Cervical Motion Research Articles

Painful Arm Mass-Weight Lifting

HISTORY: A 29 year old male reports acute onset of pain and palpable mass in his right distal bicep while weight lifting 2 weeks prior to presentation. He reports a dull ache that has persisted despite heat and ibuprofen. He developed bruising which resolved. He has continued lifting. He has no paresthesia, weakness, or radiculopathy. He has no exertional pain. He has a known history of multiple aneurysms diagnosed at the age of 7 with negative genetic testing. PHYSICAL EXAMINATION: There are no overlying skin changes or deformity. There is a tender, non-pulsatile 2cm mass within the medial distal bicep with firmness of the surrounding soft tissues. Active range of motion at the shoulder and elbow are full and symmetric. Pain cannot be recreated with manual muscle testing. Brachial and radial pulses are symmetric and equal. Right ulnar pulse is difficult to palpate. Allen’s test reveals reduced right ulnar blood flow. Lower extremity pulses are symmetric and equal. Cervical spine motion is normal. Spurling’s test is negative bilaterally. DIFFERENTIAL DIAGNOSIS: Superficial phlebitis Intramuscular hemorrhage Biceps or brachioradialis muscle tear Neoplasm (vascular, sarcoma, nerve sheath) Brachial artery aneurysm or pseudoaneurysm TEST AND RESULTS: Bilateral extremity angiogram - Right arm: multiple aneurysms proximal to the antecubital fossa, the largest measures over 1.5 cm. Aneurysms at the origin of the ulnar and radial arteries without distal abnormality. Left arm: 1.5 cm aneurysm proximal to the antecubital fossa. Right mid vertebral artery aneurysm (1.4 cm); prior coil embolization of the left vertebral artery. Lower extremities: 33 discrete aneurysms. Pseudoaneurysm at the proximal anastomosis of the aorto-bi-iliac graft that measures 4 cm proximally and 2.2 cm on the right iliac limb. FINAL WORKING DIAGNOSIS: Multiple aneurysmal disease of unknown origin TREATMENT AND OUTCOMES: This case highlights provocative issues of a rare vascular disorder with no literature related to physical activity recommendations. Increased intravascular pressure related to heavy resistance likely accelerates disease progression, and as such, the athlete was advised to refrain from weightlifting. Vascular surgery was consulted for evaluation of abdominal aortic pseudoaneurysm and right vertebral artery aneurysm.

Digital tracking algorithm reveals the influence of structural irregularities on joint movements in the human cervical spine

BackgroundDisc height loss and osteophytes change the local mechanical environment in the spine; while previous research has examined kinematic dysfunction under degenerative change, none has looked at the influence of disc height loss and osteophytes throughout movement. MethodsTwenty patients with pain related to the head, neck or shoulders were imaged via videofluoroscopy as they underwent sagittal-plane flexion and extension. A clinician graded disc height loss and osteophytes as “severe/moderate”, “mild”, or “none”. A novel tracking algorithm quantified motions of each vertebra. This information was used to calculate intervertebral angular and shear displacements. The digital algorithm made it practical to track individual vertebrae in multiple patients through hundreds of images without bias. FindingsCases without height loss/osteophytes had a consistent increase in intervertebral angular displacement from C2/C3 to C5/C6, like that of healthy individuals, and mild height losses did not produce aberrations that were systematic or necessarily discernable. However, joints with moderate to severe disc height loss and osteophytes exhibited reduced range of motion compared to adjacent unaffected joints in that patient and corresponding joints in patients without structural irregularities. InterpretationDigitally-obtained motion histories of individual joints allowed anatomical joint changes to be linked with changes in joint movement patterns. Specifically, disc height loss and osteophytes were found to influence cervical spine movement in the sagittal plane, reducing angular motions at affected joints by approximately 10% between those with and without height loss and osteophytes. Further, these joint changes were associated with perturbed intervertebral angular and shear movements.

3-Dimensional Cervical Movement Characteristics and the Influence of Thoracic Treatment on a Subgroup of Acute Neck Pain Patients

ObjectiveThe purpose of this study was to investigate the influence of thoracic high-velocity low-amplitude thrust (HVLAT) manipulation on quantitative and qualitative 3-dimensional cervical spine kinematic patterns in a subgroup of patients with acute neck pain. MethodsThirty patients with acute neck pain, aged 20 to 59, received a thoracic HVLAT manipulation. Three-dimensional kinematics of the cervical spine were registered pretreatment and posttreatment using an electromagnetic tracking system. Quantitative and qualitative parameters were calculated for axial rotation, lateral bending, and flexion-extension movement. Subjective pain ratings were measured with the visual analogue scale and the Neck Disability Index and were collected pretreatment and posttreatment. ResultsAfter treatment, the range of motion of the main motion improved significantly for axial rotation (P = .034), lateral bending (P < .001), and flexion-extension (P = .031). Although for axial rotation as the main motion, the smoothness of the flexion-extension movement improved significantly after treatment (P = .036), the reverse was true for flexion-extension as the main motion. Visual analogue scale scores exhibited a statistically (P < .001) and clinically significant reduction of pain sensation. The mean change in Neck Disability Index scores only exhibited a statistically significant improvement 1 week after treatment. ConclusionThoracic HVLAT manipulation led to positive changes in quantitative and qualitative aspects of 3-dimensional cervical spine kinematics. Because of the 1-intervention group design, external factors influencing the healing process could not be eliminated.

Hybrid Constructs for Performing Three-level Hybrid Surgery: A Finite Element Study

To systematically investigate the effect of 3-level hybrid constructs on the cervical spine biomechanics based on a validated model of the C3-C7 segments. Three hybrid constructs with 2 U-shaped dynamic cervical implants and 1 cage were simulated. The 3 constructs were 1) Cage-U-U (cage implanted at the C3-C4 level and U-shaped dynamic cervical implants implanted at the C4-C5 and C5-C6 levels), 2) U-Cage-U, and 3) U-U-Cage. Biomechanical parameters including moments, cervical motions, and stresses in the facet and implants were analyzed in flexion and extension. The flexion and extension motions at artificial cervical disc replacement levels increased for all hybrid constructs when compared with those of intact model. However, the maximum increase was 52% with U-U-Cage model. At the unoperated adjacent level, the maximum motion increase in extension was 23% with the U-U-Cage model. Also, the U-U-Cage and U-Cage-U model generated more than 40% increase in terms of flexion motion at the adjacent level. The facet stress at the adjacent level increased by 28%, 20%, and 39% with the Cage-U-U, U-Cage-U, and U-U-Cage models, respectively. The moments required to reach the same motion as the intact model were significantly increased. The study showed that the U-U-Cage model lead to more compensation in terms of motion and facet stress. Furthermore, the present results imply that when conducting the hybrid surgery, the segmental motions should be taken into account. Performing anterior cervical discectomy and fusion at the level whose motion is relatively small may decrease the compensation required at the adjacent level.

Odontoid screw fixation of a type II odontoid fracture in a patient with autofused C2–C3 vertebral bodies

Abstract Background Anterior odontoid screw fixation for the treatment of type II odontoid fractures, in contrast to posterior C1–2 fusion, allows for maintenance of cervical rotatory motion at C1–2. The approach requires an accessible C2–3 disc space from which a screw can be inserted into the vertebral body and odontoid process across the fracture. Less is known about the potential use of this technique in patients with inaccessible C2–3 disc spaces. Case description A 20 year-old female presented to the emergency department following a motor vehicle accident with diffuse neck pain in the absence of weakness or paresthesias. A CT of the patient's C-spine revealed a type II dens fracture with 3 mm of posterior displacement and congenital fusion of the C2 and C3 vertebral bodies. She was initially treated conservatively with a halo brace for 3 months, but experienced persistent neck pain and a CT of the C-spine at that time showed incomplete healing. The patient was counseled and elected to undergo anterior odontoid screw fixation. During the procedure, due to the autofusion of the C2–3 vertebral bodies, the C3–4 disc space was accessed and a screw was placed through the C2–C3 fusion block into the odontoid process. The patient tolerated the procedure well and postoperative imaging demonstrated healing of the fracture fragments. Conclusion This case demonstrates that patients with inaccessible C2–3 disc spaces can still undergo anterior fixation. In younger patients, this may be particularly valuable as the rotatory potential of their cervical spine is preserved.

Treatment of Occipital Neuralgia by Electroacupuncture Combined with Neural Mobilization

To observe the effect of electroacupuncture (EA) combined with neural mobilization (NM) in the treatment of occipital neuralgia. A total of 62 occipital neuralgia patients were randomized into EA group (19 cases), NM group (22 cases) and EA＋NM group (21 cases). EA was applied at acupoint-pairs as Yuzhen (BL 9)- Tianzhu (BL 10), Fengchi (GB 20)- Wangu (GB 12), etc. NM intervention consisted of occipital muscle group mobilization, C2 spinous process mobilization, cervical joint passive movement management mobilization, etc., was performed at the impaired cervical spine segment. The two methods were used in combination for patients in the EA＋NM group. All the treatment was given once a day for 2 weeks. Before and after treatment, the visual analogue scale (VAS) and the 6-point (1－6 points) behavioral rating scale (BRS-6) of headache were used to assess the severity of pain. The therapeutic effect was evaluated according to the "Criteria for Diagnosis and Cure-Improvement of Clinical Conditions" formulated by State Administration of Traditional Chinese Medicine of the People's Republic of China in 1994. After treatment, both VAS and BRS-6 scores were significantly lower than those before treatment in each of the three groups (P<0.05), and were significantly lower in the EA＋NM group than in the simple EA and simple NM groups (P<0.01,P<0.05). The total effective rates were 78.95% (15/19) in the EA group, 68.18% (15/22) in the NM group, and 90.48% (19/21) in the EA＋NM group, with an obviously better therapeutic effect being in the EA＋NM group relevant to each of the other two treatment groups (P<0.05). EA, NM and EA combined with NM can improve symptoms of patients with occipital neuralgia, and EA＋NM has a synergic analgesic effect for occipital neuralgia.

Anaesthetic challenges in a patient with Klippel–Feil syndrome scheduled for panendoscopy and biopsy

Klippel–Feil syndrome is one of the congenital causes of difficult airway. It is characterised by a classic triad of a short neck, restricted cervical spine movement, and a low posterior hairline, which can pose a significant challenge to the anaesthetist during airway management. A case of Klippel Feil Syndrome type 2 with associated Sprengel’s deformity for panendoscopy under general anaesthesia is presented. The anaesthetic considerations in the management of this patient are also discussed.

Utilización de sensores inerciales para la evaluación de la movilidad espinal en pacientes con espondiloartritis axial

IntroductionAxial Spondyloarthritis (AxSpa) is a rheumatic disease that affects the entire spine of the patient (lumbar, dorsal and cervical) and produces a reduction of mobility as the disease progresses. Several metrological tools have been proposed to assess this mobility. The objective of our study is to evaluate the use of inertial sensors “Inertial Measuring Unit” (IMU) as a tool for the measurement of spinal mobility in patients with AxSpA. Material and methodDescriptive and transversal study where spinal mobility is defined by cervical and dorsal-lumbar movement in frontal, lateral and transverse planes; by means of non-probabilistic sampling, 7 patients with AxSpA and 7 healthy subjects were recruited as control group. Mobility was measured synchronously with a system based on inertial motion sensors (IMU) and another video-based motion capture system (UCOTrack©). In addition, measurements of conventional metrology. Finally the BASMI (Bath Ankylosing Spondylitis Metrology Index), UCOASMI (University of Cordoba Ankilosing Spondylitis Metrology Index) and iUCOASMI index were obtained. ResultsBoth the individual measures obtained with the IMU and the composite index obtained from these measures, the iUCOASMI, show good reliability and concordance with intraclass correlation coefficients (ICC) above .7 (ICC˃.95 in the patient group), and an excellent correlation (P<.01) between iUCOASMI with UCOASMI and BASMI. In an adjustment of linear correlation of iUCOASMI/UCOASMI a R2 of .97 was obtained. DiscussionResults obtained shown that inertial sensors could be useful for analyzing spinal mobility in patients with AxSpA in a more accurate and reliable way than conventional metrology, and more flexible and economical than other advanced systems.

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is a generalised term that describes infection of the upper genital tract in women. It is commonly caused by the sexually transmitted infections Chlamydia Trachomatis and Neisseria Gonorrhoea. Clinical features of PID include pelvic pain, deep dyspareunia, cervical motion tenderness and adnexal tenderness. Complications include infertility, ectopic pregnancy and chronic pelvic pain. Therefore, it is important for GPs to have a high index of suspicion when women present with symptoms of PID and to initiate antibiotic treatment before vaginal swab results are known.

In cervical spondylotic myelopathy spinal cord motion is focally increased at the level of stenosis: a controlled cross-sectional study

Level-, age-, and gender-matched controlled cross-sectional cohort study. To investigate alterations of spinal cord (SC) motion within cervical spondylotic myelopathy (CSM) across the cervical spinal segments and its relation to cerebrospinal fluid (CSF)-flow, anatomic conditions, and clinical parameters. University Hospital Balgrist, Zurich, Switzerland. Overall, 12 patients suffering from CSM at level C5 and 12 controls underwent cardiac-gated 2D phase-contrast-MRI at level C2 and C5 and standard MRI sequences. Parameters of interest: Velocity measurements of SC and CSF (area under the curve = total displacement (normalization for duration of the heart cycle), total displacement ratio (C5/C2; intraindividual normalization for confounders)), spinal canal diameters, clinical motor- and sensory scores, and performance measures. Interrater reliability was excellent for SC motion at both levels and for CSF flow at C2, but not reliable for CSF flow at C5. Within controls, SC motion at C2 positively correlated with SC motion at C5 (p = 0.000); this correlation diminished in patients (p = 0.860). SC total displacement ratio was significantly increased in patients (p = 0.029) and correlated with clinical impairment (p = 0.017). Morphometric measures of the extent of stenosis were not related to SC motion or clinical symptoms. The findings revealed physiological interactions of CSF flow and SC motion across the cervical spine in healthy controls while being diminished in CSM patients. Findings of focally increased SC motion at the level of stenosis were related to clinical impairment and might be promising as a diagnostic and prognostic marker in CSM. CRPP Neurorehab of the University of Zurich, Switzerland.

Investigating the effects of cervical collar design and fit on the biomechanical and biomarker reaction at the skin.

BackgroundResearch has shown that up to 33% of pressure ulcers (PUs) acquired in hospitals result from the application of a medical device. Cervical collars (C-collars) have been implicated in causing PUs, due to the mechanical force they apply to the skin. In order to improve our understanding of collar-related PUs, the present study aimed to assess the biomechanical, biochemical, and microclimate effects of C-collar design and fitting tension.MethodsA cohort of 15 healthy volunteers was fit with two different C-collars according to the manufacturer guidelines. Two further collar tensions were also defined as loose and tight for each device. Each collar condition was applied for 15 minutes, with a 10 minute refractory period. Measurements at the device–skin interface included interface pressures, inflammatory biomarkers, microclimate, range of cervical motion, and comfort scores.ResultsThe interface pressures at each tissue site increased monotonically with greater collar tension (p<0.01), irrespective of collar design. Biomarker analysis revealed that inflammatory cytokines (IL-1a) were elevated during collar application, with the highest increase during the tight fit condition, representing over a fourfold increase from unloaded conditions. Regardless of collar tension or type, there was an increase in temperature 1.5°C ±0.8°C compared to baseline values. Range of motion significantly decreased with greater strap tension (p<0.05), with an associated increase in discomfort.ConclusionThe present findings revealed that increasing C-collar tensions caused elevated contact pressures at the device–skin interface, with a corresponding inflammatory response at the skin. These peak contact pressures were highest at the occiput, corresponding with reported PU locations. Devices should be designed to uniformly distribute pressures, and appropriate guidance is needed for their application.

Comparison of Morphological Characteristics of the Subaxial Cervical Spine between Athetoid Cerebral Palsy and Normal Control.

ObjectiveTo compare the morphometry of subaxial cervical spine between cerebral palsy (CP) and normal control.MethodsWe retrospectively analyzed 72 patients with CP, as well as 72 patients from normal population. The two groups were matched for age, sex, and body mass index. Pedicle, lateral mass (LM), and vertebral foramen were evaluated using computed tomography (CT) imaging. Pedicle diameter, LM height, thickness, width and vertebral foramen asymmetry (VFA) were measured and compared between the two groups. Cervical dynamic motion, disc and facet joint degeneration were investigated. Additionally, we compared the morphology of LM between convex side and concave side with cervical scoliotic CP patients.ResultsLM height was smaller in CP group. LM thickness and width were larger in CP group at mid-cervical level. In 40 CP patients with cervical scoliosis, there were no height and width differences between convex and concave side. Pedicle outer diameter was not statistically different between two groups. Pedicle inner diameter was significantly smaller in CP group. Pedicle sclerosis was more frequent in CP patients. VFA was larger in CP group at C3, C4, and C5. Disc/facet degeneration grade was higher in the CP group. Cervical motion of CP group was smaller than those of the control group.ConclusionLM morphology of CP patients was different from normal population. Sclerotic pedicles and vertebral foramen asymmetry were more commonly identified in CP patients. CP patients were more likely to demonstrate progressive disc/facet degeneration. This data may provide useful information on cervical posterior instrumentation in CP patients.

Cervical Proprioception in a Young Population Who Spend Long Periods on Mobile Devices: A 2-Group Comparative Observational Study

ObjectivesThe purpose of this study was to evaluate if young people with insidious-onset neck pain who spend long periods on mobile electronic devices (known as “text neck") have impaired cervical proprioception and if this is related to time on devices. MethodsA 2-group comparative observational study was conducted at an Australian university. Twenty-two participants with text neck and 22 asymptomatic controls, all of whom were 18 to 35 years old and spent ≥4 hours per day on unsupported electronic devices, were assessed using the head repositioning accuracy (HRA) test. Differences between groups were calculated using independent sample t-tests, and correlations between neck pain intensity, time on devices, and HRA test were performed using Pearson’s bivariate analysis. ResultsDuring cervical flexion, those with text neck (n = 22, mean age ± standard deviation [SD]: 21 ± 4 years, 59% female) had a 3.9° (SD: 1.4°) repositioning error, and the control group (n = 22, 20 ± 1 years, 68% female) had a 2.9° (SD: 1.2°) error. The mean difference was 1° (95% confidence interval: 0–2, P = .02). For other cervical movements, there was no difference between groups. There was a moderately significant correlation (P ≤ .05) between time spent on electronic devices and cervical pain intensity and between cervical pain intensity and HRA during flexion. ConclusionThe participants with text neck had a greater proprioceptive error during cervical flexion compared with controls. This could be related to neck pain and time spent on electronic devices.

Cervical spine motion during intubation: a fluoroscopic comparison between three intubation techniques

Background Anaesthetists are responsible for the management of the airway in patients with unstable cervical spine (C spine). The optimal tracheal intubation technique for patients with potential C spine injury remains controversial. Videolaryngoscopes are used in an attempt to balance the need to limit cervical motion and overcome the difficulty of obtaining laryngeal views especially with manual in-line stabilization or cervical collar. Aim The current study aimed to compare the degree of C spine movement during intubation using different devices, Macintosh direct laryngoscope, C-MAC D-Blade videolaryngoscope and flexible intubation video endoscope (FIVE), in anaesthetized patients with normal airway and simulated C spine immobilization. Patients and methods This study was carried out on 45 adult patients scheduled for radiographic procedures under general anaesthesia with endotracheal intubation (ETT). Patients were randomly divided into three equal groups (15 patients each) using the sealed envelope technique: group M (Macintosh direct laryngoscope), group D (C-MAC D-Blade) and group F (FIVE). C spine movement was recorded with continuous fluoroscopy at 3–8 frames/s using a digital videofluoroscopy unit during both laryngoscopy and intubation to capture the maximal extent of C spine movement. The following parameters were evaluated: age, BMI, airway score, haemodynamic parameters, glottic view grade (Cormack and Lehane), time to successful ETT insertion and maximum segmental spine motion. Results The three studied groups were matching as regards age, BMI and airway score. Heart rate and mean arterial blood pressure observed after insertion of the ETT were statistically higher in group M compared with groups D and F. However, there were no significant differences in mean observed HR and mean arterial blood pressure between groups D and F at all time intervals. The Macintosh (group M) had significantly higher C and L grades than the two other devices in groups D and F. There was no significant difference in C and L grades attainted by the D-Blade in group D and the FIVE in group F. D-Blade had significantly shorter intubation time compared with Macintosh and FIVE. Macintosh direct laryngoscope resulted in significantly greater cervical movement at all measured motion segments compared with D-Blade and FIVE. Meanwhile, FIVE caused significantly less motion compared with D-Blade. Conclusion In patients with potential C spine injury and cervical immobilization, D-Blade results in less cervical motion, better glottic views and shorter intubation time compared with Macintosh laryngoscope. Flexible intubation scope causes the least cervical motion but with the longest intubation time.

Comparison of laryngeal mask airway CTrach™ and Airtraq® videolaryngoscopes as conduits for endotracheal intubation in patients with simulated limitation of cervical spine movements by manual in-line stabilization.

Background and Aims:Laryngeal mask airway (LMA) CTrach™ and Airtraq® videolaryngoscopes are useful for endotracheal intubation in patients with limited cervical spine movements and other predicted difficult airways. We aimed to compare LMA CTrach™ and Airtraq® videolaryngoscopes as conduits for endotracheal intubation in patients with simulated limitation of cervical spine movements by manual in-line stabilization (MILS).Material and Methods:This was a prospective, randomized study including 50 patients undergoing elective surgeries under general anesthesia. Patients were assigned to undergo intubation using Airtraq® (n = 25) or LMA CTrach™ (n = 25) by an experienced anesthesiologist, while MILS was provided. Laryngoscopy and intubation were compared in terms of time taken to obtain optimal laryngeal view, successful intubation, total time, percentage of glottis opening (POGO) score, maneuvers required for optimal laryngeal view and alignment of endotracheal tube, and number of attempts and complications. An integrated score was calculated to classify the attempt as good, restricted, or poor.Results:Time taken to obtain optimal laryngeal view, successful intubation, and total time in both groups were comparable. POGO score >50% was seen in 25 and 21 patients in Groups A and C. Seventy-six percent and ninety-six percent in Groups A and C, respectively, had a good integrated score; 6% and 1% had restricted score; none had a poor score; and the difference between them was statistically significant (P = 0.042).Conclusions:LMA CTrach™ and Airtraq® are similar with respect to time taken for obtaining optimal laryngeal view, successful intubation, and total time when used for intubation in patients with simulated limitation of cervical spine movements.

Repeatability of Cervical Joint Flexion and Extension Within and Between Days

ObjectiveThe purpose of this study was to investigate within- and between-day repeatability of free and unrestricted healthy cervical flexion and extension motion when assessing dynamic cervical spine motion. MethodsFluoroscopy videos of 2 repeated cervical flexion and 2 repeated extension motions were examined for within-day repeatability (20-second interval) for 18 participants (6 females) and between-day repeatability (1-week interval) for 15 participants (6 females). The dynamic cervical motions were free and unrestricted from neutral to end range. The flexion videos and extension videos were evenly divided into 10% epochs of the C0-to-C7 range of motion. Within-day and between-day repeatability of joint motion angles (all 7 joints and epochs, respectively) was tested in a repeated-measures analysis of variance. Joint motion angle differences between repetitions were calculated for each epoch and joint (7 joints), and these joint motion angle differences between within-day and between-day repetitions were tested in mixed-model analysis of variance. ResultsFor all joints and epochs, respectively, no significant differences were found in joint motion angle between within-day or between-day repetitions. There were no significant effects of joint motion angle differences between within-day and between-day repetitions. The average within-day joint motion angle differences across all joints and epochs were 0.00° ± 2.98° and 0.00° ± 3.05° for flexion and extension, respectively. The average between-day joint motion angle differences were 0.02° ± 2.56° and 0.05° ± 2.40° for flexion and extension, respectively. ConclusionsThis is the first study to report the within-day and between-day joint motion angle differences of repeated cervical flexion and extension. This study supports the idea that cervical joints repeat their motion accurately.

Effects of Pilates and yoga in patients with chronic neck pain: A sonographic study.

Various studies have shown the efficacy of conventional isometric, Pilates and yoga exercises. However, data on the effects and comparison of these specific exercises on the cervical muscle morphology are insufficient or lacking. To investigate the effects of different exercise treatments on neck muscles in patients with chronic neck pain. A randomized study. Fifty-six patients with chronic neck pain were randomized into 3 groups as follows: Pilates group (n = 20), yoga group (n = 18) and isometric group (n = 18). Demographics and background information were recorded. The thickness and cross-sectional area of neck muscles were evaluated by ultrasound imaging. Cervical motions were measured with a goniometer. Pain severity was evaluated with the McGill Pain Scale, disability with the Neck Disability Index, quality of life with the Nottingham Health Profile, and emotional status with the Beck Depression Inventory. In addition to a conventional physio-therapy programme, 15 sessions of physical therapy, including hot pack, ultrasound, and transcutaneous electrical nerve stimulation (TENS), were provided to all patients. All groups performed the exercises for 6 weeks. The aforementioned assessments were performed before and 6 weeks after the treatment. Although pain, disability, depression and quality of life improved similarly within all groups (all p < 0.05), muscle thickness values as regards the semispinalis capitis were increased only in the Pilates group (p = 0.022). The lack of complex (progressive resistive) exercise treatment protocols, short treatment duration and partial supervision. All 3 types of exercise had favourable effects on pain and functional scores, but no differences were found among the groups, except for the Pilates group, in which the semispinalis capitis muscle increased in thickness.

Effect of a semiconstrained elastic integrated cervical artificial disc on the cervical motion

ABSTRACT Background and Objectives: Cervical total disc replacement (TDR) is a novel dynamically stabilizing technique for the symptomatic cervical intervertebral segment. While the long-term effect of mainstream cervical nonconstrained artificial disc group (CNAD) does not match the theoretical effects of mobility preserving and neural decompression. The cervical semiconstrained elastic integrated artificial disc (CSID) may be a more reasonable design. However, beneficial or adverse effects of this design have not been measured and data for biomechanical effect are unavailable. The aim of this study is to assess the biomechanical effect of CSID on the segmental motion at implanted and adjacent levels. Methods: This study was supported by medical science developmental funding of Nanjing (20,000 dollars). Eight cadaveric C3-T1 specimens were loaded in flexion/extension (F/E), axial rotation (AR), and lateral bending (LB) with CSID, CNAD, and anterior fusion (AF) implanted at C5-C6 level alternatively. The range of motion (ROM), neutral zone (NZ), and elastic zone (EZ) at implanted and adjacent levels were measured. The mean values of parameters in the intact specimen group (INT), CSID group, CNAD group, and AF group were compared statistically (n = 8). Results: There was no significant difference of ROM, NZ, and EZ at implanted and adjacent levels between CSID and INT in F/E, AR, and LB (P &gt; 0.05). CNAD caused a significant change of EZ in F/E and LB and ROM in LB at implanted level. Meantime, CNAD caused ROM increasing at adjacent levels (P &lt; 0.05). AF caused the most significant changes of ROM, NZ, and EZ in F/E, AR and LB, compared to CSID and CNAD (P &lt; 0.05). Conclusions: The semiconstrained elastic integrated design of cervical artificial disc may mimic of physiological disc's biomechanical effects on segmental kinematics at implanted and adjacent levels more closely, compared to nonconstrained discs and AF. CSID disc may reduce the acceleration of postTDR degeneration at the implanted and adjacent levels due to this promoted biomechanical performance. CSID disc could be a potential candidate for future cervical artificial intervertebral prosthesis studies.

Development of the circumduction metric for identification of cervical motion impairment.

IntroductionChronic neck pain results in considerable personal, clinical, and societal burden. It consistently ranks among the top three pain-related reasons for seeking healthcare. Despite its prevalence, neck pain is difficult to both assess and treat. Quantitative approaches are required since diagnostic imaging techniques rarely provide information on movement-related neck pain, and most common clinical assessment tools are limited to single plane motion measurement.MethodsIn this study, the ability of an inertial measurement unit to document the cervical motion characteristics of 28 people with chronic neck pain and 23 healthy controls was assessed. A total of six circumduction metrics and one neck circumduction trajectory model were proposed as identification metrics.ResultsFive metrics demonstrated significant differences between the two groups. The neck circumduction trajectory model successfully distinguished between the two groups.DiscussionThe evaluation of the proposed metrics provides proof of concept that novel metrics can be captured with relative ease in the clinical setting using an inexpensive wearable sensor headband. The derivation of the proposed model may open new lines of inquiry into the clinical utility of assessing the multiplanar movement of cervical circumduction. The results obtained from this study also provide additional insight for the development of a sensitive, quantifiable and real-world neck evaluation strategies.

Simulation analysis of cervical spine motion

Simulation analysis of cervical spine motion