Cervical Motion Research Articles

A New Diagnostic Medium for Cervical Spondylotic Myelopathy: Dynamic Somatosensory Evoked Potentials

To identify and reveal the sensitivity and efficiency of dynamic somatosensory evoked potentials (DSSEPs) in the diagnosis of cervical spondylotic myelopathy (CSM). This retrospective study included 31 CSM and 15 control patients. All patients received SSEP examination with stimulation of median and ulnar nerves at neutral, flexed, and extended cervical positions; latency and amplitude were recorded at the C2 and C5 spinous processes and in the scalp over the primary sensory area (C3'/4'). The percentage changes in latency and amplitude with dynamic motion were examined for each lead and compared between groups; the diagnostic cutoff values were determined using receiver operating characteristic curve analysis. All the patients with CSM received surgeries and were followed up for 1 year. Amplitude parameters varied with a dynamic position in both groups; all recorded dynamic SSEP indices except right median stimulus recorded at C5 spinous process, right ulnar stimulus recorded at scalp point C3, and right ulnar stimulus recorded at C2 spinous process were significantly different between groups (P < 0.05), but latency was not (P > 0.05). At the neutral position, the amplitude of left media stimulus recorded at C2 spinous process (LMC2) was associated with CSM, but with low diagnostic accuracy (area under the curve= 0.199). At a dynamic position, the percentage change in amplitude of LMC2 and of left ulnar stimulus recorded at C2 spinous process (LUC2) were determined to be diagnostic of CSM (P < 0.05), with areas under the curve of 0.891 and 0.912, respectively. Both records had high sensitivity and specificity in the diagnosis of CSM; the diagnostic cutoff values of LMC2 and LUC2 were calculated as 10.2% and 19.25%, respectively. The percentage change in amplitude was obvious during cervical dynamic motion, with records from LMC2 and LUC2 being predictive of CSM diagnosis; dynamic SSEPs provided a simple, accurate, and noninvasive supplementary test for the diagnosis of complicated CSM.

113. Segmental contribution to total cervical flexion-extension motion before and after cervical disc arthroplasty (CDA): influence of prosthesis design

BACKGROUND CONTEXT As a healthy cervical spine undergoes motion from extension to flexion, individual motion segments move synchronously throughout the arc of motion. The contribution of an individual spinal segment as a fraction of the total motion of the cervical spine (termed here the segmental motion fraction) depends on the flexibility of the spinal segment, but remains nearly constant in healthy segments with small variations around the average value during the arc of motion. Hypermobility, indicative of an unstable motion segment, will cause the segmental motion fraction to deviate substantially from the average value over a portion of the arc of motion. Segmental motion fraction analysis offers a bridge between motion response measured in the laboratory and in vivo kinematic assessment. PURPOSE To investigate: (1) motion contributed by individual spinal segments (C5-C6 and C6-C7) as a fraction of total cervical spine motion through the arc of motion from extension to flexion, and (2) how cervical disc prosthesis design may influence segmental motion contribution. STUDY DESIGN/SETTING Biomechanical study of CDA using Mobi-C and M6-C prostheses. PATIENT SAMPLE Sixteen human cervical spine specimens (C3-T1, 43±6 years). OUTCOME MEASURES Segmental and total cervical motion throughout the arc of motion in flexion-extension (F-E). METHODS We tested 16 human C3-T1 spine specimens under physiologic loads; first intact, after implantation of cervical disc prosthesis by an arthroplasty-trained surgeon at C5-C6 (1-level), and then at C5-C6 and C6-C7 (2-level). The Mobi-C and M6-C disc prostheses were used for 1- and 2-level implantations in eight specimens each. F-E motion was assessed before and after CDA. Quality of motion was assessed using the contribution made by each index segment toward the motion of the C3-T1 cervical spine during the F-E arc of motion. RESULTS Intact: In the intact specimens (N=16), The C5-C6 and C6-C7 segments contributed on average 23%±2.5% and 21%±3.0%, respectively, towards the total F-E motion of C3-T1 specimens. Peak deviations from the average contributions were 12%±6.1% and 14%±9.8%, respectively. M6-C (N=8): After disc replacement using the M6-C prosthesis, the contributions towards the C3-T1 F-E motion by the C5-C6 and C6-C7 segments changed to 23%±4.0% and 22%±3.8%, respectively. The peak deviations from the average contributions were 16%±3.9% and 16%±6.5%, respectively. Mobi-C (N=8): After disc replacement using the Mobi-C prosthesis, the contributions towards the C3-T1 F-E motion by the C5-C6 and C6-C7 segments changed to 23%±4.3% and 18%±6.5%, respectively. The peak deviations from the average contributions were 36%±23% and 53%±31%, respectively. CONCLUSIONS The M6-C artificial disc restored physiologic quality of motion such that the implanted C5-C6 and C6-C7 segments continued to function in harmony with the other segments of the cervical spine as before arthroplasty. The average motion contribution and the peak deviations from the average after CDA remained nearly unchanged from the healthy intact values. Conversely, the Mobi-C prosthesis, while maintaining average motion contributions similar to the pre-implantation values, demonstrated large deviations in motion contribution over the F-E arc of motion in 10 of 16 implanted segments. This behavior was attributed to the locking of the prosthesis over a portion of the arc of F-E motion in these implanted segments. Such nonphysiologic implant kinematics could lead to excessive wear of the prosthesis, and motion- and stress-shielding at adjacent segments. FDA DEVICE/DRUG STATUS Mobi C Cervical disc prosthesis (Approved for this indication), M6 C Cervical disc prosthesis (Investigational/Not approved)

13. Minimally invasive posterior cervical foraminotomy as an alternative to anterior cervical discectomy and fusion for unilateral cervical radiculopathy

BACKGROUND CONTEXT Unilateral cervical radiculopathy refractory to conservative treatment is one of the most common pathologies that spine surgeons treat surgically. Anterior cervical discectomy and fusion (ACDF) has long been considered standard treatment for cervical radiculopathy secondary to lateral disc herniation or foraminal stenosis. Recent studies suggest minimally-invasive posterior cervical foraminotomy (MI-PCF) to be an alternative to ACDF, but not without concern for reoperation and magnitude of patient outcome improvement. PURPOSE To compare patient outcomes, reoperation rate and complication rate of MI-PCF to those of ACDF by analyzing the current literature. STUDY DESIGN/SETTING Systematic review, meta-analysis. PATIENT SAMPLE A total of 1,216 patients who underwent MI-PCF for cervical radiculopathy from 14 previously published studies. OUTCOME MEASURES (1) Patient-reported outcome scores: Visual Analog Scale (VAS) for arm and neck pain, neck disability index (NDI), (2) reoperation rate, (3) complication rate. METHODS Three electronic databases (PubMed, CINAHL Plus, and SCOPUS) were queried using terms related to MI-PCF. Open approaches were excluded. MINORS scoring was used to assess study quality. A total of 14 studies were included in this analysis. Analyses for heterogeneity and publication bias were performed. Clinical outcome scores (NDI, VAS-neck and VAS-arm), reoperation proportion, and complications were assessed. Each outcome measure was compared to those of ACDF from two previously published studies. A random-effects model of meta-analysis was used for heterogenous groups, and a fixed-effects model was used for groups that were not. Overlap of 95% confidence intervals suggests no significant difference at the p RESULTS Fourteen studies were included in this analysis, with outcome data of 1,216 patients. The mean age of the study population was 51.57 years, who were 61.8% male and had a mean follow-up period of 30 months. The mean improvement in NDI was 20.30 (95% CI, 18.81-21.79) and 16.85 (95% CI, 14.96-19.10) for the MI-PCF and ACDF groups, respectively. The mean improvement in VAS-neck was 4.16 (95% CI, 2.70-5.61) and 2.47 (95% CI, 2.09-2.84) for the MI-PCF and ACDF groups, respectively. The mean improvement in VAS-arm was 5.31 (95% CI, 4.50-6.12) and 2.27 (95% CI, 1.82-2.70) for the MI-PCF and ACDF groups, respectively. 6% (95% CI, 3%-12%) of patients who underwent MI-PCF required a re-operation compared to 3.9% (95% CI, 2.77%-5.46%) of those who underwent ACDF. Complications were noted in 4% (95% CI, 3%-7%) of MI-PCF patients and 7.79% (95% CI, 5.54%-10.85%) of ACDF patients. The most common complications were transient neuropraxia, wound-related, and durotomy. CONCLUSIONS MI-PCF resulted in a greater improvement in VAS-arm scores compared to ACDF, supporting its effectiveness as a procedure for lateral pathology. There were no other significant differences in patient-reported clinical outcome scores, proportion of patients requiring re-operation, or complications between patients who underwent MI-PCF and those who underwent ACDF for unilateral cervical radiculopathy. Thus, MI-PCF may be utilized as a safe and effective alternative to ACDF in patients with unilateral cervical radiculopathy without myelopathy, without concern for increased reoperations or complications, and with advantages of preservation of cervical motion and quicker recovery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

234. Residual arm numbness after laminoplasty for the patients with cervical spondylotic myelopathy

BACKGROUND CONTEXT Laminoplasty has been widely accepted as a standard treatment option for the patients with cervical spondylotic myelopathy (CSM) with good clinical outcomes. However, some patients suffered from the residual arm numbness postoperatively. But the preoperative factor relating to residual arm numbness and its impact on the outcomes of laminoplasty are not well established. PURPOSE To identify the preoperative factor relating the residual arm numbness after laminoplasty, and to demonstrate the effect of the residual numbness on the change of clinical scores and radiographic parameters. STUDY DESIGN/SETTING Retrospective cohort study PATIENT SAMPLE One hundred three patients who underwent laminoplasty for CSM and were followed up over 2 years after surgery. OUTCOME MEASURES Japanese Orthopedic Association (JOA) score including detailed component score (finger motion, upper extremity motion, lower extremity motion, upper extremity sensory, trunk sensory, lower extremity sensory, bladder function), visual analogue scale (VAS; arm pain, arm numbness and neck pain), 36-Item Short-Form Health Survey (SF-36; physical component summary and mental component summary), preoperative radiographic x-ray film parameters (C7 slope, C2-C7 lordotic angle, C2-C7 sagittal vertical axis and range of cervical motion) and preoperative Magnetic Resonance Imaging (MRI) findings (the severity of stenosis and the existence of snake-eye appearance). METHODS Patients were divided into two groups; residual arm numbness group (postoperative VAS >40mm) and control group (≤40mm). Following to univariate analysis comparing the preoperative factors between groups, the variables of p RESULTS The residual arm numbness group included 42 patients (23 female, 67.5±11.3 years old) and the no numbness group included 61 patients (42 female, 65.1±12.7 years old). In the multivariate analysis after univariate comparison, gender and preoperative arm pain were demonstrated as the independent variables (p=0.017 and 0.046) correlating with the postoperative residual numbness. Contrary to our hypothesis, the preoperative arm numbness and intensity change of MRI were not significant factors relating to the residual arm numbness. In the comparison of the change after surgery, the improvement of physical component summary of SF-36 was significantly low in residual arm numbness group (0.040). CONCLUSIONS In our data set, up to 40% of the CSM patients had residual arm numbness 2 years after laminoplasty. Female and preoperative severe arm pain was the independent predictor for the residual arm numbness. The patients with residual arm numbness showed the lower improvement of quality of life compared to the patient without numbness. These results can help physicians to provide adequate information to treat the CSM patients and help surgeons to predict the patients with poor surgical outcomes preoperatively. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Examining endplate fatigue failure during cyclic compression loading with variable and consistent peak magnitudes using a force weighting adjustment approach: an in vitro study

Repetitive movement is common in many occupational contexts. Therefore, cumulative load is a widely recognised risk factor for lowback injury. This study quantified the effect of force weighting factors on cumulative load estimates and injury prediction during cyclic loading. Forty-eight porcine cervical spine motion segments were assigned to experimental groups that differed by average peak compression magnitude (30%, 50% and 70% of predicted tolerance) and amplitude variation (consistent, variable). Cyclic loading was performed at a frequency of 0.5 Hz until fatigue failure occurred. Weighting factors were determined and applied instantaneously. Inclusion of weighting factors resulted in statistically similar cumulative load estimates at injury between variable and consistent loading (p > .071). Further, survivorship was generally greater when the peak compression magnitude was consistent compared to variable. These results emphasise the importance of weighting factors as an equalisation tool for the evaluation of cumulative low back loading exposures in occupational contexts. Practitioner summary: Weighting factors can equalise the risk of injury based on compression magnitude. When weighted, the cumulative compression was similar between consistent and variable cyclic loading protocols, despite being significantly different when unweighted and having similar injury rates. Therefore, assessing representative occupational exposures without evaluating task performance variability may underestimate injury risk. Abbreviations: FSU: functional spinal unit; UCT: ultimate compression tolerance

Direct Fixation of C1 Jefferson Fracture Using C1 Lateral Mass Screws: A Case Report.

Jefferson fractures are classically described as burst fractures of C1. Traditional surgical treatment of these unstable fractures is either occipito-cervical or posterior C1-C2 fusion, resulting in a significant loss of range of cervical neck movement. This case report discusses the fixation of a Jefferson fracture using C1 lateral mass screws to achieve surgical stabilization while preserving the range of movement. We aim to add to the body of evidence supporting this fixation method. A 39-year-old male presented to our emergency department with an unstable Jefferson fracture caused by trauma. The various treatment options, such as cervical collar, HALO immobilization, occipito-cervical fusion, and atlanto-axial fusion and direct fixation of C1, were evaluated and discussed with the patient. Informed consent was obtained from the patient prior to writing this case report. At 3 months postoperation, the patient demonstrated near full range of movement in his neck. He had also resumed driving. By 6 months, the patient returned to work, and at 12 months, imaging confirmed union. This case report adds to the body of evidence supporting the technique of C1 lateral mass screws for direct stable fixation of Jefferson fractures. This fixation method preserves the cervical spine range of motion with minimal functional restriction.

Using exploratory factor analysis to define functional constructs of cervical spine movement in a whiplash population

To determine the reliability and validity of clinical tests to assess posture, pain location, and cervical spine mobility in adults with grades I-IV neck pain and associated disorders (NAD).We systematically searched electronic databases to update the systematic review of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Eligible reliability and validity studies were critically appraised using modified versions of the QAREL and QUADAS-2 instruments, respectively. Evidence from low risk of bias studies were synthesized following best evidence synthesis principles.We screened 14302 articles, critically appraised 46 studies, and found 32 low risk of bias articles (14 reliability and 18 validity studies). We found preliminary evidence of: 1) reliability of visual inspection, aided with devices (CROM and digital caliper) to assess head posture; 2) reliability and validity of soft tissue palpation to locate tender/trigger points in muscles; 3) reliability and validity of joint motion palpation to assess stiffness and pain provocation in combination; and 4) range of motion tests using visual estimation (in cervical extension only) or devices (digital caliper, goniometer, inclinometer) to assess cervical mobility.We found little evidence to support the reliability and validity of clinical tests to assess head posture, pain location and cervical mobility in adults with NAD grades I-III. More advanced validity studies are needed to inform the clinical utility of tests used to evaluate patients with NAD.

Surgical treatment of atypical unstable Hangman fracture in elderly osteoporotic patients

To explore the clinical effect of operative reduction and internal fixation in treating atypical unstable Hangman fracture in elderly osteoporotic patients. The clinical data of 9 elderly osteoporotic patients with atypical unstable Hangman fracture treated from December 2012 to December 2017 were retrospectively analyzed. There were 5 males and 4 females with an average age of 72.7 years (range 65 to 79) old. The fracture line was located on bilateral inferior articular surface or lamina with anterior dislocation of axis in 3 cases (similar to Levine-Edwards type II); one side of the fracture line was located on the lower articular surface and opposite side involved on the upper articular surface and the body of axis with atlantoaxial lateral mass dislocation in 4 cases; the fracture line was located at the pedicle of the axis, transverse foramen and posterior inferior wall of the vertebral body, accompanying by anterior and posterior longitudinal ligaments and C₂-C₃ intervertebral disc injury resulted in C₂-C₃ intervertebral instability in 2 cases. According to ASIA grade of spinal cord injury, 2 cases were grade D and 7 cases were grade E. Preoperative JOA scores were 9 to 11 points with an average of 9.8 points. All patients underwent routinely skull traction for reduction. Three patients with anterior dislocation of axis were treated with stage I anterior-posterior internal fixation and 6 patients with simple posterior pedicle screw fixation. Postoperative JOA score, ASIA system and the imaging data were used to evaluate clinical effects. All patients were followed up from 12 to 20 months with an average of 18 months. The neck pain disappeared after operation and cervical spine movement was well in all patients. The improvement rate of JOA at 3 months after operation was 75% to 87.5%. Two cases of ASIA grade D fully recovered to grade E. All fractures healed at 6 to 12 months after operation. Except one case occurred superior laryngeal nerve injury and had a complete recovery after 3 months, the other patients had no complications like spinal cord and vertebral artery injury, plate screw loosening and wound infection. According to the type of atypical unstable Hangman fracture in elderly osteoporotic patients, choosing a reasonable and personalized surgical plan can achieve immediate cervical stability and well reduction, which is beneficial for early ambulation and quick rehabilitation.

Head-neck rotational movements using DidRen laser test indicate children and seniors' lower performance.

Sensorimotor control strategies during cervical axial rotation movements have been previously explored in narrow age ranges but never concurrently in Children and Seniors during a well-standardized task. However, the lifespan developmental approach provides a framework for research in human sensorimotor control of the head-neck complex. A cross-sectional design was used to investigate the influence of age on head-neck dynamic performance adopted by asymptomatic Children, Adults and Seniors using a standardized task (DidRen Laser test). Participants performed 5 cycles of left/right head-neck complex fast rotational movements toward 3 targets with 30° of angular separation. Dynamic performances were computed from total execution time of the test and kinematic variables derived from rotational motion of head measured by an optoelectronic system. Eighty-one participants, aged 8–85 yrs, were stratified in four groups: Children, Younger adults, Older adults and Seniors. Children were significantly slower than Younger (p<0.001) and Older adults (p<0.004) and Seniors slower than Younger adults (p<0.017) to perform the test. Children adopted a lower average speed compared to Younger (p<0.001) and Older adults (p<0.008). Children reached the peaks speed significantly later than Younger (p<0.004) and Older adults (p<0.04) and acceleration significantly later than Younger (p<0.001) and Older adults (p<0.013). From the peak acceleration, Children reached end of the cycle significantly slower than Younger (p<0.008) and Older adults (p<0.008). Children significantly differed from all other groups for rotational kinetic energy, with smaller values compared to Younger adults (p<0.001), Older adults (p<0.005) and Seniors (p<0.012). Variability was also significantly higher for Seniors and Children. In conclusion, age influences head-neck visually elicited rotational dynamics, especially in Children. These results suggest that age should be taken into account when establishing normative data and assessing dynamic head-neck sensorimotor control of patients with neck pain.

Factors Predicting Difficult Endotracheal Intubation.

Factors Predicting Difficult Endotracheal Intubation.

Prosthesis design influences segmental contribution to total cervical motion after cervical disc arthroplasty.

We investigated a new metric for assessing the quality of motion of the cervical segments over the arc of extension-to-flexion motion after cervical disc arthroplasty (CDA). We quantified: (1) the amount of motion contributed by individual spinal segments to the total cervical spine motion, termed segmental motion fraction, and its variation throughout the arc of extension-to-flexion motion and (2) how cervical disc arthroplasty using two distinct prosthesis designs may influence the segmental motion contributions. We tested 16 human C3-T1 spine specimens under physiologic loads; first intact, after CDA at C5-C6, and then at C5-C6 and C6-C7. The M6-C (Orthofix, USA) and Mobi-C (Zimmer, USA) disc prostheses were used in eight specimens each. The designs of the cervical disc prostheses tested significantly influenced the variation in segmental motion fraction as the spine underwent motion between the endpoints of extension and flexion. While the mean segmental motion contribution to the total cervical motion was not influenced by prosthesis design, the way the motion took place between the extension and flexion endpoints was significantly influenced. The M6-C artificial disc restored physiologic motion quality such that implanted segments continued to function in harmony with other segments of the cervical spine as measured before arthroplasty. Conversely, the Mobi-C prosthesis, while maintaining average motion contributions similar to the pre-implantation values, demonstrated large deviations in motion contribution over the extension-to-flexion arc motion in ten of 16 implanted segments. Such non-physiologic implant kinematics could cause excessive prosthesis wear and motion and stress shielding at adjacent segments. These slides can be retrieved under Electronic Supplementary Material.

Standalone Transoral Vertebroplasty for Treatment of Painful Metastatic C2 Lesion: A Case Report

Introduction: Metastatic involvement of the spine may present with pathologic fractures, deformity, neurologic deficit due to vertebral canal compromise, and pain. Pain is usually managed with non-steroidal anti-inflammatory agents, corticosteroid injections, calcitonin, etc. Since the introduction of percutaneous vertebroplasty in 1984, it has proven as an effective armamentarium in the management of painful metastatic spine lesions. Herein, we present a case of breast cancer with osteolytic C2 metastasis, for whom trans-oral vertebroplasty without posterior fusion resulted in long-standing pain control and maintenance of normal motions and stability. Case Presentation: A 41-year-old woman, a known case of breast cancer with severe neck pain for three months, was admitted due to an osteolytic lesion in C2. The pain was incapacitating and resistant to conservative measures. Standalone transoral vertebroplasty resulted in pain control and a three-year follow-up showed durable control of pain. After positioning the patient and insertion of Dingman mouth gag, the oropharynx was prepped and injected with epinephrine/lidocaine solution. Under biplanar fluoroscopic guidance, a needle was introduced into the C2 body through the oropharynx. The lytic lesion was filled with about 2 cc of PMMA cement. The VAS score decreased from 10 prior to operation to 5 immediately after recovery from general anesthesia and improved to 2 after six months. At a 36-month follow-up visit, the VAS score was 0, normal cervical motions were preserved, and lateral neutral and dynamic cervical X-rays disclosed stability. Conclusions: Standalone transoral vertebroplasty can be safely practiced as an effective treatment for painful osteolytic metastases of C2 with normal dynamics.

Efficacy of Atlantoaxial Joint Glucocorticoid Injection in Patients with Rheumatoid Arthritis: A Randomized Trial

Background: The atlantoaxial joint (AAJ) plays a pivotal role in the cervical spine motion. Unfortunately, it is the most common cervical spine joint that is affected in patients with rheumatoid arthritis. Inflammation of the AAJ results in neck disability, nerve root compression, and finally spinal cord compression. Objectives: We aim to evaluate the efficacy of intraarticular triamcinolone injection of the AAJ on neck pain and disability. Study Design: A prospective randomized, controlled clinical trial. Setting: An interventional pain unit in a tertiary center at a university hospital in Egypt. Methods: Sixty patients with rheumatoid arthritis complaining of AAJ arthritis were randomized into 2 groups. Group AAJI (n = 30) received AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of 20 mg of triamcinolone, in addition to oral placebo tablets (2 tablets every 8 hours for one week). Group SS (n = 30) received systemic steroids, oral prednisolone tablets (5 mg, 2 tablets every 8 hours for one week), in addition to AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of normal saline solution. The percentage of patients who showed ≥ 50% reduction of their visual analog scale (VAS) pain score (measured at 1, 2, and 3 months postoperatively), VAS pain score and neck disability index (NDI) (measured at 2, 4, 6, 8, and 12 weeks postoperatively), and the magnetic resonance imaging (MRI) changes of AAJ (assessed 4 weeks postoperatively) were all evaluated. Results: There was significant reduction in the percentage of patients who showed ≥ 50% reduction of their VAS pain score postoperatively in group AAJI compared with group SS at one month (75% vs. 46.45%; P = 0.033), 2 months (60.7% vs. 25%; P = 0.009), and 3 months (53.6% vs. 17.9%; P = 0.007). There was significant reduction in overall VAS and overall NDI in group AAJI compared with group SS (mean ± standard error) (41.5 ± 2.6 vs. 52.1 ± 2.6; P = 0.005) and (43.7 ± 3.1 vs. 52.4 ± 3.1; P = 0.040), respectively. Analysis of postoperative MRI findings revealed significant improvement of bone marrow edema in group AAJI (AAJI vs. SS) (71.4% vs. 42.9%; P = 0.033), also the synovial enhancement disappeared significantly in group AAJI compared with group SS, (16/22 [72.7%] vs. 10/23 [43.5%]; P = 0.026), moreover, there was a significant reduction in pannus size in group AAJI compared with group SS, (6/10 [60%] vs. 1/9 [11%]; P = 0.041). Limitations: The study follow-up period was limited to only 3 months. Conclusions: For acutely inflamed AAJ due to rheumatoid arthritis, AAJ steroid injection is a potential therapeutic option; it decreased cervical neck pain, improved neck mobility, and hastened recovery of the joint from an acute inflammatory stage. Key words: Rheumatoid arthritis, atlantoaxial joint injection

Radiological and Clinical Outcomes of Anterior Cervical Discectomy and Fusion in Older Patients: A Comparative Analysis of Young-Old Patients (Ages 65-74 Years) and Middle-Old Patients (Over 75 Years).

ObjectiveAnterior cervical discectomy and fusion (ACDF) is the most commonly performed procedure for degenerative cervical spondylosis. Because of its relatively low invasiveness and surgical procedure, old age is not regarded as an exclusion criterion for ACDF. However, very few studies have been conducted on the radiological and clinical outcomes of ACDF in older patients. The purpose of this study was to evaluate the radiological and clinical outcomes of ACDF in older patients. MethodsWe retrospectively analyzed 48 patients (> 65 years) who underwent ACDF from January 2011 to December 2015. We divided the patients into 2 groups: young-old age group (65–74 years) and middle-old age group (≥ 75 years). Cervical lateral radiographs taken in the neutral standing position were evaluated preoperatively (PRE), on postoperative day 7 (POST), and at the 1-year follow-up (F/U). The radiological parameters included cervical angle (CA: C2–7 Cobb angle), segmental angle, total intervertebral height, disc height, sagittal vertical axis (SVA), T1 slope (T1s), and range of cervical motion (extension CA minus flexion CA). Postoperative hospital days, comorbidities, complications, and clinical outcomes were also analyzed. ResultsWe analyzed data from 48 patients (group A: n = 30 patients, 46 segments, mean age, 68.60 ± 3.36 years; group B: n = 18 patients, 23 segments, mean age, 79.22 ± 2.63 years). The surgical levels were as follows: C3/4, 4; C4/5, 7; C5/6, 10; C6/7, 29; and C7/ T1, 6 levels, and there were no significant between-group differences in the distribution. There were no significant between-group differences in the fusion and subsidence rates (fusion rate: group A, 76.2%; group B, 71.4%; p = 0.732; subsidence rate: group A, 34.8%; group B, 26.1%; p = 0.587). There was no longitudinal trend in the repeated-measurements analysis of variance test of the 2 groups of the PRE, POST, and F/U data for each radiological parameter. According to the paired t-test, T1 slope (T1s), SVA, and CA did not differ preoperatively and postoperatively. There was no statistically significant difference in visual analogue scale scores (axial, arm), the Neck Disability Index, or Odom’s criteria between the 2 groups (p = 0.448, p = 0.357, and p = 0.913). ConclusionThere was no significant difference in radiological and clinical outcomes between young-old and middle-old patients. Middle-old age does not seem to be a limitation to ACDF, but larger-scale and longer-term studies are needed to confirm the findings of this study.

Clinical assessment of cervical movement sense in those with neck pain compared to asymptomatic individuals

BackgroundA simple clinical test involving subject tracing zigzag (ZZ) and figure of eight (F8) patterns with a head mounted laser device in determining cervical movement sense has proven reliability and feasibility. However, its validity in comparing individuals with and without neck pain (NP) has not been examined. MethodsSeventy-six subjects (38 NP and 38 asymptomatic subjects) performed both patterns while motion of their laser point was videoed. Independent examiners subsequently rated the videos (real-time) to record the time needed and the number of errors when completing each task. Sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR-) for various cut-offs to optimise clinical interpretation were determined. Comparisons between 25 subjects with idiopathic neck pain versus 13 with whiplash-associated disorders were also undertaken. ResultsAll outcome variables except ZZ time were significantly different between individuals with NP and controls. Optimal cut-offs of 9 and 10 errors yielded LR+/LR- of 3.67/0.17 (F8) and 3.00/0.38 (ZZ). Whiplash patients performed the ZZ task faster with similar errors to those with idiopathic neck pain. ConclusionThe clinical utility of this inexpensive measure to assess cervical movement sense in people with NP is supported. Moderate LRs+ were demonstrated for number of errors for both patterns. Individuals with NP generated significantly more errors while tracing each pattern. Optimal cut offs of 9 errors for ZZ and 10 errors for F8 were established. Overall, these tests appear to be clinically suitable to determine altered cervical movement sense in those with NP.

Acupuncture for chronic neck pain with sensitive points: study protocol for a multicentre randomised controlled trial

IntroductionChronic neck pain is a challenging condition to treat in clinical practice and has a considerable impact on quality of life and disability. According to the theory of traditional Chinese...

Impact of Cervical Collars on Intracranial Pressure Values in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Prospective Studies.

Spinal cord injury (SCI) is present in around 2-4% of trauma victims. More than half of this injuries are located at the cervical region. Twenty percent of victims with cervical spinal trauma and 5% of patients with severe traumatic brain injury (TBI) will have an SCI. Cervical immobilization with rigid or semirigid collars is routinely used as prophylactic or definitive treatment intervention in general trauma care. An important adverse effect of cervical collars application is the increase in intracranial pressure (ICP) values. This systematic review and meta-analysis aim to estimate the overall magnitude of ICP changes after cervical collar application. Major electronic databases (Ovid/Medline, Embase and Cochrane Library) were systematically searched for prospective studies that assessed ICP changes after cervical collar applications. Study level characteristics and ICP values before, during and after cervical collar application, were extracted. The meta-analysis was performed using random-effects model. Five studies comprising 86 patients were included in the systematic review and the quantitative synthesis. The overall increase in ICP after collar application was statistically significant (weighted mean difference [WMD] = 4.43; 95%CI 1.70, 7.17; P < 0.01), meaning an overall ICP increase of approximately 4.4mmHg. The decrease in ICP values after collar removal reached statistical significance (WMD = - 2.99; 95%CI - 5.45, - 0.52; P = 0.02), meaning an overall ICP decrease of approximately 3mmHg after collar removal. ICP values before and after cervical collar application were not statistically significant (WMD = 0.49; 95%CI - 1.61, 2.59; P = 0.65), meaning no ICP change. Heterogeneous studies of application of cervical collars as a partial motion restriction strategy after injuries have demonstrated increases in ICP in TBI patients. Increases in ICP can induce complications in TBI patients. Appropriate selection criteria for cervical motion restriction in TBI patients need to be considered.

Percutaneous full-endoscopic anterior transcorporeal cervical discectomy and channel repair: a technique note report

BackgroundCompared to anterior cervical discectomy and fusion (ACDF), cervical motion segment and disc was retained through anterior transcorporeal herniotomy (ATH). But surgical field and manipulation in traditional ATH was restricted by the narrow channel. Percutaneous full-endoscopic transdiscal cervical discectomy is a minimally invasive and functional spine surgery. However, significant loss of intervertebral disc height was inevitable. This study was done to illustrate the feasibility, safety, and efficacy and present our surgical experience of percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) and channel repair (CR) for the treatment of cervical disc herniation (CDH).MethodsFour patients with CDH were chosen to undergo PEATCD and CR with a follow-up care for at least 22 months. The visual analogue score (VAS), Japanese Orthopedic Association (JOA), and modified Macnab criteria were recorded during the postoperative periods. CT images were obtained to observe the healing of the channel at 1 week and 3 months after the operation.ResultsThe average operating time was 83.75 min. Drainage tubes were unnecessary. No procedure-related complications occurred. The postoperative VAS and JOA scores were improved compared to those of the preoperative assessment. The clinical efficacy was excellent in 3 patients and good in 1 patient at final follow up stage according to the modified Macnab criteria. The hernia was removed completely in all patients according to postoperative MRI. Migration of the repair implementation and collapse of the drilled vertebrae were not observed during the postoperative periods. The bony channel was nearly absent on CT images obtained at 3 months postoperative.ConclusionThis is the first time that the anterior transcorporeal cervical discectomy and CR have been performed simultaneously under endoscopy. Less damage to disc and the retained cervical motion segment were achieved through this method. This is a feasible, safe, and minimally invasive procedure.Trial registrationNumbers: ChiCTR1800016383. Registered 29 may 2018. Retrospectively registered. Trial registry: Chinese Clinical Trial Registry.

CORRELATION BETWEEN CERVICAL MORPHOLOGY, PAIN, FUNCTIONALITY, AND ROM IN INDIVIDUALS WITH CERVICALGIA

ABSTRACT Objective: To verify if there is a correlation between the morphology of the cervical spine curvature, pain intensity, functional disability, and range of motion in individuals with cervicalgia. Methods: Thirty-nine individuals were evaluated using x-rays in the right sagittal plane (Cobb C1-C7 two-line method), visual analogue scale, Neck Disability Index questionnaire, and fleximeter. Descriptive statistical analysis (percentage, mean and standard deviation) and inferential (independent t-test and Pearson product-moment correlation coefficient, α=0.05) were performed. Results: There were significant correlations, ranging from moderate to high, between functional capacity and pain intensity (r=0.637, p&lt;0.001), and total range of motion (r=-0.568, p&lt;0.001), and extension (r=-0.610, p&lt;0.001), and between pain intensity and range of motion (r=-0.422, p=0.007). Regarding the morphology of the cervical spine curvature, none of the variables showed a significant correlation. Conclusions: Cervical morphology, more specifically related to the curvature in the sagittal plane, does not seem to interfere alone with pain, functionality, and range of motion. In contrast, it is possible to affirm that higher levels of pain generate a smaller range of cervical movement, especially of extension, which, in turn, results in greater functional losses in individuals with neck pain. Level of Evidence II; Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

Cervical vertigo - reality or fiction?

The existence of cervical vertigo is still a question under debate. The basic hypothesis of the disease is that the abnormalities of the neck cause dizziness. The name itself is not accurate, as on the basis of the descriptions we cannot talk about true vertigo. The most common symptoms of cervical vertigo are cervical pain or discomfort, imbalance or dizziness and limitation of cervical movement. The origin of the disease is unclear. Based on the literature, there are four most accepted hypotheses: neurovascular, vascular, proprioceptive theory and migraine-associated cervicogenic vertigo. Of these, the neurovascular theory has already been discredited and its existence is clearly disproved. When diagnosing cervical vertigo, we always face the following difficulties: there is no diagnostic method specific to the disease, pathognomic clinical elements are unavailable, no clear therapeutic recommendation exists. The diagnosis of the disease requires the exclusion of alternatives, but the possibility of the existance of psychogenic vertigo causes further difficulties for the clinicians. Regarding the treatment, the combination of manual therapies and vestibular rehabilitation seems to be the most effective. Orv Hetil. 2019; 160(25): 967-972.