Cervical Motion Research Articles

Medical management/Non-surgical of ectopic pregnancy: Case report and review of literature

Ectopic pregnancy is a cause of maternal morbidity and mortality. Management options are surgical, medical and expectant management. Medical management also known as the non-surgical approach is not widely practiced in our environment despite its several advantages over the traditional open salpingectomy including its less invasiveness, reduced cost and absence of anaesthetic risk, surgical risk and need for hospital admission. It however requires early presentation and diagnosis before tubal rupture, a well motivated patient and fulfilment of strict criteria in well selected patients. Aim. To present this rare case report of the medical/non-surgical management of unruptured ectopic pregnancy and a review of the literature. Case report: Mrs AW, Para 3+0 (2 alive) who presented with lower abdominal pains and abnormal scanty vaginal bleeding following 6 weeks of amenorrhoea. Her physical examination revealed a stable cardiovascular state. There were no significant abdominal findings. Vaginal examination revealed positive cervical motion tenderness. A diagnosis unruptured ectopic pregnancy was made. Pelvic ultrasound scan revealed a cystic left adnexial mass measuring 1.94 cm by 1.7 cm with thickened, well circumscribed margins and it contained an echogenic mass (fetal pole) with cardiac pulsation (145/min). The crown-rump length was 0.76cm which corresponded to 6 weeks plus 5 days of gestation. Her serum β hCG was 3625.8miu/ml. She expressed her aversion for a surgical intervention having had 3 previous surgeries. She gave an informed consent for medical/non-surgical management with intramuscular Methotrexate. She subsequently received 3 doses of weekly 100mg intramuscular methotrexate. Each dose of Methotrexate was preceded by re-evaluation of liver/renal function test, full blood count and serum β hCG. By the 4th week of treatment the success of her treatment was confirmed by the insignificant level of β hCG and findings at TVS. She was counselled on the need for prompt localization of any subsequent pregnancy. Conclusion: We presented Mrs AW who was successfully managed for unruptured ectopic pregnancy using the medical/non-surgical approach on out-patient basis. Proper patient selection and follow-up is required for a favourable outcome,

AN ESSENTIAL TOOL TO BE OPTIMIZED: SYNDROMIC MANAGEMENT OF VAGINAL DISCHARGE IN HAITI.

Haiti, like many low-income countries in crisis, has limited resources for etiologic diagnosis of vaginal discharge. As such, we sought to characterize variability in diagnoses of women presenting with vaginal discharge syndrome, with the goal to improve standardization of syndromic management. Participants aged 18 years and older endorsing vaginitis, or dysuria were recruited at Jerusalem Clinic over two, one-week periods in April 2018 and July 2019. We calculated Spearman rank correlations among history, exam findings, and diagnoses based on clinical presentation, to understand presentation groupings and their management. Among 98 women, median age was 33.5 years, and most frequent symptoms were: vaginal discharge (97%), vaginal itch (73%), and/or suprapubic pain (68%). Most common physical exam findings were vaginal discharge (86%), suprapubic/lower quadrant tenderness (29%), cervical motion tenderness (24%), and cervical erythema (20%). Most symptoms and physical exam findings were weakly correlated with each other. Nearly one-third (31%) were diagnosed with normal physiologic vaginal discharge or no diagnosis, followed by Bacterial vaginosis (31%), vulvovaginal candidiasis (15%), cervicitis/PID (13%), and STI (7%). No reported symptoms strongly differentiated diagnostic categories. Diagnoses varied considerably by exam findings. The weak correlations between symptoms, exam findings, and diagnoses could represent variability in assessment. In the absence of reliable and accessible laboratory testing, the importance of standardizing syndromic management becomes increasingly relevant. Results from our study support the utility of speculum examination and more standardized documentation of physical exam findings. Next steps include the development of local algorithms to promote standardization of treatment of vaginal discharge syndrome.

C1 Transposterior Arch Lateral Mass Screws Combined With C2 Pedicle Screw and Rod Fixation for Pediatric Atlantoaxial Subluxation: A Minimal 10-Year Follow-up Outcome Analysis.

Although the short-term outcomes of the 1-step reduction and fixation technique using C1 transposterior arch lateral mass screws combined with C2 pedicle screw and rod fixation system for the treatment of pediatric atlantoaxial subluxation (AAS) have been satisfactory, its long-term outcomes and impact on spinal development are not well studied. This study was intended to assess the long-term reliability of this technique for pediatric AAS. A retrospective case series study was conducted to analyze the minimum 10-year follow-up outcomes from 7 pediatric patients with AAS who underwent atlantoaxial fusion using the aforementioned technique. Quality of life and cervical range of motion were both measured thoroughly. In addition, vertical growth within the fusion construct (C1-2), overall cervical alignment, and subaxial cervical spine degeneration were evaluated radiographically. The mean age of the 7 patients was 8.14 ± 2.41 (6-12) years at the time of surgery. The mean follow-up period was 11.00 ± 1.15 (10-13) years. No patients presented identifiable intervertebral disk degeneration or segmental instability in the subaxial cervical spine except for 1 patient who showed mild intervertebral disk degeneration. Vertical growth did continue within the atlantoaxial complex after surgery (11.90% ± 2.37%); however, there was a decrease in the percentage of vertical growth compared with the corresponding normal populations of the same age and sex. Moreover, there was a significant decrease in the range of cervical extension and rotation motion, and the overall cervical alignment straightened at the latest follow-up. The 1-step reduction and fixation technique is a relatively reliable surgical technique for pediatric AAS, which does not adversely affect the postoperative quality of life or the subaxial cervical degeneration. Nevertheless, certain limitations, such as decreased cervical range of motion and changes in cervical alignment, should be concerned.

The biomechanical effect of different types of ossification of the ligamentum flavum on the spinal cord during cervical dynamic activities

Ossification of the ligamentum flavum (OLF) is thought to be an influential etiology of myelopathy, as thickened ligamentum flavum causes the stenosis of the vertebral canal, which could subsequently compress the spinal cord. Unfortunately, there was little information available on the effects of cervical OLF on spinal cord compression, such as the relationship between the progression of cervical OLF and nervous system symptoms during dynamic cervical spine activities. In this research, a finite element model of C1-C7 including the spinal cord featured by dynamic fluid-structure interaction was reconstructed and utilized to analyze how different types of cervical OLF affect principal strain and stress distribution in spinal cord during spinal activities towards six directions. For patients with cervical OLF, cervical extension induces higher stress within the spinal cord among all directions. From the perspective of biomechanics, extension leads to stress concentration in the lateral corticospinal tracts or the posterior of gray matter. Low energy damage to the spinal cord would be caused by the high and fluctuating stresses during cervical movements to the affected side for patients with unilateral OLF at lower grades.

Clinical Effectiveness of Artificial Disc Replacement in Comparison With Anterior Cervical Discectomy and Fusion in the Patients With Cervical Myelopathy: Systematic Review and Meta-analysis.

Cervical myelopathy (CM) describes the compressive cervical spinal cord state, often accompanied by serious clinical condition, by herniated disc or hypertrophied spurs or ligament. Anterior cervical discectomy and fusion (ACDF) has been frequently employed as conventional surgical solution for this CM despite its inherent biomechanical handicap. Alternatively, an artificial disc replacement (ADR) preserves cervical motion while still decompressing the spinal canal and neural foramen. This analysis elaborated to clarify the potential benefits of ADR application to CM over ACDF from the conglomerated results of the past references. A literature search was performed using MEDLINE, Embase, Cochrane review, and KMbase databases from the studies published until March 2023. Six studies (3 randomized controlled study [RCTs] and 3 non-RCTs) were included in a qualitative and quantitative synthesis. Data were extracted and analyzed using a random effects model to obtain effect size and its statistical significance. Quality assessment and evidence level were established in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. Among 6 studies, 2 studies showed that ADR group achieved significantly better clinical improvement than the ACDF group, while the rest 4 studies revealed no significant difference. A meta-analysis showed better clinical outcomes with or without statistical significance. The level of evidence was low because of inconsistency and imprecision. ADR was superior or at least, not inferior to ACDF in terms of functional recovery. However, its application to the CM patients is merely empowered with weak strength due to low level of evidence.

The Robotic System for the Treatment of Locally Advanced Cervical Cancer with Stereotactic Body Radiotherapy Boost: Results of a Phantom-Based and Preliminary Study

To fix uterocervical position, compensate uterocervical intrafraction motion, and thus improve the accuracy of dose delivery based on the robotic system for the treatment of locally advanced cervical cancer with stereotactic body radiotherapy boost. CT images were acquired after robot arm implanted a fixator with fiducial markers into the cervix of pelvic phantom. The treatment plans were designed by contoured a simulated tumor lesion site. The fiducial markers position was obtained by real-time image guidance system and was registered with digitally reconstructed radiographs to calculate correlation error of six directions. The correlation error was delivered to the robotic arm to precisely adjust the position and posture of the fixator, and thus compensated uterocervical intrafraction movement through the interactive interface of the robotic system. The pressure sensor at the head of the fixator provided real-time feedback on the pressure value at the contact surface between the fixer and the cervix. The correlation error of six directions and the pressure value were extracted and analyzed from the log file. The data from the log file indicated that the three translational direction correlation error of x, y and z were 0.19mm, 0.20mm and 0.10mm, respectively. The three rotational direction correlation error of roll, pitch and yaw were 0.25°, 0.21° and 0.23°, respectively. With the increase of the relative distance between cervix and pressure sensor, the mean value of pressure variation decreases gradually. When the relative distance is 0.5mm and 3mm, the mean value of pressure variation is approximately 76% and 32%, respectively. The correlation accuracy of the robotic system meets the clinical requirements. The robot arm can fix and monitor the cervical motion in real time during radiotherapy. The robot system adjusts the position of the fixator to correct the uterocervical intrafraction motion error, which is feasible and has good clinical application prospect.

Effects of complex neck therapy – kinesiotherapy and interspinal muscles massage – on tinnitus

Introduction<i></i>Past studies have shown connections between the somatosensory system (the neck and temporomandibular joint region) and the auditory system. It is therefore likely that tinnitus patients might benefit from neck therapy. The aim of this study was to investigate the effects of physiotherapy of the neck, comprising cervical spine kinesiotherapy and interspinal muscles massage, on subjective tinnitus. We also investigated the effects of the therapy on the range of cervical spine motion and cervical muscles tension.Material and methodsThis was a non-randomised controlled trial. Adult patients with chronic subjective tinnitus (<i>n</i> = 118) were enrolled in an intervention group and received 10 sessions, over 2 weeks, of neck therapy comprising active exercises, massage of the cervical interspinal muscles, and post-isometric relaxation exercises. There was also a control group (waiting list). The effects of the therapy on tinnitus were assessed at baseline, immediate post-treatment, and follow-up (2 weeks after the end of therapy) using the Polish Tinnitus Functional Index (TFI-Pl, primary outcome measure), a visual analogue scale (VAS) of tinnitus loudness, and the Polish Tinnitus Handicap Inventory (THIPl). Effects of therapy on neck were assessed using two measures: the range of cervical spine movement (cervical flexion, cervical rotation, and cervical side bending measured in cm using a tape measure); and muscle tension – assessed by palpation and graded using a scale of either 0 (normal) or 1 (increased).ResultsIn the intervention group, the mean TFI score was reduced significantly from baseline (mean = 52.6, SD = 20.4) to post treatment (mean = 40.9, SD = 19.0, <i>p</i> < 0.001) and at follow-up (mean = 40.4, SD = 21.1, linear mixed model). In the control group, mean TFI score did not change significantly from baseline (mean = 46.8, SD = 20.1) to post treatment (mean = 45.8, SD = 40.9) and follow-up (mean = 45.2, SD = 26.2, linear mixed model). Improvement in tinnitus in the intervention group was accompanied by a reduction in cervical muscles tension and improvement in the range of cervical spine motion.ConclusionsComplex neck therapy of the neck appears to be a promising intervention for tinnitus treatment. Further randomised studies are needed to confirm the positive effects of the therapy on tinnitus and explore the mechanisms leading to improvement.

Direct versus indirect epiglottis elevation in cervical spine movement during videolaryngoscopic intubation under manual in-line stabilization: a randomized controlled trial

BackgroundDuring videolaryngoscopic intubation, direct epiglottis elevation provides a higher percentage of glottic opening score than indirect epiglottis elevation. In this randomized controlled trial, we compared cervical spine movement during videolaryngoscopic intubation under manual in-line stabilization between the two glottis exposure methods.MethodsVideolaryngoscopic intubation under manual in-line stabilization was performed using C-MAC® D-blade: direct (n = 51) and indirect (n = 51) epiglottis elevation groups. The percentage of glottic opening score was set equally at 50% during videolaryngoscopic intubation in both groups. The primary outcome measure was cervical spine movement during videolaryngoscopic intubation at the occiput–C1, C1–C2, and C2–C5. The secondary outcome measures included intubation performance (intubation success rate and intubation time).ResultsCervical spine movement during videolaryngoscopic intubation was significantly smaller at the occiput–C1 in the direct epiglottis elevation group than in the indirect epiglottis elevation group (mean [standard deviation] 3.9 [4.0] vs. 5.8 [3.4] °, P = 0.011), whereas it was not significantly different at the C1–C2 and C2–C5 between the two groups. All intubations were successful on the first attempt, achieving a percentage of glottic opening score of 50% in both groups. Intubation time was longer in the direct epiglottis elevation group (median [interquartile range] 29.0 [24.0–35.0] vs. 22.0 [18.0–27.0] s, P < 0.001).ConclusionsWhen performing videolaryngoscopic intubation under manual in-line stabilization, direct epiglottis elevation can be more beneficial than indirect epiglottis elevation in reducing cervical spine movement during videolaryngoscopic intubation at the occiput–C1.Trial registrationClinical Research Information Service (number: KCT0006239, date: 10/06/2021).

Effect of high-intensity laser therapy in patients with non-specific chronic neck pain: study protocol for a randomized controlled trial

BackgroundChronic non-specific neck pain (CNNP) is a prevalent musculoskeletal disorder known for its significant disability and economic burden, ranking second only to low back pain in musculoskeletal conditions. Physical therapy offers effective interventions for CNNP, including low-level laser therapy (LLLT). High-intensity laser therapy (HILT) is a recent treatment for musculoskeletal pain, but studies that support its use in CNNP are limited. The objective of this study is to assess the effect of high-intensity laser therapy on pain intensity in patients with CNNP, given the existing evidence on LLLT for this condition.MethodsThis is a 2-arm, randomized, placebo-controlled trial with blinded evaluators. The research will be carried out in the laboratory of physical agents at the Andrés Bello University, Campus Casona de las Condes. Eligible participants include the entire internal and external community associated with Andrés Bello University suffering from chronic non-specific NP. Participants will be stratified by sex (4 subgroups) and randomized into 2 study groups: group 1 (HILT and stretching exercises) and group 2 (sham HILT and stretching exercises). Treatments will be performed twice a week for 4 weeks with 3 assessments: before treatment (T0), at the end of treatment (T1), and 12 weeks after treatment (follow-up) (T2). The main outcomes will be pain intensity at rest, pain intensity at movement (active cervical movements: flexion, extension, right and left side bending, and right and left rotation), and pain pressure threshold (average obtained for six evaluation points). Secondary outcome measures will include neck range of motion in the sagittal, coronal, and transverse planes and neck disability.DiscussionIn this study, HILT’s effects on patients with non-specific NP will be compared to those of a sham laser intervention. This RCT will offer new evidence regarding the potential benefits of HILT in terms of pain intensity, range of movement, and disability in people suffering with non-specific NP.Trial registrationClinicalTrials.gov NCT05689788. January 19, 2023.

Adult Atlantoaxial Subluxation in Post COVID-19 Recovery: A Case Series

Background: Non-traumatic atlantoaxial subluxation in adults is a rare condition usually common in patients with rheumatoid arthritis, and infection of the upper respiratory tract is also considered to be a trigger of inflammation and laxity of ligaments and further subluxation. to date there have been some reported cases of atlantoaxial as complication of COVID-19. Diagnosis and management of atlantoaxial subluxation is currently based on x-ray with special views. Therefore, it is important to early diagnosis and treating adult patients suffering from neck pain and stiffness as a suspected case of nontraumatic atlantoaxial subluxation. Case reports: In this case series, we reported 17 healthy elderly patients (11 male and 6 female) who had atlantoaxial subluxation after a mild (8 patients 4 male and 4 female) and 9 moderate cases (6 males with 3 females) of COVID-19. The patients had neck pain (pain score ranged 6 to9 wit mean 7,5), occipital headache (7 patient with severe and moderate occipital headache with only 3 with mild), and stiffness with different levels of limitation of cervical movements after recovering from Covid-19 in varying periods between 3 and 7 months. Conservative treatment included antibiotics; non-steroid anti-inflammatory agents, short course of corticosteroids, and immobilization with soft cervical collar followed by physiotherapy after pain subsided was done for the patients, and the clinical recovery observed within 8-10 weeks with good results in 10 patients with relieving pain and restoring the cervical motion to the normal, and 7 patients with acceptable result of treatment with slight limitation of cervical movements. Conclusion: As atlantoaxial subluxation in adult patients may be a late complication of COVID-19, more research is needed to determine the specific association between COVID-19 and atlantoaxial subluxation in adults.

Association of joint hypermobility with range of cervical motion and its impact on the motor unit loss in patients with Hirayama disease.

Some patients with Hirayama disease (HD) may have generalized joint hypermobility (GJH), which may excessively increase cervical range of motion (ROM) and then worsen the HD. The purpose of this study was to identify the frequency of GJH in HD patients and to analyze the effect of GJH on cervical ROM and the severity of HD. The Beighton scoring system (≥4) was used to diagnose GJH in 84 HD patients. All patients underwent assessments of cervical-flexion/extension ROM; motor unit number estimation in bilateral abductor pollicis brevis (APB) muscles; handgrip strength; and the disabilities of the arm, shoulder, and hand assessments. Concomitant GJH was identified in 20 (23.8%) HD patients. The HD patients with GJH exhibited greater cervical-flexion (P < .001) and cervical-extension (P = .033) ROM than those without GJH. Both greater single motor unit potential amplitudes (symptomatic side: P = .005; less-symptomatic side: P = .011) and lower motor unit numbers (symptomatic side: P = .008; less-symptomatic side: P = .013) in bilateral APB, along with lower compound muscle action potential amplitudes on the symptomatic-side APB (P = .039), were observed in patients with GJH than those without GJH. There was a mild negative correlation between motor unit number and cervical-flexion ROM in HD patients (symptomatic side: r = -0.239, P = .028; less-symptomatic side: r = -0.242, P = .027). The frequency of GJH in HD patients may be higher than in the general population. Importantly, GJH may exacerbate excessive cervical-flexion ROM, thereby worsening motor unit loss in HD patients. A cautious approach should be taken when treating HD due to possible comorbid GJH.

Evidence for an association of serum microanalytes and myofascial pain syndrome

BackgroundMyofascial Pain Syndrome (MPS) is a common pain disorder. Diagnostic criteria include physical findings which are often unreliable or not universally accepted. A precise biosignature may improve diagnosis and treatment effectiveness. The purpose of this study was to assess whether microanalytic assays significantly correlate with characteristic clinical findings in people with MPS.MethodsThis descriptive, prospective study included 38 participants (25 women) with greater than 3 months of myofascial pain in the upper trapezius. Assessments were performed at a university laboratory. The main outcome measures were the Beighton Index, shoulder range of motion, strength asymmetries and microanalytes: DHEA, Kynurenine, VEGF, interleukins (IL-1b, IL-2, IL-4, IL-5, IL-7, IL-8, IL-13), growth factors (IGF-1, IGF2, G-CSF, GM-CSF), MCP-1, MIP-1b, BDNF, Dopamine, Noradrenaline, NPY, and Acetylcholine. Mann–Whitney test and Spearman’s multivariate correlation were applied for all variables. The Spearman’s analysis results were used to generate a standard correlation matrix and heat map matrix.ResultsMean age of participants was 32 years (20–61). Eight (21%) had widespread pain (Widespread Pain Index ≥ 7). Thirteen (34%) had MPS for 1–3 years, 14 (37%) 3–10 years, and 11 (29%) for > 10 years. The following showed strong correlations: IL1b,2,4,5,7,8; GM-CSF and IL 2,4,5,7; between DHEA and BDNF and between BDNF and Kynurenine, NPY and acetylcholine. The heat map analysis demonstrated strong correlations between the Beighton Index and IL 5,7, GM-CSF, DHEA. Asymmetries of shoulder and cervical spine motion and strength associated with select microanalytes.ConclusionCytokine levels significantly correlate with selected clinical assessments. This indirectly suggests possible biological relevance for understanding MPS. Correlations among some cytokine clusters; and DHEA, BDNF kynurenine, NPY, and acetylcholine may act together in MPS. These findings should be further investigated for confirmation that link these microanalytes with select clinical findings in people with MPS.

Not every twist is ovarian torsion: a case report of isolated torsion of the fallopian tube in a child.

A 15-year-old girl presented with complaints of sudden onset left lower quadrant pain, nausea, and vomiting. There was tenderness in the left iliac fossa. Ultrasonography revealed inconclusive findings and contrast-enhanced computed tomography of the abdomen and pelvis suggested possible left adnexal torsion. Hence, she underwent a diagnostic laparoscopy which revealed a twisted, edematous, and congested left fallopian tube. The diagnosis of isolated left fallopian tube torsion was made and she was managed with unilateral salpingectomy. Women of the reproductive age group are usually affected by this condition. The common presentations are abdominal pain, nausea, and vomiting. The physical examination may reveal abdominal and cervical motion tenderness. Per abdominal ultrasound is the first go-to modality in children. Magnetic resonance imaging, if available, is advised in children if the ultrasound is inconclusive because of the absence of radiation. However, it may require sedation. Therefore, contrast-enhanced computed tomography abdomen gives an added advantage in such scenarios as in our case. This condition is managed by surgery with salpingectomy or tube detorsion with preservation of the tube, depending on the intraoperative findings. Clinicians should be aware of the condition given the rarity and challenges in the diagnosis of isolated fallopian tube torsion.

How cervical curvature changes after ACAF and ACDF: a radiological retrospective study.

To assess changes in cervical curvature and demonstrate the feasibility of using ACAF technology to restore lordosis, imaging data from patients undergoing multilevel ACAF and ACDF surgeries were retrospectively analyzed. Forty-seven patients receiving multilevel ACAF and ACDF were included in the study. Total cervical curvature and anterior, middle, and posterior column curvature, spinal canal diameter, cervical range of motion, and surgical complications were measured and analyzed by non-parametric or chi-square tests before and after surgery. The Spearman correlation between imaging data was analyzed. Compared with ACDF, the operation time of the ACAF group was longer, the cervical motion was larger, the median and change value of the middle column curvature was larger, and the change value of the posterior column curvature was smaller (P < 0.05). The postoperative differences in cervical lordosis angle, vertebral canal diameter, and middle and posterior column curvature in the ACAF group were significantly greater than those in the ACDF group (p = 0.015). The expansion of vertebral canal diameter was significantly correlated with the difference in curvature between the middle and posterior columns (r = 0.523, P < 0.01), and the curvature of the anterior column was correlated with that of the middle and posterior columns (P < 0.05). The curvature change of the anterior column is closely related to the curvature change of the middle column and the posterior column. Compared with ACDF, ACAF expands the diameter and volume of the spinal canal by increasing the curvature of the middle column and reducing the anterior movement of the posterior column.

A comparative study to evaluate the cervical spine movements during laryngoscopy using Macintosh and Airtraq laryngoscopes.

Intubation with Macintosh requires flexing the lower cervical spine and extending the atlanto-occipital joint to create a "line of sight." Primary aim of study was to compare the extent of cervical spine movement during laryngoscopy using conventional Macintosh laryngoscope and Airtraq. A total of 25 patients of either sex between the age group of 18 and 60 years, having American Society of Anesthesiologists (ASA) physical status of Grade-I and Grade-II, scheduled for elective surgery under image control requiring general anesthesia and intubation were enrolled. A baseline image of the lateral cervical spine including the first four cervical vertebrae was taken by an image intensifier. After administration of general anesthesia, laryngoscopy was first performed using a Macintosh laryngoscope and a second X-ray image of the lateral cervical spine was taken. The second laryngoscopy using a Airtraq laryngoscope was done and the third image of the lateral cervical spine was taken. Angles between occiput and C1; C1 and C2; C2 and C3; C3 and C4; and occiput and C4 were calculated. Atlanto-occipital distance (AOD) was calculated as the distance between occiput and C1. Macintosh showed greater cervical movement as compared with Airtraq but a significant difference in the movement was observed at C2-C3 and C0-C4. Baseline mean AOD was 2.21 ± 1.25 mm, after Macintosh and Airtraq laryngoscopy was found to be 1.13 ± 0.60 and 1.6 ± 0.78 mm, respectively, and was found to be significant (P < 0.05). We conclude that Airtraq allows intubation with less movement of the upper cervical spine makes Airtraq preferred equipment for intubation in patients with a potential cervical spine injury.

Progress on the impact of adjacent vertebral arch after single open door laminoplasty

Single-door laminoplasty has been widely used in the treatment of multisegment cervical myelopathy, with the clinical advantages of decompression of the spinal cord, relieving preoperative neurological symptoms or signs, and maintaining cervical mobility. However, in clinical work, patients with limited cervical spine activity after single open door laminoplasty are often encountered, and the direct contact with the adjacent vertebral arch can be observed in the postoperative X-ray of the anterior and lateral cervical spine, which is called the adjacent vertebral arch bone impact, which is one of the important causes of the limited cervical spine movement. In recent years, there have been many reports on the prevention of bone impact, although the short-term clinical effect is significant, but long-term clinical efficacy to be further study, and the cause and the pathogenesis of bone impact is no consensus, this paper on the surgery of adjacent vertebral arch impact epidemiology, biomechanics, clinical performance, surgical effect and improvement.

PENYULUHAN MC KENZIE CERVICAL EXERCISE UNTUK MENGURANGI NECK PAIN PADA PEGAWAI POLI KIA PUSKESMAS SINGOSARI

Mc Kenzie Neck Exercise is a spine and muscle stretching exercise that is carried out throughout the exercise movement with predetermined repetitions. Counseling was carried out aiming to provide understanding to employees at the KIA room at the Singosari Health Center regarding the role of physiotherapy in treating neck pain, especially its causes, how to prevent it, and how to do the Mc Kenzie cervical exercise to reduce neck pain. Presentation of counseling material in the form of definitions, causes, ways to prevent it, as well as various McKenzie neck exercise movements that can be done independently by employees. The health promotion media used was in the form of leaflets accompanied by demonstrations of the Mc Kenzie cervical exercise movements. Counseling was successful and understandable to the participants, so the evaluation results showed that after the material was given, the participants' knowledge increased from 40% to 100%. Counseling activities can broaden participants' understanding of the role of physiotherapy in neck pain, as well as Mc Kenzie cervical exercises to reduce neck pain which can be done independently.

Cervical Range of Motion Assessment through Inertial Technology: A Validity and Reliability Study

Inertial technology has spread widely for its comfortable use and adaptability to various motor tasks. The main objective of this study was to assess the validity of inertial measurements of the cervical spine range of motion (CROM) when compared to that of the optoelectronic system in a group of healthy individuals. A further aim of this study was to determine the optimal placement of the inertial sensor in terms of reliability of the measure, comparing measurements obtained from the same device placed at the second cervical vertebra (C2), the forehead (F) and the external occipital protuberance (EOP). Twenty healthy subjects were recruited and asked to perform flexion–extension, lateral bending, and axial rotation movements of the head. Outcome measurements of interest were CROM and mean angular velocities for each cervical movement. Results showed that inertial measurements have good reliability (0.75 &lt; ICC &lt; 0.9). Excellent reliability (ICC &gt; 0.9) was found in both flexion and right lateral bending angles. All parameters extracted with EOP placement showed ICC &gt; 0.62, while ICC &lt; 0.5 was found in lateral bending mean angular velocities both for F and C2 placements. Therefore, the optimal sensor’s positioning emerged to be EOP. These results suggest that inertial technology could be useful and reliable for the evaluation of the CROM.

The Effects of Cervical Orthoses on Head and Intervertebral Range of Motion.

Prospective Cohort. Quantify and compare the effectiveness of cervical orthoses in restricting intervertebral kinematics during multiplanar motions. Previous studies evaluating the efficacy of cervical orthoses measured global head motion and did not evaluate individual cervical motion segment mobility. Prior studies focused only on the flexion/extension motion. Twenty adults without neck pain participated. Vertebral motion from the occiput through T1 was imaged using dynamic biplane radiography. Intervertebral motion was measured using an automated registration process with validated accuracy better than 1 degree. Participants performed independent trials of maximal flexion/extension, axial rotation, and lateral bending in a randomized order of unbraced, soft collar (foam), hard collar (Aspen), and cervical thoracic orthosis (CTO) (Aspen) conditions. Repeated-measures ANOVA was used to identify differences in the range of motion (ROM) among brace conditions for each motion. Compared with no collar, the soft collar reduced flexion/extension ROM from occiput/C1 through C4/C5, and reduced axial rotation ROM at C1/C2 and from C3/C4 through C5/C6. The soft collar did not reduce motion at any motion segment during lateral bending. Compared with the soft collar, the hard collar reduced intervertebral motion at every motion segment during all motions, except for occiput/C1 during axial rotation and C1/C2 during lateral bending. The CTO reduced motion compared with the hard collar only at C6/C7 during flexion/extension and lateral bending. The soft collar was ineffective as a restraint to intervertebral motion during lateral bending, but it did reduce intervertebral motion during flexion/extension and axial rotation. The hard collar reduced intervertebral motion compared with the soft collar across all motion directions. The CTO provided a minimal reduction in intervertebral motion compared with the hard collar. The utility in using a CTO rather than a hard collar is questionable, given the cost and little or no additional motion restriction.

Three-dimensional assessment of interfractional cervical and uterine motions using daily magnetic resonance images to determine margins and timing of replanning.

This study was conducted to determine the margins and timing of replanning by assessing the daily interfractional cervical and uterine motions using magnetic resonance (MR) images. Eleven patients with cervical cancer, who underwent intensity-modulated radiotherapy (IMRT) in 23-25 fractions, were considered in this study. The daily and reference MR images were converted into three-dimensional (3D) shape models. Patient-specific anisotropic margins were calculated from the proximal 95% of vertices located outside the surface of the reference model. Population-based margins were defined as the 90th percentile values of the patient-specific margins. The expanded volume of interest (expVOI) for the cervix and uterus was generated by expanding the reference model based on the population-based margin to calculate the coverage for daily deformable mesh models. For comparison, expVOIconv was generated using conventional margins: right (R), left (L), anterior (A), posterior (P), superior (S), and inferior (I) were (5, 5, 15, 15, 10, 10) and (10, 10, 20, 20, 15, 15) mm for the cervix and uterus, respectively. Subsequently, a replanning scenario was developed based on the cervical volume change. ExpVOIini and expVOIreplan were generated before and after replanning, respectively. Population-based margins were (R, L, A, P, S, I) of (7, 7, 11, 6, 11, 8) and (14, 13, 27, 19, 15, 21) mm for the cervix and uterus, respectively. The timing of replanning was found to be the 16th fraction, and the volume of expVOIreplan decreased by >30% compared to that of expVOIini . However, margins cannot be reduced to ensure equivalent coverage after replanning. We determined the margins and timing of replanning through detailed daily analysis. The margins of the cervix were smaller than conventional margins in some directions, while the margins of the uterus were larger in almost all directions. A margin equivalent to that at the initial planning was required for replanning.