Cervical Joint Research Articles

Cervical spine sensorimotor deficits persist in people post-concussion despite minimal symptoms

Background The mechanisms of a concussion place stress on the cervical spine like that of a whiplash event, which can result in cervical spine dysfunction. This study aimed to determine if underlying cervical spine mobility and sensorimotor function deficits occur in individuals who are post-concussion with near resolution of symptoms. Methods Twenty-five participants with a self-reported concussive event within a year (PC group: post-concussion 157 + 120 d, 9 men, age: 25 ± 8 yr) and 26 comparable peers (Peer group, 9 men, age: 25 ± 7 yr) were tested. The Post-Concussion Symptom Scale (PCSS) quantified residual concussion symptoms. Participants completed cervical joint position error (JPE) and cervical spine joint mobility tests blinded from each other. Group mean differences were analyzed using t-tests. Results The PC group had minimal symptoms (PCSS = 6.8 ± 6.5) but substantial differences in JPE tests compared to the Peer group (PC = 7.4 ± 1.8 cm; PG = 5.6 ± 1.1 cm; p < .001). Those PC participants with pain during joint testing (n = 15) had worse JPE (Painful = 8.1 ± 1.8 cm, No-pain = 6.3 ± 1.6 cm; p = .02) and less averaged lower cervical spine joint mobility compared to PC participants without pain (Painful = 0.66 ± 0.22, No-pain = 0.87 ± 0.19; p = .02, Normal motion = 1.0). Conclusion Following a concussion, it is a reasonable recommendation to screen the cervical spine to identify impairments in joint mobility and JPE that contribute to neck dysfunction.

Unveiling the Therapeutic Impact of Virtual Reality Game-Based Exercises on Cervicocephalic Kinesthetic Sensibility in Individuals Battling Cervical Vertigo

This study was aimed to investigate the therapeutic impact of Virtual Reality game-based exercises with Epley maneuver on cervicocephalic kinesthetic sensibility in individuals experiencing cervical vertigo. 8 subjects were selected by simple random sampling method included clinically diagnosed male and female cervical vertigo patients between 40-55 years of age, who had recurring symptom of dizziness over three months, episodic dizziness lasting minutes to hours .Written consent was taken and a detailed outcome assessment was done.Intervention includes Virtual Reality abyss sharks &amp;amp; sea worlds for a duration of 10 minutes with a five-minute rest period and Virtual Reality thrills, for a duration of 10 minutes with a five-minute rest period along with epley maneuver 10 minutes targeting cervicocephalic kinesthetic sensibility.Total duration of the intervention includes 40min/day for 6 days for 12 weeks. Pre test included Cervical Joint Position Error Test for cervicocephalic kinesthetic sensibility and Videonystagmography measures nystagmus, rapid eye movements with a slow and fast phase, to provide objective information about vertigo. Post test done on 6th and 12th week of intervention with the same measures. On comparing pre- and post-intervention outcomes shows higher mean value (P≤0.001).In conclusion the findings of this study had the potential to contribute valuable insights into the therapeutic utility of Virtual Reality game-based exercises in managing cervical vertigo, offering a novel and engaging approach to rehabilitation. Virtual Reality-based interventions is found effective treatment for individuals battling cervicocephalic kinesthetic sensibility among patients with cervical vertigo.

Evaluation of Radiological and Anatomical Features of Cervical Vertebrae in Adult Persian Cat.

Radiographic studies of Persian cat's cervical vertebrae can provide us with valuable information used in identifying its anatomical features, investigating various species of Persian cats and evaluating their cervical pathologies. The present study aimed to investigate the anatomical and radiological features of cervical vertebrae in Persian cats to create a comprehensive and accurate reference for the normal range of cervical bones and joints that can be used for clinical decision-making and interpretation of radiographic findings in these cats. The present descriptive-cross-sectional study included 10 adult Persian cats, including 5 males and 5 females. All cats underwent radiography in the dorsoventral, ventrodorsal, left lateral and right lateral recumbency. Then, anatomical investigations were performed. According to our findings, Persian cats were different from other cat species in some cervical vertebral characteristics, which can be suggested as comparative anatomy in these species. The most important differences were as follows: the C3 and C7 had the lowest and highest spinous process height (SPH), respectively. The atlas had the highest transverse process width (TPW), which was significantly different with other cervical vertebrae (p ≤ 0.05). Moreover, the cervical vertebrae were not significantly different in vertical diameter of cranial vertebral foramen (VDCrVF) and transverse diameter of cranial vertebral foramen (TDCrVF) (p ≤ 0.05). The caudal surface of the atlantic vertebral arch had two dorsal and ventral tubercles. Also, the ventral crest of the axis was quite indistinct in the cranial part while becoming prominent in the caudal part. The C3 spinous process was a wide, small tubercle, while the C7 spinous process was extended vertically. Finally, the C6 transverse processes had a large ventrocranial tubercle forming a sagittal plate with cranial and caudal parts separated by a notch. The accurate and comprehensive standard ranges obtained from the present study can be used for the interpretation of imaging results, clinical decision-making, and finding the normal and abnormal sizes of the cervical vertebrae and their processes in Persian cats.

Good vibes for the brain - Placebo versus real vibration in patients with chronic neck pain: A randomized cross-over study

BackgroundNeck muscle vibration decreases pain and improves sensorimotor impairments in patients with chronic neck pain. However, the impact of placebo on these effects are still unclear. ObjectiveThe aim was to evaluate the effect of neck muscle vibration compared to placebo neck muscle vibration in patients with chronic neck pain. MethodsTwenty-three people with chronic neck pain participated in this double-blinded, randomized crossover study. After baseline assessment at day 1, patients received either neck muscle vibration or placebo neck muscle vibration at day 2. At day 3, patients underwent the other treatment. The primary outcomes assessed at each day were active cervical joint position sense acuity, resting pain, and pressure pain threshold. ResultsCervical joint position sense revealed a significant time effect (F1, 22 = 4.366, p = 0.016, η2 = 0.902). Post-hoc testing revealed significant increases in cervical joint position sense after neck muscle vibration (p = 0.023; d = 0.602) but not after placebo vibration. Resting pain (F1, 22 = 7.550, p = 0.003, η2 = 0.418) displayed significant time effects for neck muscle vibration and placebo vibration. Pressure pain threshold demonstrated a significant time to condition effect (F1, 22 = 6.146; p = 0.008, η2 = 0.369). Post-hoc tests revealed that only neck muscle vibration significantly increased pressure pain threshold (p = 0.043, d = 0.516). ConclusionThe study demonstrates the efficacy of neck muscle vibration to decrease neck pain and improve cervical joint position sense in patients with chronic neck pain. Nevertheless, the influence of placebo effects should not be underestimated as they may contribute to these effects, indicated by similar decreases in resting pain.

C0-C1 joint injection: Anatomical, clinical and technical review

BackgroundCervicogenic headaches (CGH) are proven clinical entities. The prevalence of CGH arising from the atlanto-occipital (AO) joint is unknown. The best evidence for treatment of CGH is for third occipital nerve radiofrequency neurotomy. Treatment of CGH includes intra-articular injections into upper cervical spine joints. ObjectiveTo perform a review of the anatomy and clinical presentation of AO joint (AOJ) pain referral as well as a technical description to safely access the AOJ. MethodsA literature review was performed to explore the intricacies of the cranio-cervical junction (CCJ) with a focus on the relation between the AOJ and vascular anatomy. Our technical approach is described with complementary images. ResultsThe AOJ lies anterior to a venous sinus and slightly superior to the horizontally oriented vertebral artery crossing the joint line. ConclusionThe authors propose a modified superior needle trajectory that seeks to avoid these vascular structures and to access the AOJ safely.

Assessment of Cervical Joint Position Sense and Head Posture in Individuals With Myogenic Temporomandibular Dysfunctions and Identifying Related Factors: A Case-Control Study.

Temporomandibular dysfunctions (TMDs) have the potential to cause changes in cervical muscle strength, muscle endurance and position sense by changing muscle activation patterns, especially as a result of forward head posture. The effects of TMDs on cervical joint position sense (CJPS) and head posture remain controversial. The aim of this study was to evaluate the head posture and CJPS of individuals with TMDs and compare them with healthy individuals. This research, which was designed as a case-control study, was concluded with the inclusion of total of 84 participants (42 individuals diagnosed with myogenic TMDs, 42 controls). The assessment of participants included pain severity, neck and jaw functionality and disability, CJPS, head posture and temporomandibular joint (TMJ) range of motion (ROM). Individuals with TMDs exhibited higher angular deviation in CJPS during flexion and extension (p < 0.001). Additionally, individuals with TMDs demonstrated higher TMJ pain, limitation and dysfunction severity, as well as a more limited TMJ ROM (p < 0.001). Head posture was similar between groups (p > 0.05). There is a significant relationship between VAS-TMJ with VAS-cervical, FAI, NDI, JFLS-8 and TMJ ROM (p < 0.05). Moreover, a significant correlation was observed between NDI with FAI and TMJ ROM (p < 0.05). These results indicate that in addition to higher pain severity, disability and lower jaw ROM, CJPS of individuals with TMDs is also negatively affected. Also, parameters related to disability and functionality of cervical and TMJ were significantly correlated. Further studies are needed to determine the factors contributing to these results.

Firefighter helmets and cervical intervertebral Kinematics: An OpenSim-Based biomechanical study

The assessment of cervical intervertebral kinematics can serve as the basis for understanding any degenerative changes in the cervical spine due to the prolonged wear of a heavyweight, imbalanced firefighting helmet. Therefore, this study aimed to analyze cervical intervertebral kinematics using the OpenSim musculoskeletal modeling platform in order to provide much-needed insights into how the inertial properties of firefighter helmets affect cervical spinal mobility. A total of 36 firefighters (18 males and 18 females) were recruited to perform static and dynamic neck flexion, extension, and left and right lateral bending tasks for three conditions: 1) no-helmet, 2) US-style helmet with a comparatively superior center of mass (COM), and 3) European-style helmet with relatively higher mass but an inferior COM. Three custom-made OpenSim head-neck models were created to calculate cervical intervertebral kinematics for each helmet condition. Results showed that helmet use significantly (p < 0.001) affects neck and cervical spinal kinematics. Despite its lighter weight, the superior COM placement in the US-style helmet caused more pronounced angular changes and higher velocity of peak flexion and extension angles compared to the European-style helmet across all cervical joints. Moreover, results revealed discrepancies between OpenSim-derived neck and cervical range-of-motion and those reported in previous in-vivo studies. In conclusion, the present study underscores the importance of designing firefighter helmets with a lower profile (less superior COM) to enhance neck range of motion and minimize potential neck injuries.

Cervical Sensorimotor Function Tests Using a VR Headset-An Evaluation of Concurrent Validity.

Sensorimotor disturbances such as disturbed cervical joint position sense (JPS) and reduced reaction time and velocity in fast cervical movements have been demonstrated in people with neck pain. While these sensorimotor functions have been assessed mainly in movement science laboratories, new sensor technology enables objective assessments in the clinic. The aim was to investigate concurrent validity of a VR-based JPS test and a new cervical reaction acuity (CRA) test. Twenty participants, thirteen asymptomatic and seven with neck pain, participated in this cross-sectional study. The JPS test, including outcome measures of absolute error (AE), constant error (CE), and variable error (VE), and the CRA test, including outcome measures of reaction time and maximum velocity, were performed using a VR headset and compared to a gold standard optical motion capture system. The mean bias (assessed with the Bland-Altman method) between VR and the gold standard system ranged from 0.0° to 2.4° for the JPS test variables. For the CRA test, reaction times demonstrated a mean bias of -19.9 milliseconds (ms), and maximum velocity a mean bias of -6.5 degrees per seconds (°/s). The intraclass correlation coefficients (ICCs) between VR and gold standard were good to excellent (ICC 0.835-0.998) for the JPS test, and excellent (ICC 0.931-0.954) for reaction time and maximum velocity for the CRA test. The results show acceptable concurrent validity for the VR technology for assessment of JPS and CRA. A slightly larger bias was observed in JPS left rotation which should be considered in future research.

Radiofrequency vs Steroid Injections for Spinal Facet and Sacroiliac Joint Pain: A Systematic Review and Meta-Analysis.

Pain management for spinal facet joint (SFJ) and sacroiliac joint (SIJ) pain is challenging, often requiring interventions like radiofrequency ablation (RFA) or corticosteroid injections (CI). This study aims to assess and compare the effectiveness of CI and RFA in treating SFJ and SIJ pain. We combine these treatments due to their shared pathophysiology, similar therapeutic interventions, and the necessity for an integrated approach to spinal pain management. Literature search from PubMed, Scopus, CENTRAL and Google Scholar for published studies upto 31st December 2023, and reporting data of patients who were treated using CI of RFA for SFJ and SIJ pain. Pooled standardized mean difference (SMD) with a 95% Confidence Interval (CI) was calculated. Our meta-analysis incorporated thirteen studies. Overall, patients, treated with CI had a higher pain intensity score compared to patients treated with RFA (SMD=0.92; 95% CI: 0.19 to 1.65) at 3 months, and at 6 months (SMD=1.53; 95% CI: 0.66 to 2.40) after the treatment. No significant association was reported at 12 months (SMD=1.47; 95% CI: -0.03 to 2.97). Subgroup analysis based on joint types revealed increased pain intensity scores in patients who were treated with CI for SIJ (SMD=1.25; 95% CI: 0.39 to 2.11) and SFJ (SMD=1.33; 95% CI: 0.09 to 2.57) pain. A negative but not significant effect was detected in patients, treated with CI for cervical joint pain (SMD=-0.40; 95% CI: -0.90 to 0.10). Patients treated with CI exhibited higher functional disability score compared to patients treated with RFA at 3 months (SMD=1.28; 95% CI: 0.20 to 2.35) post-treatment. This study suggests that RFA may offer superior pain relief with longer duration compared to steroid injections for spinal facet and sacroiliac joint pain. Decision regarding specific interventions should be individualized and consider patient preferences, clinical context, and potential risks.

Comparison of head posture and neck proprioceptive sense of individuals with chronic neck pain and healthy controls: A cross-sectional study.

Chronic pain can affect body perception at the central level by causing the somatosensory cortex to rearrange. Additionally, cervical afferent abnormalities in individuals with neck pain can impair proprioceptive sensitivity, potentially leading to alterations in body alignment and biomechanics. Nevertheless, there are insufficient studies exploring these notions. The main objective of this study was to compare the head posture and neck proprioceptive sense of individuals with chronic neck pain and healthy controls. Utilizing a cross-sectional study, a total of 76 volunteers comprising 38 individuals with neck pain and 38 matched healthy controls participated in the study. Head posture and cervical joint position sense were measured using a Cervical Range of Motion Deluxe (CROM) device. Firstly, the deviation angles of the head in three planes were evaluated, then the Head Repositioning Accuracy (HRA) test was performed to determine the joint position error. Visual Analogue Scale (VAS) was used to determine the severity of pain in individuals with neck pain. The deviation angles of the head in all three planes were significantly lower in the healthy control group (p< 0.05). Joint position error values were significantly higher in all directions (flexion-extension, right-left lateral flexion, and rotation) in the neck pain group (p< 0.001). The findings show that the proprioceptive sensation of the cervical region in individuals with neck pain was adversely affected, with changes were observed in the head posture. The abstract of this study was presented as a verbal declaration at the International Congress of Health Sciences-ICHES-IDU 2020 that was held in İzmir on 20-21 June 2020.

Ultrasound-guided caudal cervical articular process arthrocentesis is accurate in live horses with and without arthropathy.

Cervical articular process joint (CAPJ) therapy is advocated for horses with neck disorders. Several ultrasound-guided CAPJ techniques have been described in cadaver studies with 72%-89% intra-articular injection accuracy; however, the CAPJ injection accuracy in clinical equine practice has not been extensively reported. To describe a modified cranial approach for ultrasound-guided caudal CAPJ injections, to investigate the accuracy of this CAPJ injection technique in live horses, and to assess the effect of CAPJ injection location, laterality, operator, and radiographic CAPJ enlargement on injection accuracy. Retrospective case study. Medical records of adult horses in which ultrasound-guided caudal (C4-T1) CAPJ injections were performed using a modified cranial approach between November 2006 and December 2020 were reviewed. Radiographic images of caudal cervical vertebrae were assessed by a blinded radiologist and the degree of CAPJ enlargement was graded using a previously described grading system (Rgrade 1-5b). Ultrasound-guided caudal CAPJ injection accuracy was determined by synovial fluid retrieval during an individual CAPJ injection. Statistical analysis was performed using mixed-effects multivariable logistic model to evaluate the association of CAPJ injection accuracy and the CAPJ injection location, Rgrade, laterality (right, left), and operator. The study included 149 horses with 177 hospital admissions. Synovial fluid was obtained from 586/658 (89.1%) caudal CAPJs using modified cranial ultrasound-guided approach for CAPJ injections. C6-C7 CAPJ injections had 7-fold higher likelihood (OR = 6.78, 95% CI: 1.67-27.52; p = 0.007) of synovial fluid retrieval compared with C4-C5 CAPJ injections. Operator, CAPJ injection side (left, right), and degree of radiographic CAPJ enlargement did not have significant effects on the success of synovial fluid retrieval from ultrasound-guided caudal CAPJ injections. Retrospective study design. Intra-articular ultrasound-guided caudal CAPJ injections using a modified cranial approach can be performed accurately in live horses with and without CAPJ arthropathy.

Efficacy of scapulothoracic exercises on proprioception and postural stability in cranio-cervico-mandibular malalignment: A randomized, double-blind, controlled trial.

Cranio-cervico-mandibular (CCM) malalignment is associated with forward head posture (FHP) and temporomandibular joint (TMJ) disorders and affects masticatory muscles. This randomized, double-blind controlled trial aimed to compare the efficacy of scapula-thoracic (ST) exercises on temporomandibular and cervical joint position sense and postural stability in individuals with CCM malalignment. Fourty-nine participants with CCM malalignment were randomly assigned to the ST exercise group (STEG, n= 24) or the control group (CG, n= 25). STEG included progressive strengthening, proprioceptive, and stabilization exercises. All participants were assessed before treatment, at the end of the 8th week treatment period and at the 12th week post-treatment follow-up. Cranio-vertebral angle measurement, Fonseca's Questionnaire, Helkimo Clinical Dysfunction Index, TMJ position test, cervical joint position error test and postural stability assessment were used. The TMJ and cervical joint position sense, total sway degree, area gap percentage, sway velocity and antero-posterior body sway results showed significant improvement in the STEG compared to the CG (p< 0.05), however medio-lateral body sway did not differ between groups (p> 0.05). Postural stability, TMJ and cervical joint position sense appear to be affected in individuals with CCM malalignment. Our results showed that an exercise program including ST stabilization, proprioception and strengthening of the scapular muscles may be effective in the management of CCM malalignment and will allow clinicians to plan holistic treatment.

Effects of video-based cervical stabilization home exercises in patients with rheumatoid arthritis: arandomized controlled pilot study.

This study aimed to examine the effects of aremote video-based cervical stabilization exercise program on cervical proprioception, functional status, and disease-related quality of life in patients with rheumatoid arthritis (RA). Patients with RA were evaluated regarding cervical joint positioning error, cervical region functional status (Neck Disability Index), general functional status (Health Assessment Questionnaire), and disease-related quality of life (Rheumatoid Arthritis Quality of Life Scale). Patients were randomized to exercise (n = 14, 10female) and control (n = 12, 9female) groups. Patients in the exercise group performed avideo-based home exercise program consisting of progressive cervical stabilization exercises three times aweek for sixweeks in addition to their routine medication. The patients in the control group continued their routine medication only. Evaluations were repeated in both groups in the seventh week following the baseline evaluation. Groups were similar at baseline (p > 0.05). Patients in both groups had low disease activity (DAS-28 CRP ≤ 3.2). The remote video-based exercise program led to significant improvements in cervical proprioception, functional status, and disease-related quality of life (p < 0.05). No significant changes were detected in any parameters in the control group (p > 0.05). Obtained changes were superior in the exercise group compared to the control group (d > 1.00, p < 0.05). Cervical stabilization exercises may increase cervical proprioception, improve functional status, and enhance disease-related quality of life in patients with RA when administered as aremote program. https://clinicaltrials.gov/study/NCT04948775 , NCT04948775.

Effect of Integrated Postural Training in Individuals with Text Neck Syndrome

Background: Text neck syndrome is a repetitive stress injury caused by prolonged use of electronic gadgets, particularly smartphones. With smartphone addiction surpassing internet addiction, it has led to increased musculoskeletal problems. Currently, symptomatic treatment for text neck syndrome includes neck pain, postural changes, and cervical proprioceptive errors. The condition is chronic and progressive, and timely intervention and postural correction are crucial to minimize early consequences in later life. The aim of this study was to investigate the effect of integrated postural training in individuals with text neck syndrome. Methods: This study included 80 participants clinically diagnosed with text neck syndrome who were selected based on inclusion and exclusion criteria. They were further divided into two groups, with Group A receiving a conventional exercise program and Group B receiving integrated postural training 3 times a week for 6 weeks. Pre- and post-assessment scores of visual analog scale (VAS), neck disability index (NDI), range of motion (ROM) of the cervical spine, tragus to wall test (TTW), Vernier Caliper measurements for rounded shoulders and cervical joint position error testing (CPJE Testing) were taken and the results were obtained by statistical analysis of the data. Results: The results of this study showed that there was an extremely significant improvement in neck pain, cervical ROM, forward head posture, and rounded shoulder posture in both the groups with a p-value of &lt;0.0001 except for the CPJE testing, which showed to be significant in the Group B with a p-value &lt;0.0001 as compared to Group A. Conclusion: The study concluded that integrated postural training showed significant improvement and has been beneficial in relieving pain, improving cervical range of motion, posture, and the cervical joint position error in individuals with text neck syndrome.

Effects of Whole-Body Vibration Therapy in Weight-Bearing and Non-Weight Bearing Positions for Upper and Lower Extremities on Balance and Cervical Joint Position Sense in Children With Cerebral Palsy.

Cerebral palsy (CP) is a complex pathological entitythat affects muscular control, coordination, proprioception, fine andgross motor abilities, position, stability, and, in some cases, cognition. This study aimed to compare the effects of whole-body vibration therapy (WBVT) in weight bearing and non-weight bearing positions for the upper and lower extremities on balance and cervical joint position sense in children with spastic CP. A randomized controlled trial was carried out on 60 hemiplegic children with spastic CP aged 5-15 years. Following randomization, all participants were allocated into six equal-sized groups based on the application ofWBVT for upper extremities, lower extremities, or both simultaneously in either weight-bearing or non-weight-bearingpositions. Pediatric balance scale (PBS) and laser tracker system were used to assess functional balance and cervical joint position sense. One-way analysis of variancefor Inter-group analysis showed a statistically significant difference among all groups in PBS and cervical joint position sense (p<0.05). WBVT was found to be beneficial in improving balance and cervical joint position sense in both weight-bearing and non-weight-bearing positions for the upper and lower extremities in children with cerebral palsy. However, the simultaneous application of WBVT in weight-bearing positions for both upper and lower extremities showed the most significant improvements in improving both balance and cervical joint position sense, indicating the most efficacious position of this treatment approach in children with cerebral palsy.

Primary phenotypic features associated with caudal neck pathology in warmblood horses.

Detailed descriptions of clinical signs associated with radiological findings of the caudal cervical vertebral column are not available. Describe the clinical features associated with neck pain or stiffness, neck-related thoracic limb lameness, proprioceptive ataxia consistent with a cervicothoracic spinal cord or nerve lesion, and their frequency of occurrence compared with control horses. A total of 223 Warmblood horses. Case-control study. Controls and cases were recruited prospectively. All horses underwent predetermined lameness and neurologic examinations. The frequency of occurrence of each clinical feature was compared between cases and controls and relative risk (RR) were calculated. Ninety-six cases and 127 controls were included. Forty-seven (49%) of the cases were classified as neurologic, 31 (32.3%) had thoracic limb lameness, and 18 (18.7%) had neck stiffness or pain or both. Focal caudal cervical muscle atrophy (46, 47.9%), hypoesthesia (38, 39.6%), patchy sweating (16, 16.7%), hyperesthesia (11, 11.5%), and pain upon firm pressure applied over the caudal cervical articular process joints and transverse processes (58, 60.4%) were only observed in cases (P < .001). Sideways flexion of the neck was restricted in a higher proportion of cases (47/96, 49%) compared with controls (40/127, 31.8%; P = .009, RR 1.5). Hopping-type thoracic limb lameness was only observed in cases, (30, 31.6%). Deterioration in lameness after diagnostic anesthesia occurred in 13/31 (41.9%) cases. Systematic clinical evaluation using the methods described should enable clinical differentiation between horses with caudal cervical lesions and horses with other causes of gait abnormalities.

Does the novel artificial cervical joint complex resolve the conflict between stability and mobility after anterior cervical surgery? a finite element study.

Our group has developed a novel artificial cervical joint complex (ACJC) as a motion preservation instrument for cervical corpectomy procedures. Through finite element analysis (FEA), this study aims to assess this prosthesis's mobility and stability in the context of physiological reconstruction of the cervical spine. A finite element (FE)model of the subaxial cervical spine (C3-C7) was established and validated. ACJC arthroplasty, anterior cervical corpectomy and fusion (ACCF), and two-level cervical disc arthroplasty (CDA) were performed at C4-C6. Range of motion (ROM), intervertebral disc pressure (IDP), facet joint stress (FJS), and maximum von Mises stress on the prosthesis and vertebrae during loading were compared. Compared to the intact model, the ROM in all three surgical groups demonstrated a decline, with the ACCF group exhibiting the most significant mobility loss, and the highest compensatory motion in adjacent segments. ACJC and artificial cervical disc prosthesis (ACDP) well-preserved cervical mobility. In the ACCF model, IDP and FJS in adjacent segments increased notably, whereas the index segments experienced the most significant FJS elevation in the CDA model. The ROM, IDP, and FJS in both index and adjacent segments of the ACJC model were intermediate between the other two. Stress distribution of ACCF instruments and ACJC prosthesis during the loading process was more dispersed, resulting in less impact on the adjacent vertebrae than in the CDA model. The biomechanical properties of the novel ACJC were comparable to the ACCF in constructing postoperative stability and equally preserved physiological mobility of the cervical spine as CDA without much impact on adjacent segments and facet joints. Thus, the novel ACJC effectively balanced postoperative stability with cervical motion preservation.

Investigation of The Correlation Between Pain, Proprioception and Range of Motion in Patients With Temporomandibular Joint Dysfunction

Purpose: The aim of study was to investigate the relationship between pain, proprioception and range of motion in patients with temporomandibular joint dysfunction (TMD). Material and Methods: The study was completed with 45 participants diagnosed with TMD and 45 healthy controls. Visual analog scale and graded chronic pain scale were used to assess pain intensity, dolorimeter was used for pain pressure threshold (PPT) assessment. Evaluation of cervical proprioception by cervical joint position error test (JPET), cervical joint range of motion assessment by digital goniometer, mouth opening measurements were made with a ruler. Results: In the study, pain intensity was high and PPT was low in the TMD group. In the JPET, the right-left rotation and left lateral flexion values in the TMD group had higher mean values than the control group (p=0.028, p=0.003, p=0.004, respectively). There was a significant difference between the groups in digital goniometer measurement in right-left rotation, right-left lateral flexion movements(p=0.008, p=0.001, p=0.041, p=0.005, respectively). The TMD group had a lower mean than the control group in painless, maximum assisted and unassisted mouth opening measurements(p=0.001, p=0.001, p=0.001, respectively). Conclusion: TMD patients presented a lower PPT, less accurate head repositioning, and some impairment in cervical range of motion.

Markers associated with the development of osteoporosis in children with juvenile idiopathic arthritis

Background. The purpose of the study was to investigate the association between bone mineralization le­vel in children with juvenile idiopathic arthritis (JIA) and various exogenous and endogenous factors. Materials and ­me­thods. The study group consisted of 162 children diagnosed with JIA. Medical history, clinical features, and treatment of JIA were studied. Disease activity was evaluated using the Juvenile Arthritis Disease Activity Score (JADAS-27), health status — with the Childhood Health Assessment Questionnaire (CHAQ). Complete blood count with erythrocyte sedimentation rate, biochemical analysis (C-reactive protein, total and ionized calcium) were performed, and instrumental methods (ultrasound densitometry, X-ray and ultrasound examination of joints) were used. Serum levels of osteocalcin, 25-hydroxyvitamin D (25(OH)D), and parathyroid hormone were evaluated using an enzyme-linked immunosorbent assay on an ER500 analyzer (Sinnowa, China). Results. According to our study, osteoporosis was observed in 19 patients (11 girls and 8 boys) out of 162 children with JIA, accounting for 11.7 %. It was significantly more frequent in patients with polyarthritis (73.7 %) compared to those with oligoarthritis (26.3 %) (p &lt; 0.05). Conclusions. Osteoporosis can develop in children with JIA who do not receive systemic glucocorticoid therapy. The main markers associated with osteoporosis in children with JIA include non-infectious disease onset trigger, cervical joint involvement at disease onset, involvement of more than 3 joint groups at onset, gait disturbances, high JADAS-27 and CHAQ scores, signs of systemic inflammatory process, including elevated erythrocyte sedimentation rate.

Responsiveness of the cervical joint position error test to detect changes in neck proprioception following four weeks of home-based proprioceptive training.

People with chronic neck pain (CNP) commonly exhibit a range of physical impairments including cervical proprioceptive deficits. Assessing proprioception using a head mounted laser to assess joint position error (JPE) is a reliable and valid measure. However, the responsiveness of this measure has not been assessed. To assess the responsiveness of the measure of cervical JPE after a 4-week home-based neck proprioceptive training intervention in people with CNP. An observational study to assess the responsiveness of the measure of cervical JPE. The JPE test was assessed in people with CNP before and after 4 weeks of neck proprioception training. JPE was assessed as participants performed neck joint position sense tests for flexion, extension, right rotation, and left rotation in sitting and standing which were performed in a random order. Both the absolute and constant JPE were assessed. The intervention consisted of neck repositioning exercises as well as movement sense exercises. Cohen's d effect size was used to assess the internal responsiveness of the JPE test. The Pearson's correlation was used to assess the change of scores of the laser pointer and measures from inertial measurement units (IMUs) (external responsiveness). After 4 weeks of proprioception training, JPE assessed in sitting reduced from 2.69◦-3.57◦ to 1.88◦-1.98◦ for flexion, extension, and right rotation with large effect sizes (Cohen's d range: 1.25-2.00). For left rotation, JPE reduced from 3.23◦ to 1.9◦, and the effect size was close to being large (Cohen's d: 0.79). When assessed in standing, JPE reduced from 3.49◦-4.52◦ to 1.5◦-2.33◦ with large effect sizes (Cohen's d range: 0.89-1.25) for flexion, extension, right rotation, and left rotation. Large effect sizes were not observed for the constant JPE when assessed in either sitting or standing. The assessment of the external responsiveness revealed weak correlations between the change of scores obtained from the laser pointer and the IMUs for all movements, apart from the constant JPE in sitting for left rotation, which showed a strong correlation (r = 0.7). The results of this study showed that the measure of the JPE has sufficient internal responsiveness, however, the external responsiveness was inadequate. Further research is advised.