Cervical Stabilization Research Articles

Effectiveness of McKenzie exercises plus stabilization exercises versus McKenzie exercises alone on disability, pain, and range of motion in patients with nonspecific chronic neck pain: A randomized clinical trial.

Chronic nonspecific neck pain is a common disorder that causes disability and reduced quality of life. Effective conservative treatment options are needed to manage this condition. This randomized trial compared the efficacy of McKenzie exercises alone versus McKenzie plus cervical and scapulothoracic stabilization training for patients with chronic nonspecific neck pain. A randomized controlled trial was conducted in an outpatient physical therapy clinic. 76 patients with chronic (> 3 months) neck pain were randomized to 6 weeks of either McKenzie exercises alone (n= 38) or McKenzie plus stabilization exercise (n= 38). The McKenzie protocol included posture correction, range of motion exercises, and lateral neck stretches. The stabilization program added targeted exercises for the neck and scapula. The combination of McKenzie plus stabilization exercises resulted in significantly greater reduction in current neck pain intensity compared to McKenzie alone at 6 weeks (mean difference: -1.2 points on 0-10 scale, 95% CI -1.8 to -0.6; p< 0.001). Neck disability improved in both groups. Cervical range of motion also improved more with the addition of stabilization, except for extension. Adding specific cervical and scapulothoracic stabilization exercises to a standard McKenzie protocol led to clinically meaningful reductions in neck pain compared to McKenzie therapy alone in patients with chronic nonspecific neck pain. This combined approach can improve outcomes.

Comparison of the long-term efficacy of ROI-C and conventional cage-plate in treatment of spinal cord injury without fracture or dislocation: a retrospective study

BackgroundThe self-locking cage (ROI-C, LDR, Troyes, France) has been clinically applied in the treatment of cervical degenerative disc disease (CDDD). However, only a few long-term clinical and radiographic studies have been conducted on the treatment of spinal cord injury without fracture or dislocation (SCIWFD) so far. A comparison between ACDF with either ROI-C or CCP was performed to determine the better treatment for SCIWFD.MethodsA total of 83 patients who underwent ACDF using either ROI-C or CCP were reviewed for radiological and clinical outcomes. The cohort comprised 60 males and 23 females, aged between 32 and 88 years old, with an average age of 58.23 years. All patients exhibited symptoms of nerve injury, including limb numbness, muscle weakness, hypoesthesia or urinary dysfunction. The preoperative ASIA classification of spinal nerve function: 7 cases of grade A, 23 cases of grade B, 34 cases of grade C and 19 cases of grade D were included in the study.ResultsA total of 48 patients underwent ACDF with ROI-C, while 35 patients received a conventional cage-plate. They were studied with a follow-up of 28.63 ± 17.41 months and 29.48 ± 15.43 months respectively. No significant difference was found in blood loss, JOA and ASIA between the two groups. No significant difference was found in cervical lordosis (CL) (P > 0.05). However, statistical difference was found in disc height of fused segment and T1 slope between the two groups (P < 0.05). No statistical difference was in the incidence of cage subsidence (P > 0.05). There was significant difference in the incidence of dysphagia. Both of two groups achieved bony fusion at final follow-up.ConclusionOur study demonstrated that ROI-C has the same efficacy as CCP in improving the cervical stability in treatment of SCIWFD. The migration of cage didn’t occur in ROI-C group at final follow-up, showing steadily fixed in cervical column. Moreover, the ROI-C does have the advantages of good therapeutic effect, mis-invasive, shorter operation time and fewer complications.

The effect of tongue-to-palate on deep neck flexor activity

Deep neck flexor (DNF) muscles contribute to cervical stability and proprioception. Reduced muscle strength and endurance lead to faulty movement patterns, muscle imbalances, and dysfunction. Potentially, the orofacial muscles contribute to cervical strength by providing stability through muscular connections. This study examined effects of tongue muscle activity on cervical spine muscular stiffness. Twenty-three healthy subjects assumed three supine positions [at rest (AR), chin tuck (CT), and head lift (HL)] with and without tongue-to-palate pressure. The DNF stiffness was measured using shear wave elastography. Without tongue-to-palate, stiffness increased with CT and HL compared to AR (p <0.001) but not between CT and HL (p = 0.22). Tongue-to-palate increased stiffness AR (p <0.001) but not during CT (p = 0.95) or HL (p = 0.67). Stiffness levels between the AR and HL conditions during tongue-to-palate performance did not differ (p = 0.734), but CT stiffness was significantly greater than AR (p = 0.029) with tongue-to-palate. Tongue-to-palate AR increases DNF stiffness to a similar level as HL with or without tongue-to-palate, while CT with or without tongue-to-palate resulted in the highest stiffness levels. Tongue-to-palate pressure AR or with CT performance may be alternatives to HL strengthening in healthy necks. This may be a useful strategy to increase cervical stability during loads on the cervical spine.

Biomechanical study of the stability of posterior cervical expansive open-door laminoplasty combined with bilateral C4/5 foraminotomy and short-segment lateral mass screw fixation: a finite element analysis

BackgroundPosterior cervical expansive open-door laminoplasty (EODL) may cause postoperative C5 palsy, and it can be avoided by EODL with bilateral C4/5 foraminotomy. However, prophylactic C4/5 foraminotomy can compromise cervical spine stability. To prevent postoperative C5 palsy and boost cervical stability, We propose a new operation method: EODL combined with bilateral C4/5 foraminotomy and short-segment lateral mass screw fixation. However, there are no studies on the biomechanical properties of this surgery.PurposeEvaluating the biomechanical characteristics of EODL combined with bilateral C4/5 foraminotomy and short-segment lateral mass screw fixation and other three classic surgery.MethodsAn original model (A) and four surgical models (B-E) of the C2-T1 vertebrae of a female patient were constructed. (B) EODL; (C) EODL combined with bilateral C4/5 foraminotomy; (D) C3-6 expansive open-door laminoplasty combined with bilateral C4/5 foraminotomy and short-segment lateral mass screw fixation; (E) C3-6 expansive open-door laminoplasty combined with bilateral C4/5 foraminotomy and C3-6 lateral mass screw system. To compare the biomechanical properties of cervical posterior internal fixation; (E) C3-6 expansive open-door laminoplasty combined with bilateral C4/5 foraminotomy and C3-6 lateral mass screw system. To compare the biomechanical properties of cervical posterior internal fixation methods, six physiological motion states were simulated for the five models using a 100N load force and 1.5Nm torque. The biomechanical advantages of the four internal fixation systems were evaluated by comparing the ranges of motion (ROMs) and maximum stresses.Results The overall ROM of Model C outperformed the other four models, reaching a maximum ROM in the extension state of 10.59°±0.04°. Model C showed a significantly higher ROMs of C4/5 segment than other four models. Model D showed a significantly lower ROM of C4/5 segment than both Model B and Model C. Model E showed a significantly lower ROM of C4/5 segment than Model D. The stress in the four surgical models were mainly concentrated on the internal fixation systems.ConclusionEODL combined with bilateral C4/5 foraminotomy and short-segment lateral mass screw fixation can maintain the stability of the spine and has minimal effects on the patient’s cervical spine ROMs in the extension and flexion state. As a result, it may be a promising treatment option for cervical spondylotic myelopathy (CSM) to prevention of postoperative C5 palsy.

Pilates mat versus cervical stabilization exercises on the craniovertebral angle, pain, function, and myoelectrical activity of the cervical muscles in forward head posture: a randomized controlled trial

IntroductionOne of the most prevalent postural problems involving the neck is called forward head posture (FHP), which is defined as the anterior head protruding from the sagittal plane and appearing to be positioned in front of the body. The incidence of FHP is 70% in young adults. This study aimed to compare Pilates mat versus cervical stabilization exercises on the craniovertebral angle (CVA), pain, function, and myoelectric activity of the upper trapezius (UT) and sternocleidomastoid (SCM) muscles in patients with FHP. Also, both experimental groups were compared to the control group in terms of CVA, pain, function, and myoelectric activity of the UT and SCM muscles.MethodsSixty participants (18 to 25 years old) with symptomatic FHP were randomly assigned to three groups using an opaque sealed envelope; Pilates mat and postural correction exercises were assigned group A, cervical stabilization and postural correction exercises were assigned group B, and solely postural correction exercises were assigned group C for 12 weeks at a frequency of 3 times/week. The patients were assessed before and after 12 weeks of interventions. The photogrammetric method was used to determine CVA, the visual analog scale (VAS) for pain intensity, the Arabic neck disability index (ANDI ) for neck function, and surface electromyography (sEMG) for the UT and SCM muscle root mean square during rest and activity.ResultsMultiple pairwise comparisons revealed statistically significant differences between pre and post-treatments for all variables in the Pilates, cervical stabilization, and control groups with a &lt;i&gt;p&lt;/i&gt; &lt; 0.05. Between groups, analyses showed that there were statistically significant differences (&lt;i&gt;p&lt;/i&gt; &lt; 0.05) at post-treatment between the Pilates and cervical stabilization groups and also between Pilates and the control, and finally between the cervical stabilization and control groups with more favor to the Pilates group.ConclusionsPilates mat and cervical stabilization exercises are both effective interventions for FHP, with Pilates mat exercises being superior.

Cervical facet joint degeneration, facet joint angle and paraspinal muscle degeneration are correlated with degenerative cervical spondylolisthesis at C4/5: a propensity score-matched study

BACKGROUND CONTEXTPrior studies have hypothesized that degenerative cervical spondylolisthesis (DCS) may be influenced by loss of stability due to disc, facet joint or cervical alignment. Meanwhile, it is commonly believed that the facet joints and paraspinal muscles participate in maintaining cervical spine stability. However, the impact of paraspinal muscle morphology and detailed facet joint features on DCS requires further investigation. PURPOSETo compare facet joint characteristics, disc degeneration and muscle morphology between patients with DCS and those without DCS. STUDY DESIGN/SETTINGRetrospective cohort study. PATIENT SAMPLEConsecutive surgical patients with degenerative cervical spondylosis from June 2016 to August 2023 were recruited. OUTCOME MEASURESDCS was assessed on X-ray based on the translation distance. Cervical facet joint degeneration (CFD), the facet joint angle on the axial plane (FA-A) and the facet joint angle on the sagittal plane (FA-S), and facet joint tropism (FT) were measured on computerized tomography (CT). Paraspinal muscle degeneration was assessed on magnetic resonance imaging (MRI) including by the adjusted cross-sectional area (aCSA), the functional aCSA, the fat infiltration ratio (FI%). The Pfirrmann grade of the cervical disc was also evaluated. METHODSDemographic and clinical data were compared in matched and unmatched cohorts. Disc degeneration, muscle degeneration and facet joint characteristics, including FA, FT and CFD, were compared between patients with and without DCS. Furthermore, the degree of CFD was compared with that of adjacent segments in both groups. Additionally, logistic regression was performed to determine independent risk factors for DCS. Finally, the receiver operating characteristic (ROC) curve, area under the curve (AUC) and cutoff value for the risk factors were calculated. RESULTSA total of 431 surgical patients were propensity score matched for age, sex and BMI, and 146 patients were included in the final analysis, with 73 patients in the DCS group and 73 patients in the non-DCS group. DCS patients exhibited more severe CFD at C4/5 (segment with spondylolisthesis). Additionally, DCS was generally associated with more severe CFD, a more horizontal FA-S, more FT and worse paraspinal muscle health but similar disc degeneration. In addition, anterior spondylolisthesis was related to more severe CFD and decreased functional aCSA of the flexors and extensors. Finally, more severe CFD, a more horizontal FA-S and a higher FI% on deep extensor were revealed to be risk factors for DCS, with cutoff values of 1.5, 44.5̊, and 37.1%, respectively. CONCLUSIONSThis study demonstrated that CFD, the FA and FT and parasipnal muscle degeneration were associated with DCS. And may provide novel insight into the pathogenesis and nature history of DCS and suggest the evolution of degeneration in the cervical spine.

Biomimetic Porous Ti6Al4V Implants: A Novel Interbody Fusion Cage via Gel-Casting Technique to Promote Spine Fusion.

An interbody fusion cage (Cage) is crucial in spinal decompression and fusion procedures for restoring normal vertebral curvature and rebuilding spinal stability. Currently, these Cages suffer from issues related to mismatched elastic modulus and insufficient bone integration capability. Therefore, a gel-casting technique is utilized to fabricate a biomimetic porous titanium alloy material from Ti6Al4V powder. The biomimetic porous Ti6Al4V is compared with polyetheretherketone (PEEK) and 3D-printed Ti6Al4V materials and their respective Cages. Systematic validation is performed through mechanical testing, in vitro cell, in vivo rabbit bone defect implantation, and ovine anterior cervical discectomy and fusion experiments to evaluate the mechanical and biological performance of the materials. Although all three materials demonstrate good biocompatibility and osseointegration properties, the biomimetic porous Ti6Al4V, with its excellent mechanical properties and a structure closely resembling bone trabecular tissue, exhibited superior bone ingrowth and osseointegration performance. Compared to the PEEK and 3D-printed Ti6Al4V Cages, the biomimetic porous Ti6Al4V Cage outperforms in terms of intervertebral fusion performance, achieving excellent intervertebral fusion without the need for bone grafting, thereby enhancing cervical vertebra stability. This biomimetic porous Ti6Al4V Cage offers cost-effectiveness, presenting significant potential for clinical applications in spinal surgery.

The effect of cervical stabilization and thoracic spine extension exercises on neck functional ability for forward head posture patients

Background: The widespread usage of cell phones may encourage everyone to rely more on technology in all aspects of their lives. However, if technology use in daily tasks is not balanced with physical exercise, musculoskeletal problems may develop. The most common concern associated with this syndrome is forward head posture. This study aimed to determine whether giving cervical stabilization and thoracic spine extension exercises can increase neck functional ability for forward head posture patients. Methods: The study used an experimental design. There were 23 physiotherapy students of Universitas 'Aisyiyah Yogyakarta as samples for this study, who had forward head posture and underwent measurement of neck functional ability by using the neck disability index (NDI). The independent administrator randomly assigned the treatment and control groups. The interventions were s conducted three times a week for four weeks. Data analysis employed a paired sample T-test to assess the effect of treatment and control groups. An independent sample T-test was used to compare the impact of treatments and control groups. Results: The results of the paired sample T-test in treatment and control groups, with p-values=0.001, indicate that both interventions improved the functional ability of the neck. The difference between treatment and control groups tested by the independent sample T-test shows p-value=0.062 for the pre-test and (p-value=0.444), suggesting no difference in effectiveness between cervical stabilization and thoracic spine extension on neck functional ability for forward head posture conditions. Conclusion: There was no difference in the effect of cervical stabilization and thoracic spine extension on the functional ability of the neck for forward head posture.

Effects of video-based cervical stabilization home exercises in patients with rheumatoid arthritis: arandomized controlled pilot study.

This study aimed to examine the effects of aremote video-based cervical stabilization exercise program on cervical proprioception, functional status, and disease-related quality of life in patients with rheumatoid arthritis (RA). Patients with RA were evaluated regarding cervical joint positioning error, cervical region functional status (Neck Disability Index), general functional status (Health Assessment Questionnaire), and disease-related quality of life (Rheumatoid Arthritis Quality of Life Scale). Patients were randomized to exercise (n = 14, 10female) and control (n = 12, 9female) groups. Patients in the exercise group performed avideo-based home exercise program consisting of progressive cervical stabilization exercises three times aweek for sixweeks in addition to their routine medication. The patients in the control group continued their routine medication only. Evaluations were repeated in both groups in the seventh week following the baseline evaluation. Groups were similar at baseline (p > 0.05). Patients in both groups had low disease activity (DAS-28 CRP ≤ 3.2). The remote video-based exercise program led to significant improvements in cervical proprioception, functional status, and disease-related quality of life (p < 0.05). No significant changes were detected in any parameters in the control group (p > 0.05). Obtained changes were superior in the exercise group compared to the control group (d > 1.00, p < 0.05). Cervical stabilization exercises may increase cervical proprioception, improve functional status, and enhance disease-related quality of life in patients with RA when administered as aremote program. https://clinicaltrials.gov/study/NCT04948775 , NCT04948775.

Optimizing Pain Relief and Range of Motion in Unilateral Cervical Radiculopathy: A Study on Neural Tissue Mobilization and Cervical Stabilization Exercises.

Background This study aimed to analyze the combined effect of neural mobilization along with cervical stabilization exercises on pain and cervical range of motion in unilateral cervical radiculopathy patients. Methodology A total of 30 patients aged 30-45 years with unilateral cervical radiculopathy were randomly divided into the following two groups: experimental (n = 15) and control (n = 15). The experimental group received neural mobilization along with cervical stabilization exercises, while the control group received conventional treatment. Outcome measures included pain intensity measured on a visual analog scale (VAS), functional status of the neck measured by the Neck Disability Index (NDI), and cervical range of motion measured by a goniometer. All measures were taken before treatment, after treatment, and at the one-week follow-up. Results The results showed statistically significant positive improvements in VAS, NDI score, and cervical range of motion in unilateral cervical radiculopathy subjects of the experimental group. Conclusions Neural mobilization combined with cervical stabilization exercises led to significant improvements in pain, functional status, and cervical range of motion in patients with unilateral cervical radiculopathy compared to conventional treatment.

Improving Function and Quality of Life in Patients with Chronic Neck Pain, Tension-Type Headache, and Forward Head Posture: The Role of Eyeball Exercise and Cervical Stabilization Programs.

BACKGROUND The purpose of this study was to investigate the effects of eyeball exercise and cervical stabilization programs to patients with chronic neck pain, tension-type headache (TTH), and forward head posture (FHP). MATERIAL AND METHODS The design of this study was a randomized controlled trial. A total of 40 participants were randomly divided into 2 groups: the experimental group (n=20) and the control group (n=20). Both groups received cervical manual therapy and biofeedback-guided stabilization exercises (30 min/session, 3 sessions/week, 6 weeks). In addition to the regular treatments, the participants in the experimental group also performed eyeball exercises for 20 minutes per session, 3 sessions per week, for a total of 6 weeks. Changes in neck pain (numeric rating scale, NRS), neck disability index (NDI), quality of life (Short Form-12 Health Survey Questionnaire, SF-12), headache impact test-6 (HIT-6), craniovertebral angle (CVA), cranial rotation angle (CRA), and muscle tone were measured. RESULTS Both groups showed significant improvements in NRS, NDI, SF-12, HIT-6 scores, CVA, CRA, and muscle tone (p<0.05). The experimental group had significant differences in NDI, SF-12, HIT-6 scores, and suboccipital muscle tone compared to the control (p<0.05). CONCLUSIONS Combining the eyeball exercise program with commonly used manual therapy and stabilization exercises for patients with chronic neck pain can help reduce nerve compression and promote muscle relaxation in the eye and neck areas. The method is thus proposed as an effective intervention to enhance function and quality of life in patients with chronic neck pain patients, TTH, and FHP.

The effect of craniocervical flexors endurance training on suprahyoid muscle activation in healthy adults: A randomised controlled trial.

Cervical posture affects swallowing function through contractile and non-contractile structures. Craniocervical flexor endurance training (CCFET), which focuses on the activation of deep cervical muscles, is used to ensure cervical posture stability. The aim of this study was to investigate the effect of CCFET on the suprahyoid muscles (SH), which play an important role in swallowing function. Eighty healthy individuals (52 female and 28 male, mean age 21.77 ± 1.81 years) were recruited and randomly assigned to groups that underwent either deep cervical flexor (DCF) training with a pressure biofeedback unit (CCFET group, n = 41) or no intervention (control group, n = 39). The intervention was applied for 4 weeks (five sessions per week). Static endurance and activation of DCF muscles (Craniocervical Flexion Test, CCFT), tragus-wall distance (TWD) for forward head posture and surface electromyographic (sEMG) activation of suprahyoid muscles were evaluated. The endurance and activation of the DCF muscles were significantly increased in the CCFET group (p = <.001). In the CCFET group, TWD significantly lower than the control group (p = <.001) Peak SH amplitude and mean SH amplitude were lower in the CCFET group compared to the control group (p = .013, p = .003). The study shows that 4 weeks of CCFET reduced SH muscle activation, allowing the same work to be done with fewer motor units. CCFET can be included in rehabilitation programs as an additional method that has an effect on the muscles involved in swallowing by providing cervical motor control.

Cervical anatomy and its relation to foraging habits in aquatic birds (Aves: Neornithes: Neoaves).

Birds have extremely flexible necks, which help in their search for food. However, studies on the variation in bird cervical anatomy and its relationship with foraging are rare, despite the different habits presented between species. Here, we analyze the anatomy of the neck of aquatic birds and relate it to their foraging strategies. We dissected specimens representing four species of Charadriiformes, 11 species of Phaethoquornithes, and two specimens belonging to the outgroup Telluraves. We chose to emphasize Charadriiformes and Phaethoquornithes because they present several strategies that require cervical mobility and stability. We note that vertebral anatomy and dimensions vary, which affects the shape and size of the soft tissues attached throughout the neck. The synovial cartilage present in the articulatio intercorporalis represents an additional length in the neck, however, this is not longer than that observed in animals with intervertebral discs. Our analysis indicates that birds have a prevalence of dorsoventral movements in the middle of the neck and lateral and rotational movements near the base of the neck, while the region near the head presents a wide range of movement in all directions. Cervical ligaments and muscles throughout the neck provide stability in all segments, although the robustness of the soft tissues indicates that the most caudal portion of the neck is the most stable. The vertebral and soft tissue anatomy is consistent with the extensive mobility in pitching, yaw, and roll movements performed mainly by the head and first segment of the neck during the different foraging of the analyzed birds. Furthermore, the muscles closer to the skull are robust and allow the execution of a variety of habits to capture food in different species. The subsequent cervical segments present differences that explain their reduction in mobility, but they are equally stable.

Effect of smartphone use on cervical spine stability

Using a smartphone often involves a sustained head-forward tilt posture, which may deteriorate the mechanism of muscle reaction efficiency or reduce the stiffness of connective tissues of the cervical spine. These changes in muscular and connective tissues can impair cervical spine stability and contribute to developing neck pain symptoms. In this experiment, change in the cervical spine stability associated with a sustained smartphone use posture was evaluated by quantifying the effective stiffness and the reflexive responses of the head to sudden perturbations. Seventeen young smartphone users maintained their heads tilted forward approximately 30° for 30 min while watching videos on their smartphones in sitting. Data show that the measures of cervical spine stability did not change significantly after the smartphone use task despite developing mild to moderate neck and upper body discomfort symptoms. Study findings imply that keeping the head tilt posture for 30 min for smartphone use did not significantly alter spinal stability, rejecting its association with neck discomfort.

Retro-Odontoid Pseudotumor due to Rheumatoid Arthritis Pannus and its Craniocervical Instability

Retro-Odontoid Pseudotumor due to Rheumatoid Arthritis Pannus and its Craniocervical Instability

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

Occipital condyle fracture in the pediatric population: A management algorithm and systematic review.

This study aims to develop an accessible stepwise management algorithm for pediatric presentations of occipital condyle fractures (OCFs) based on a systematic review of the published literature regarding diagnostic evaluation, treatment, and outcomes. A systematic review of the literature was conducted on PubMed to locate English language studies reporting on the management of pediatric OCFs. Data extraction of clinical presentation, management strategies, imaging, and treatment outcome was performed. A total of 15 studies reporting on 38 patients aged 18 years and younger presenting with OCFs were identified. Loss of consciousness (LOC), depressed level of consciousness, neck pain, decreased neck range of motion (ROM), and cranial nerve injury were the most common presenting symptoms. Diagnostic imaging included radiographs, computed tomography (CT) scans, magnetic resonance imaging (MRI), and functional radiographs to assess cervical stability. Treatment options varied and included soft collar, hard collar, and halo vest. All studies resulted in a complete healing of the OCF, with resolution of associated pain. The proposed treatment algorithm suggests a framework for the management of pediatric OCFs based on the available evidence (levels of evidence: 3, 4). This review of the literature indicated that a stepwise approach should be utilized in the management of isolated pediatric OCFs.

Biomechanical Comparison of Anterior Cervical Corpectomy Decompression and Fusion, Anterior Cervical Discectomy and Fusion, and Anterior Controllable Antedisplacement and Fusion in the Surgical Treatment of Multilevel Cervical Spondylotic Myelopathy: A Finite Element Analysis.

Multilevel cervical spondylotic myelopathy poses significant challenges in selecting optimal surgical approaches, warranting a comprehensive understanding of their biomechanical impacts. Given the lack of consensus regarding the most effective technique, this study aims to fill this critical knowledge gap by rigorously assessing and comparing the biomechanical properties of three distinct surgical interventions, including anterior controllable antedisplacement and fusion (ACAF), anterior cervical corpectomy decompression and fusion (ACCF), and anterior cervical discectomy and fusion (ACDF). The study offers pivotal insights to enhance treatment precision and patient outcomes. The construction of the cervical spine model involved a detailed process using CT data, specialized software (Mimics, Geomagic Studio, and Hypermesh) and material properties obtained from prior studies. Surgical instruments were modeled (titanium mesh, anterior cervical plate, interbody cage, and self-tapping screws) to simulate three surgical approaches: ACAF, ACCF, and ACDF, each with specific procedures replicating clinical protocols. A 75-N follower load with 2 Nm was applied to simulate biomechanical effects. The range of motion decreased more after surgery for ACAF and ACDF than for ACCF, especially in flexion and lateral bending. ACCF have higher stress peaks in the fixation system than those of ACAF and ACDF, especially in flexion. The maximum von Mises stresses of the bone-screw interfaces at C3 of ACCF were higher than those of ACAF and ACDF. The maximum von Mises stresses of the bone-screw interfaces at C6 of ACDF were much higher than those of ACAF and ACCF. The maximum von Mises stresses of the grafts of ACCF and ACAF were much higher than those of ACDF. The maximum von Mises stresses of the endplate of ACCF were much higher than those of ACAF and ACDF. The ACAF and ACDF models demonstrated superior cervical reconstruction stability over the ACCF model. ACAF exhibited lower risks of internal fixation failure and cage subsidence compared to ACCF, making it a promising approach. However, while ACAF revealed improved stability over ACCF, higher rates of subsidence and internal fixation failure persisted compared to ACDF, suggesting the need for further exploration of ACAF's long-term efficacy and potential improvements in clinical outcomes.

Comparison of laminoplasty and posterior segment fusion with laminoplasty and anterior segment fusion for treating acute extensional cervical spinal cord injury in pre-existing canal stenosis: a multicenter retrospective study

Background: Patients with pre-existing cervical spinal canal stenosis (CSCS) are more likely to suffer from an extensional spinal cord injury (SCI). However, the appropriate surgical alternatives for extended cervical SCIs in individuals with pre-existing CSCS remain unknown. The purpose of this study was to evaluate the clinical efficacies of laminoplasty and posterior short-segment fusion (PSF) with laminoplasty and anterior short-segment fusion (ASF) in the treatment of these patients. Methods: The clinical data of 258 patients from six spine centers were included in this retrospective study. Patients were divided into two different groups based on the surgical approach: laminoplasty and PSF (PSF group) and laminoplasty and ASF (ASF group). ASIA grades and JOA scores were obtained before and after surgery to assess neurological function. Results: There were 116 patients in the PSF group and 142 patients in the ASF group. The average operation time, intraoperative blood loss, and hospital stay were 188 min, 298 ml, and 7.6 days, respectively, in PSF group, compared to 245 min, 366 ml, and 10.4 days in PSF group, respectively. Complete decompression was achieved in all patients, and fusion was achieved 6 months after surgery. A post-operative computed tomography scan revealed that 39/464 (8.4%) screws had perforated, but no neurovascular complications occurred. Both surgical strategies improved the ASIA grade and there was no significant difference between the two groups (P = 0.926). The JOA score improved from 6.21 ± 1.85 to 10.90 ± 3.56 in the PSF group and from 6.45 ± 2.17 to 11.48 ± 3.62 in the ASF group, but at the final follow-up, there was no significant difference between the two groups (P = 0.134). The incidence of post-operative complications in the ASF group (24/142, 16.9%) (P = 0.043) was higher than that in the PSF group (6/116, 5.17%). Conclusions: Cervical laminoplasty combined with short-segment transpedicular screw fixation is a reliable option to treat extensional cervical SCIs in patients with CSCS. This surgical strategy is beneficial for achieving sufficient cervical spinal cord decompression, preserving cervical spine stability, and avoiding extra anterior cervical decompression and fusion, thereby reducing surgery time, intraoperative blood loss volume, post-operative complication rate, and length of hospital stay. Relevance for Patients: Cervical laminoplasty combined with posterior segmental fusion (PSF) reduces operative time, bleeding, and complications and achieves adequate spinal cord decompression in the treatment of extension cervical SCI in patients with CSCS.

Efficacy of lumbar motor control training in treatment of patients with cervicogenic headache

BackgroundCervicogenic headache (CGH), is a secondary headache arising from cervical disorders. Training core muscles have a corrective effect on the whole spine. Moreover, increased deep neck flexors (DNFs) activation is closely linked with balanced core stabilization of the global cervical-thoracic-lumbopelvic chains. This study aimed to investigate the effect of lumbar motor control training combined with cervical stabilization exercises compared to cervical stabilization exercises alone in CGH patients.MethodsFifty-two subjects of both genders with CGH and chronic mechanical neck pain (CMNP) participated in this study. They were recruited from the outpatient Physical Therapy Clinic at Mubarak Central Hospital, Giza, Egypt; their mean age was 28.1 ± 5.8 years and their BMI was 22.8 ± 1.6 kg/m2. They received treatment for three sessions per week for 4 weeks. Subjects were assigned randomly into two equal groups; the control group: received cervical stabilization exercises (axial elongation, cranio-cervical flexion, cervical extension, rowing, and Y-exercise). Study group: received cervical stabilization exercise in addition to lumbar motor control training (abdominal draw-in maneuver, side plank, and quadruped position), each exercise had a 4-week progression. Headache frequency, duration, intensity by visual analog scale (VAS), and neck functional disability by Neck Disability Index (NDI) were measured before the first session and after the last session of the 4 weeks of treatment.ResultsThere was a high statistically significant difference in post-treatment mean values of headache frequency, headache duration, headache intensity, and neck functional disability between the two groups in favor of the study group.ConclusionAdding lumbar motor control training to cervical stabilization exercise is more effective than cervical stabilization alone in decreasing headache frequency, duration, intensity, and neck functional disability in CGH patients with CMNP.Trial registrationNCT05952115. Registered 11 July 2023-retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=1&cx=-jg9qo4.