between normal and osteoporotic bone; and Spinal fusion in the elderly.
Hukins, D.W.L. Nelson, M.A.
The aim of this study was to investigate the effectiveness of the therapeutic ultrasound on the psycho-physiological functioning in patients who presented with neck pain. There is a limited number of scientific studies which provide information on clinical effectiveness of the therapeutic ultrasound and its effect on the psycho-physiological functions. The present study investigated 100 patients (average age 55), 69 females and 31 males, who presented with neck pain. Treatment protocol consisted of 15 treatments spread over three weeks (five treatments per week). Patients were separated into the two groups (test and control). Both groups of patients undertook programed isometric exercises specific for the cervical spine as well as transcutaneous electrical stimulation. The test group received continuous therapeutic ultrasound on the neck five times a day with the intensity of 0.5 w/cm2, while in the control group ultrasound machine was switched off during the therapy. It has been found that programed isometric exercises specific for the cervical spine in combination with transcutaneous electrical nerve stimulation (TENS) had the same therapeutic effect on the psycho-physiological functioning as the combination of these two therapies with the therapeutic ultrasound. PMID:23213953
Matijevi?-Mikeli?, Valentina; Crnkovi?, Maja; Matijevi?, Marko; Leovi?, Dinko; Demarin, Vida
Regrowth of Cervical Intradural Lipoma without Spinal Dysraphism.
A 49 years old male patient who suffered from deterioration of posterior neck pain, left hand numbness, left lower limb pain and gait disturbance for 3 years visited our outpatient department. He had been diagnosed as non-dysraphic cervical intradural lipoma and operated in August 1990. On the radiologic images, we found the regrowth of non-dysraphic cervical intradural lipoma from C2 to C7 level, which surrounds and compresses the cervical spinal cord. Previous subtotal laminectomy from C2 to C7 and severe cervical lordosis were also found. Appropriate debulking of lipoma mass without duroplasty was successfully done with intraoperative neurophysiological monitoring (IONM). We are following up the patient for 24 months via outpatient department, his neurologic symptoms such as hand numbness, gait disturbance, left lower limb pain and posterior neck pain have improved. We describe a rare case of regrowth of non-dysraphic cervical intradural lipoma. PMID:25328656
Son, Doo Kyung; Son, Dong Wuk; Choi, Chang Hwa; Song, Geun Sung
Regrowth of Cervical Intradural Lipoma without Spinal Dysraphism
A 49 years old male patient who suffered from deterioration of posterior neck pain, left hand numbness, left lower limb pain and gait disturbance for 3 years visited our outpatient department. He had been diagnosed as non-dysraphic cervical intradural lipoma and operated in August 1990. On the radiologic images, we found the regrowth of non-dysraphic cervical intradural lipoma from C2 to C7 level, which surrounds and compresses the cervical spinal cord. Previous subtotal laminectomy from C2 to C7 and severe cervical lordosis were also found. Appropriate debulking of lipoma mass without duroplasty was successfully done with intraoperative neurophysiological monitoring (IONM). We are following up the patient for 24 months via outpatient department, his neurologic symptoms such as hand numbness, gait disturbance, left lower limb pain and posterior neck pain have improved. We describe a rare case of regrowth of non-dysraphic cervical intradural lipoma. PMID:25328656
Son, Doo Kyung; Choi, Chang Hwa; Song, Geun Sung
The advantages and disadvantages of different methods of carrying objects on spine loading are still not fully understood. Previous studies have either examined the effects of carrying using physiological measures or examined isolated spine segments using biomechanical models. Additionally, most studies have been restricted to only a small number of carrying conditions. Very few studies have attempted to examine the various factors influencing spine loading together. To improve understanding of interacting factors on carrying, this study assessed the lumbar spine loads of 16 subjects as they assumed six styles of carrying at two weight levels and two activity levels (walking vs. standing). Concurrent with each trial, a subject-specific biomechanical model was used to assess spine forces over the full lumbar spine. Most carrying methods in the trials resulted in relatively low levels of spine loading. Anterior/posterior (A/P) shear loading was the only spine-loading dimension that reached biomechanically meaningful levels. Two carrying conditions, with bins carried in front of the body, significantly increased A/P shear compared with other carrying styles. This increase appeared to be due to the greater moment arms occurring in these conditions. Many of the other carrying styles produced A/P shears that were similar to those observed when carrying nothing at all. Of all the tasks, the backpack carry characteristically produced especially low spine loads. The findings of the study suggest that to achieve optimal carrying in terms of spine loading, loads should be positioned close to the body, even when carrying relatively light loads. PMID:24073718
Rose, J D; Mendel, E; Marras, W S
Peripheral Pain Mechanisms in Chronic Widespread Pain
Clinical symptoms of chronic widespread pain (CWP) conditions including fibromyalgia (FM), include pain, stiffness, subjective weakness, and muscle fatigue. Muscle pain in CWP is usually described as fluctuating and often associated with local or generalized tenderness (hyperalgesia and/or allodynia). This tenderness related to muscle pain depends on increased peripheral and/or central nervous system responsiveness to peripheral stimuli which can be either noxious (hyperalgesia) or non-noxious (allodynia). For example, patients with muscle hyperalgesia will rate painful muscle stimuli higher than normal controls, whereas patients with allodynia may perceive light touch as painful, something that a �normal� individual will never describe as painful. The pathogenesis of such peripheral and/or central nervous system changes in CWP is unclear, but peripheral soft tissue changes have been implicated. Indirect evidence from interventions that attenuate tonic peripheral nociceptive impulses in patients with CWP syndromes like FM suggest that overall FM pain is dependent on peripheral input. More importantly, allodynia and hyperalgesia can be improved or abolished by removal of peripheral impulse input. Another potential mechanism for CWP pain is central disinhibition. However, this pain mechanism also depends on tonic impulse input, even if only inadequately inhibited. Thus a promising approach to understanding CWP is to determine whether abnormal activity of receptors in deep tissues is fundamental to the development and maintenance of this chronic pain disorder. Conclusions Most CWP patients present with focal tissue abnormalities including myofascial trigger points, ligamentous trigger points, or osteoarthritis of the joints and spine. While not predictive for the development of CWP these changes nevertheless represent important pain generators that may initiate or perpetuate chronic pain. Local chemical mediators, including lactic acid, ATP, and cytokines seem to play an important role in sensitizing deep tissue nociceptors of CWP patients. Thus the combination of peripheral impulse input and increased central pain sensitivity may be responsible for wide-spread chronic pain disorders including FM. PMID:22094192
Staud, Roland
Cervical synovial cyst: case report and review of literature
Synovial cysts, typically observed in the lumbar spine eventually associated with degenerative changes of the facet joints,\\u000a only rarely present in the cervical spine. Up to now, only 28 symptomatic cases are described in literature. Typically, the\\u000a treatment of these cases is a decompressive laminectomy followed by complete surgical removal of the lesion. The authors present\\u000a the case of an
Francesco Costa; Claudia Menghetti; Andrea Cardia; Maurizio Fornari; Alessandro Ortolina
Cervical synovial cyst: case report and review of literature.
Synovial cysts, typically observed in the lumbar spine eventually associated with degenerative changes of the facet joints, only rarely present in the cervical spine. Up to now, only 28 symptomatic cases are described in literature. Typically, the treatment of these cases is a decompressive laminectomy followed by complete surgical removal of the lesion. The authors present the case of an 84-year-old man with a symptomatic synovial cyst involving the space between C7 and T1. PMID:19603197
Costa, Francesco; Menghetti, Claudia; Cardia, Andrea; Fornari, Maurizio; Ortolina, Alessandro
Other Causes of Leg Pain | NIH MedlinePlus the Magazine
... this page please turn Javascript on. Feature: Peripheral Artery Disease Other Causes of Leg Pain Past Issues / ... of the skin Spinal stenosis �narrowing in the spine, causing pressure on the nerves and spine, with ...
... The most common subtype of cervical cancer, called squamous cell carcinoma, arises from the surface lining of the ectocervix, ... successful at decreasing the number of patients with squamous cell carcinoma of the cervix, it has not yet been ...
Temporary nerve blocks using local anesthetic are employed extensively in the evaluation of pain problems, particularly lurnbosacral spine disease. Their specificity and sensitivity in localizing anatomic sources of pain have never been studied formally, however, and so their diagnostic and prognostic value is questionable. There have been anecdotal reports of relief of pain by temporary blocks directed to areas of
Richard B. North; David H. Kidd; Marianna Zahurak; Steven Piantadosi
Spines, backbones and orthopedic surgery. Spines, backbones and orthopedic surgery.
1/ 17 Spines, backbones and orthopedic surgery. Spines, backbones and orthopedic surgery. Simon;2/ 17 Spines, backbones and orthopedic surgery. Motivation #12;2/ 17 Spines, backbones and orthopedic and orthopedic surgery. Motivation Recent work (B-boys & Schweinsberg, Aidekon-Harris) considers branching
\\u000a It is estimated that by the end of 1999 in the United States, 12,800 new cases of invasive cervical cancer will be diagnosed\\u000a and that 4800 women will die. Worldwide, cervical cancer is the second most common cancer among women and the leading cause\\u000a of death in many non-industrialized nations (Parkin, 1998). As is true generally for cancer, the burden
Colleen M. McBride; Delia Scholes
Cervical injuries under flexion and compression loading.
Cervical spine segmental tests were performed to determine the specific patterns of initial cervical injury in response to loading just beyond the point of structural failure. Well-defined combinations of flexion rotation and compression translation were applied to segments with varying degrees of disc and facet degeneration. Twelve cervical spine specimens (from human cadavers ages 52-91 years), each consisting of three vertebrae (two motion segments) from the middle (C2-C5) or lower (C5-T1) regions, were subjected to pure flexion rotation (seven specimens) or to combined flexion rotation and axial compression translation (five specimens). Specimens were sectioned and dissected to determine the patterns of structural failure. Pure flexion, and combined flexion and compression produced similar patterns of injuries. The disc was the most commonly injured structure, with annular injuries noted in 8 of the 12 specimens, and with anterior herniation of the nucleus occurring in two specimens. Wedge fractures and posterior ligament injuries were noted in both specimen groups and with both modes of loading. We conclude that similar patterns of initial anterior bony compressive failure and posterior ligamentous failure can occur with both flexion and with combined flexion-compression, without axial or lateral rotation, at low rates of loading. Anterior cervical disc herniations were produced in both middle and lower cervical segments. PMID:8504231
Crowell, R R; Shea, M; Edwards, W T; Clothiaux, P L; White, A A; Hayes, W C
Cervical spinous process reconstruction.
Posterior neck deformity with an unsightly crater-like defect may result after cervicothoracic laminectomies. The authors present a new technique, spinous process reconstruction, to address this problem. A 64-year-old man presented with progressive quadriparesis secondary to cervical spondylotic myelopathy. Previously he had undergone multiple neck surgeries including cervicothoracic decompressive laminectomy. Postoperatively, he developed severe craniocervical spinal deformity and a large painful concave surgical defect in the neck. The authors performed craniocervical decompression and craniocervicothoracic instrumented stabilization. At the same time, cervicothoracic spinous process reconstruction was performed using titanium mesh to address the defect. Cervicothoracic decompressive laminectomy results in varying degrees of neck defect with resulting unsightly and an often painful surgical wound defect despite an appropriate multilayer closure. The presented spinous process reconstruction is a simple technique to address this problem with good clinical outcome. PMID:24206034
Panchal, Ripul R; Duong, Huy T; Shahlaie, Kiarash; Kim, Kee D
An 18-year-old female patient presented with left dominant neck pain after a motor vehicle collision. Her cervical spine MRI revealed syringomyelia with associated Type I Arnold-Chiari malformation. Some researchers have reported that these might be considered contraindications to spinal manipulation. Nevertheless, her benign and functional clinical examination suggested otherwise and she underwent four manipulative treatments in 2?weeks. By the end of the treatment plan and after 1-month follow-up, she was asymptomatic, no adverse effects were noted and her outcome assessment score decreased from 56% to 0%. This case illustrates that spinal manipulation may be a useful adjunctive treatment procedure for spinal pain, even in the presence of syringomyelia and Chiari malformation, which may not necessarily be a contraindication to spinal manipulation, when performed by a skilled and well-trained physician. PMID:25385566
Tieppo Francio, Vinicius
[An old remedy newly evaluated: the cervical syndrome].
Among the group of more than 5,000 patients reported here and suffering from headaches the cause of these headaches was to be found in 39.5% of the cases in the cervical spine. Two thirds of these revealed a malpositioning of two vertebrae against each other while the remaining third showed narrowing of the intervertebral foramina. Other cervical pathology comprises less than 6% of a total of more than 17,000 patients diagnosed as having a cervical syndrome. In the first group manual repositioning of the cervical spine brought about 82% of complete normalization of the position of the cervical spine (with concomitant total loss of symptoms) while of the remaining 18% half turned out to be free of symptoms as well. In case of narrowing of i.v. foramina electric blocking of the respective nerves using a very special type of current also lead to loss of symptoms in between 80 and 90% of these cases. Diagnostic aids and special techniques are presented. Thus in cervical causation of headaches clear diagnosis leads to proper and very effective therapy (without drugs). It should be thought of more frequently for the benefit of patients. PMID:8053213
Jenkner, F L