Cervical Position Research Articles

Non-invasive methods to maintain cervical spine position after pediatric tracheal resections

ObjectivesTo present our experience with two methods of neck stabilization after pediatric tracheal resection with primary anastomosis as possible alternatives to the traditional chest-chin suture. MethodsChildren undergoing tracheal resection and/or cricotracheal resection with anastomosis under tension were placed in cervical spine flexion postoperatively with either a chest-chin (Grillo) suture, an Aspen cervical collar or Trulife Johnson cervical-thoracic orthosis (CTO). A retrospective chart review of tracheal resections performed between 2005 and 2016 was completed to evaluate the positive and negative factors associated with each neck flexion technique. ResultsOf the 20 patients, there were 13 patients with the Grillo suture, 4 with the Aspen collar and 3 patients with the Johnson CTO. There were 13 tracheal resection procedures and 7 cricotracheal resections, all of which had anastomosis under tension. One major anastomosis dehiscence was noted with the Grillo suture technique which required reoperation. Two patients with the Grillo suture experienced skin breakdown at the suture site. The Aspen cervical collar, which fixed the cervical spine and prevented lateral and rotational motion, was limited in several cases in that it placed the spine in slight hyperextension. The Johnson CTO provided the most support in a flexed position and prevented cervical spine motion in all directions. No anastomosis complications were noted with the Aspen collar or the Johnson CTO, however, several patients sustained minor cutaneous wounds. ConclusionIn this series the Aspen cervical collar and Johnson CTO were used successfully as non-Grillo alternatives to postoperative neck stabilization in pediatric tracheal resections. Modifications to both devices are proposed to minimize cutaneous injuries and increase immobilization of the cervical spine in the desired flexed position. Although these devices appear to be safe and may be better tolerated, further innovation is needed to improve the design and fit of these devices.

Assessment of Head and Trunk Posture in Men with Cervicogenic Headache via Photogrammetry: A Pilot Study

Introduction: Cervicogenic headache (CGH) is a type of chronic and recurrent headache that originates from cervical musculoskeletal impairments. The muscular disorders observed in patients with CGH, relation between head and neck posture and cervical muscles dysfunction, and association between pelvic alignment and spinal curves highlight the importance of postural assessment in these patients. Therefore, the objective of this study was the assessment of spinal and pelvic posture in men with CGH via photogrammetry in static standing position by measuring different angles. Materials and Methods: In this case-control study, 10 men with CGH and 10 healthy men with matched age and body mass index (BMI) were recruited. A digital camera was used to take photographs from anterior, posterior, and lateral views (3 photographs from each viewpoint). The postural angles were measured using the AutoCAD software. Results: Among the measured postural angles, the mean of cervical inclination (C2-T2) (P = 0.022), head horizontal alignment (P = 0.001), scapula horizontal alignment (P 0.72]. Conclusion: It seems that the upper cervical position of men with CGH differs from that of healthy subjects and C2 is more forward relative to the cervicothoracic spine. Therefore, the cervical inclination angle could be a suitable indicator of C2 position through photogrammetry.

Cervical spine reposition errors after cervical flexion and extension

BackgroundUpright head and neck position has been frequently applied as baseline for diagnosis of neck problems. However, the variance of the position after cervical motions has never been demonstrated. Thus, it is unclear if the baseline position varies evenly across the cervical joints. The purpose was to assess reposition errors of upright cervical spine.MethodsCervical reposition errors were measured in twenty healthy subjects (6 females) using video-fluoroscopy. Two flexion movements were performed with a 20 s interval, the same was repeated for extension, with an interval of 5 min between flexion and extension movements. Cervical joint positions were assessed with anatomical landmarks and external markers in a Matlab program. Reposition errors were extracted in degrees (initial position minus reposition) as constant errors (CEs) and absolute errors (AEs).ResultsTwelve of twenty-eight CEs (7 joints times 4 repositions) exceeded the minimal detectable change (MDC), while all AEs exceeded the MDC. Averaged AEs across the cervical joints were larger after 5 min’ intervals compared to 20 s intervals (p < 0.05).ConclusionsThis is the first study to demonstrate single joint reposition errors of the cervical spine. The cervical spine returns to the upright positions with a 2° average absolute difference after cervical flexion and extension movements in healthy adults.

Value of vaginal cervical position in estimating uterine anatomy.

The anatomy of the uterus is defined with the angles of the vagina, cervix and uterine corpus. Hereunder there are angles of version and flexion. The cervical position observed during the vaginal speculum examination, may give information about the uterine anatomy. In this study, we investigated the place of the cervical position in the estimation of the uterine anatomy observed during the cervical examination. We enrolled 240 patients in our study, who applied to our routine gynecology outpatient clinic with various complaints. We divided these patients into two groups according to the cervical position (anterior cervical position and posterior cervical position) observed during the speculum examination. We recorded the uterine anatomy also with the transvaginal ultrasonography. During the speculum examination, we determined that 90% of the cases with posterior fornix position were anteverted and 10% retroverted; 64.2% of the cases with anterior fornix position were anteverted and 35.8% retroverted. According to these findings, cervical position observed during the speculum examination might be useful in the estimation of the uterine anatomy regarding the angles of the version. However, the ultrasonographic examination is essential for a definitive determination of the uterine anatomy. Clin. Anat. 30:404-408, 2017. © 2017 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

Association of age on cervical joint position error

This study quantitatively assesses the association between age and cervical joint position error (JPE) and compares JPE between young and older asymptomatic subjects. Subjects (n=230) ranging in age from 17 to 70years volunteered to participate in the study. Cervical JPE was measured for all subjects with the active movement angle reproduction test in degrees using a digital inclinometer; testing was done in all cervical movement directions (flexion, extension, side-bending right and left, rotation right and left). Subjects were divided into two groups: young (n=169, mean age: 32.4years; range 17–49years) and older (n=61, mean age: 61.9years; range 50–70years) and JPE was compared. Pearson’s product-moment correlation coefficients were significant and positive for the association of age on cervical JPE in flexion (r=0.71), extension (r=0.81), side-bending right (r=0.77), side-bending left (r=0.84), rotation right (r=0.84), and rotation left (r=0.84). JPE was significantly larger (for all movement directions) in the older subject group (P<0.001). Advancing age was significantly associated with the increasing cervical JPE and older subjects showed greater errors when compared to younger subjects.

Craniofacial and airway growth in 9–11 years old normal dental occlusion in Iranian adolescents: A longitudinal cephalometric study

Introduction: The present study was aimed to assess the amount and direction of growth in cranial base, jaws, and soft tissue of airway structures by cephalometric analysis in 9–11-years-old Iranian girls and boys. Materials and Methods: Thirty-four Iranian children with normal occlusion and class I molar relationships were recruited, and 2 lateral cephalograms were obtained from 9 and 11-year-old children Cephalometric variables included variables defining cranial base length and angle, maxillomandibular length and height, dental relationship, head and cervical position, soft palate and tongue, vallecula and hyoid position, and pharyngeal dimension. Normal distribution was confirmed by Kolmogorov–Smirnov analysis (P>0.05). Paired t-test was used for assessing growth changes. P value was set at 0.05. Results: Anterior, posterior, and total cranial base length were increased significantly. The increase in total and upper anterior, total and lower posterior facial heights, ramus height, and palatal inclination were statistically significant. Maxillomandibular length increased significantly with insignificant change in their position. Dental relationship and head and cervical posture were stable. Oropharyngeal and nasopharyngeal anteroposterior dimension did not change. However, hypopharynx sagittal length increased significantly. Nasopharyngeal vertical dimension increased and hyoid moved anteriorly and inferiorly. Conclusion: The results of the present study showed that cranial base and jaws grow anteriorly and inferiorly while maintaining dental occlusion and head posture. Most of the airway structures grow simultaneously with craniofacial components.

융복합적 기술이 적용된 성문위기구들의 삽관용이성 비교

융복합적 기술이 적용된 성문위기구들의 삽관용이성 비교

A novel classification of screw placement accuracy in the cervical spine.

Goal of this study is to present an easily reproducible and reliable measurement to evaluate accuracy of screw placement in cervical spine. Accuracy of cervical screw position was assessed in 52 patients treated with 163 screws. Each patient receiving pedicle, transarticular C1/2, lateral mass, or laminar screws and postoperative CT scan was included. Placement position was categorized in 5 grades: Grade 1 is ideal with pedicle wall perforation < 1 mm, grade 2 < 2 mm, grade 3 < 3 mm, and grade 4 < 4 mm. Grade 5 > 4 mm and/or obstruction of transverse foramen by more than half a screw diameter. Intraclass correlation coefficient (ICC) values were assessed for inter- and intraobserver reliability. The mode of individual evaluations was calculated to assign a single value to each screw. This yielded 89 grade 1 (54.6%), 48 grade 2 (29.4%), 14 grade 3 (8.6%), 3 grade 4 (1.8%), and 9 grade 5 (5.5%) screws. Intraobserver reliability ICC was 0.966 and 0.959 for measurements. Interobserver reliability ICC was 0.938. This study introduces a reliable classification of cervical spine instrumentation with various screw types. This should enable the use of a uniform and reproducible, and thus comparable classification for screw position in cervical spine.

349 Safety of the Sitting Cervical Position for Elective Spine Surgery

349 Safety of the Sitting Cervical Position for Elective Spine Surgery

Simplified Bishop score including parity predicts successful induction of labor

ObjectiveOur objectives were to confirm the predictiveness of parity for successful labor induction and propose an improvement in the Bishop's score to take parity into account and simultaneously simplify the original Bishop score. Study designRetrospective study of 326 deliveries induced by oxytocin and amniotomy before prostaglandins between January 1, 1987, and June 30, 1988. We conducted a univariate and then a multivariate analysis of the relation between successful labor induction – defined by vaginal delivery- and the components of Bishop's score and parity. ResultsNulliparous accounted for 38% of the studied population. The mean Bishop at induction was 5.75±1.4. Fetal station, cervical effacement, and parity were the only factors associated with the success of induction in this study. Removing the cervical position and consistency from the score as well as adding parity significantly improved the prediction of success (ROC curves, AUC 0.88 vs 0.68, p<0.001). By taking 5% as the maximum risk of induction failure, a cutoff point of 4 for the new score makes it possible to induce labor in 90% of the women that were considered in the study (vs 26% or 60%, according to whether the cutoff point of the original Bishop's score is set, respectively, at 7 or 6, p<0.001). ConclusionCervical position and consistency are not necessary for predicting successful labor induction by oxytocin and amniotomy. We confirmed the usefulness of a simplified Bishop score that considers parity.

Influences of the individual cervical hyperextension position on the hemodynamics of vertebral artery in patients with thyroidectomy

Objective To explore the influences of the individual cervical hyperextension position on the hemodynamics of vertebral artery in patients with thyroidectomy. Methods According to the random number table, 80 participants were divided into the intervention group (n=40) and the control group (n=40). The intervention group used individual cervical hyperextension position while the control group used conventional cervical hyperextension position. The hemodynamics changes of the bilateral vertebral artery for C4~5 and the incidence rates for the posture symptom of thyroid surgery were compared between the two groups. Results Both the blood flow rates and volumes of the bilateral vertebral artery were lower in the control group compared with those in the intervention group (P<0.05). The incidence rates for the posture symptom of thyroid surgery were significantly reduced in the intervention group (P<0.01). Conclusions The individual cervical hyperextension position can effectively improve the hemodynamics of vertebral artery and reduce the incidence for the posture symptom of thyroid surgery. Key words: Cervical hyperextension position; Thyroidectomy; Vertebral artery; Hemodynamics; Syndrome of postoperative nausea and vomiting

A Comparison of the Mallampati evaluation in neutral or extended cervical spine positions: a retrospective observational study of >80 000 patients

BackgroundThe Mallampati examination is a standard component of an airway risk assessment. Existing evidence suggests that cervical spine extension improves the predictive power of the Mallampati examination for detecting difficult laryngoscopy and tracheal intubation, but a comparative effectiveness study has not been conducted. MethodsThe extended Mallampati examination (EMS) was introduced to the standard preoperative airway assessment, in addition to the standard Modified Mallampati examination (MMP). This study compared the accuracy of both Mallampati examinations on the prediction of difficult laryngoscopy, tracheal intubation, and bag mask ventilation. Univariate and adjusted analyses were performed. Results80 801 patients with recorded MMP and EMS, and subsequent glottic view obtained during direct laryngoscopy, were examined. There was increased specificity (88.7% cf. 81.9%) but reduced sensitivity (33.3% cf. 45.7%) in the detection of difficult direct laryngoscopy with use of the EMS. The area under the receiver operating characteristic curve of each test performed in combination with other airway predictors for the models predicting difficult laryngoscopy was 0.740 (95% CI 0.731–0.753) for MMP and 0.739 (95% CI 0.729–0.752) for EMS. The area under the receiver operating characteristic curve of each test, performed in combination with other airway predictors for the models predicting difficult intubation was 0.699 (95% CI 0.688–0.711) for MMP and 0.695 (95% CI 0.683–0.707) for EMS. ConclusionsThis retrospective observational study demonstrates that cervical extension improves the specificity but decreases sensitivity of Mallampati examination. The Mallampati evaluation should be performed with the cervical spine in the neutral position to maximize test sensitivity.

EP-1821: Adaptive external radiation therapy of cervical cancerwith different uterine fundus positions

EP-1821: Adaptive external radiation therapy of cervical cancerwith different uterine fundus positions

Short term Efficacy of C0-C1 Mobilization in the Cervical Neutral Position in Upper Cervical Hypomobility: A Randomized Controlled Trial

The purpose of this study is to explore the effects of mobilization of C0-C1 and C7-T1 applied to asymptomatic individuals with reduced upper cervical rotation during the FRT. Design: parallel randomized controlled trial. 48 subjects(38.52 years±15.13) with C1-C2 rotation hypomobility in TFR joined the study and were randomized into three groups(C0, C7, control group). FRT in both directions was measured before and after the intervention. C0 intervention consisted of a dorsal translatoric mobilization of C0-C1 in the cervical neutral position. C7 intervention consisted of a ventral cranial translatoric mobilization of C7- T1 in neutral position and the control group maintained a supine position. C0 group experienced a FRT ROM to the restricted side increase of 17.64。(SD=4.55), that was significantly greater (P<0.001) than 5.95。 (SD=4.81) of the C7 group and 2.45。(SD=5.05) of the control group. The results showed that a dorsal translatoric mobilization of C0-C1 in neutral position restored the physiological FRT mobility in subjects with C1-C2 hypomobility and experienced statistical significant improvement in FRT as compared to a C7-T1 translatoric mobilization and a control group. (Level of evidence: 1b).

Cervical spine bending: a factor confounding whole trunk and lumbar forward bending range of motion.

Knee bending during tests of lumbar forward bending (FB) may introduce confounding variability. Precluding bending at the knees has, therefore, long been standard protocol to produce valid and reproducible results. However, there is limited research on cervical spine bending as a confounding variable in whole trunk and lumbar FB. To examine the role of cervical spine bending on the range of whole trunk and lumbar FB. Participants were recruited from the faculty, staff, and student population of Nova Southeastern University's Health Professions Division. Each participant underwent 4 FB tests with varying cervical starting positions. Range of motion was measured for whole trunk FB and lumbar FB by using the fingertip-to-floor and double digital inclinometer techniques, respectively. Two hundred thirty-six participants met the study criteria. Statistically significant differences were found in both whole trunk (6.96 cm) and lumbar (3.95°) FB range of motion when the cervical spine was backward bent after full spine FB (P<.05). Statistically significant differences were also found in both whole trunk (15.72 cm) and lumbar (7.38°) FB when the cervical spine was backward bent before thoracolumbar spine FB (P<.05). Cervical spine bending influences the ability of the trunk and lumbar spine to bend forward and is, therefore, a confounding variable during tests of whole trunk and lumbar spine FB.

Decreased neck muscle strength in patients with the loss of cervical lordosis

BackgroundThe loss of cervical lordosis is associated with some negative clinical outcomes. No previous study has examined cervical muscle strength, specifically in patients with the loss of cervical lordosis. This study aims to investigate whether there is weakness of the cervical muscles or an imbalance between cervical flexor and extensor muscle strength in patients with the loss of cervical lordosis compared with healthy controls matched by age, gender, body mass index (BMI), and employment status. MethodsThirty-two patients with the loss of cervical lordosis (23 F, 9 M) and 31 healthy volunteers (23 F, 8 M) were included in the study. Maximal isometric neck extension and flexion strength, and the strength ratio between extension and flexion were used as evaluation parameters. All measurements were conducted by a blinded assessor using a digital force gauge. The participants were positioned on a chair in a neutral cervical position and without the trunk inclined during measurements. FindingsMaximal isometric neck extension and flexion strength values were significantly lower in the patients versus healthy controls (P<0.001 and P=0.040, respectively). The mean (SD) values of the extension/flexion ratio were 1.21 (0.34) in the patients and 1.46±0.33 in the controls (P=0.004). InterpretationAccording to our results, patients with the loss of cervical lordosis have reduced neck muscle strength, especially in the extensors. These findings may be beneficial for optimizing cervical exercise prescriptions.

A prospective study into the benefits of simulation training in teaching obstetric vaginal examination

To assess the benefits of incorporating simulations in obstetric vaginal-examination training. A single-center, randomized, prospective study was conducted in a French University Hospital. Medical students without obstetric experience were assigned, by simple random sampling, to perform either 10 or 30 vaginal-examination training procedures using a simulator. A control group of students that had not performed any simulator training procedures was also enrolled. Medical students performed six vaginal examinations on patients who were in labor. The students reported the findings of the examinations in terms of five items (cervical length, position, consistency, dilation, and fetal presentation). The students' findings were then compared with those of experienced midwives (whose answers were considered to be the gold standard) who examined the same patients. A total of 66 students were included in the analyses. Students who had performed 10 simulated procedures demonstrated significantly greater accuracy in vaginal examination assessments in comparison with the control group (P<0.001). No significant difference was observed between the results for students that had performed 10 or 30 simulated procedures (P=0.44). Simulation training assisted novice students in improving their vaginal-examination skills before performing such procedures on real patients. Vaginal-examination simulations should be included in the training curriculum for students who will examine pregnant patients.

The effect of cervical stabilization exercise on active joint position sense: A randomized controlled trial.

We attempted to investigate the effect of cervical stabilization exercise for a period of 5 weeks on active joint position sense in healthy young adults. Twenty-four subjects were randomly assigned to either the exercise group or the control group. The exercise group performed cervical stabilization exercise during the 5-week period. Cervical active joint position sense was measured using the head repositioning accuracy test. The result showed a positive interaction between time and group in the left and right rotation, flexion, and extension. Cervical stabilization exercise significantly improved the sense for four position senses in the exercise group (p< 0.05). However, there was no difference in the four position senses in the control group (p> 0.05). In conclusion, we suggested that cervical stabilization exercise leads to improvement in accuracy of the joint position sense.

Relationship between position sense and reposition errors according to the degree of upper crossed syndrome.

[Purpose] The purpose of this study was to compare reposition errors in subjects with upper crossed syndrome to examine the effects of upper crossed syndrome on position senses. [Subjects and Methods] A sample population of 60 subjects was randomly divided into three groups of 20: a normal group, a mild group, a moderate group. A cervical range of motion device was attached to the head of each subject using straps and the reposition errors of cervical flexion, extension, right lateral flexion, left lateral flexion, right rotation and left rotation were measured. [Results] The normal group showed smaller reposition errors than the mild group and the mild group showed smaller reposition errors than the moderate group but none of the differences among the three groups was significant. [Conclusion] Reposition errors increased in the order of the normal, mild, moderate group but the differences were not significant. In addition, the degree of the subjects’ postural misalignment was higher in the moderate than in the mild group. These results demonstrate that cervical spine position sense declines as postural misalignment becomes more severe.

Effect of labiolingual inclination of a maxillary central incisor and surrounding alveolar bone loss on periodontal stress: A finite element analysis.

ObjectiveThe aim of this study was to investigate whether labial tooth inclination and alveolar bone loss affect the moment per unit of force (Mt/F) in controlled tipping and consequent stresses on the periodontal ligament (PDL).MethodsThree-dimensional models (n = 20) of maxillary central incisors were created with different labial inclinations (5°, 10°, 15°, and 20°) and different amounts of alveolar bone loss (0, 2, 4, and 6 mm). The Mt/F necessary for controlled tipping (Mt/Fcont) and the principal stresses on the PDL were calculated for each model separately in a finite element analysis.ResultsAs labial inclination increased, Mt/Fcont and the length of the moment arm decreased. In contrast, increased alveolar bone loss caused increases in Mt/Fcont and the length of the moment arm. When Mt/F was near Mt/Fcont, increases in Mt/F caused compressive stresses to move from a predominantly labial apical region to a palatal apical position, and tensile stresses in the labial area moved from a cervical position to a mid-root position. Although controlled tipping was applied to the incisors, increases in alveolar bone loss and labial tooth inclination caused increases in maximum compressive and tensile stresses at the root apices.ConclusionsIncreases in alveolar bone loss and labial tooth inclination caused increases in stresses that might cause root resorption at the root apex, despite the application of controlled tipping to the incisors.