Cervical Muscle Groups Research Articles

Endotracheal Intubation without Neuromuscular Blocking Agent in Patient with Fracture Cervical Spine C1 and C4 Underwent Fusion C1–2 and C4–6

About 30% of cervical spine fractures involve injuries to the C1 and C2 vertebrae, which are considered unstable. Ensuring the stability of the injured cervical spine throughout perioperative period, including preoperative examinations, anesthesia induction, laryngoscopy, and intubation, is crucial for anesthesiologists. A 40-year-old woman suffered neck pain following a motorcycle accident, suffering a Spinal Cord Injury ASIA Impairment Scale (SCI AIS) E, a fracture of the C5 vertebral body (CV) classified as AO Spine Type A2, a Jefferson Type IV fracture, and mild head trauma. She underwent surgical fusion of the C1–C2 and C4–C6 vertebrae under general anesthesia, which included dexmedetomidine, propofol, sevoflurane, and fentanyl without any neuromuscular blocking agents (NMBA). The primary goal of perioperative airway management in cervical injury is a secured airway, while maintaining cervical stability without inflicting secondary injury. The cervical muscle group is essential for maintaining cervical stability, and the use of NMBA may jeopardize this stability, necessitating external cervical stabilization, especially during laryngoscopy and intubation. Induction agents in combination with opioid, widely used to facilitate laryngoscopy and intubation without using NMBA. Anesthesiologists must precisely arrange the management of cervical spine injuries patient to avoid secondary injury and improve surgical outcomes

Cervical muscle morphometry and composition demonstrate prognostic value in degenerative cervical myelopathy outcomes.

This study aimed to examine whether preoperative cervical muscle size, composition, and asymmetry from magnetic resonance imaging (MRI) can predict post-operative outcomes in patients with degenerative cervical myelopathy (DCM). A total of 171 patients with DCM were included. Relative total cross-sectional area (RCSA), functional CSA (fat-free area, FCSA), ratio of FCSA/CSA (fatty infiltration) and asymmetry of the multifidus (MF) and semispinalis cervicis (SCer) together (MF + SCer), and cervical muscle as a group (MF, SCer, semispinalis capitis, and splenius capitis) were obtained from T2-weighted axial MR images at the mid-disk, at the level of maximum cord compression and the level below. Univariate and multivariate linear regression analyses were used to assess the relationship between baseline cervical muscle measurements of interest with the modified Japanese Orthopedic Association (mJOA), Nurick Classification, Neck Disability Index (NDI), and SF-36 health survey at 6-month and 12-month post-surgery. Lower RCSA of MF + SCer, less CSA MF + SCer asymmetry and greater FCSA/CSA for the cervical muscle group (e.g., less fatty infiltration), and younger age were significant predictors of higher mJOA scores (e.g., less disability) at 6-month and 12-month post-surgery (all p < 0.05). Greater CSA asymmetry in MF + SCer and lower FCSA/CSA (e.g., more fatty infiltration) for the cervical muscle group were significant predictors of higher Nurick scores (e.g., more disability) at 6-month and 12-month post-surgery (all p < 0.05). Lower FCSA MF + Scer asymmetry, lower FCSA/CSA asymmetry of the muscle group, and greater RCSA MF + SCer were significant predictors of higher NDI scores at 6-month and 12-month post-surgery. Finally, greater FCSA/CSA asymmetry of the MF + SCer, greater FCSA asymmetry of the muscle group, greater RCSA of the muscle group, and greater CSA asymmetry of MF + SCer were significant predictors of lower post-operative SF-36 scores at 6- and 12-month post-surgery. Our result suggested that cervical paraspinal muscle morphology, specifically greater asymmetry, and fatty infiltration may be important predictors of functional recovery and post-surgical outcomes in patients with DCM.

Comparison between cutting versus retraction of anterior cervical musculature during endoscopic thyroidectomy.

To compare the different techniques of managing the anterior cervical muscle group during endoscopic thyroidectomy via the trans-thoraco-areolar approach. A total of 90 patients with thyroid tumors less than 3 cm were evaluated. The time for each intraoperative step, total surgery duration, intraoperative blood loss volume, pathology results, number of lymph nodes dissected and patient satisfaction with esthetics were assessed. Intraoperative blood loss volume, drainage volume on the first postoperative day, number of lymph nodes dissected in the central region, postoperative hospitalization duration, number of transient laryngeal nerve palsy cases, and number of transient hypocalcemia cases were similar between the muscle transection (MT) and muscle retraction (MR) groups. The MT group had significantly higher postoperative pain scores after 12 hours, but pain scores at 48 hours postoperatively were not significantly different between the 2 groups. In the unilateral thyroidectomy subgroup, the durations of isthmus resection, freeing the lateral thyroid, exposing the laryngeal recurrent nerve, and management of the inferior pole were similar for both muscle management methods. The muscle dissection and suture time was significantly longer for the MT group than that for the MR group; in contrast, the upper pole management time of the muscle resection group was significantly shorter. In the bilateral resection subgroup, both muscle management methods required similar durations for managing the contralateral upper pole after ipsilateral thyroidectomy. However, intraoperative blood loss was significantly higher for MR than for MT, while postoperative pain was relatively mild. In the malignant tumor subgroup, duration of inferior thyroid pole management was significantly less for MT than for MR. There are significant differences between the 2 muscle management methods in handling and suturing muscles. Both methods have satisfactory postoperative outcomes for resection of thyroid nodules with diameters ≤3 cm. For tumors located in the upper pole, transection of the anterior cervical muscles confers higher feasibility of the thyroidectomy technique; however, suturing becomes difficult in such scenarios.

A Prospective, Randomized, Controlled Clinical Study of Cervical Muscle Group Training Improving Radiotherapy Setup Accuracy Repeatability for Head and Neck Tumors

<h3>Purpose/Objective(s)</h3> Studies have shown that head and neck tumors are impossible to achieve an ideal match over the entire length of the neck due to the wide range of radiotherapy target areas. Previous studies have shown random deformation errors of 0.5 to 3.6 mm in the head and neck, the difference between any two different matched areas can reach 2 to 6 mm. we aimed to evaluate the role of neck muscle group training on the repeatability of the pose in patients treated with radiotherapy for head and neck tumors. <h3>Materials/Methods</h3> Patients treated with radiotherapy for head and neck tumors were randomly assigned (1:1) to a study group and a control group. The study group started cervical spine exercises+massage training one week before the start of radiotherapy until the end of radiotherapy. In the control group, conventional treatment without specific interventions was performed. The primary endpoint was the difference in the reproducibility of cervical spine set-up between the two groups, and the secondary endpoints were the differences in cervical curvature changes on lateral cervical radiographs before and after treatment between the two groups, and the differences in the timing and extent of side effects before, during, and after treatment between the two groups. <h3>Results</h3> A total of 947 CBCT scans were performed in 166 patients, including 479 CBCTs in 83 patients in the study group and 468 CBCTs in 83 patients in the control group. 26.51% (22/83) of the study group and 33.73% (28/83) of the control group had an error of ≥3 mm during the first treatment, (P=0.31). Patients with clivus and neck error >3mm in anterior-posterior direction during treatment accounted for 8.43% (7/83) of the study group and 26.51% (22/83) of the control group(P=0.002). The number of repeated setups except the first treatment was 2.42% in the study group and 7.02% in the control group (P=0.01). The error range from clivus to neck was (7, 3, 7) mm. setup error: in the clivus position of the two groups in the X, Y, Z three directions of the Setup error were (0.95 ± 0.89, 1.09 ± 0.94, 1.62 ± 1.18) mm vs (1.02 ± 0.94, 1.14 ± 0.96, 1.82 ± 1.21) mm, p in the z-direction is statistically significant (p = 0.01); The position of the 4,7th cervical vertebra also had statistical significance in the Z direction. Comparison between the surgical study group and non-surgical study group, the errors in the x and Z directions of the clivus and the 7th cervical vertebra were (0.99±0.96, 1.65±1.36 and 1.64±1.23, 1.61±1.37) mm vs (0.80±0.77, 1.85±1.44 and 1.67±1.07, 1.95±1.60) mm, P = 0.02, 0.11, 0.77, 0.01; the results were similar to it when comparing surgical controls to non-surgical controls. It can be seen from the data that in the X and Z directions from the clivus to the neck, the error change of the surgical group is smaller than that of the non-surgical group. There was no difference in toxicity and side effects. <h3>Conclusion</h3> The results show that neck muscle training can improve the anterior and posterior neck deformation error, improve the radiotherapy accuracy and setup efficiency.

Pathology confirmation of the efficacy and safety of microwave ablation in papillary thyroid carcinoma.

BackgroundThe incidence of papillary thyroid carcinoma (PTC) has rapidly increased in recent years. Microwave ablation (MWA) was proposed as an alternative treatment for PTC. This study aimed to investigate the efficacy and safety of MWA by exploring the postoperative pathology results of post-ablation lesions in patients with PTC.MethodsThis study retrospectively analyzed data from 12 patients who underwent thyroid surgery after MWA treatment for primary PTC between January 2015 and November 2021 in six hospitals.ResultsThe average age of the 12 patients (8 female) was 45.3 ± 9.7 years. There was one patient with PTC (size > 1 cm) and 11 patients with micro-PTC (size ≤ 1 cm), of which eight patients had unifocal micro-PTC and three patients had multifocal micro-PTC. A total of 17 tumor foci with mean size of 6.2 ± 2.6 mm were treated by MWA. The median interval time between MWA and surgery was 6.6 months (range: 0.4–21.9 months). Intraoperatively, adherence to the anterior cervical muscle group was observed in three cases (3/12). Upon postoperative pathologic examination, all the post-ablation lesions of the eight unifocal micro-PTC and two multifocal micro-PTC showed no residual carcinomas. Outside the ablation zone, PTCs were detected in three cases, including two of the eight patients with unifocal micro-PTC and one of the three patients with multifocal micro-PTC. Cervical lymph node metastases were detected in seven patients (7/12).ConclusionMWA was feasible for the treatment of primary unifocal low-risk micro-PTC (T1aN0M0) with good efficacy and safety. However, the use of MWA for treating PTC (size > 1 cm) and multifocal micro-PTC remains controversial.

Therapeutic observation on Fu's acupuncture for cervical spondylosis of vertebral artery type based on Tongtuo method

To verify the superiority of Fu's acupuncture for cervical spondylosis of vertebral artery type (CSA) based on Cheng's Tongtuo method. A total of 150 patients with CSA were randomly divided into a Tongtuo Fu's acupuncture group, a Tongtuo acupuncture group and a conventional Fu's acupuncture group, 50 cases in each group. Under the guidance of the theory of Tongtuo method, the Tongtuo Fu's acupuncture group was treated with Fu's acupuncture, the distal Tong method was performed at the distal myofascial trigger point (MTrP) of the dorsal forearm, and then the Tuo method was performed at the proximal MTrP of the cervical muscle group. In the Tongtuo acupuncture group, acupuncture was given at distal acupoints (Neiguan [PC 6], Quchi [LI 11], Taichong [LR 3], Xingjian [LR 2], etc.), and then at proximal acupoints (Fengchi [GB 20] and Baihui [GV 20]). In the conventional Fu's acupuncture group, Fu's acupuncture was only performed at the MTrP of cervical muscle group. Each group was treated once a day, 3 days were taken as one course, and 2 courses were given. The score of cervical vertigo symptoms and function evaluation scale, peak systolic velocity (PSV) and resistance index (RI) of vertebral artery were observed before and after treatment in the 3 groups. After treatment, the scores of cervical vertigo symptoms and function evaluation scale and PSV in each group were higher than those before treatment (P<0.01), and the RI was lower than that before treatment (P<0.01). The score of cervical vertigo symptoms and function evaluation scale and PSV in Tongtuo Fu's acupuncture group were higher than those in the other two groups (P<0.01), and the RI was lower than that in the other two groups (P<0.01). Fu's acupuncture based on Tongtuo method could improve the symptoms of cervical vertigo and the blood flow state of vertebral artery in patients with CSA, and the curative effect is better than Tongtuo acupuncture and conventional Fu's acupuncture.

A case of dropped head syndrome suspected due to Dipeptidyl peptidase (DPP)-4 inhibitor use

There have been a few reports on Dipeptidyl peptidase (DPP)-4 inhibitor-induced dropped head syndrome. However, there has been no known report on temporal changes in MRI findings. The patient described here was a 63-year-old man who was prescribed oral sitagliptin (50mg/day) in February 2019. He experienced a dropped head from mid-January 2020, and in early April that year, he was admitted to our hospital for further evaluation. Weakness of the cervical extensor muscles (MMT 3) was noted, and MRI findings showed that the posterior cervical muscle group was hyperintense on short inversion time inversion recovery (STIR). We suspected sitagliptin to be the cause of his dropped head and discontinued it. On the 10th day of admission, his posture improved to the median position. One month after discontinuation of sitagliptin, MRI findings showed an improvement in the STIR hyperintensity of the posterior cervical muscle. In conclusion, if the initiation of a DPP-4 inhibitor results in dropped head syndrome, discontinuation of the drug should be considered.

The clinical research progress of neck muscle tensity detection methods and evaluation index

Cervical muscle group has complex anatomical and physiological characteristics, which plays an important role in maintaining cervical stability and participating in cervical activity. Long-term bow of the head will cause irreversible injury to the neck muscle. The clinical manifestations are stiffness of the neck, and increased muscle tension. In severe cases, muscle spasms are like stripes. The pain caused by it for more than 3 months is called chronic neck pain(CNP). With the increasing incidence of chronic neck pain in the population, the related case reports and clinical studies are also increasing. At present, it is generally believed that persistent non-autonomous hypertension of neck muscle is the primary pathological mechanism of chronic neck pain. For the objective, quantitative analysis and evaluation of neck muscle tension is helpful to predict the occurrence of chronic neck pain, explain its pathogenesis and formulate treatment measures, which has gradually become the main development trend in this field. In recent years, with the development of auxiliary medicine, evaluation methods have changed with each passing day, which provides a variety of options for clinical research. In this paper, several mainstream detection methods of cervical muscle tension are summarized, and the shear wave elastography technology, surface electromyography, magnetic resonance imaging and diffusion tensor imaging are introduced respectively. Their development history, and the working principle of each technology aredescribed in detail. By reviewing the classical clinical research cases at domestic and abroad, the research status of each technology in the field of cervical muscle detection is deeply analyzed. The development trend, potential advantages and limitations of Yang's modulus, integrated electromyography, root mean square value, mean power frequency, median frequency, cross sectional area and apparent diffusion coefficient were evaluated. The purpose of this paper is to summarize experience, guide clinic, deepen the understanding of microcosmic pathogenesis of chronic neck pain, provide theoretical basis for exploring new detection methods, provide omni-directional, multi-level and three-dimensional new clinical diagnosis and treatment strategies for related fields, and provide new methods and ideas for the follow-up study of chronic neck pain.

A Rodent Model for Chronic Brain Hypoperfusion Related Diseases: Permanent Bilateral Occlusion of the Common Carotid Arteries (2VO) in Rats.

Permanent occlusion of bilateral common carotid arteries (2VO) in rat is considered as a suitable animal model to mimic chronic brain hypoperfusion status, which is proved to be a risk factor to precede the Alzheimer's disease or/and vascular dementia. In this protocol, we describe how to successfully ligate the bilateral common carotid arteries covered by anterior cervical muscle group, and provide the details for understanding the surgical procedures of 2VO.

Can treatment with statins have a negative influence on the tolerance of mandibular advancement devices?

Statins are considered the most effective drugs used in the treatment of dyslipidemias. Some of their adverse effects are related to muscle problems. Myalgias produced by statins appear more often during exercise. Mandibular advancement devices (MAD) force the propulsory and elevatory musculature of the mandible to exercise by making the jaw move forward. The aim of this study is to evaluate the incidence of muscular side effects (referred, spontaneous, or under palpation pain, myofascial pain, mandibular rigidity and fatigue, tension and sensitivity of the masticatory muscles) in a group of patients with a diagnosis of obstructive sleep apnea being treated with MAD. This was a prospective study, involving consecutively 104 patients with a diagnosis of OSAS, and who had begun treatment with a custom made oral device. Muscular side effects were collected by anamnesis (verbal request and questionnaires), psychological status and clinical assessment (manual muscle palpation in the masticatory and cervical muscle groups), before and during MAD treatment. Of the total sample, 22.1% presented muscular side effects with the oral device. However, in patients taking statins, this percentage was 57.1%, as opposed to 16.7% of the non-statins patients (p<0.001). The risk of suffering muscular alterations during oral device treatment is higher in statin patients (odds ratio 6.67, p=0.002). Treatment with statins can give rise to the appearance of undesirable side effects among patients being treated with oral devices.

The relationship between forward head posture and cervical muscle performance in healthy individuals

Background Forward head postures (FHP) are proposed to adversely load cervical spine structures. Neck muscles provide support for the neck, and thus an imbalance in neck muscle performance could potentially contribute to the development of FHP. Previous studies have not considered the interaction of multiple muscle groups with regard to postural orientation. Given the interdependence of muscles along the cervical spine for optimal orientation and physical support of the vertebral column, the performance of a single muscle group may not accurately reflect the coordinated ability of the muscles to maintain a neutral neck posture. Purpose The purpose of this study was to investigate the relationship between FHP and the balance between the cervical extensor and flexor muscle groups in healthy individuals. We hypothesised that the magnitude of FHP would be associated with the strength and endurance performance ratios between the cervical extensor and flexor muscle groups. Methods Twenty male and 24 female volunteers were photographed in the sagittal plane wearing surface markers. The FHP of each participant was measured via the tragus-sternum marker distance over two conditions: (1)in relaxed standing and (2)during a sustained sitting task. Maximal strength (Nm) and endurance (s) performance of the extensor and flexor muscle groups were recorded at the upper (craniocervical flexion/extension (CCF/CCE)) and lower (cervicothoracic flexion/extension (CTF/CTE)) cervical regions. Muscle performance measures were expressed as extension:flexion ratios and their relation to FHP evaluated. A stepwise multiple regression analysis using backward elimination was utilised to examine the relationship between the postural measures and the muscle performance ratio measures. Separate models were used for the two different postural conditions (standing, sustained sitting). Gender was included as a constant correction factor in all regression models. Where gender was a significant variable in the model, analyses were repeated separately for males and females. Results Greater FHP in standing was significantly associated with reduced proportional CTE to CCF strength in females (R2 = 0.21, P = 0.03) and greater proportional CTE to CTF strength in males (R2 = 0.23, P = 0.03). A greater drift into FHP during sustained sitting was associated with a relative reduction in CCE endurance proportional to CTF endurance in females only (R2 = 0.27, P = 0.017). Conclusion(s) This initial study indicates that the balance in performance between the cervical flexor and extensor muscle groups may impact FHP in healthy individuals. However, the findings were inconsistent across different muscle performance ratios and gender. Larger scale studies are therefore now needed to further clarify the relationship between FHP and muscle performance. Implications The findings suggest that relative performance of the various cervical muscle groups needs to be accounted for when considering postural correction strategies in the clinical setting, as is often recommended.

Estudio transversal de fiabilidad y concordancia de un nuevo dispositivo para la evaluación de torsión y tolerancia a la fatiga en flexo extensores cervicales de voluntarios sedentarios asintomáticos

ObjectiveTo determine the reliability and agreement of a method to evaluate maximum voluntary isometric torque (MVIT) and muscle fatigue local tolerance (MFLT) measurement in the cervical flexor-extensor muscles of sedentary life style asymptomatic volunteers. Material and methodFor this observational cross-sectional study, 42 subjects (15 women and 27 men), who were asymptomatic, with sedentary life style, and with no background of cervical pathology were assessed with the cervical muscle testing dynamometer system. The MVIT (Newton-meters; Nm) was recorded with three measurements for each muscle group (n=42). Twenty-four hours later, MFLT (seconds) was measured twice at 60±2.5% of MVIT with two measurements for the cervical flexor and extensor (n=40). After one week, a MVIT and MFLT retest was performed (n=13). ResultsThe general measurement of reliability and agreement for the MVIT show a intra-class correlation coefficient >0.89, coefficient of variation <11% and standard error of measurement <1Nm in both muscle groups. The measurement of MFLT flexor provided intra-class correlation coefficient >0.80, coefficient of variation =20% and standard error of measurement <10seconds; while the results for the extensors were intra-class correlation coefficient <0.50, coefficient of variation =30% and standard error of measurement >20sec. ConclusionsIn both cervical muscle groups, the proposed method and device are reliable and concordant for MVIT evaluation. On its part, gender is a significant scatter factor in MFLT testing.

Botulinum a toxin for the treatment of spasmodic torticollis: Dysphagia and regional toxin spread

Chemodenervation of cervical muscles with botulinum A toxin, although useful in treating spasmodic torticollis, has been associated with dysphagia. Retrospective analysis of dose and injection site (sternomastoid vs. posterior cervical muscle groups) in 26 patients (49 injections) suggested that dysphagia was related to the quantity of toxin injected into the sternomastoid muscle: dysphagia, median 150 IU (7 injections); and no dysphagia, median 100 IU (42 injections; p = 0.026 Wilcoxon test). In a prospective study (31 injections to 24 patients), limiting the dose administered to the sternomastoid to 100 IU, substantially reduced the incidence of dysphagia (0 of 31, p = 0.27, Fisher's exact test). Denervation of human orbicularis muscle fibers, 5 weeks to 4 months after injection of botulinum A toxin for the treatment of blepharospasm, was successfully demonstrated by intense, diffuse acetylcholinesterase staining. A weight-adjusted dose similar to that given for torticollis was injected into longissimus dorsi muscle in 6 albino rabbits. Using the acetylcholinesterase stain as a marker, a diffusion gradient was noted over a distance of 30 to 45 mm from the point of injection and in contralateral muscle 15 to 25 mm from this point. Thus, denervation was demonstrated to occur within a definable area which crossed anatomic barriers, such as fascia and bone. These clinical and laboratory data suggest that dysphagia following botulinum toxin therapy results from toxin spread to pharyngeal musculature from the sternocleidomastoid injection site. Limiting of the injection dose to 100 IU or less to the sternomastoid substantially decreases the incidence of this complication.