Neck Extension Research Articles

The Relationship of Anthropometric and Physical Performance Characteristics on Competitive Success in Amateur, Elite, and Professional Rodeo Athletes.

Oranchuk, DJ, Gullett, LK, Kicia, M, Thome, B, and Game, A. The relationship of anthropometric and physical performance characteristics on competitive success in amateur, elite, and professional rodeo athletes. J Strength Cond Res 37(7): 1495-1506, 2023-Reference anthropometric and physical performance qualities can improve understanding of sporting needs and streamline preparation and rehabilitation programs. However, these data and their relationships with competitive success are absent in rodeo athletes. We hypothesized that riding performance would be most correlated with hip adductor, neck, and grip strength, whereas jump, reactive strength index (RSI), and change of direction abilities would best predict bull-fighting performance. Forty-three amateur ( n = 9), professional ( n = 23), or internationally ranked ( n = 11) male rodeo athletes (bareback = 9, bull riders = 16, saddle bronc = 7, bullfighters = 11) (26.8 ± 5.6 years) volunteered for this study. Anthropometrics included body mass, height, and body fat percentage. Performance measures included isometric hip adduction and abduction, neck flexion and extension, handgrip strength, squat and countermovement jump heights, eccentric utilization ratio, reactive strength index, change of direction, bike sprints, and several pneumatic power measures. Bullfighters were taller and heavier than bull riders (effect size [ES] = 0.84-0.87, p = 0.008-0.017). Bull riders were leaner than bullfighters (ES = 0.74, p = 0.012). Fighters had greater RSI than riders (ES = 0.73-1.47, p < 0.001-0.030). Competitive level of rodeo riders ( n = 32) correlated with age, rodeo experience (ρ = 0.37-0.43, p = 0.013-0.049), bent-leg abduction (ρ = 0.43, p = 0.014), straight-leg hip adduction and abduction (ρ = 0.49-0.56, p < 0.001-0.005), neck flexion force (ρ = 0.43, p = 0.016), and rotational power (ρ = 0.50, p = 0.004). The competitive level of the fighters correlated with age (ρ = 0.64, p = 0.036) and time trial performance (ρ = -0.76, p = 0.006). This is the first study providing normative and correlational strength and power performance data in a rodeo population. These data highlight the need for more event-specific physical preparation. Riders should focus their physical preparation on hip and neck strength and rotational power. Bullfighters should prioritize stiffness and anaerobic power.

A REVIEW OF THE POSTERIOR ASPECT OF GREEVA SHARIR AND ITS IMPORTANCE

Nowadays, many people complain about cervical pain. Everyone is busy with work, which requires long sitting hours and improper posture. The use of mobile and laptops is increasing nowadays. Because of all these reasons, cervical region diseases are increasing in the community. Greeva is called “Uttamang” in Ayurveda. The posterior aspect of greeva contains various structures. It is a complex structure of bones, muscles, vessels, nerves, ligaments, and tendons. It contains the important structure of bone, i.e., cervical vertebrae. They give neck structure, support the head and provide a wide range of neck movement. It also contains various intervertebral joints, which offer movements like flexion, extension, and lateral neck rotation. The cervical spine contains intervertebral discs, which act as shock absorbers to the demands positioned on the spine. They also provide a cushion between the vertebrae during weight-bearing activities. Many muscles are present in the cervical region; not all are attached to the spine, but many do. Krukatika marma is located on the posterior region of the greeva at the junction of the head and neck. Injury to this marma causes ‘Chala Moordhata’, i.e., instability of the head. The neck is covered by numerous muscles which allow a lot of different movements of the head. These muscles contain many tiny and elastic fibres. The complaints we see in everyday life are spasms, strain, headache, and numbness in the neck region. All these complaints are associated with injury to neck muscles. Many vital structures in the posterior of the greeva make it an important topic for study.

Neck strength and force in reaction time task of adolescent athletes with and without concussion history: A pilot study

ObjectivesAssess the impact of concussion by comparing reaction time, peak force recruitment, and rate of force development of adolescent athletes returning from concussion against age- and sex-matched controls in visual-elicited neck movement. DesignAthletes sat secured in a custom-built isometric device with their heads secured in a helmet and attached to a 6-axis load cell. They performed neck flexion, extension, and lateral flexion in response to a visual cue. Three trials in each direction were used for statistical analyses; peak force and rate of force development were normalized against athlete mass. SettingLaboratory. Participants26 adolescent/young adult athletes (8F/18M), either recently concussed (and cleared for return to sport) or an age- and sex-matched healthy control. Main outcome measuresReaction time, angle, standard deviation of angle, deviation from target angle, peak force, and RFD over 50, 100, 150,and 200 ms of movement were measured for each trial. ResultsConcussed athletes had decreased normalized peak force (P = 0.008) and rate of force development (P < 0.001–0.007). In neck extension, concussed athletes also had decreased movement precision (P = 0.012). ConclusionsConcussion is associated with alterations of neck biomechanics that decrease overall neck strength.

A modified finite element dummy model of Chinese adult male used for train collision simulations

ABSTRACT This work established a modified finite element (FE) dummy model representing the Chinese 50th percentile males through the whole segment scaling method, referring to the Total Human Model for Safety (THUMS-AM50) of European and American 50th percentile males. The head, neck, chest, abdomen, and knee-thigh-hip (KTH) of the modified model were validated, respectively, by the cadaver experimental results. Integrating the dummy models with a four-car marshalling train collision FE model, we analysed the dynamic response in terms of human body posture, head, and neck injuries of the Chinese 50th percentile males and the European and American 50th percentile males during the frontal train collision process. The corresponding simulation results fitted well with the experimental tests, indicating that the established modified model exerted great biological fidelity. Compared with European-American 50th percentile males, the Von-Mises stress, shear stress, maximum principal strain (MPS), and the cumulative strain damage measure CSDM0.15 of the brain in the Chinese 50th percentile males were approximately higher by 22.21%, 19.85%, 36.58%, and 47.55%, respectively. That meant the Chinese males might be at a higher risk of brain contusion and diffuse axonal injury (DAI) during the train collision. Meanwhile, the Chinese 50th percentile males had more severe neck extension, especially the maximum cervical vertebrae Von-Mises stress and neck injury predictor (Nij) were increased by 30.3% and 50%, respectively. The established modified model could provide a more accurate simulation for predicting the Chinese body injury response during the train collision.

Effect of head and neck positions on tracheal intubation using a McGRATH MAC video laryngoscope: A randomised, prospective study.

Different head and neck positions may affect video laryngoscopy in terms of laryngeal exposure, intubation difficulty, advancement of the tracheal tube into the glottis and the occurrence of palatopharyngeal mucosal injury. We investigated the effects of simple head extension, head elevation without head extension and the sniffing position on tracheal intubation using a McGRATH MAC video laryngoscope. A randomised, prospective study. Medical centre governed by a university tertiary hospital. A total of 174 patients undergoing general anaesthesia. Patients were randomly allocated to one of three groups: simple head extension (neck extension without a pillow), head elevation only (head elevation with a pillow of 7 cm and no neck extension) and sniffing position (head elevation with a pillow of 7 cm and neck extension). During tracheal intubation using a McGRATH MAC video laryngoscope in three different head and neck positions, we assessed intubation difficulty by several methods: a modified intubation difficulty scale score, time taken for tracheal intubation, glottic opening, number of intubation attempts, requirements for other manoeuvres (lifting force or laryngeal pressure) for laryngeal exposure and advancement of the tracheal tube into the glottis. The occurrence of palatopharyngeal mucosal injury was evaluated after tracheal intubation. Tracheal intubation was significantly easier in the head elevation group than in the simple head extension (P = 0.001) and sniffing positions (P = 0.011). Intubation difficulty did not differ significantly between the simple head extension and sniffing positions (P = 0.252). The time taken for intubation in the head elevation group was significantly shorter than that in the simple head extension group (P < 0.001). A lifting force or laryngeal pressure was required less frequently for tube advancement into the glottis in the head elevation group than in the simple head extension (P = 0.002) and sniffing position groups (P = 0.012). The need for a lifting force or laryngeal pressure for tube advancement into the glottis was not significantly different between the simple head extension and sniffing positions (P = 0.498). Palatopharyngeal mucosal injury occurred less frequently in the head elevation group than in the simple head extension group (P = 0.009). The head elevation position facilitated tracheal intubation using a McGRATH MAC video laryngoscope compared with a simple head extension or sniffing position. ClinicalTrials.gov (NCT05128968).

A Diagnostic Biomarker for Cervical Myelopathy Based on Dynamic Magnetic Resonance Imaging.

Multicenter prospective observational study. Diffusion tensor imaging in flexion extension improves the diagnosis of degenerative cervical myelopathy (DCM). We aimed to provide an imaging biomarker for the detection of DCM. DCM is the most common form of spinal cord dysfunction in adults; however, imaging surveillance for myelopathy remains poorly characterized. Symptomatic DCM patients were examined in maximum neck flexion-extension and neutral positions in a 3T-magnetic resonance imaging scanner and allocated to 2 groups: (1) Patients with visible intramedullary hyperintensity (IHIS) on T2-weighted imaging (IHIS+, n = 10); and (2) Patients without IHIS (IHIS-, n = 11). Range of motion, space available for the spinal cord, apparent diffusion coefficient (ADC), axial diffusivity (AD), radial diffusivity, and fractional anisotropy were measured and compared between the neck positions and between the groups as well as between control (C2/3) and pathologic segments. Significant differences between the control level (C2/3) and pathologic segments were appreciated for the IHIS+ group at neutral neck position in AD; at flexion in ADC and AD; and at neck extension in ADC, AD, and fractional anisotropy values. For the IHIS- group, significant differences between the control level (C2/3) and pathologic segments were found only for ADC values in neck extension. When comparing diffusion parameters between groups, radial diffusivity was significantly different in all 3 neck positions. Significant increases in ADC values between the control and pathologic segments were found for both groups in neck extension only. This may serve as a diagnostic tool to identify early changes in the spinal cord related to myelopathy to indicate potentially reversible spinal cord injury and support the indication for surgery in select circumstances.

Differences in spinal cord biomechanics after laminectomy, laminoplasty, and laminectomy with fusion for degenerative cervical myelopathy.

Spinal cord stress/strain during neck motion contributes to spinal cord dysfunction in degenerative cervical myelopathy (DCM), yet the effect of surgery on spinal cord biomechanics is unknown. It is expected that motion-preserving and fusion surgeries for DCM will have distinct effects on spinal cord biomechanics. The aim of this study was to compare changes in spinal cord biomechanics after laminectomy with fusion, laminectomy, and laminoplasty using a patient-specific finite element model (FEM) for DCM. A patient-specific FEM of the cervical spine and spinal cord was created using MRI from a subject with mild DCM. Multilevel laminectomy with fusion, laminectomy, and laminoplasty were simulated for DCM using the patient-specific FEM. Spinal cord von Mises stress and maximum principal strain during neck flexion-extension, lateral bending, and axial rotation were recorded. Segmental range of motion, intradiscal pressure, and capsular ligament strain were also measured. FEM outputs were calculated as a change with respect to the preoperative values and compared between the three models. Across the surgical levels, spinal cord stress increased after laminectomy for neck flexion (+50%), neck extension (+37.8%), and axial rotation (+23%). Similarly, spinal cord strain increased in neck extension (+118.4%) and axial rotation (+75.1%) after laminectomy. Laminoplasty was associated with greater spinal cord stress in neck flexion (+57.4%) and increased strain in lateral bending (+56.7%) and axial rotation (+20.9%). Compared with laminectomy and laminoplasty, spinal cord biomechanics for laminectomy with fusion revealed significantly reduced median extension stress (13.7 kPa vs 9.7 kPa, p = 0.03), lateral bending strain (0.01 vs 0.007, p = 0.007), axial rotation stress (3.7 kPa vs 2.1 kPa, p = 0.04), and axial rotation strain (0.017 vs 0.009, p = 0.04). Spinal cord strain decreased in neck flexion in all three models, yet spinal cord stress increased with neck flexion for laminectomy and laminoplasty. Changes in spinal cord biomechanics for laminoplasty parallel those for laminectomy with fusion except during neck flexion, lateral bending, and axial rotation. Compared with motion-preserving approaches such as laminectomy and laminoplasty, laminectomy with fusion was associated with the lowest spinal cord stress and strain in flexion-extension, lateral bending, and axial rotation of the neck.

MP26-12 A COMPARATIVE ANALYSIS OF ERGONOMIC RISK UTILIZING THE 4K-3D EXOSCOPE VERSUS STANDARD OPERATING MICROSCOPE FOR MALE FERTILITY MICROSURGERY

You have accessJournal of UrologyCME1 Apr 2023MP26-12 A COMPARATIVE ANALYSIS OF ERGONOMIC RISK UTILIZING THE 4K-3D EXOSCOPE VERSUS STANDARD OPERATING MICROSCOPE FOR MALE FERTILITY MICROSURGERY Nicholas Deebel, Rohit Reddy, Alexander Weber, Kevin Chu, Jesse Ory, Ryan Terlecki, and Ranjith Ramasamy Nicholas DeebelNicholas Deebel More articles by this author , Rohit ReddyRohit Reddy More articles by this author , Alexander WeberAlexander Weber More articles by this author , Kevin ChuKevin Chu More articles by this author , Jesse OryJesse Ory More articles by this author , Ryan TerleckiRyan Terlecki More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The standard operating microscope (OM) places microsurgeons in uncomfortable and risky positions. The 4K-3D exoscope lacks eyepieces allowing for a “heads up” posture. Additionally, surgeons may maintain a more “neutral” upper arm position. We aim to stratify ergonomic risk amongst infertility surgeons using the 4K-3D exoscope versus the OM with wearable technology. METHODS: The surgeon was calibrated with wearable sensor inertial measurement units (IMUs) on the head and upper arms. Each IMU contained an accelerometer, magnetometer, and gyroscope to measure surgeon joint angle change during microscopic procedures for male fertility. The validated modified rapid upper limb assessment was used to determine the proportion of time spent in ranges of risk. Categories 1-4 were assigned for the head and upper extremities (4= highest ergonomic risk) (Figure 1). Chi-squared analysis was used to test proportions. RESULTS: A total of 500 and 479 microsurgical minutes from 4K-3D exoscope and OM guided surgeries were analyzed. The 4K-3D exoscope significantly favored upper arm category 1 positioning compared to the OM (56.2% vs. 37.7%; p < 0.0001) (Figure 2). The OM exposed the surgeon to higher category 3 positioning (14.6% vs. 1.6%; p <0.0001). More time was spent with the neck “extended” using the 4K-3D exoscope (51.8% vs. 19.5%; p < 0.0001). During 4K-3D exoscope use, 67% of neck extension time was between 0-10 degrees (category 1). Only 1% of 4K-3D exoscope operative time was spent with the neck in the high-risk interval (category 4). When considering both neck extension and flexion, more time was spent in risk group 1 and 2 with the operating microscope (p < 0.0001). CONCLUSIONS: The 4K-3D exoscope offers favorable ergonomic positioning for the upper extremities which may reduce work stress related injury. More operative time was spent with the neck in mild extension with 4K-3D exoscope use. However, the OM favored longer operative times in low-risk neck ergonomic positions. Source of Funding: Investigator initiated funding from Olympus. NIH Grant R01 DK130991 and Clinician Scientist Development Grant from the ACS to RR © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e357 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Deebel More articles by this author Rohit Reddy More articles by this author Alexander Weber More articles by this author Kevin Chu More articles by this author Jesse Ory More articles by this author Ryan Terlecki More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF downloadLoading ...

The effects of an ergonomic chinrest among professional violin players. A biomechanical investigation in a randomised crossover design

This study aimed to compare violinists' upper body kinematics and muscle activity while playing with different supportive equipment: their usual chinrest (UC) or an ergonomic chinrest (EC), each mounted on the violin. Three-dimensional motion capture and electromyographic data were acquired from the upper body while 38 pain-free professional violinists performed an excerpt of a music piece. There were only minor differences between the two set-ups tested. The EC resulted in less left rotation of the head (3.3°), slightly more neck extension (1.3°) and less muscle activity (0.5–1.0 %MVE). However, the overall high static muscle activity (4–10 %MVE across all muscles) was maintained using EC. For both setups, the head posture was left-rotated >15°, ≤6° flexed and left-bent 90% of the time. The EC did not produce a substantial difference in biomechanical load. Instead, future studies may focus on aspects other than chinrest design to lower the static workload demands.

Radical prostatectomy findings in patients with locally aggressive Grade group 5 prostatic adenocarcinoma and negative limited or extended pelvic lymph node dissection

Current management options for high-risk prostate cancer (PCa) patients include radical prostatectomy with lymph node dissection and other local or systemic therapeutic approaches. However, there is paucity of data in the pathology literature on the radical prostatectomy findings in patients with locally aggressive Grade group 5 PCa with negative limited or extended lymph node dissection. A search was made through our Urologic Pathology files and consults of the senior author for patients who had radical prostatectomy specimens with locally aggressive Grade group 5 PCa and limited or extended lymph node dissection from 2010 to 2022. Patients with lymph node metastasis were excluded. Clinicopathologic and follow up data were obtained. Forty-two patients were included in the study. Mean age was 64 years (range: 49–79 years). Forty-one (98 %) patients had PCa Gleason score 4 + 5 = 9 and 1 (2 %) patient had Gleason score 5 + 4 = 9. Extraprostatic extension and/or bladder neck invasion was present in 30 (71 %) patients and seminal vesicle invasion was present in 20 (48 %) patients, of which 10 (50 %) were bilateral. Extended lymph node dissection was performed in 18 patients with mean of 22 lymph nodes (range: 6–51 lymph nodes). Limited lymph node dissection was performed in 24 patients with mean of 7 lymph nodes (range: 2–25 lymph nodes). This study demonstrates that a subset of patients with very advanced/high grade PCa still benefit from radical prostatectomy/tumor debulking even in the setting of positive margins, and may not have lymph node metastasis.

Airway assessment: Predictors for difficult intubation – A prospective observational study

Airway management remains an important challenge in the contemporary practice of anaesthesia and preoperative airway assessment facilitates appropriate preparation when difficulty with intubation or ventilation is anticipated prior to induction of anaesthesia.: Aim: To study the important predictors for difficult laryngeal intubation. To determine the predictors of difficult laryngeal intubation. Secondary: To determine the most significant predictor for difficult intubation and to determine the incidence of unanticipated difficult intubation.This single centre prospective observational study done in Bangalore Baptist hospital (after obtaining clearance from ethical committee) included adult patients posted for elective surgeries who received general anaesthesia. Patients of either gender in the 18 – 65 year age group, with an American Society of Anaesthesiologists physical status classification of I or II, who required endotracheal intubation for general anaesthesia. The sample size was 413 with confidence level 95%. In our study the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Mallampati class were found to be 75.8%, 78.06%, 37.90%, 94.80% respectively. The sensitivity, specificity, PPV and NPV of mouth opening were found to be 33.87%, 81.19%, 24.13%, 87.42% respectively. The sensitivity, specificity, PPV and NPV of upper lip bite test found to be 27.41%, 96.29%, 56.66%, 88.25% respectively. The sensitivity, specificity, PPV and NPV of neck extension found to be 54.83%, 92.59%, 56.66%, 92.06% respectively. The sensitivity, specificity, PPV and NPV of BMI found to be 53.22%, 75.49%, 27.73%, 90.13% respectively. The incidence of difficult intubation was 15%.:In conclusion, no single predictor is sufficient for prediction of difficult intubation on its own. All the studied bedside tests are poor to moderate predictors of difficult intubation. All the tests showed poor positive predictive values and high negative predictive values which suggests that they can be more useful predictors of easy intubation than difficult intubation.

Laminoplasty is relevant for degenerative cervical spondylolisthesis when there is little risk of postoperative excessive kyphosis during neck flexion

BackgroundElderly patients with degenerative cervical myelopathy frequently have severe symptoms due to spondylolisthesis. The effectiveness of laminoplasty for degenerative cervical spondylolisthesis (DCS) is an important question. ObjectiveThe aim of this study is to elucidate factors associated with the outcome of laminoplasty for DCS. MethodEighty-nine patients with cervical spondylotic myelopathy (CSM) who underwent laminoplasty without instrumented posterior fusion were enrolled. Positive spondylolisthesis was defined as more than 2 mm during neck flexion or extension, from this, 46 DCS cases and 43 non-DCS cases were classified.Radiological parameters, including cervical alignment, balance, range of motion, and slippage along with the Japanese Orthopedic Association (JOA) score, were obtained before and 1 year after surgery. Factors associated with good surgical outcomes for DCS were analyzed using multivariate logistic analysis. ResultsThere were no significant differences in background and preoperative JOA score, but the DCS group recovery rate was significantly less (42% vs 53%). Multivariate logistic analysis revealed only the postoperative C2-7 angle during neck flexion was associated with a favorable outcome for DCS (P = 0.0039, Odds ratio: 1.49, 95% CI: 1.14–1.94). Multivariate regression analysis positively correlated the preoperative C2-7 angle in neutral and during flexion with the postoperative C2-7 angle during flexion. ConclusionThe major factor related to poor outcome was the magnitude of postoperative kyphotic C2-7 angle during neck flexion. Slippage was not directly related to outcome and postoperative cervical alignment. Caution is recommended for surgeons performing laminoplasty on patients with risk factors for postoperative excessive kyphotic C2-7 angle during flexion.

Clinical and Radiological Characteristics of Cervical Spondylotic Myelopathy in Young Adults: A Retrospective Case Series of Patients under Age 30.

Background and Objectives: Cervical spondylotic myelopathy (CSM) is a degenerative disease and occurs more frequently with age. In fact, the development of non-herniated CSM under age 30 is uncommon. Therefore, a retrospective case series was designed to clarify clinical and radiological characteristics of young adult patients with CSM under age 30. Materials and Methods: A total of seven patients, all men, with non-herniated, degenerative CSM under age 30 were retrieved from the medical records of 2598 hospitalized CSM patients (0.27%). Patient demographics and backgrounds were assessed. The sagittal alignment, congenital canal stenosis, dynamic canal stenosis, and vertebral slips in the cervical spine were radiographically evaluated. The presence of degenerative discs, intramedullary high-signal intensity lesions, and sagittal spinal cord compression on T2-weighted magnetic resonance images (MRIs) and axial spinal cord deformity on T1-weighted MRIs was identified. Results: All patients (100.0%) had relatively high daily sports activities and/or jobs requiring frequent neck extension. Cervical spine radiographs revealed the sagittal alignment as the "reverse-sigmoid" type in 57.1% of patients and "straight" type in 28.6%. All patients (100.0%) presented congenital cervical stenosis with the canal diameter ≤12 mm and/or Torg-Pavlov ratio <0.80. Furthermore, all patients (100.0%) developed dynamic stenosis with the canal diameter ≤12 mm and/or posterior vertebral slip ≥2 mm at the neurologically responsible segment in full-extension position. In MRI examination, all discs at the neurologically responsible level (100.0%) were degenerative. Intramedullary abnormal intensity lesions were detected in 85.7% of patients, which were all at the neurologically responsible disc level. Conclusions: Patients with non-herniated, degenerative CSM under age 30 are rare but more common in men with mild sagittal "reverse-sigmoid" or "straight" deformity and congenital canal stenosis. Relatively high daily activities, accumulating neck stress, can cause an early development of intervertebral disc degeneration and dynamic canal stenosis, leading to CSM in young adults.

Management of dynamic cervical kyphosis with dorsal epidural lipomatosis: a Hirayama disease variant? Illustrative case.

Hirayama disease, a cervical myelopathy characterized most commonly by a self-limiting atrophic weakness of the upper extremities, is a rare entity, scarcely reported in the literature. Diagnosis is made by spinal magnetic resonance imaging (MRI), which typically shows loss of normal cervical lordosis, anterior displacement of the cord during flexion, and a large epidural cervical fat pad. Treatment options include observation or cervical immobilization by collar or surgical decompression and fusion. Here, the authors report an unusual case of a Hirayama-like disease in a young White male athlete who presented with rapidly progressive paresthesia in all 4 extremities and no weakness. Imaging showed characteristic findings of Hirayama disease as well as worsened cervical kyphosis and spinal cord compression in cervical neck extension, which has not previously been reported. Two-level anterior cervical discectomy and fusion and posterior spinal fusion improved both cervical kyphosis on extension and symptoms. Given the disease's self-limiting nature, and a lack of current reporting, there remains no consensus on how to manage these patients. Such findings presented here demonstrate the potentially heterogeneous MRI findings that can be observed in Hirayama disease and emphasize the utility of aggressive surgical management in young, active patients whereby a cervical collar may not be tolerated.

An Optical Intervention to Improve Cycling Time Trials: A Feasibility Study

(1) Background: Many professional and recreational cyclists experience that neck extension in time trial position negatively impacts either speed, comfort, or power production—especially at high cycling speeds or for long distances. We conducted a feasibility study with one subject to assess whether redirecting the sight of a cyclist while in time trial position could reduce aerodynamic drag and neck strain by maintaining a more neutral neck position. (2) Methods: A physical immersive exercise bike was developed (called a FAAST-trainer) that emulates posture, velocity, and power to be delivered by the user through an adaptable power load adjusted in real time. As an optical intervention, we used prism glasses to redirect the cyclist’s sight. The subject trained his perceptive-muscular system while cycling on the FAAST-trainer to get used to wearing prism glasses. He feels confident that the glasses are safe to test for future experiments in a velodrome. (3) Results: A consistent reduction in drag was found (p &lt; 001) when wearing prism glasses with the FAAST-trainer, ranging from 3.5% to 4.7%. Accordingly, the cyclist could thus save between 9.7 watts and 13.0 watts cycling at 45 km/h, compared to having his head in an upright position. (4) Conclusions: Our experiment on the FAAST-trainer indicates that an optical intervention to reduce neck extension by redirecting sight might be safe to use for outdoor cycling. However, no vestibular effects, neither auditive nor complex combinations, were assessed, so we recommend additional research and development of a dedicated design for the prism glasses. Outdoor experiments should be conducted to confirm this reduction in aerodynamic drag and further asses the safety when wearing prism glasses.

Reducing the Risk of Spinal Cord Injury in Patients With Asymptomatic Cervical Stenosis Undergoing Cardiac and Vascular Surgery

NECK HYPEREXTENSION is used commonly during surgical positioning to provide optimal anatomic positioning and exposure. Iatrogenic tetraplegia has been reported in patients with asymptomatic cervical stenosis after prolonged neck extension during cardiac and noncardiac surgeries. Standardized protocols to screen patients for underlying degenerative cervical disease, such as cervical spondylotic myelopathy or cervical stenosis, have been shown to alter perioperative decision-making. 1 Diaz A Chin C Burks SS et al. A retrospective pilot study for preoperative screening to prevent iatrogenic cervical spinal cord injury. Cureus. 2021; 13: e12550 PubMed Google Scholar Here, the authors present the case of a patient with a significant risk of intraoperative spinal cord injury during combined cardiac and vascular surgery, which was managed successfully without complication. They discuss the pathophysiology, prevention, and treatment of this devastating complication.

Effects of Functional Electrical Stimulation with and without Kinesiotherapy on Pain, Range of Motion and Quality of Life in Patients with Cervical Dystonia; A Randomized Clinical Trial

Methods: This study was a Randomized Controlled Trial conducted at The University of Lahore Teaching Hospital, University Institute of Physical Therapy, Lahore. n= 84 patients with Cervical Dystonia were recruited in this study using non- probability convenient sampling technique. Patients suffering with Cervical Dystonia who aged between 30 till 50 years were randomly assigned into two groups, 42 patients in each group. First Group A which was the control group which was treated with Functional Electrical Stimulation and routine physical therapy only while Group B was the Experimental group which was treated with Functional Electrical Stimulation also with kinesiotherapy and routine physical therapy. Both the groups were evaluated and assessed using the Toronto Western Spasmodic Torticollis Rating Scale, the Pain Numerating Scale, the 36- item short form health survey( SF-36), Neck Disability index and range of motion of neck flexion, neck extension and neck rotation was measured using universal goniometer. Results: Functional Electrical Stimulation combined with kinesiotherapy given to the experimental group showed more improvement in range of motion, quality of life , functional disability and the symptom of the pain also was reduced in the experimental group as compared to the control group. The mean values showed that there was a statistically significant difference in different variables between both the groups. When the scores( scores at baseline and at 16th week) for Toronto Western Spasmodic Torticollis Rating Scale for both the groups were compared it showed statistical difference between both the groups(p&lt;0.05). Conclusion: Despite the fact that cervical dystonia has central neurological etiology, this study concludes that multimodal kinesiotherapy program which included stretching and relaxation, active exercises in addition to Functional Electrical Stimulation and Routine Physical Therapy tempts to have beneficial effects on a patient suffering from Cervical Dystonia. It showed beneficial effects on pain, quality of life, functional disability and range of motion of patients with cervical dystonia. Key Words: Functional Electrical Stimulation, Kinesiotherapy, Cervical Dystonia, Pain, Rang of Motion, Quality of life

Effectiveness of Manual Therapy Versus Electrotherapy in Patients with Neck Pain Due to Poor Posture –A non-randomized trial

Background: Neck pain has become increasingly common in families and individuals. Due to prolong bending of cervical spine the following structure are compromised shoulders , scapular, thoracic spine that leads to flexion deformity of upper segment and extension deformity of lower cervical spine. The overuse of the muscles causes muscular imbalances.&#x0D; Objective: The main objective of this study was to determine the comparative effectiveness of manual therapy versus electrotherapy in patients with neck pain due to poor posture.&#x0D; Methodology: The data was collected from different Physiotherapy Clinics of Lahore. The study was completed in four months after the approval. The sample size was 40 participants. The participant’s male and females patients, age range 18-45 years. Numeric Pain rating score of 3 from last 3 months with forward head posture were included. In group a manual therapy (Post-isometric stretching, Jones technique) were used. .A portable digital TENS model BE-660 was used with frequency 80Hz, intensity level 6(strong but comfortable) in Group B. Outcome was assessed using Numeric pain rating, Goniometry and Neck disability index (NDI). The data was analyzed using SPSS Version 16. Paired t test and independent sample t test was used for within and between group analysis.&#x0D; Results: In group A 6(30%) were underweight and 2(10%) were overweight whereas in group B 10(50%) were under weight and 1(5%) was obese with a mean age of 29.5±8.23. This study showed that study variables were not statistically significant at the time of baseline. In both groups, pre post mean difference of pain, neck disability index, neck flexion (and neck extension was statistically significant. The mean value of pain and neck disability index of both groups were statistically significant at the end of study&#x0D; Conclusion: The current study shown that both treatment strategies including manual therapy and electrotherapy play a significant role in treating the patients with chronic neck pain due to poor posture.&#x0D; Key words: Manual therapy, Electrotherapy, Patients, Neck pain, Posture, Exercise, Neck disability, Range of Motion

The versatility of the transnasal sphenopalatine ganglion block.

Dear Editor, We read with great interest the article by Ferjani et al.1 on how a patient’s headache from a postoperative spinal dural tear was successfully relieved with a bilateral transnasal sphenopalatine ganglion block. This is a simple and valuable technique that was discovered in 1908, but few anesthesiology or pain physicians are familiar with the block and its versatility. Intranasal devices for the administration of the transnasal sphenopalatine ganglion block are available but are expensive and might not be readily available at all institutions. To safely and inexpensively perform the transnasal sphenopalatine ganglion block to treat headaches and also extend the treatment to other types of pain, we have created our own device from supplies that are readily accessible in most medical facilities. For our transnasal sphenopalatine ganglion block applicator, we attached a 3-mL syringe (filled with 4% lidocaine hydrochloride solution) to one side of intravenous extension tubing with a stopcock, and we attached a hollow cotton swab dipped into 5% lidocaine ointment to the other side of the tubing. The patients position themselves supine with neck extension and hemodynamic monitoring. The applicator is gently advanced perpendicular to the patient’s nostril until the tip reaches the back of the nasal pharynx and gentle resistance is met. Lidocaine 4% is administered slowly under low pressure through the cotton-tipped applicator until the medication is felt in the back of the throat. A second applicator is then inserted into the opposite nostril, and the medication is administered as before. Symptoms are evaluated 15 minutes after insertion. If the symptoms are not sufficiently relieved, this procedure is repeated up to 2 more times. In our experience, this transnasal sphenopalatine ganglion block has successfully relieved the pain amenable to sphenopalatine ganglion blockade; importantly, this approach has not had a technical failure.

Steady-state cerebral blood flow and dynamic cerebral autoregulation during neck flexion and extension in seated healthy young adults.

Neck flexion and extension show differences in various physiological factors, such as sympathetic nerve activity and intracranial pressure (ICP). We hypothesized that differences would exist in steady-state cerebral blood flow and dynamic cerebral autoregulation between neck flexion and extension in seated, healthy young adults. Fifteen healthy adults were studied in the sitting position. Data were collected during neck flexion and extension in random order for 6min each on the same day. Arterial pressure at the heart level was measured using a cuff sphygmomanometer. Mean arterial pressure at the middle cerebral artery (MCA) level (MAPMCA ) was calculated by subtracting the hydrostatic pressure difference between heart and MCA levels from mean arterial pressure at the heart level. Non-invasive cerebral perfusion pressure (nCPP) was estimated as the MAPMCA minus the non-invasive ICP as determined from transcranial Doppler ultrasonography. Waveforms of arterial pressure in the finger and blood velocity in the MCA (MCAv) were obtained. Dynamic cerebral autoregulation was evaluated by transfer function analysis between these waveforms. The results showed that nCPP was significantly higher during neck flexion than during neck extension (p=0.004). However, no significant differences were observed in mean MCAv (p=0.752). Likewise, no significant differences were observed in any of the three indices of dynamic cerebral autoregulation in any frequency range. Although non-invasively estimated cerebral perfusion pressure was significantly higher during neck flexion than during neck extension, no differences in steady-state cerebral blood flow or dynamic cerebral autoregulation were evident between neck flexion and extension in seated healthy adults.