Cervical Disc Injury Research Articles

Analysis of Severe Spinal Injuries in Korean Elite Female Wrestlers

Women’s wrestling is actively practiced in many countries. While severe spinal injuries pose a threat to an athlete’s career and health, research on severe spinal injuries in female wrestlers remains limited. The aim of this study was to investigate the characteristics of severe spinal injuries and post-injury management in Korean female wrestlers. We enrolled 54 female wrestlers participating in the national team selection competition. Interviews were conducted to examine the characteristics of spinal injuries that resulted in a time loss of more than three weeks from training throughout their athletic careers and their post-injury management practices. Approximately 46% of participants experienced severe spinal injuries, and 52% faced re-injuries during their wrestling careers. These injuries predominantly occurred during technical training due to overuse during tackling and standing attacks. The most frequent injuries were lumbosacral disc injuries (72%) and cervical disc injuries (20%), with 36% requiring surgery. Nearly half of the injured athletes received specialized rehabilitation, yet roughly 76% resumed training without medical clearance. Athletes injured during their student years were notably less likely to receive specialized rehabilitation compared with those injured during their professional careers (p = 0.011). On average, athletes returned to play within 2.7 to 3.0 months. Spinal injury characteristics and post-injury management were not significantly different between the light- and heavyweight classes. While Korean female wrestlers are at a high risk of experiencing severe spinal injuries and re-injuries during their careers, appropriate post-injury management is often lacking, highlighting the need for proactive intervention by healthcare professionals to prevent recurrent spinal injuries in female wrestlers and to ensure safe return to training.

Evaluation of outcome of zero-profile implant for anterior cervical discectomy and fusion in traumatic cervical sub-axial disc injury in Indian population: A prospective study

Evaluation of outcome of zero-profile implant for anterior cervical discectomy and fusion in traumatic cervical sub-axial disc injury in Indian population: A prospective study

Cervical Disc and Ligamentous Injury in Hyperextension Trauma: MRI and Intraoperative Correlation.

ABSTRACTBACKGROUND AND PURPOSETo identify and evaluate diagnostic magnetic resonance imaging (MRI) features in patients with suspicion of discoligamentous cervical injury after hyperextension trauma of the cervical spine.METHODSMR images with a standard protocol (1.5 T, including sagittal T2‐weighted images and short tau inversion recovery [STIR]) in 21 patients without any sign of fracture or instability on multidetector computed tomography of the cervical spine were assessed. Among other structures we evaluated the following: prevertebral hematoma, anterior longitudinal ligament (ALL), intervertebral disc, and spinal cord. Presence and the anatomic level of injury were identified and recorded. Results were then compared with intraoperative findings as a reference standard. Simple descriptive statistical analysis, agreement coefficients (given by calculating the percent agreement), and the determination of Gwet's AC1 coefficient were used to analyze our results.RESULTSThe overall percent agreement between STIR and intraoperative findings was 90.9% (AC1 = .881) and for T2 69.7% (AC1 = .498). For the ALL, the overall agreement was 87.9% (AC1 = .808) and for the intervertebral disc 78.8% (AC1 = .673), in which STIR always showed a higher agreement. Prevertebral hematoma was found in 20 of 21 patients with the maximum thickness at the same anatomic level as the intraoperatively proven lesion in 12 of 18 patients (67%). Edema and/or hemorrhage of the spinal cord was shown in 16 of 21 being at the same anatomic level as the intraoperatively confirmed pathology in 16 of 16 patients (100%).CONCLUSIONSMRI is a reliable tool for the evaluation of discoligamentous injuries in the cervical spine, with ancillary features proven as helpful information.

Mechanisms of Cervical Spine Disc Injury under Cyclic Loading.

Study DesignDetermination of human cervical spine disc response under cyclic loading.PurposeTo explain the potential mechanisms of intervertebral disc injury caused by cyclic loading.Overview of LiteratureCertain occupational environments in civilian and military populations may affect the cervical spine of individuals by cyclic loading. Research on this mechanism is scarce.MethodsHere, we developed a finite element model of the human C4–C5 disc. It comprised endplates, five layers of fibers, a nucleus, and an annulus ground substance. The endplates, ground substance, and annular fibers were modeled with elastic, hyperviscoelastic, and hyper-elastic materials, respectively. We subjected the disc to compressive loading (150 N) for 10,000 cycles at frequencies of 2 Hz (low) and 4 Hz (high). We measured disc displacements over the entire loading period. We obtained maximum and minimum principal stress and strain and von Mises stress distributions at both frequencies for all components. Further, we used contours to infer potential mechanisms of internal load transfer within the disc components.ResultsThe points of the model disc displacement versus the loading cycles were within the experimental corridors for both frequencies. The principal stresses were higher in the ground matrix, maximum stress was higher in the anterior and posterior annular regions, and minimum stress was higher along the superior and inferior peripheries. The maximum principal strains were radially directed, whereas the minimum principal strains were axially/obliquely directed. The stresses in the fibers were greater and concentrated in the posterolateral regions in the innermost layer.ConclusionsDisc displacement was lower at high frequency, thus exhibiting strain rate stiffening and explaining stress accumulation at superior and interior peripheries. Greater stresses and strains at the boundaries explain disc injuries, such as delamination. The greater development of stresses in the innermost annular fiber layer (migrating toward the posterolateral regions) explains disc prolapse.

Can the Zero-Profile Implant Be Used for Anterior Cervical Discectomy and Fusion in Traumatic Subaxial Disc Injury? A Preliminary, Retrospective Study

ObjectiveThe zero-profile implant (Zero-P) is accepted for use in anterior cervical fusion for the treatment of degenerative cervical disease. However, evidence pertaining to its efficiency and safety in traumatic cervical injury is largely insufficient. This study aimed to compare the overall outcomes of patients who underwent Zero-P for traumatic cervical disc injury. MethodsData from a total of 53 consecutive patients who underwent surgery for traumatic or degenerative cervical disc disease using the Zero-P were reviewed. Seventeen patients (group A) had traumatic cervical disc injury and the remaining 36 (group B) had degenerative cervical disc herniation. The fusion and subsidence rates and Cobb angle were measured retrospectively from plain radiographs. The patients’ clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score and Odom’s criteria. ResultsThe C2–7 Cobb and operative segmental angles increased by 3.45±7.61 and 2.94±4.59 in group A; and 2.46±7.31 and 2.88±5.49 in group B over 12 postoperative months, respectively. The subsidence and fusion rate was 35.0% and 95.0% in group A; and 36.6% and 95.1% in group B, respectively. None of the parameters differed significantly between groups. The clinical outcomes were similar in both groups in terms of increasing the JOA score and producing a grade higher than “good” using Odom’s criteria. ConclusionThe application of Zero-P in patients with traumatic cervical disc injury was found to be acceptable when compared with the clinical and radiological outcomes of degenerative cervical spondylosis.

Finite element investigation of the intervertebral disc behaviour

Cervical disc injury due to impact has been observed in clinical and biomechanical investigations; however, there is a lack of data that helps to elucidate the mechanisms of disc injury during thes...

Diagnosis and treatment of injury to cervical anterior longitudinal ligaments

Objective To discuss the diagnosis and treatment of the injury to cervical anterior longitudinal ligaments (CALL) . Methods Forty-six patients were enrolled in this study whose CALL injury had been confirmed by radiological examination from March 2001 to July 2003. Their AP X-ray films and MRI of cervical spine were taken within 3 hours to 3 days after injury. Prevertebral soft tissue swelling was found in 35 cases and low cervical spinal instability in 14 cases. Damaged ligaments showed gray or gray-white signals which broke sometimes on MRT1-WI, and sheet sagittal widen uneven high signals which were usually disrupted on MRT2-WI. Early surgery was done for 19 patients complicated with spinal cord injury (SCI) (15 anterior decompression fusion, 2 posterior decompression fusion, 2 anteropesterior decompression fusion). Of 27 patients with simple neck pain, early operation was done for 6, cervical plaster orthosis was applied for 5 and cervical collar for 16. Results The mean follow-up time was from 6 to 41 (average, 16. 7) months in 45 patients. Complete SCI was improved to incomplete one in 2 of the 5 patients with complete SCI. Incomplete SCI was improved in different degrees in 10 of the 14 patients with incomplete SCI. No kyphosis or chronic neck pain was found after early operation for the 6 cases of simple neck pain. Of the 21 patients who were treated by cervical plaster orthosis or cervical collar, 7 had evidence of instability on flexion-exteusion imaging and thus underwent anterior decompression fusion to release their chronic neck pain and discomfort Anterior surgery was done for other 2 patients 2 to 3 years after injury because of disc degeneration and extrusion. Other 3 patients had complaints of discomfort and another one was lost for follow-up. The rest 8 were good. Conclusions MRI is the most valuable measure for diagnosis of CALL injury. Decompression and fusion should be done early for CALL injury complicated with spinal cord compression or with severe vertebral iustability. Early anterior discectomy and fusion should be done for cervical disc and longitudinal ligament injury without spinal cord injury. Key words: Cervical vertebrae; Longitudinal ligaments; Magnetic resonance imaging (MRI)

An accurate finite element model of the cervical spine under quasi-static loading

Cervical disc injury due to impact has been observed in clinical and biomechanical investigations; however, there is a lack of data that helps to elucidate the mechanisms of disc injury during these collisions. Therefore, it is necessary to understand the behavior of the cervical spine under different types of loading situations. A three dimensional finite element (FE) model for the multi-level cervical spine segment (C0–C7) was developed using computed tomography (CT) data and applied to study the internal stresses and strains of the intervertebral discs under quasi-static loading conditions. The intervertebral discs were treated as nonlinear, anisotropic and incompressible subjected to large deformations. The model accuracy was validated by comparing it with previously published experimental and numerical results for different movements. It was shown that the use of a fiber reinforced model to describe the behavior of the annulus of the discs would predict higher maximum shear strains than an isotropic one, being therefore important the use of complex constitutive models in order to be able to detect the appearance of injured zones, since those strains and stresses are supposed to be related with damage to soft tissues. Several movements were analyzed: flexion, extension and axial rotation, obtaining that the maximum shear stresses in the disc were higher for a flexo-extension movement.

Cervical Spine Clearance in the Obtunded Patient: It Takes More Than a Simple CT

A basic assumption of caring for multi-injured patients is that all patients are suspected of having a cervical spine injury until proven otherwise. It is known that 2% to 4% of all blunt trauma injury patients have a cervical spine injury. Missed or delayed diagnosis of cervical spine injury occurs in 4% to 8% of patients of whom 70% have altered levels of consciousness. When these missed diagnoses lead to neurologic sequelae the consequences are devastating with estimates of potential lifetime cost to each patient of up to $2.2 million dollars. In a multicenter study looking at neurologic deterioration from missed spinal injuries the most common etiology was found to be insufficient imaging studies completed (14/24) with the definition of insufficient being that had another study been added the unstable spinal injury would not have been missed as illustrated by the following case study. A 43-year-old female presented to a trauma center after a high-speed MVA, and was evaluated and treated for multiple injuries, including a facial degloving injury and a closed head injury (Glasgow Coma Scale 11). She underwent lateral and anteroposterior cervical spine radiographs and thin-cut CT, both of which were reported as normal and was cleared. Seven days later, she was noted to have progressive weakness of her hands and was unable to walk, even with assistance (ASIA D). Emergency MRI was performed and showed bilateral perched facets at C6C7, with signal change involving the interspinous ligament of C6C7 and associated cord compression. Ghanta performed a retrospective review of 124 trauma patients including 59 unconscious patients and found that 19% had cervical spine injury diagnosed only on MRI. He concluded that plain views and CT may not be adequate for unstable cervical ligamentous and disc injuries in obtunded patients. Although the Eastern Association for the Surgery of Trauma guidelines recommend static flexion extension films and the neurosurgical guidelines recommend dynamic flexion extension films or MRI at the surgeon’s discretion, many surgeons are reluctant to perform these studies for fear of inducing injury and indeed there has been at least one reported case in the literature. Stassen found that 25% of C-spine injuries were missed by CT alone. Diaz looked at patients with traumatic brain injury and found that 45% had ligamentous injury. He concluded that CT demonstrated a poor ability to screen for ligamentous injury. Based on the literature it is my conclusion that in the obtunded patient if the initial CT is negative and the patient is still obtunded at 72 hours an MRI should be obtained. Patients that fit into a high velocity pattern will be defined and this group should have dynamic flexion extension films if the MRI is negative.

Documentation of myofascial pain syndrome with infrared imaging Marcos

The myofascial trigger points (TP) are involved as much pathologies of hyperextension/hyperflexion cervical injuries, disc injuries, and overuse injuries. One of the basic indications and clinical uses of infrared (IR) imaging is documentation of soft tissue pathology, particularly in conditions which cannot be demonstrated on radiologic tests, electroneuromyography or laboratory workup. The authors review the literature regarding IR imaging in the documentation of myofascial pain syndrome. The IR imaging is a diagnostic test which objectively documents TP in the form of hyperradiant hot spots. These hyperradiant spots corresponding to areas of pain usually represent active TP in clinical examination. They can be corroborated by local tenderness in the region, thus confirming the patient’s complaint. The areas of pain are presented as thermal asymmetry between corresponding areas of opposite sides of the body. Latent TP, not subject to patient complaints at the time of IR imaging examination, are detected in the form of hyperradiant spots. The presence of these latent TP can be documented by abnormal pressure threshold measurement in these areas. There was an alteration of the skin thermal profile after TP local anesthesia/dry needling demonstrating an immediate neurovegetative sympathetic response. The IR imaging findings represent an objective mean to document TP, thus corroborating with the subjective patient’s complaints. The documentation of TP by IR imaging is important to introduce the most adequate treatment directed the pain cause as well as to evaluate its response.

Isolated Ligamentous Cervical Spinal Injury in the Polytrauma Patient with a Head Injury

The evaluation of the cervical spine in the unconscious trauma patient is a difficult and controversial topic in trauma management. Conventional cervical clearance protocols consisting of plain radiology and computed tomography may not adequately detect unstable cervical ligament and disc injuries, even though a high-risk mechanism of injury has occurred. We present two cases where cervical clearance protocols, utilising plain X-rays and multi-slice computed tomography, failed to identify significant ligamentous spinal injuries. A delay in diagnosis or a missed spinal injury can lead to delays in treatment, thereby increasing the risk of neurological deterioration with the potential devastating sequela of quadriplegia. Therefore, in the unconscious trauma patient who, by definition, has sustained a high-risk mechanism injury, we routinely recommend the use of magnetic resonance imaging in addition to plain X-rays and computed tomography, to evaluate further discoligamentous status.

Diagnosis and treatment for the injury of cervical disc and longitudinal ligament

To study the diagnosis and treatment for the injury of cervical disc and longitudinal ligament. From 2001 to 2005, the clinical data of sixty-three patients with cervical disc and longitudinal ligament injury were studied. Early treatment was done based on spinal cord injuries and spinal stabilities by X rays and MRI. Early operation was done in fifty-four cases and early non-operation in nine cases. The follow-up time was six to forty-one months in all patients. The neurological recovery was found in two of eight complete SCI post-operation, thirty-one in thirty-nine incomplete SCI. Cervical collar or plaster orthotic were used in nine cases with four to six weeks. Evidence of instability was noted in four patients, who were operated with anterior decompression fusion. Neck chronic pain was found in two patients, anterior decompression and fusion was done in one with cervical spinal cord compression. MRI examination is the most value measure for the diagnosis of cervical disc and longitudinal ligament injury. Early anterior decompression and fusion was an important approach for cervical disc and longitudinal ligament injury.

The rehabilitation of a professional Rugby Union player following a C7/T1 posterior microdiscectomy

Rugby Union is a popular international sport [ Bathgate, A., Best, J., Craig, G., & Jamieson, M. (2002) with a high incidence of cervical injury. A prospective study of injuries to elite Australian rugby union players. British Journal of Sports Medicine 36, 265–269.] with a high incidence of cervical injury. The purpose of this case study was to explore the rehabilitation of a professional rugby union player following a cervical disc injury affecting the C8 nerve root and subsequent microdiscectomy. The isometric strength of the cervical musculature was measured using 1 Repetition Maximum (1RM). A 10-week rehabilitation programme was then commenced whereby the player performed periodised upper limb and Maximal Isometric Voluntary Muscle Contraction (IVMCmax) neck exercises with a graduated return to contact training and playing. Re-tests of the cervical musculature were performed after Phases 1, 2, 3 and 4 of the 10-week rehabilitation programme. The results show a dramatic improvement in the strength of the cervical musculature acting in the four directions of movement tested (cervical flexion, extension and left and right side flexion). The player returned to professional club rugby 16 weeks post-operation and returned to International duty 2 weeks later. At the time of writing this case study, the player had not missed any game time due to cervical symptoms.

Cervical intervertebral disc injury during simulated frontal impact.

Cervical disc injury due to frontal impact has been observed in both clinical and biomechanical investigations; however, there is a lack of data that elucidate the mechanisms of disc injury during these collisions. The goals of the current study were to determine the peak dynamic disc annular tissue strain and disc shear strain during simulated frontal impact of the whole human cervical spine model with muscle force replication at 4 g, 6 g, 8 g and 10 g horizontal accelerations of the T1 vertebra. These data were compared with those obtained during physiological loading, and with previously reported rear impact data. Peak disc shear strain and peak annular tissue strain during frontal impact exceeded (p<0.05) corresponding physiological limits at the C2-C3 intervertebral level, beginning at 4 g and 6 g, respectively. These subsequently spread throughout the entire cervical spine at 10 g, with the exception of C4-C5. The C5-C6 intervertebral level was at high risk for injury during both frontal and rear impacts, while during frontal impact, in addition to C5-C6, subfailure injuries were likely at superior intervertebral levels, including C2-C3. The disc injuries occurred at lower impact accelerations during rear impact as compared with frontal impact. The subfailure injuries of the cervical intervertebral disc that occur during frontal impact may lead to the chronic symptoms reported by patients, such as head and neck pain.

Incidence of intravascular penetration in transforaminal cervical epidural steroid injections

Michael B. Furman, MD, Michael T. Giovanniello, MD, York, PA, USA; Erin O'Brien, MD, Philadelphia, PA, USA; Jenna Bridell, York, PA, USACervical epidural steroid injections are an accepted treatment for cervical pain with a radicular component secondary to a cervical disc injury or spinal stenosis. Incorrectly placed, intravascular cervical spinal injections result in medication flow systemically and not to the desired target. Previous studies have evaluated the incidence of inappropriate needle placement and the incidence of vascular penetration with positive aspiration in caudal epidural steroid injections (ESIs). A recently published study demonstrates a high incidence of intravascular injections and a low sensitivity of a “flash” (blood in the needle hub) or blood aspirate to predict an intravascular injection in transforaminal lumbosacral epidural steroid injections. No studies to date have evaluated the incidence of vascular injections in transforaminal cervical ESIs nor have they calculated the ability of flash or blood aspiration to predict a vascular injection. This prospective, observational study evaluated the incidence of vascular penetration during fluoroscopically guided, contrast-enhanced transforaminal cervical ESIs and whether a flash or aspiration of blood can be used to predict a vascular injection.The incidence of a flash or positive blood aspiration and the incidence of fluoroscopically confirmed vascular spread were prospectively observed in 372 patients treated with cervical fluoroscopically guided transforaminal ESIs. Presence of a flash or positive aspiration was documented. Contrast was injected to determine whether the needle tip was intravascular.A total of 392 transforaminal ESIs were included. The overall rate of intravascular injections was 19.6%. Using a flash or positive blood aspirate to predict intravascular injections was 96.5% specific but only 44.2% sensitive.Compared with a previous study of lumbosacral ESIs, there is a higher incidence of intravascular injections with cervical transforaminal ESIs. Using a flash or blood aspirate to predict an intravascular injection is not sensitive, and therefore a negative flash or aspiration is not reliable. Fluoroscopically guided procedures without contrast confirmation are instilling medications intravascularly and therefore not into the desired epidural location. This finding confirms the need for not only fluoroscopic guidance but also contrast injection instillation in cervical transforaminal ESIs.

In neck to neck competition are women more fragile?

Recent studies indicate numerous differences between female and male athletes regarding injuries of the upper and lower extremities. Studies have been much less clear concerning a gender differential regarding injuries of the cervical spine. For the purposes of the current review, injuries have been divided into three categories. The first category is cervical strain injury. It has been reported that strain injuries are more prevalent in female athletes than male athletes. The second category is cervical disc injury and cervical disc herniation. It has been reported that the male to female incidence is approximately equal in this category. In the third category, which is referred to as major structural injury, studies to date have almost entirely reported on injuries in males showing a significant male preponderance. With increasing participation of women in contact sports that cause major structural injury, a greater incidence of these injuries may be seen in women.

Pathology of spinal cord injuries due to fracture-dislocations of the thoracic and lumbar spine

The pathology of intervertebral disc injuries, hyper-extension injuries and spinal cord injuries due to fracture-dislocations of the cervical spine has been reported previously. Between 1957 and 1987, autopsy was performed on 4 patients with fracture-dislocation of the thoracic spine and on one patient with that of the lumbar spine. This paper presents the results of a clinicopathologic study conducted on two patients with a fracture-dislocation of the thoracic spine and on one patient with that pathology of the lumbar spine. The methods employed in the present study are the same as those that were described in my previous report on the pathology of cervical inter-vertebral disc injuries.

The lucent cleft, a new radiographic sign of cervical disc injury or disease

Moderately severe neck injury or disease may be associated with negative routine radiographs. Three cases are presented which show small, smooth, lucent clefts adjacent to the vertebral body end-plate anteriorly, seen only on the extension lateral view. This was the only radiographic sign of cervical injury or disease. An explanation of the finding is given and it is distinguished from the well known vacuum phenomena of disc degeneration.