Cervical Spine In Patients Research Articles

Radiofrequency neurotomy in patients with cervical pain syndrome

Introduction. Chronic pain in the neck, shoulders and upper limbs is often at degenerative changes of cervical spine joints.The purpose. Study efficacy of radiofrequency neurotomy of medial branch of spinal nerve dorsal root of cervical spine in patients with pain in the neck, shoulders and upper limbs, factors that could affect the outcome were analyzed.Materials and methods. Demographic data, types of pain location, the response to double control block, electrical stimulation parameters, the number and level of neurotomy, results of surgical treatment were studied during 12 months after surgery. Electrical stimulation intensity was from 0.3 to 0.69 V, an average — 0.45 V (to origin of pain specific for the patient).Results. In 19 (68%) among 28 patients satisfactory results were achieved, in 8 (42%) — pain disappeared completely. In 4 patients pain recrudesced in 6–12 months.Conclusions. Neurotomy of spinal nerve medial branch is an effective method for treatment of pain in the neck, shoulders and upper limbs in patients with degenerative changes in cervical spine joints.

Is magnetic resonance imaging in addition to a computed tomographic scan necessary to identify clinically significant cervical spine injuries in obtunded blunt trauma patients?

BackgroundGuidelines are in place directing the clearance of the cervical spine in patients who are awake, alert, and oriented, but a gold standard has not been recognized for patients who are obtunded. Our study is designed to determine if magnetic resonance imaging (MRI) detects clinically significant injuries not seen on computed tomographic (CT) scans. MethodsThe trauma registry was used to identify and retrospectively review medical records of blunt trauma patients from January 1, 2005, to March 30, 2012. Only obtunded patients with a CT scan and MRI of the cervical spine were included. ResultsThe study cohort consisted of 277 patients. In 13 (5%) patients, MRI detected clinically significant cervical spine injuries that were missed by CT scans, and in 7 (3%) these injuries required intervention. The number needed to screen with MRI to prevent 1 missed injury was 21. ConclusionsThe findings suggest that the routine use of MRI in clearing the cervical spine in the obtunded blunt trauma patient.

Sticking our neck out: is magnetic resonance imaging needed to clear an obtunded patient's cervical spine?

BackgroundEvaluating the cervical spine in the obtunded trauma patient is a subject fraught with controversy. Some authors assert that a negative computed tomography (CT) scan is sufficient. Others argue that CT alone misses occult unstable injuries, and magnetic resonance imaging (MRI) will alter treatment. This study examines the data in an urban, county trauma center to determine if a negative cervical spine CT scan is sufficient to clear the obtunded trauma patient. MethodsRecords of all consecutive patients admitted to a level 1 trauma center from January 2000 to December 2011 were retrospectively analyzed. Patients directly admitted to the intensive care unit with a Glasgow Coma Scale score ≤13, contemporaneous CT and MRI, and a negative CT reading were included. The results of the cervical spine MRI were analyzed. ResultsA total of 309 patients had both CT and MRI, 107 (35%) of whom had negative CTs. Mean time between CT and MRI was 16 d. Of those patients, seven (7%) had positive acute traumatic findings on MRI. Findings included ligamentous injury, subluxation, and fracture. However, only two of these patients required surgical intervention. None had unstable injuries. ConclusionsIn the obtunded trauma patient with a negative cervical spine CT, obtaining an MRI does not appear to significantly alter management, and no unstable injuries were missed on CT scan. This should be taken into consideration given the current efforts at cost-containment in the health care system. It is one of the larger studies published to date.

Cervical spine clearance in the traumatically injured patient: is multidetector CT scanning sufficient alone?

Clearance of the cervical spine in patients who have sustained trauma remains a contentious issue. Clinical examination alone is sufficient in neurologically intact patients without neck pain. Patients with neck pain or those with altered mental status or a depressed level of consciousness require further radiographic evaluation. However, no consensus exists as to the appropriate imaging modality. Some advocate multidetector CT (MDCT) scanning alone, but this has been criticized because MDCT is not sensitive in detecting ligamentous injuries that can often only be identified on MRI. Patients were identified retrospectively from a prospectively maintained database at a Level I trauma center. All patients admitted between January 2004 and June 2011 who had a cervical MDCT scan interpreted by a board-certified radiologist as being without evidence of acute traumatic injury and who also had a cervical MRI study obtained during the same hospital admission were included. Data collected included patient demographics, mechanism of injury, Glasgow Coma Scale score at the time of MRI, the indication for and findings on MRI, and the number, type, and indication for cervical spine procedures. A total of 1004 patients were reviewed, of whom 614 were male, with an overall mean age of 47 years. The indication for MRI was neck pain in 662 patients, altered mental status in 467, and neurological signs or symptoms in 157. The MRI studies were interpreted as normal in 645 patients, evidencing ligamentous injury alone in 125, and showing nonspecific degenerative changes in the remaining patients. Of the 125 patients with ligamentous injuries, 66 (52.8%) had documentation of clearance (29 clinical, 37 with flexion-extension radiographs). Another 32 patients were presumed to be self-cleared, bringing the follow-up rate to 82% (98 of 119). Five patients died prior to clearance, and 1 patient was transferred to another facility prior to clearance. Based on these data, the 95% confidence interval for the assertion that clinically irrelevant ligamentous injury in the face of normal MDCT is 97%-100%. No patient with ligamentous injury on MRI was documented to require a surgical procedure or halo orthosis for instability. Thirty-nine patients ultimately underwent cervical surgical procedures (29 anterior and 10 posterior; 5 delayed) for central cord syndrome (21), quadriparesis (9), or discogenic radicular pain (9). None had an unstable spine. In this study population, MRI did not add any additional information beyond MDCT in identifying unstable cervical spine injuries. Magnetic resonance imaging frequently detected ligamentous injuries, none of which were found to be unstable at the time of detection, during the course of admission, or on follow-up. Magnetic resonance imaging provided beneficial clinical information and guided surgical procedures in patients with neurological deficits or radicular pain. An MDCT study with sagittal and coronal reconstructions negative for acute injury in patients without an abnormal motor examination may be sufficient alone for clearance.

Alterações radiográficas de coluna cervical em artrite reumatoide

IntroductionThe involvement of the cervical spine is a common feature of rheumatoid arthritis (RA). ObjectiveTo study the prevalence of radiographic changes of the cervical spine in patients with RA and their association with clinical and serological profiles of the disease. MethodsWe analysed lateral (neutral position, hyperextension, hyperflexion) and transoral views of cervical spine radiographs from 80 individuals with RA to investigate the presence of atlanto-axial subluxation (AAS), basilar invagination (BI), and subaxial instability (SAI). Demographic, clinical (nodules, interstitial pneumonitis, secondary Sjögren's syndrome, medications etc.), and serologic (rheumatoid factor - RF, cyclic citrullinated peptide antibody – anti-CCP, and antinuclear factor - ANF) data were obtained from the clinical records. ResultsCervical spine misalignments were identified in 26/80 (32.5%) participants; AAS occurred in 12/80 (15%) participants, BI in 6/80 (7.5%), and SAI in 13/80 (32.5%). Odontoid erosions were identified in 16/80 (20.0%) participants. Cervical spine misalignment exhibited associations with age at onset and disease duration (P=0.03 and 0.02, respectively). No associations were identified between the cervical spine changes and the participants’ ethnicity or gender, presence of nodules, interstitial pneumonitis, secondary Sjögren's syndrome, RF, ANF, or anti-CCP. The participants with cervical spine misalignment exhibited higher frequencies of odontoid erosion (P=0.03). ConclusionsCervical spine misalignment was a common radiographic finding and occurred more frequently in participants with earlier onset and longer length of RA.

Radiographic changes of the cervical spine in rheumatoid arthritis

IntroductionThe involvement of the cervical spine is a common feature of rheumatoid arthritis (RA). ObjectiveTo study the prevalence of radiographic changes of the cervical spine in patients with RA and their association with clinical and serological profiles of the disease. MethodsWe analysed lateral (neutral position, hyperextension, hyperflexion) and transoral views of cervical spine radiographs from 80 individuals with RA to investigate the presence of atlanto-axial subluxation (AAS), basilar invagination (BI), and subaxial instability (SAI). Demographic, clinical (nodules, interstitial pneumonitis, secondary Sjögren's syndrome, medications etc.), and serologic (rheumatoid factor - RF, cyclic citrullinated peptide antibody – anti-CCP, and antinuclear factor - ANF) data were obtained from the clinical records. ResultsCervical spine misalignments were identified in 26/80 (32.5%) participants; AAS occurred in 12/80 (15%) participants, BI in 6/80 (7.5%), and SAI in 13/80 (32.5%). Odontoid erosions were identified in 16/80 (20.0%) participants. Cervical spine misalignment exhibited associations with age at onset and disease duration (P=0.03 and 0.02, respectively). No associations were identified between the cervical spine changes and the participants’ ethnicity or gender, presence of nodules, interstitial pneumonitis, secondary Sjögren's syndrome, RF, ANF, or anti-CCP. The participants with cervical spine misalignment exhibited higher frequencies of odontoid erosion (P=0.03). ConclusionCervical spine misalignment was a common radiographic finding and occurred more frequently in participants with earlier onset and longer length of RA.

AB0414 Predisposing factors in the development of lesions of the cervical spine in patients with rheumatoid arthritis

BackgroundInvolment of the cervical spine in patients with RA is particulary important for the injury of the neurogical structures.ObjectivesThe main aim of the present study was to determine the predisposing...

Is cervical lordosis relevant in laminoplasty?

Background contextLaminoplasty aims to decompress the spinal cord and stabilize the cervical spine in patients with multilevel cervical lesions. Not every patient with cervical compressive myelopathy is a good candidate for laminoplasty. Most studies recommend that neutral or kyphotic alignments are contraindications for laminoplasty. However, cervical sagittal alignment does not have a strong and consistent effect on the clinical outcomes of laminoplasty. Moreover, many reports on the effect of cervical sagittal alignment did not designate the ideal definition of alignment and used different definitions of lordosis. PurposeTo identify the effect of preoperative cervical alignment according to two different definitions after midline splitting double-door laminoplasty. Study designRetrospective cohort study. Patient sampleFrom August 2008 to September 2010, 58 patients were diagnosed with cervical myelopathy and treated with midline splitting double-door laminoplasty. Outcome measuresThe clinical results were assessed with the modified Japanese Orthopedic Association (JOA) score, neck disability index (NDI), and visual analog scale (VAS) and were compared to analyze the rate of change between preoperative and postoperative values. Postoperative radiological results at the final follow-up examinations were compared between groups to obtain the change in range of motion and sagittal alignment. MethodThe effect of cervical alignment on JOA, NDI, and VAS scales and also on change of alignment and change of range of motion (ROM) at the final follow-up examinations was analyzed statistically between two groups according to two different definitions such as Toyama classification and Cobb angle. ResultsNo difference was found between the two groups according to Toyama classification in terms of the postoperative improvement rate of the modified JOA score (p=.086), decreasing rate of the VAS (p=.940) or NDI (p=.211), postoperatively. Additionally, no difference was found for the decreasing rate of ROM (p=.427) or sagittal alignment (p=.864) based on the radiological evaluation results. Also, there was no difference between two groups according to Cobb angle in terms of the modified JOA score (p=.743), VAS (p=.548), or NDI (p=.32), postoperatively. Additionally, no difference was found for the ROM (p=1.000) or sagittal alignment (p=.440) based on the radiological evaluation results. ConclusionsDespite nonlordosis cervical sagittal alignment, double-door laminoplasty would be effective for patients with cervical myelopathy because of cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament. Furthermore, sagittal alignment is not the absolute and sole factor that surgeons should consider when determining the optimal treatment strategy.

Predicting the risk and severity of acute spinal cord injury after a minor trauma to the cervical spine

Background contextAcute spinal cord injury (SCI) after a minor trauma to the cervical spine has been reported in patients without preceding neurologic symptoms. Spinal canal stenosis may be the reason for the discrepancy between the severity of the injury and that of the trauma. The spinal canal to vertebral body ratio is often used to assess canal stenosis on conventional radiographs. However, the ratio does not appraise soft-tissue stenosis and canal narrowing at the level of the intervertebral disc. Parameters measured on magnetic resonance (MR) images may thus be more meaningful. The relevance of MR image parameters for predicting the risk and severity of acute SCI in patients after a minor trauma to the cervical spine has not yet been established. PurposeTo investigate MR image parameters of the cervical spine in patients suffering from acute SCI after a minor trauma to the cervical spine. To investigate the use of these parameters for predicting the risk and severity of acute cervical SCI after a minor trauma to the cervical spine. Study design/settingRetrospective radiological study of consecutive patients. Patient sampleFifty-two patients suffering from acute cervical SCI and 131 patients showing no neurologic deficits after a minor trauma to the cervical spine. Outcome measuresOn sagittal MR images: vertebral body diameter, midvertebral canal diameter, disc-level canal diameter, and spinal cord diameter. On lateral conventional radiographs: vertebral body diameter and midvertebral canal diameter. MethodsConventional lateral radiographs and sagittal T2-weighted MR images of the cervical spine (C3–C7) were analyzed. The following calculations were performed using measurements from MR images: the spinal canal to vertebral body ratio, the space available for the cord, and the canal-to-cord ratio. Using measurements from conventional radiographs, the spinal canal to vertebral body ratio was determined. Receiver-operating curves were calculated for evaluating the classification accuracy of the different parameters for predicting the risk, severity, and course of SCI. ResultsAll investigated MR image parameters in the SCI group were significantly (p<.001) smaller compared with the control group. However, there was no significant (p>.9) difference in any parameter among the different American Spinal Injury Association impairment score groups. A cutoff value of 8.0 mm for the minimal sagittal disc-level canal diameter yielded the largest positive predictive value and likelihood ratio for predicting SCI. ConclusionsPatients at risk of acute SCI after a minor trauma to the cervical spine can be identified by applying a disc-level canal diameter cutoff value (measured on MR images) of 8 mm. Additional factors to the radiological characteristics of the spinal canal affect the severity of acute SCI after a minor trauma to the cervical spine.

Relationship Between the Alignment of the Occipitoaxial and Subaxial Cervical Spine in Patients With Congenital Atlantoxial Dislocations

Prospective radiographic analysis. This study aimed to characterize the relationship between the alignment of the occipitoaxial (OA) and the subaxial spine, establish normal parameters, and to determine the influence of upper cervical spine alignment on subaxial degenerative disc disease (DDD) and clinical outcomes in this population. Previous studies reported that the alignments of the upper and lower cervical spine are closely interrelated in patients with atlantoaxial dislocations of a rheumatoid etiology. None have focused on congenital etiologies or included patients with OA kyphosis. The influence of the upper cervical alignment on subaxial (DDD) and outcomes is also unclear. Fifty-eight patients with congenital AAD undergoing surgical reduction and fusion were included. C0-C2 and C2-C7 angles were measured and DDD was assessed using plain radiographs. The relationship between the alignment of the OA joint and the subaxial cervical spine was evaluated, as well as the relationships between the cervical alignment, outcomes, and cervical DDD. C0-2 improved from a mean of 1.59±17.3 degrees preoperatively to a mean of 15±9.8 degrees postoperatively (P<0.001). C2-7 changed from a mean of 25.55±19.6 degrees to a mean of 14.2±14.4 degrees postoperatively (P<0.001). The OA and subaxial alignment were negatively correlated in this population both before (r=-0.84; P<0.001) and after (r=-0.64; P<0.001) surgical treatment. There was an increased incidence of DDD postoperatively (P<0.01), which was positively correlated with the postoperative C0-2 angle (r=0.54; P<0.001), but negatively correlated with the postoperative C2-7 angle (r=-0.79; P<0.001). Changes in OA alignment before and after surgery are associated with changes in the subaxial spine. There is a high incidence of postoperative DDD in the subaxial spine that seems to be related to sagittal alignment after surgery.

Videolaryngoscopy with Glidescope Reduces Cervical Spine Movement in Patients with Unsecured Cervical Spine

BackgroundUnconscious patients with severe trauma often require urgent endotracheal intubation. In trauma victims with possible cervical spine injury, any movement of the head and neck should be avoided. Study ObjectivesWe investigated the effect of GlideScope videolaryngoscopy on cervical spine movement compared with conventional laryngoscopy in anesthetized patients with unsecured cervical spines. MethodsSixty patients scheduled for elective surgery with general anesthesia and without anticipated airway problems were enrolled in the study after ethics committee approval and written informed consent. Intubation was performed with videolaryngoscopy (GlideScope®, Verathon Inc., Bothell, WA) or conventional laryngoscopy (MacIntosh). Using video motion analysis with a lateral view, the maximum extension angle α was measured with reference to anatomical points (baseline and line drawn from processus mastoideus to os frontale [glabella]). Values were analyzed using Mann Whitney U-tests. ResultsThe deviation of α was a median 11.8° in the videolaryngoscope group and 14.3° in the conventional group (p = 0.045), with a maximum of 19.2° (videolaryngoscopy) vs. 29.3° (conventional). Intubation by physicians with some experience in videolaryngoscopy was associated with a reduced angle deviation (α = 10.3°) compared to inexperienced physicians (12.8°, p = 0.019). Intubation time was a median 24 s (min/max 12/75 s) in the MacIntosh group and 53 s (min/max 28/210 s) in the GlideScope group. In 3 patients randomized to the conventional group in whom conventional intubation failed, intubation could be successfully performed using videolaryngoscopy. ConclusionGlideScope videolaryngoscopy reduces movements of the cervical spine in patients with unsecured cervical spines and therefore might reduce the risk of secondary damage during emergency intubation of patients with cervical spine trauma.

The Torg-Pavlov ratio for the prediction of acute spinal cord injury after a minor trauma to the cervical spine

Background contextAcute cervical spinal cord injury (SCI) has been observed in some patients after a minor trauma to the cervical spine. The discrepancy between the severity of the trauma and the clinical symptoms has been attributed to spinal canal stenosis. However, to date, there is no universally established radiological parameter for identifying critical spinal stenosis in these patients. The spinal canal–to–vertebral body ratio (Torg-Pavlov ratio) has been proposed for assessing developmental spinal canal stenosis. The relevance of the Torg-Pavlov ratio for predicting the occurrence and severity of acute cervical SCI after a minor trauma to the cervical spine has not yet been established. PurposeTo investigate the Torg-Pavlov ratio values of the cervical spine in patients suffering from acute cervical SCI after a minor trauma to the cervical spine and the use of the Torg-Pavlov ratio for identifying patients at risk of cervical SCI and predicting the severity and course of symptoms. Study design/settingRetrospective radiological study of consecutive patients. Patient sampleForty-five patients suffering from acute cervical SCI and 68 patients showing no neurologic symptoms after a minor trauma to the cervical spine. Outcome measuresMidvertebral sagittal cervical spinal canal diameter and the sagittal vertebral body diameter. Calculation of the Torg-Pavlov ratio values. MethodsConventional lateral radiographs of the cervical spine (C3–C7) were analyzed to determine the Torg-Pavlov ratio values. Receiver operating characteristic curves were calculated for evaluating the classification accuracy of the Torg-Pavlov ratio for predicting SCI. ResultsThe Torg-Pavlov ratio values in the SCI group were significantly (p<.04) smaller compared with that in the control group. A Torg-Pavlov ratio cutoff value of 0.7 yielded the greatest positive likelihood ratio for predicting the occurrence of SCI. However, there were no significant differences in the Torg-Pavlov ratio values between the different American Spinal Injury Association Impairment Score groups and between patients with complete, partial, and no recovery of symptoms. ConclusionsDevelopmental cervical spinal canal stenosis assessed by the Torg-Pavlov ratio was characteristic for patients suffering from acute cervical SCI after a minor trauma to the cervical spine. Patients at risk of SCI after a minor trauma to the cervical spine can be identified by applying a Torg-Pavlov ratio cutoff value of 0.7. Other factors in addition to the spinal canal–to–vertebral body ratio affect the severity and course of symptoms as a result of cervical SCI.

Spondyloptosis of the Cervical Spine in a Patient with Neurofibromatosis Type 1: A Case Report and Review of the Literature.

Kyphotic deformities of the cervical spine in patients with neurofibromatosis type 1 (NF-1) have received little attention because of their low incidence and the presence of coexisting thoracic or thoracolumbar spine deformities1-3. To the best of our knowledge, there are few cases (Table I) of severe cervical kyphosis (>90°) in a patient with NF-1 that have been reported in the literature4-7. We present the case of an adolescent who was referred to our NF-1 clinic for a progressive cervical kyphosis (130°) with no neurologic deficits. There was radiographic evidence of a C2-C3 intramedullary spinal cord tumor (IMSCT) with extensive cervical plexiform neurofibromas with intraspinal encroachment. The patient and his parents were informed that data regarding this case would be submitted for publication, and they provided consent. View this table: TABLE I Cases in the Literature of Severe Cervical Kyphosis (>90°) in Patients with Neurofibromatosis Type 1 An eleven-year-old boy with NF-1 was referred to our institution with a history of severe cervical kyphosis. Progressively worsening neck pain was present, although there were no symptoms of weakness, numbness or tingling sensation, or bladder and bowel incontinence. Physical examination revealed multiple cafe-au-lait spots, plexiform neurofibromas in the region of the cervical spine, axillary and inguinal freckles, and substantial cervical kyphosis with no neurological deficit. Radiographs of the cervical spine revealed a kyphosis of 87° (Figs. 1-A and 1-B). Magnetic resonance imaging (MRI) revealed an IMSCT at C2-C3 and large paraspinal plexiform neurofibromas involving the right-sided nerve roots of the cervical spine that extended to T2 with an intraspinal extension from C3-C6, dural ectasia, and focal kyphosis (Figs. 2-A and 2-B). Based on the clinical examination and imaging studies, we recommended intervention. However, the patient was not able to return for the treatment for one year. Fig. 1 Anteroposterior ( Fig. 1-A ) and …

The effect of systematic nursing on the rehabilitation and complications in patient cervical spine fracture

Objective To explore the effect of systematic nursing on the rehabilitation and complications in patient cervical spine fracture.Methods A total of 80 patients with cervical spine fracture were divided into the observation group and the control group with 40 cases in each.The control group was given routine nursing,the observation group was treated with systemic nursing.Two groups were compared with rehabilitation efficacy and complications.Results The scores of sense,movement and activity of daily living in the observation group were higher than those in the control group (P ＜ 0.05).The occurrence rates of bedsore,infection,thrombosis and other complications in the observation group were significantly lower than those in the control group (P ＜ 0.05).Conclusions Systematic nursing is helpful to reduce the occurrence of complications in patients with cervical spine fracture,promoting the rehabilitation of patients,improve the quality of life of patients. Key words: Systematic nursing; Cervical spine fracture; Rehabilitation effect; Complications

Computed Tomography Evaluation of the Brain and Upper Cervical Spine in Patients With Traumatic Cardiac Arrest Who Achieved Return of Spontaneous Circulation

The outcomes of patients with traumatic cardiac arrest (TCA) have been dismal. However, imaging modalities are improving rapidly and are expected to play a role in treatment of patients with TCA. In this retrospective study, whether obtaining computed tomography (CT) immediately after resuscitation had any clinical value was evaluated. Among 145 patients with TCA admitted to our institution during 4 years, hemodynamically stable return of spontaneous circulation (ROSC) was achieved in 38 (26%). Brain and cervical spine CT was obtained prospectively, and the frequency and type of traumatic brain injury (TBI)/upper cervical spine injury (UCSI) were investigated. CT was performed uneventfully in all patients with an average door-to-CT time of 51.5 ± 18.6 min. Twenty (53%) had CT evidence of TBI. However, no patients underwent brain surgery because of lack of return of brainstem functions. Among the 18 patients without TBI, CT signs of hypoxia were present in 15 patients (39%), and CT was considered intact in 3 patients (8%). None of the 35 patients with abnormal CT findings survived, and the presence of such findings predicted fatality with high sensitivity and specificity. While 13 of the 38 patients (34%) had CT evidence of UCSI, concomitant TBI and USCI were uncommon. None of the 13 patients with UCSI underwent spine surgery because of lack of return of brainstem functions, and the presence of USCI might also be associated with fatality. Although obtaining CT was useful in the prognostication of TCA patients with ROSC, it did not have much impact in therapeutic decision making.

Modic changes of the cervical spine in patients with whiplash injury: A prospective 11-year follow-up study

IntroductionThere are few studies on Modic changes of the cervical spine in patients suffering from whiplash. This study compared Modic changes seen in whiplash patients 10 years after the injury with those observed in asymptomatic volunteers. MethodsThis is a follow-up study of 133 patients who suffered whiplash injuries in 1994–1996 and underwent MRI with a superconductive imager (63 men, 70 women, mean age 49.6±15.3 years, mean follow-up 11.4 years). In addition, 223 healthy volunteers who underwent MRI during the same period were included as controls (123 men, 100 women, mean age 50.5±15.0 years, mean follow-up 11.6 years). All participants underwent follow-up MRI. We examined all participants for Modic changes, and investigated relationships between Modic changes and clinical symptoms or potentially related factors. ResultsModic changes were observed in 4 patients (3%) and at 7 intervertebral levels in the initial study, and in 17 patients (12.8%) and at 30 intervertebral levels at the follow-up. Modic Type 2 changes were the most prevalent in the whiplash patients in both the initial and follow-up studies. There was no significant difference in the percentage of whiplash patients versus control subjects with positive Modic changes, either at the initial study or at follow-up. Modic changes were not related to clinical symptoms present at follow-up, but were associated with preexisting disc degeneration. There was no association between Modic changes and the details of the car accident that caused the injury. ConclusionsWhile Modic changes became more common in whiplash patients in the 10-year period after the accident, they occurred with a similar frequency in control subjects. We did not find any association between Modic changes and the nature of the car accident in which the whiplash occurred. Modic changes found in whiplash patients may be a result of the physiological ageing process rather than pathological findings relating to the whiplash injury.

Strain–counterstrain to treat restrictions of the mobility of the cervical spine in patients with neck pain—A sham-controlled randomized trial

Strain-counterstrain is an osteopathic technique which is widely used for treating mobility restrictions in the neck. We aimed to investigate whether a single strain-counterstrain intervention is more effective than a sham intervention in improving restricted cervical range of motion in patients with neck pain. 61 adult patients with neck pain and restricted cervical mobility were randomly allocated to receive either a single strain-counterstrain intervention or a sham treatment. After outcome measurement all patients received full individualized osteopathic treatment. Mobility of the cervical spine was measured by a blinded observer using the Cervical Range of Motion (CROM) tool. In addition, patients rated pain intensity and assessed the treatment effect. The main outcome measure was the sum of changes in mobility restriction (in %) after treatment compared to normal mobility. All patients completed the study. Mobility restriction decreased by 2.0% (SD 6.9%) in the group receiving strain-counterstrain treatment and 0.6% (SD 5.7%) in the group receiving sham treatment (mean difference 1.5%, 95% confidence interval -1.7 to 4.8%; p=0.35). There were no significant differences between groups for secondary outcomes. After receiving the full osteopathic treatment the group initially receiving strain-counterstrain improved by another 4.2% (7.0%; p=0.003) and the group initially receiving sham by another 5.6% (SD 6.8%; p<0.001). Strain-counterstrain as a single intervention did not have immediate effects on mobility and pain over a sham treatment. Future studies should probably focus on the investigation of full osteopathic treatment.

Incidence and Aggravation of Cervical Spine Instabilities in Rheumatoid Arthritis

A prospective minimum 5-year follow-up study of the cervical spine in patients with rheumatoid arthritis (RA) initially without cervical involvement. To clarify the incidence and aggravation of cervical spine instabilities and their predictive risk factors in patients with RA. Many reports have shown the progression of cervical spine involvement in RA. However, few articles have described comprehensive evaluation of its prognostic factors. A total of 140 patients with "definite" or "classical" RA initially without cervical involvement were prospectively followed for more than 5 years. Radiographical cervical findings were classified into 3 instabilities: atlantoaxial subluxation (AAS: atlantodental interval >3 mm), vertical subluxation (VS: Ranawat value <13 mm), and subaxial subluxation (SAS: irreducible translation ≥ 2 mm). "Severe" extents were defined as AAS with atlantodental interval 10 mm or more, VS with Ranawat value 10 mm or less, and SAS with translation 4 mm or more or at multiple levels. Incidence of these developments and predictors for "severe" instabilities were investigated. During 6.0 ± 0.5 years, 43.6% of 140 patients developed cervical instabilities: AAS in 32.1%, VS in 11.4%, and SAS in 16.4% with some combinations. "Severe" instabilities were exhibited in 12.9% of patients: AAS in 3.6%, VS in 6.4%, and SAS in 5.0%. Furthermore, 4.3% presented canal stenosis, with 13 mm or less space available for the spinal cord (SAC) due to "severe" AAS or "severe" VS in 2.9% and 12 mm or less SAC due to "severe" SAS in 2.1%. Multivariable logistic regression analysis identified corticosteroid administration, mutilating changes at baseline, and the development of nonmutilating into mutilating changes during the follow-up period correlated with "severe" instabilities (P < 0.05). A minimum 5-year follow-up reveals the occurrence of cervical instabilities in 43.6%, "severe" aggravation in 12.9%, and decreased SAC in 4.3% of patients with RA. Characteristics of severe disease activity-established mutilating changes, progressive development into mutilating changes, and potentially concomitant corticosteroid treatment-are indicators for poor prognosis of the cervical spine in RA.

Quantitative analysis of movement of a cervical target during stereotactic radiosurgery using the Leksell Gamma Knife Perfexion

The design of the Leksell Gamma Knife Perfexion facilitates stereotactic radiosurgery (SRS) on cervical spine targets provided that the target itself is located superior to the standard G stereotactic head frame base ring and does not move. This study was designed to measure potential deviations of targets in the upper cervical spine while using the currently available Leksell Coordinate Frame G. A commercially available skull-and-cervical spine model was adapted for SRS using the Leksell Gamma Knife Perfexion. The Leksell Coordinate Frame G was attached to the model, and both CT and fluoroscopic imaging were performed to determine the potential for target deviation at standard Gamma Knife treatment angles of 70°, 90°, and 110°. In addition, target deviations observed at various heights of the patient positioning table were analyzed using a pair of orthogonal fluoroscopic images obtained at a standard 90° gamma angle and compared with target position as it relates to a reference bed height of 4.5 cm. An examination of multiple radiopaque targets embedded in or affixed to the model showed target deviations ranging from as low as 3.53 mm at the medial occiput-C1 junction to 15.56 mm at the C3-4 level during 70° extension. Target deviations at 110° flexion relative to targets on a 90° CT scan included deviations ranging from 0.58 mm at the medial occiput-C1 junction to 13.32 mm at the medial C3-4 level. Relative to targets observed at the Perfexion table height of 4.5 cm, target deviation at a table height of 3 cm varied from 0.44 to 5.26 mm. At a table height of 5.5 cm, target deviation varied from 0.44 to 3.60 mm, and at a maximum height of 5.8 cm, target deviation varied from 0.62 to 4.30 mm. Target deviation grossly exceeded clinical tolerance and was greater the farther the distance between the cranial base and the cervical spine target. Simple and reproducible methods that allow SRS centers to immobilize the patient's cervical spine using the currently available model G head frame are necessary to increase the range of targets that can be treated safely using the Leksell Gamma Knife Perfexion.

Database of movement control in the cervical spine. Reference normal of 182 asymptomatic persons

In this study, the first normative database of movement control in the cervical spine has been established. For this purpose the Fly Test was used, which is a reliable and valid clinical test capable of detecting deficient movement control of the cervical spine in patients with neck pain and its associated disorders. One hundred and eighty-two asymptomatic persons, eighty-three men and ninety-nine women, aged 16–74 years, divided into six age groups, were recruited. The Fly Test, using a 3-space Fastrak device, recorded the accuracy of cervical spine movements when tracking three incrementally difficult movement patterns. Amplitude accuracy (AA), directional accuracy (DA), and jerk index (JI) were compared across patterns and age groups. A multivariate analysis of variance revealed a significant effect for age (p < 0.001) but not gender (p > 0.05). Lower accuracy for AA and DA in all three movement patterns was observed in the groups of subjects aged 55–64 and 65–74 years, and also for JI in the easy and medium patterns. Knowledge of normative values for the Fly Test is important and useful in identifying impaired movement control and monitoring the effectiveness of treatment interventions in patients with neck pain of traumatic and non-traumatic origin.