C2 Spinous Process Research Articles

The cervical spine of Australopithecus sediba

Cervical vertebrae are rare in the early hominin fossil record, presenting a challenge for understanding the evolution of the neck and head carriage in hominin evolution. Here, we examine the cervical vertebrae of Australopithecus sediba, which unlike other South African taxa is known from associated cervical vertebrae. The A. sediba cervical vertebrae exhibit human-like values for wedging, pedicle cross-sectional areas, and articular facet heights, indicating reduced ventral loading relative to African apes. These features combine with a pattern of vertebral body bone distribution and caudally progressive size expansion suggesting a mode of cervical lordosis, load mitigation, and head carriage similar to humans and distinct from the cantilevered mode of head carriage of the extant African great apes. Yet these derived features in A. sediba are accompanied by ape-like vertebral body and dorsal pillar sizes, articular facet orientation, and uncinate process morphology signaling reduced lateral and rotational coupled movements between vertebral elements and indicate a considerably stiffer neck than in humans. A primitively long and horizontally-oriented C7 spinous process is likely related to a prognathic viscerocranium, although the complimentary C3 spinous process is short, implying large moments emanating from scapular and shoulder elevators rather than large muscles of head stabilization. Cross-sectional spinous process shape and robust anterior tubercles similarly signal increased arm elevation consistent with climbing behavior in corroboration with arboreal signatures previously observed in the shoulder, arms, and hand of A. sediba. Spinal canal shape and size suggests that A. sediba lacked the cervical spinal cord enlargement of Homo that confers humans with enhanced motor control to the upper limbs. The cervical spine of A. sediba thus presents a mosaic of primitive and derived characters, with anatomical features relating to neck posture and head carriage mirroring humans juxtaposed with most other aspects of functional anatomy that resemble chimpanzees.

Optimizing Prone Cardiopulmonary Resuscitation: Identifying the Vertebral Level Correlating With the Largest Left Ventricle Cross-Sectional Area via Computed Tomography Scan.

Placing the patient in the prone position frequently is required for some surgical procedures. If cardiac arrest occurs and the patient cannot be safely turned supine, cardiopulmonary resuscitation (CPR) may need to be performed with the patient in the prone position. Although clear landmarks have been defined for supine CPR, the optimal hand position for CPR in the prone position has not been clearly determined. The purpose of this study was to determine anatomically the optimal hand position for CPR in the prone position. We reviewed retrospectively the chest computed tomography images of 100 patients taken in the prone position. The vertebral body levels crossing the medial angle of the scapula, the inferior angle of the scapula, and the spinous process of the vertebral body connected to the most inferior rib were identified, and we selected the image level at which the left ventricular (LV) cross-sectional area was the largest. This level was defined as the optimal compression level and correlated to surface anatomical landmarks. We calculated the ratio of the distance from the C7 spinous process to the level of the largest LV cross-sectional area divided by the distance from the C7 spinous process to the spinous process of the vertebral body connected with the most inferior rib. The level of the largest LV cross-sectional area in the prone position was 1 vertebral segment below the inferior angle of the scapula in 45% (99% confidence interval [CI], 33-58) of patients and 0 to 2 vertebral segments below that in 95% (99% CI, 86-98) of patients. The mean (SD) ratio of the distance from the C7 spinous process to the level of the largest LV cross-sectional area divided by the distance from the C7 spinous process to T12 spinous process was 67% ± 7% (99% CI, 65-69). When the patient is positioned prone, the largest LV cross-sectional area is 0 to 2 vertebral segments below the inferior angle of the scapula in at least 86% of patients. Further studies are needed to determine whether this position is optimal for chest compressions in the prone position.

Open-door Laminoplasty with Preservation of Muscle Attachments of C2 and C7 for Cervical Spondylotic Myelopathy: Retrospective Study.

Some restriction and complications, such as progression of kyphosis, incidence of axial neck pain and decrease of postoperative cervical range of motion are concern. We designed this retrospective clinical study to evaluate the effect of laminoplasty by preserving the muscle attachments of C2 and C7 spinous processes on range of motion (ROM), axial neck pain and cervical lordosis. Twenty-seven cases with cervical spondylotic myelopathy underwent open-door laminoplasty with the protection of muscle attachments to the C2 and C7 spinous process and laminae between 2007 and 2013. At the end of the followup, cases were evaluated with preoperative and postoperative modified Japanese Orthopedic Association (mJOA) scores, recovery rate, ROM, lordosis angle and visual analogue scale (VAS). Also, patients were divided into two groups and evaluated according to the magnetic resonance imaging (MRI) findings, with or without T2 signal change. The mean age of the patients was 66 years. The mean follow-up duration was 25 months. The postoperative mJOA scores were significantly higher than the preoperative mJOA scores (p < 0.001). The recovery rate was 57.4%. Although the postoperative VAS score was higher than the preoperative VAS score and the mean postoperative ROM was lower than the preoperative ROM there was no significant difference between preoperative and postoperative VAS score and ROM (p > 0.05). The postoperative lordosis angle was significantly lower than the preoperative lordosis angle (p < 0.05). There were no significant differences regarding the postoperative lordosis angle, ROM and mJOA scores with or without T2 signal change on MRI. Protection of the anatomic structures around the cervical spine such as the muscles and ligaments provides us better results regarding ROM and cervical axial pain.

Sprengel Deformity and Omovertebral Bone

Abstract: Sprengel deformity is the most common congenital abnormality of the shoulder girdle, resulting from an elevated, dysplastic, and variably fixed scapula. It has cosmetic implications that make it readily identifiable, and may be also associated with functional impairment. It may associate with other structural abnormalities, such as the presence of an omovertebral bone, or bar. When present, it adds to the immobility of the scapula. We present the images relating to the case of a 8-year old boy, with previous history of spina bifida and hydrocephalus. He presented with scapular elevation and limitation of shoulder motion, and was diagnosed with a Cavendish 4 type Sprengel deformity of the scapula. An associated omovertebral bone connecting the superomedial angle of the scapula and cervical spine was detected on CT scan. 3D reconstruction of the images allowed accurate definition of the deformity and the relations of the abnormal bone. The deformity was afterwards surgically treated, by means of a clavicle osteotomy, omovertebral bone resection, and Woodward procedure. The patient had an eneventful recovery, and had satisfactory functional and cosmetic gains.Case Presentation An 8-year old boy, previously surgically treated for hydrocephalus and spina bifida, was referred to our Paediatric Hospital for evaluation of the fixed elevation and limited motion of the right shoulder (Figure 1). A clinical diagnosis of Sprengel Deformity was made, being a Cavendish 4 grade [1] in severity. In the investigations ordered scapular elevation was confirmed and the presence of an anomalous omovertebral bone was noted between the superomedial angle of the scapula and C6 spinous process (Figure 2). Surgery was proposed, and a clavicular osteotomy, omovertebral bone resection and Woodward procedure were performed (Figure 3). Sprengel Deformity is a complex congenital pectoral girdle deformity, with cosmetic and functional implications. It is associated with other deformities, such as spinal dysraphism (as spina bifida in this case), scoliosis, and rib and vertebral segmentation abnormalities, such as Klippel-Feil. [2] The omovertebral bone is an anomalous bone connecting the elevated scapula to the cervical spine, being called omovertebral bar should it be fused between them. It contributes to the immobility of the scapula and the functional impairment, and its resection should be performed if surgical treatment is pursued [1]. It may not be always visible on plain x-rays, and so more advanced imaging is recommended prior to surgery for assessment and planning, such as CT (ideally with 3D reconstruction) [3]. Clavicle osteotomy is advised either in the treatment of associated clavicle deformity, or as to lower the chances of brachial plexus injury [4] in higher grade corrections.The child in the case described had an uneventful postoperative course, and received rehabilitation treatment, having later satisfactory functional and cosmetic gains. Conclusion: Sprengel deformity is a complex shoulder girdle abnormality. If surgical treatment is considered, associated abnormalities such as the omovertebral bone should be sought - CT scan with 3D reconstruction is advised. When found, omovertebral bone should be excised during surgery

A case report on giant C5 spinous process with partial block vertebrae at C2, C3, and C4 levels

The spine is a complex and vital structure. Its function includes not only the structural support of the body as a whole but it also serves as a conduit for safe passage of the neural elements while allowing proper interaction with the brain. We report the case of a 7-year-old child who presented with a swelling in the posterior aspect of the neck. On lateral radiograph, there was elongated spinous process in the neck. Computed tomography examination better depicted this congenital variant and clearly showed giant spinous process of the C5 vertebrae. There was associated spina bifida at this level. Moreover, there was asymmetrical fusion of the posterior elements at C2, C3, and C4. Magnetic resonance imaging showed normal signal intensity of cervical cord. This is a very rare congenital anomaly. Very few cases have been reported previously.

The effects of various visual conditions on trunk control during ambulation in chronic post stroke patients

Downward gazing is commonly observed among patients after a stroke during standing or walking as they struggle to maintain equilibrium. In this study, we aimed to evaluate the effects of fixed gazing and downward gazing on trunk control ability during gait. Sixteen subjects after a stroke (age: 51.3±4.9years) and seven healthy subjects (age: 65.1±3.4years) participated in this study. Participants walked 10m at a comfortable speed while they faced forward (no gaze point), gazed forward (with a fixed gaze point), gazed downward, and gazed downward while concealing their legs. Trunk acceleration was measured using tri-axial accelerometers attached to the back of the upper (C7 spinous process) and lower (L3 spinous process) trunk. The coefficient of attenuation (CoA) of acceleration at the trunk was computed to assess trunk control ability. Results in the stroke group showed that the CoA during fixed-point and downward gazing was better than that while facing forward with no gaze point (p<0.001). In the stroke group, the CoA during gazing downward with their legs concealed was worse than that during downward gazing. Our findings indicate that patients after a stroke might use visual information for reducing their neck oscillation (C7) during fixed-point and downward gazing. Our results indicate that the visual information during downward gazing might work the same as during fixed-point gazing.

The response of the body when carrying ahandbag.

Carrying aload in hand is commonly seen in daily life. There were many studies investigating the optimal weight when carrying abackpack, however, only afew studies investigated optimal weight when carrying abag in different ways. To investigate the optimal weight for carrying ahandbag. This study involved 13 healthy females, randomized into four carrying weight patterns [no load, bag weight of 5% body weight (BW), 7% BW, and 10% BW] who were walking barefoot on the platform at preferable speed. The center of pressure (COP) was collected by the platform. Spinous processes of C7, T1, T12, L1, S2 and the right tragus were attached with markers. The muscle activities of upper trapezius, erector spinae, and rectus abdominis muscles were measured. All data including discomfort scale were recorded. The spinal curvature was not affected from carrying ahandbag. However, the COP trend was toward the carrying side when carrying agreater load. Asymmetrical activities of the upper trapezius and erector spinae were shown (p < 0.05). The discomfort areas were the right upper trapezius and right finger flexor muscles. Continuously carrying ahandbag greater than 10% BW can cause musculoskeletal problems.

Influence of electrode configuration on the electric field distribution during transcutaneous spinal direct current stimulation of the cervical spine.

Transcutaneous spinal direct current stimulation (tsDCS) is a recent technique with promising neuromodulatory effects on spinal neuronal circuitry. The main objective of the present study was to perform a finite element analysis of the electric field distribution in tsDCS in the cervical spine region, with varying electrode configurations and geometry. A computational model of a human trunk was generated with nine tissue meshes. Three electrode configurations were tested: A) rectangular saline-soaked sponge target and return electrodes placed over C3 and T3 spinous processes, respectively; B1) circular saline-soaked sponge target and return electrodes placed over C7 spinous process and right deltoid muscle, respectively; B2) same configuration as B1, considering circular shaped electrodes with sponge and rubber layers and a small circular connector on the top surface. The electric field distribution for cervical tsDCS predicted higher magnitude in configurations B1 and B2, reaching a maximum of 0.71 V/m in the spinal white matter and 0.43 V/m in the spinal grey matter, with values above 0.15 V/m in the region of the spinal circuits related with upper limb innervation. In configuration A, the values were found to be <; 0.15 V/m through the entire spinal cord. Electric fields with magnitude above 0.15 V/m are thought to be effective in neuromodulation of the human cerebral cortex, so the configurations B1 and B2 could be an optimal choice for cervical tsDCS protocols. Computational studies using realistic models may be a powerful tool to predict physical effects of tsDCS on the cervical spinal cord and to optimize electrode placement focused on specific neurologic patient needs related with upper limb function.

Dynamic global sagittal alignment evaluated by three-dimensional gait analysis in patients with degenerative lumbar kyphoscoliosis.

Sagittal vertical axis (SVA) is the most commonly used parameter for evaluating global sagittal alignment (GSA) in a static condition. However, its dynamic statuses remain unclear. The aim of this study was to evaluate dynamic GSA of degenerative lumbar kyphoscoliosis (DLKS) using three-dimensional motion analysis system (3D-MAS). Twenty-six patients with DLKS underwent gait analysis using 3D-MAS. Static (S-) and dynamic (D-) trunk angle (TA) (the angle between the vertical axis and the line connecting C7 and S1 spinous processes) and S-sagittal trunk shift (STS) and D-STS (the distance between the two vertical lines running through C7 and S1 spinous process) were recorded during treadmill walking. Pelvic angle (PA) (the angle between the horizontal axis and the line connecting the posterior and anterior superior iliac spine) were also recorded. S-PA and D-PA represent retroversion or anteversion of the pelvis, which can be substituted for pelvic tilt. As to dynamic parameters, those at the initial five steps (Di) and the final five steps (Df) of treadmill walking were also recorded. The median S-TA, S-STS, and S-PA were 16.0°, 11.9cm, and -5.5° (retroversion). The median D parameters were Di-TA/Df-TA 21.8°/26.9°; Di-STS/Df-STS 14.1/21.1cm; and Di-PA/Df-PA 15.7°/22.8° (anteversion). All D parameters were significantly greater than S parameters (P<0.01) and all Df parameters were also significantly worse than Di parameters (P<0.001). Thus, compensated GSA by pelvic retroversion in static condition was lost due to anteversion change of the pelvis immediately after start of walking and worsened over time. Dynamic GSA assessment using 3D-MAS can avoid underestimation of GSA loss that is detected by static standing full-length radiography.

Prevalence of axial symptoms after posterior cervical decompression: a meta-analysis.

To investigate the prevalence of axial symptoms (AS) in patients following posterior cervical decompression. We searched the PubMed, Embase, and Cochrane databases for relevant studies that reported the incidence of AS after posterior cervical decompression, and manually screened reference lists for additional studies. Relevant prevalence estimates were calculated. Subgroup analysis, sensitivity analysis and publication bias assessment were also performed. Our meta-analysis included 44 studies, with 893 AS cases in 2984 patients. The pooled AS prevalence was 28% (95% CI 24-32). The prevalence of AS was higher after expansive open-door laminoplasty (39%) than after modified open-door laminoplasty (MOLP, 23%) and laminectomy instrumented fusion (29%). AS prevalence was also higher in those that wore a neck collar for 2-3months (34%) compared with 2weeks (21%). The lowest AS prevalence (9%) was found in patients who underwent MOLP with C3 laminectomy and C7 spinous processes conserved. There was an intermediate AS prevalence after MOLP with C7 spinous processes conserved (16%), MOLP with preservation of the unilateral posterior muscular-ligament complex (19%), MOLP with C3 laminectomy (22%), and MOLP with plate fixation (23%). Prevalence of AS might be higher in patients <60years and increased in populations with a higher proportion of females. Posterior cervical surgery carries a high risk of postoperative AS. Postoperative AS may be reduced through preserving posterior muscles and structures, stabilizing cervical vertebrae, and reducing external cervical immobilization time.

Compression Myelopathy due to Proliferative Changes around C2 Pars Defects without Instability.

We report a case with compression myelopathy due to proliferative changes around the C2 pars defects without instability. A 69-year-old man presented with progressive clumsy hands and spastic gait. Plain radiographs showed bilateral spondylolysis (pars defects) at C2 and fusion between C2 and C3 spinous processes. Dynamic views revealed mobility through the pars defects, but there was no apparent instability. Computed tomography showed proliferative changes at the pars defects, which protruded into spinal canal. On magnetic resonance imaging, the spinal cord was compressed and intramedullary high signal change was found. A diagnosis of compression myelopathy due to proliferative changes around the C2 pars defects was made. We performed posterior decompression. Postoperatively, symptoms have been alleviated and images revealed sufficient decompression and no apparent instability. In patients with the cervical spondylolysis, myelopathy caused by instability or slippage have been periodically reported. The present case involving C2 spondylolysis is extremely rare.

Feasibility Study of Free-Hand Technique for Pedicle Screw Insertion at C7 without Fluoroscopy-Guidance.

Study DesignRetrospective interventional study.PurposeTo introduce a free-hand pedicle screw (PS) insertion technique without fluoroscopic guidance in the C7 vertebra and evaluate the procedure's feasibility and radiologic outcomes.Overview of LiteratureAlthough PS insertion at C7 has been recognized as a critical procedure in posterior cervical fusion surgery, conventional techniques for C7 PS have several limitations.MethodsThirty two patients (64 screws) who underwent PS insertion in C7 with the novel technique were included in this study. Postoperative clinical and radiological outcomes were evaluated. Special attention was paid to the presence of any problems in the screw position including cortical breaches of the PS and encroachment of the PS into the spinal canal or the vertebral foramen. This novel technique for PS insertion in C7 without fluoroscopy guidance had three key elements. First, the ideal PS entry point was chosen near the C6–7 facet joint using preoperative images. Second, the convergent angle distance was measured at axial computed tomography (CT) imaging, which defined the distance between the tip of C7 spinous process and the extended line passing through the pedicle axis from the ideal entry point. Third, the cranial-caudal angle distance was measured in sagittal CT images, which defined the distance between the tip of the C7 spinous process and the extended line passing through the pedicle axis.ResultsCortical breach on postoperative CT images was observed in three screws. All violated only the lateral wall of the affected pedicle. The breached screws occurred in the initial five cases. Postoperative neurologic deterioration was not observed in any patient, regardless of cortical breaching.ConclusionsThe novel technique successfully allows for C7 PS to be placed and is associated with a low rate of cortical breach.

A Rare Case of Cervical Dumbbell Meningioma with the C2 Spinous Process Preservation

Dumbbell growth is often observed in schwannoma but rarely in meningioma. In particular, the occurrence of dumbbell meningioma at the cervical cord level in Japan is markedly rare. We reported an elderly case with symptomatic meningioma that developed in a dumbbell shape from cervical spine and was treated successfully by surgery.

Is That Only a Spinous Process Fracture? Report of a Case of a C6 Spinous Process Fracture with Accompanying Complex Ligamentous Injury Resulting in a Delayed Unilateral Facet Dislocation at the C6-7 Level

Is That Only a Spinous Process Fracture? Report of a Case of a C6 Spinous Process Fracture with Accompanying Complex Ligamentous Injury Resulting in a Delayed Unilateral Facet Dislocation at the C6-7 Level

Reliability and Validity of the Measurement of Scapular Position Using the Protractor Method.

The protractor method is a proposed clinical assessment tool, the first to measure vertical scapular position, that directly compares scapular and spinal landmarks. This tool has the potential to reliably and accurately measure excessive scapular elevation or depression. The purpose of this study was to determine reliability and validity of the protractor method to measure resting scapular position. An interrater and intratester reliability and validity study was conducted. Testing was conducted on the same day by 2 physical therapists who were blinded to each other's results. The vertical distances between the spinous process of C7 and the superior margin of the medial aspect of the spine of the scapula (C7 method) and the spinous process of T8 and the inferior angle of the scapula (T8 method) were palpated and measured on the symptomatic shoulder in 34 people with current shoulder pain using the protractor method. Measurements were compared with 2-dimensional camera analysis to assess validity. For intertester reliability, the standard error of measure, minimal detectable change, and intraclass correlation coefficient were 6.3 mm, 17.3 mm, and .78, respectively, for the C7 method and 5.7 mm, 15.7 mm, and .82, respectively, for the T8 method. For intratester reliability, the standard error of measure, minimal detectable change, and intraclass correlation coefficient were <0.9 mm, <2.5 mm, and .99, respectively. For validity, significant correlations (r) and mean differences were .83 and 10.1 mm, respectively, for the C7 method and .92 and 2.2 mm, respectively, for the T8 method. The results of this study are limited to static measurement of the scapula in one plane. Both protractor methods were shown to have good reliability and acceptable validity, with the T8 method demonstrating superior clinical utility. The clinical use of the T8 method is recommended for measurement of excessive resting scapular elevation or depression.

Expansive Open-Door Cervical Laminoplasty: In Situ Reconstruction of Extensor Muscle Insertion on the C2 Spinous Process Combined With Titanium Miniplates Internal Fixation.

Retrospective cohort study.To evaluate efficacy and relevant problems of in situ reconstruction of extensor muscle insertion on the C2 spinous process combined with titanium miniplates internal fixation in expansive open-door cervical laminoplasty in order to improve surgical treatment effect.Expansive open-door cervical laminoplasty has been widely applied in clinical practice, but there are a series of postoperative problems. Therefore, decreasing postoperative complications in order to more effectively relieve symptoms remains a subject for additional research.From October 2011 to September 2013, a total of 60 patients who suffered cervical canal stenosis were treated by expansive open-door laminoplasty with in situ reconstruction of extensor muscle insertion on the C2 spinous process combined with titanium miniplates internal fixation. Changes of cervical curvature index (CI) and range of motion (ROM) were calculated using data from preoperative and postoperative cervical spine X-ray examinations. Clinical function was scored using the Japanese Orthopedics Association Scoring System (JOA) and the neck disability index (NDI).The mean CI before the operation and at 1-year postoperation were 10.49% ± 3.93% and 14.14 ± 2.85 (P < 0.05). The mean ROM values were 43.35 ± 7.55 before the operation, 34.83 ± 7.41 at 1-year postoperation (P < 0.05). The NDI scores decreased from 19.42 ± 4.12 to 7.37 ± 2.58, and the JOA scores increased from 8.87 ± 1.99 to 13.55 ± 1.72, representing significant improvement (P < 0.05). One patient had postoperative C5 nerve root palsy and completely recovered 1 month later. Neither collapse nor door closure in the open-door side occurred in any of the patients.Expansive open-door cervical laminoplasty with in situ reconstruction of extensor muscle insertion on the C2 spinous process combined with titanium miniplates internal fixation is a safe and effective surgical method, and can effectively decrease postoperative complications and achieve satisfactory clinical results.

Incidence and Risk Factors for Late Neurologic Deterioration after C3-C6 Laminoplasty for Cervical Spondylotic Myelopathy.

Study Design Retrospective study. Objective We previously reported that the long-term neurologic outcomes of C3–C6 laminoplasty for cervical spondylotic myelopathy (CSM) are satisfactory, with reduced frequencies of postoperative axial neck pain and kyphotic deformity. However, only 20 patients were included, which is a limitation in that study. The present study investigated the incidence of late neurologic deterioration (LND) of myelopathic symptoms after C3–C6 laminoplasty for CSM and attempted to identify significant risk factors for LND in a larger patient population. Methods Subjects comprised 137 consecutive patients with CSM who underwent C3–C6 laminoplasty (bilateral open-door laminoplasty, n = 85; unilateral open-door laminoplasty, n = 52) and were followed for >24 months (mean follow-up, 70 months; range, 25 to 124 months). The patients' medical records were examined for evidence of LND due to cervical myelopathy. The age at time of surgery, sex, surgical procedures, anteroposterior spinal canal diameter at the C7 level, type of C6 spinous process, pre- and postoperative C2–C7 angle, C3–C6 range of motion (ROM), and disk height at the C6–C7 level were analyzed to identify risk factors for LND. Results Three patients (2.2%) developed LND of myelopathic symptoms due to caudal segment pathology adjacent to the C3–C6 laminoplasty (LND group). In these three patients, mean Japanese Orthopaedic Association (JOA) score improved from 10.2 before surgery to 12.2 at the time of maximum recovery, and declined to 9.7 just before additional surgery. On the other hand, in 134 patients without LND (non-LND group), the mean JOA score significantly improved from 10.2 before surgery to 13.4 at the time of maximum recovery and was maintained by the final follow-up (13.2). Compared with the non-LND group, the LND group showed significantly smaller anteroposterior spinal canal diameter at C7, more restricted postoperative C3–C6 ROM, and greater postoperative decrease in disk height at C6–C7, although a logistic regression analysis showed no significant differences. Conclusions In patients with CSM with more severe developmental spinal canal stenosis at C7, accelerated degeneration at the caudal segment resulting from restricted C3–C6 ROM after C3–C6 laminoplasty might lead to LND.

Do kinematic behaviors of the pelvis and trunk during single-leg standing reflect the peak knee adduction moment of during walking?

Background: A high external knee adduction moment (KAM) during walking is known as one of the risk factors for progression of knee osteoarthritis (KOA). In the clinical practice, it is important to find a convenient method that can predict aKAMduringwalking in patientswithKOA.Wehave then hypothesized that kinematic behaviors of the pelvis and the trunk during single-leg standing could reflect the peak KAM during walking. Purpose: The purpose of the present study was to investigate the relationship between kinematic behaviors of the pelvis and the trunk during single-leg standing and the peak KAM during walking in the healthy subjects. Methods: Twenty-eight healthy subjects were recruited for this study (23.6± 4.0 years). These subjects performed the gait and the single-leg standing trials. In the single-leg standing trial, subjects stood on two force platforms. The subjects lifted one lower limb off the force plate ‘as fast as possible’ following a sonic cue, and held the posture. The onset of lift-off point (lift-off onset) was defined as the time when the vertical component of the ground reaction force becomes less than 10N. All data were recorded during the period from a ‘sonic cue’ until 1000ms following the lift-off onset. In the gait trial, subjectswalked at a self-selected speed. The data were collected with a six-camera motion analysis system and two force plates that were time synchronized and sampled at 200Hz and 1000Hz, respectively. Helen Hays marker set with additional markers placed on the spinous processes of C7 and S1 was used. The peak KAM during the walking and the single-leg standing were determined using the SIMM6.0.2 software. The maximum andminimum value of the lateral lean angle of the trunk and the lateral tilt angle of the pelvis during single-leg standing were calculated using the custom Matlab code. The trunk lean toward the swing limb side and the contralateral pelvis drop were denoted as a negative angle. Pearson correlation coefficients were used to determine a relationship between the KAM gait and the other variables during SLS. The level of significance was set at 0.05. Results: The peak KAM during single-leg standing was significantly correlated with that during walking (r= 0.40, p= 0.03). The peak KAM during walking was significantly correlated with the maximum value of the lateral lean angle (r=−0.45, p= 0.02) and lateral tilt angle of the pelvis (r=−0.40, p= 0.04) during single-leg standing. Conclusion(s): The present study showed that the lateral lean angle of the trunk and the lateral tilt angle of the pelvis during single-leg standing reflect the peakKAMduring walking. Implications:Findings of the present study indicate a possibility that kinematic behaviors during a single-leg standing task can predict a peak KAM during walking in the KOA patients.

Can Modified Kurokawa's Double-Door Laminoplasty Reduce the Incidence of Axial Symptoms at Long-term Follow-up?: A Prospective Study of 152 Patients With Cervical Spondylotic Myelopathy.

A prospective cohort study. The purpose of this study was to determine whether the modified procedure reduces long-term axial symptoms (AS) and to understand better why the AS occur. Following Kurokawa's double-door laminoplasty, postoperative AS reduce the quality of life of patients with cervical spondylotic myelopathy. The etiology of AS remains unclear. Some studies report that preservation of the C7 spinous process can reduce the frequency of AS. The modified Kurokawa procedure prevents AS by preserving the semispinalis cervicis insertion in the spinous process of C2. However, it remains unclear whether the modified procedure lowers the incidence of AS in the long term (ie, >3 y). This prospective cohort study investigated preoperative and postoperative v, cervical intervertebral range of motion, postoperative neurological recovery, neck disability index, visual analog scale, surgical cost, and time and blood loss. Both groups had satisfied improvement of neurological functions (P>0.05). At 3 months and 1 year after surgery, the difference in frequency between no symptoms and mild/severe symptoms was significant (traditional group, 39.06%; modified group, 20.45%) (P<0.05). Interestingly, 3 years after surgery, there were no significant between-group differences (P>0.05). This modified approach reduced the incidence of postoperative ASs at 3 months and 1 year after the operation; however, the between-group difference was not significantly different at the 3-year follow-up. The reason for this finding is unclear; it may indicate that the incidence of AS is caused by other factors, such as the preservation of the C7 spinous process rather than the C2 spinous process.

Myoarchitectonic advancement of the C2 spinous process for C1-C2 posterior fusion: A novel technique.

Study Design:Retrospective descriptive study of an innovative surgical technique.Objective:To assess the feasibility of using a large C2 spinous process as a vascularized bone graft donor with muscles attached to it in C1-C2 posterior fusion with evaluation of post operative fusion and pain in these cases.Summary of Background Data:C1-C2 posterior fusion essentially requires a bone graft and for this a separate incision is needed at the donor site with its associated morbidity. The procedure also entails detachment of muscles attached to the C2 spinous process. Due to the detachment of these muscles with important functions, postoperative nuchal pain is common in these patients. We developed a novel technique of harvesting the vascularized C2 spinous process as a bone graft to minimize the above-mentioned complications.Materials and Methods:Five patients with atlanto-axial dislocation due to various pathologies underwent C1-C2 posterior arthrodesis with the present technique. They were followed up for 6 to 18 months and were evaluated for feasibility of procedure, post operative fusion and post operative complications, especially pain.Results:The procedure was accomplished successfully in all patients without any perioperative complications. All patients were pain free 3 months after surgery—mean Visual Analogue Scale (VAS) was 0.4. Fusion (confirmed by plain radiography in three and by CT scan in two patients) was achieved in all five patients (100%).Conclusion:Myoarchitectonic advancement of C2 spinous process is a novel technique of C1-C2 posterior fusion in which a local vascularized bone graft is used avoiding donor site morbidity and at the same time preservation of dynamic function of muscles attached reduces the post operative pain.