Fourth Cervical Vertebral Body Research Articles

Cervical vertebral bone age estimation and its correlation to chronological age

Introduction: Cervical vertebrae are used as a reliable tool to assess the skeletal maturation of an individual and predict the maximum growth potential.Aim and objective: This study aimed to estimate bone age by measuring 3rd and 4th cervical vertebrae(C3, C4) dimensions on cephalometric radiographs.Materials and Methods: A total of 100 girls in the age group of 7-15 years were taken into consideration. Using cephalometric radiographs, we measured the cervical vertebral bodies and using a regression formula, cervical vertebral bone age was obtained based on the ratios of measurements in the third and fourth cervical vertebral bodies. It was then correlated with the chronological age.Results: The Spearman correlation coefficient between chronologic age and cervical vertebrae skeletal maturation was 0.695, with a (p-value < 0.001) which was statistically significant.Conclusion: The cervical-vertebrae maturation stages are considered clinically useful maturity indicators of the pubertal growth period.

Cervical Vertebral Height Approximates Hyoid Displacement in Videofluoroscopic Images of Healthy Adults.

Clinicians and researchers commonly judge the completeness of hyoid displacement from videofluoroscopic swallow study (VFSS) videos. Judgments made during the clinical exam are often subjective, and post-examination analysis reduces the measure's immediate value. This study aimed to determine the validity and feasibility of a visual, anatomically scaled benchmark for judging complete hyoid displacement during a VFSS. The third and fourth cervical vertebral bodies (C3 and C4) lie at roughly the same vertical position as the hyoid body and are strongly correlated with patient height. We hypothesized that anterior and superior displacement of the hyoid bone would approximate the height of one C3 or C4 body during safe swallows. Trained raters marked points of interest on C3, C4, and the hyoid body on 1414 swallows of adult patients with suspected dysphagia (n = 195) and 50 swallows of age-matched healthy participants (n = 17), and rated Penetration Aspiration Scale scores. Results indicated that the mean displacements of the hyoid bone were greater than one C3 unit in the superior direction for all swallows from patient and healthy participants, though significantly and clinically greater in healthy participant swallows (p < .001, d > .8). The mean anterior and superior displacements from patient and healthy participant swallows were greater than one C4 unit. Results show preliminary evidence that use of the C3 and/or C4 anatomic scalars can add interpretive value to the immediate judgment of hyoid displacement during the conduct of a clinical VFSS examination.

Spinal ataxia in a 2‐year‐old colt caused by a compressive primary vertebral osteosarcoma

SummaryNeoplasia is a rare cause of ataxia in horses. This report describes a 2‐year‐old colt presented with sudden‐onset ataxia in which a cervical vertebral osteosarcoma causing severe compression of the spinal cord was diagnosed. Radiological changes included a large osteolytic lesion in the vertebral body, the vertebral arch, the right cranial articular process and the right transverse process of C4, interrupting the borders of the vertebral foramen and the right transverse foramen. Myelography revealed a marked spinal cord compression. Necropsy confirmed the presence of a well‐demarcated, invasive and firm mass protruding from the fourth cervical vertebral body that led to severe compression of the spinal cord. In spite of its strongly pleomorphic nature, the detection of osteoid confirmed the diagnosis of a central osteosarcoma of the combined type. To the best of our knowledge, a primary single vertebral osteosarcoma causing ataxia in a juvenile horse has not previously been reported, and findings of this case report could help in the diagnostic work‐up of similar cases.

Primary Intracranial Ewing's Sarcoma (Peripheral Primitive Neuroectodermal Tumour of Parietal Bone) with Spinal and Pelvic Metastasis in a Young Female Child: Rare Case Report and Review

Introduction The Peripheral Primitive Neuroectodermal Tumour (pPNET)/Ewing's sarcoma family tumor (ESFT) group is a recently redefined term which includes all small round cell tumors of bone, soft tissue, and nerve with a common neuroectodermal origin. These highly aggressive pediatric soft tissue tumors occur less frequently in the craniospinal axis. Primary cranial lesion associated with spinal and pelvic metastasis is a rare presentation. Clinical Presentation A 9-year old girl was hospitalized with features of progressive increase in intracranial pressure with quadriparesis. The patient had ⅘ quadriparesis with bilateral papilledema. Brain MRI showed a large, hetero intense, contrast enhancing right parietal bony lesion infiltrating the dura with mass effect over the brain. Brain CT showed bony expansion and multiple calvarial lytic lesions. MRI cervical spine revealed collapsed fourth cervical vertebral body with extensive paravertebral and paraspinal soft tissue components with cord compression. Metastatic workup revealed a lytic lesion in the left iliac bone and left lung. The patient underwent a surgically challenging C4 corpectomy with cage fixation followed by craniotomy and excision of parietal bony lesion with titanium mesh cranioplasty in the same sitting. Histopathology revealed pPNET and was confirmed by CD99 positivity. Conclusion This rare multiple site tumor presentation was carefully planned and effectively managed by a combined single-stage surgical approach involving total excision of primary parietal bone and metastatic cervical spine tumors with primary titanium mesh cranioplasty and cervical spine stabilization, followed with radiotherapy and chemotherapy, which resulted in good recovery and improved the overall prognosis for the patient.

Anatomical features of the vertebral artery for transbrachial direct cannulation of a guiding catheter to perform coil embolization of cerebral aneurysms in the posterior cerebral circulation.

Transbrachial approach is an alternative technique for coil embolization of posterior circulation aneurysms. The purpose of our study was to investigate the anatomical features of the vertebral artery (VA) for transbrachial direct VA cannulation of a guiding catheter (GC) to perform coil embolization of posterior circulation aneurysms. Included in retrospective analysis were patients who underwent transbrachial coil embolization of cerebral aneurysms in the posterior cerebral circulation by direct VA cannulation of a GC from 2007 to 2013. Investigated were patient characteristics, preoperative sizes of aneurysms, aneurysms location, the angle formed by the target VA and the subclavian artery (AVS), and the VA diameter at the level of the fourth cervical vertebral body (VAD) in the side of the transbrachial access route. Thirty-one patients with 32 aneurysms met our criteria. The locations of aneurysms were the VA (n = 16), basilar artery (BA) tip (n = 10), BA trunk (n = 3), BA superior cerebellar artery (n = 1), BA anterior inferior cerebellar artery (n = 1), and VA posterior inferior cerebellar artery (n = 1). The right brachial artery was punctured in 27 cases with 28 aneurysms as transbrachial direct cannulation of a GC, and left was in 4 cases with 4 aneurysms. The average AVS, ranging from 45° to 95°, was 77°, and the average VAD, ranging from 3.18 to 4.45 mm, was 3.97 mm. For transbrachial direct cannulation of a GC, it seems required that the AVS is about 45° or more and the VAD is about 3.18 mm or more.

A special method of predicting mandibular growth potential for Class III malocclusion.

The purpose of this study was to establish an equation to predict the mandible growth potential (GP) for Class III malocclusion on the basis of the analysis of the cervical vertebrae in a single cephalometric radiograph and to compare its predictive accuracy with other methods. Data comprised two groups each with 22 Japanese girls. Group A was examined to construct the prediction equation. Group B served to compare the predictive accuracy with the GP method and the method of Mito et al (MM). The following results were obtained: (1) an equation was determined to obtain mandible GP on the basis of measurements in the third and fourth cervical vertebral bodies and (2) the average errors between the predicted increment and the actual increment for each method were 1.45 mm for the equation, 2.91 mm for the GP method, and 2.48 mm for the MM. These results suggest that using cervical vertebral measurements might allow predicting the mandible GP length for Class III malocclusion.

A new method of predicting mandibular length increment on the basis of cervical vertebrae.

The purpose of this study was to establish an equation to predict incremental mandibular length on the basis of the analysis of the cervical vertebrae in a single cephalometric radiograph and to compare the predictive accuracy with other methods. Data comprised two groups of 23 Japanese girls between CVMS I and CVMS V. Group A was examined to construct the predication equation. Group B served to compare the predictive accuracy with the growth potential method and the growth percentage method. The following results were obtained: (1) an equation was determined to obtain mandibular length increments on the basis of the measurements in the third and fourth cervical vertebral bodies, and (2) the average error between the predicted increment and the actual increment was 1.5 mm for the equation method, 2.4 mm for the growth potential method, and 2.8 mm for the growth percentage method. These results suggest that with the use of cervical vertebral measurements, it may be possible to evaluate the mandibular growth potential.

内頚動脈のcervical segmental agenesis

●Abstract● Objective: Segmental agenesis of the cervical portion of the internal carotid artery (ICA) is reported. Case presentation: A 39-year-old man was admitted to our hospital for examination of a pharyngeal mass. Cerebral angiography revealed that left common carotid artery had a stump at the level of the fourth cervical vertebral body, and ascended without branching off the ICA. All the branches of the external carotid artery branched off normally. Thereafter, the artery ran tortuously and continued as the ICA at the level of the third cervical vertebral body. The distal portion of the ICA was normal. Conclusion: From an embryological point of view, it is speculated that the proximal portion of the cervical segment of the ICA might have been involuted (segmental agenesis) and its distal portion reconstituted by the ipsilateral external carotid artery.

Maturação das vértebras cervicais e sua correlação com a idade óssea da mão e punho como indicadores no tratamento ortodôntico

OBJETIVOS: a proposta deste estudo prospectivo, transversal e multicêntrico foi correlacionar as alterações morfológicas das vértebras cervicais C2, C3 e C4, com a idade cronológica e comparar com a idade esqueletal dos ossos da mão e punho; e verificar se existem diferenças no padrão de crescimento ósseo entre os gêneros masculino e feminino. METODOLOGIA: a amostra foi constituída por 140 pacientes, 74 do gênero feminino e 66 do masculino. A avaliação das alterações das vértebras cervicais foi feita pelo método de Hassel e Farman modificado por Baccetti, Franchi e McNamara para 5 estágios que se correlacionam com o crescimento puberal em telerradiografias cranianas em norma lateral. As radiografias da mão e punho avaliaram os eventos de ossificação por meio do método de Greulich e Pyle. RESULTADOS: os resultados demonstraram correlação dos estágios de maturação das vértebras cervicais com a idade cronológica; e correlação positiva e moderada, estatisticamente significante entre os dois métodos com r = 0,6326 (IC = 95%) e p &lt; 0,0001. CONCLUSÕES: desta forma, pôde-se concluir que a idade aumenta proporcionalmente em relação aos estágios de maturação, sendo que a maioria dos pacientes da amostra encontrou-se no estágio II, considerado bom para o início da terapêutica ortodôntico/ortopédica. O nível de correlação entre os métodos demonstrou que a avaliação dos estágios de maturação das vértebras cervicais é um método adicional útil e confiável na determinação do estágio de crescimento facial nas crianças em crescimento puberal. O gênero feminino apresentou estágios de crescimento mais precoces que o gênero masculino, atingindo o início e o final do surto de crescimento puberal em idade cronológica mais inferior.

Cervical vertebral bone age during puberty

To explore a method for objectively and accurately evaluating cervical vertebral bone age among Chinese growing subjects. Using cephalometric and hand-wrist radiographs of 90 boys and 90 girls who were during pubertal period, we measured the third and fourth cervical vertebral bodies and calculated hand bone age using Liaokawa's method. A formula for calculating cervical vertebral bone age was determined by stepwise multiple regression analysis. A method for objectively evaluating cervical vertebral bone age among Chinese growing subjects during pubertal period was established. Y (Y: cervical vertebral bone age) = -20.189 + 24.666X(1) (X(1): AH(4)/AP) +46.468X(2) (X(2): AH(3)/AP(3)) +39.854X(3) (X(3): AH(4)/H) (r = 0.901). The R square of the equation was 0.81. The mean and standard deviation were as follows: constant = -20.19 +/- 4.89 (t = -4.13, P < 0.01), AH(4)/AP(4) = 24.67 +/- 8.32 (t = 2.97, P < 0.01), AH(3)/AP(3) = 46.47 +/- 6.60 (t = 7.04, P < 0.01), AH(4)/H(4) = 39.85 +/- 7.04 (t = 5.66, P < 0.01). This method could be used to evaluate Chinese growth stages objectively.

頚椎に発生した脊索腫の治療経験

We report a rare case of entirely intra-osseous chordoma occurring in the fourth cervical vertebral body. Chordoma is a rare tumor of the axial skeleton most commonly found in the sacrococcygeal region and the base of the skull. The typical findings are large bone destruction and expansive growth into the soft tissue. A 67-year-old female complained of neck pain extending into the right shoulder. Radiographs and bone scintigraphy were normal. MRI demonstrated the lesion clearly, and showed low-intensity in T1 weighted images and high-intensity in T2 weighted images within the vertebral body. No expansion into the soft tissue was revealed. CT showed no bone destruction. We performed vertebrectomy and anterior spinal fusion. histopathological findings were compatible with chordoma. Her pain disappeared after surgery. One year after surgery, there is no local recurrence, but lung metastasis was suggested by CT. Careful follow up is necessary.

Cervical vertebral bone age in girls

The purpose of this study was to establish cervical vertebral bone age as a new index for objectively evaluating skeletal maturation on cephalometric radiographs. Using cephalometric radiographs of 176 girls (ages 7.0-14.9 years), we measured cervical vertebral bodies and determined a regression formula to obtain cervical vertebral bone age. Next, using cephalometric and hand-wrist radiographs of another 66 girls (ages 8.0-13.9 years), we determined the correlation between cervical vertebral bone age and bone age using the Tanner-Whitehouse 2 method. The following results were obtained: (1) a regression formula was determined to obtain cervical vertebral bone age based on ratios of measurements in the third and fourth cervical vertebral bodies; (2) the correlation coefficient for the relationship between cervical vertebral bone age and bone age (0.869) was significantly (P <.05) higher than that for the relationship between cervical vertebral bone age and chronological age (0.705); and (3) the difference (absolute value) between the cervical vertebral bone age and bone age (0.75 years) was significantly (P <.001) smaller than that between cervical vertebral bone age and chronological age (1.17 years). These results suggest that cervical vertebral bone age reflects skeletal maturity because it approximates bone age, which is considered to be the most reliable method for evaluating skeletal maturation. Using cervical vertebral bone age, it might be possible to evaluate maturity in a detailed and objective manner on cephalometric radiographs. (Am J Orthod Dentofacial Orthop 2002;122:380-5)

Electrophysiological, histological, and behavioral studies in a cat with acute compression of the spinal cord

We made an animal model of cervical spinal cord injury in a cat and performed electrophysiological, histological, and behavioral studies. The cervical spinal cord injury model was made by inserting a screw through the fourth cervical vertebral body of the cat. After the injury, muscle tonus of the limbs and trunk diminished. The cat was able to walk and to perform target reaching after the injury, although the trunk was unstable and the movement of the forelimb was ataxic. Atrophy of the back muscle remained. The cat was unable to stand bipedally. These behavioral disturbances suggested dysfunction of the ventral funiculus. After behavioral analysis for 3 months, an electrophysiological study was performed. Action potentials of the ventral funiculus evoked by stimulation of the lateral vestibular nucleus or the medial longitudinal fasciculus were recorded at several levels of the cervical cord. They were diminished at levels caudal to the compression site. After the recording, the cervical cord was studied histologically. There was demyelination and gliosis in the ventral funiculus and in part of the ventrolateral funiculus at or near the injured site. Electrophysiological and histological findings were in good agreement with the behavioral ones. Behavioral studies seem useful for evaluating the function of the spinal cord, especially for assessing the injured system in the spinal cord.