Neck Extension Research Articles

The effect of home exercises with kinesiotaping on pain, functionality, and work performance in bus drivers with non-specific neck pain.

Clinical research on the management and rehabilitation of work-related upper spinal pain in bus drivers is sparse, indicating a gap in knowledge and treatment strategies. This highlights the growing need for innovative approaches to rehabilitation programs in this area. To examine the effects of kinesio taping (KT) on pain, functionality, and work performance in bus drivers experiencing neck pain. The study involved 44 participants who were randomised into two different groups: the exercise group (n= 22) and the kinesio tape group (n= 22), with participants in both groups undertaking exercise interventions. Evaluations were made before and after 6 weeks of treatment. At the end of the 6-week, the participants' ROM, pain evaluations and functional scales were evaluated with disability, and work functionality. Neck pain severity decreased in both groups (p< 0.001 for each value), but there was no difference between the groups (p: 0.071). When disability scores were evaluated, improvement was noted in both groups (p: 0.001 for each value), but no statistically significant difference was found (p: 0.754). When the improvements in ROM values before and after the treatment were examined, the difference between the groups was recorded only in the neck extension ROM value (p: 0.011). Significant improvement was noted in all sub-steps of job performance in both groups (p< 0.05). KT added to ergonomic training and home exercise programmes is effective in controlling work-related musculoskeletal pain in drivers with neck pain. However, the addition of KT to exercise therapy was found to be no more effective than exercise therapy alone in improving pain control, functionality and work performance.

Comparison of Routine Preoperative Ultrasound-Guided Airway Examination Versus Clinical Airway Examination in Predicting Difficult Laryngoscopy in Patients Coming for Elective Surgery: An Observational Study.

Background As part of preoperative patient evaluations, it is customary to estimate the likelihood of difficulties during laryngoscopy and intubation. A diverse array of predictors is frequently employed by anesthesiologists to anticipate difficult laryngoscopy (DL); however, no single predictor has been established as the gold standard. In the present study, we compared routine preoperative ultrasound-guided airway examination and clinical airway examination in predicting DL in patients coming for elective surgery. Methodology The present study is a single-blinded observational study that spanned 12 months, beginning in March 2018 and concluding in February 2019. The study took place at Kovai Medical Center and Hospital (KMCH), which is a tertiary-care facility in Coimbatore, India. The data were obtained through face-to-face interviews, with a sample size of 135 research participants. The questionnaire contained comprehensive data regarding the patient's age, weight, gender, comorbidities, planned surgery, and preoperative assessment, which encompassed a detailed examination of the airway. The clinical airway examination comprised assessing mouth opening, performing the modified Mallampati test, measuring thyromental height (TMH) and thyromental distance (TMD), evaluating neck circumference, and observing neck extension. Ultrasound-guided airway examination was performed during the immediate pre-operative period, focusing on specific parameters such as the pre-epiglottic space, anterior neck soft tissue at the level of vocal cords, thyrohyoid membrane, suprasternal notch, hyoid bone (single parameter measured at different levels), hyo-mental ratio, and tongue volume (TV). Results Among the ultrasound parameters, TV (72.15 cm3) is the best ultrasound parameter to predict DL (95%CI: 0.65 to 0.82), with a high sensitivity of 82% and specificity of 45.88%. Other parameters that are useful are anterior neck soft tissue at the level of the thyrohyoid membrane (0.67 cm), suprasternal notch (1.01 cm), and, lastly, pre-epiglottic space (0.57 cm). Among clinical parameters, modified Mallampati grade (grade 3 or more) is the best parameter to assess the airway clinically and predict DL, followed by neck circumference (>42 cm) and TMH (>5 cm). Based on the findings, we observed that both clinical and ultrasound parameters are comparable to predict DL. Conclusion We observed that routine clinical airway examination and ultrasound examination yielded comparable results in predicting DL. Therefore, the routine use of clinical airway examination still holds good in predicting DL.

Graviception Uncertainty, Spatial Anxiety, and Derealization in Patients with Persistent Postural-Perceptual Dizziness

Objectives: Persistent Postural-Perceptual Dizziness (PPPD) is a frequent diagnosis in patients with chronic dizziness, ineffective postural control, visual dependence, and emotional symptoms. Methods: 53 patients with PPPD (25–84 years old) and 53 adults (29–84 years old) with no vestibular disease agreed to participate in this study. Assessments included: vestibular function tests (sinusoidal yaw rotation and vestibular-evoked myogenic potentials); accuracy and precision of Subjective Visual Vertical (SVV) estimation while static and during on-axis yaw rotation; static posturography with open/closed eyes and 30° neck extension, while standing on hard/soft surface; questionnaires on symptoms of unsteadiness, spatial anxiety, dizziness-related handicap, anxiety/depression, depersonalization/derealization, and perceived stress. After preliminary bivariate analyses, analysis of covariance was performed on the measurements of postural sway, spatial anxiety, and dizziness-related handicap (p &lt; 0.05). Results: Higher intraindividual variability (reduced precision) on SVV estimations was evident in patients with PPPD compared to adults with no vestibular disease, which was related to the length of postural sway, to velocity displacement in the sagittal plane, as well as to spatial anxiety and common mental symptoms (including depersonalization/derealization symptoms). Covariance analysis showed contribution of these factors to the dizziness-related handicap reported by the patients. Conclusions: Unprecise graviception could be a contributing factor to the postural instability and mental symptoms reported by patients with PPPD, which in turn contribute to their dizziness-related handicap.

A case of anterior mediastinal mature teratoma with severe inflammatory extension into the neck

BackgroundWe present the case of a rare occurrence of an anterior mediastinal mature teratoma extending into the neck, commonly referred to as a cervicothoracic mature teratoma.Case presentationA 19-year-old female presented with right-sided neck pain and swelling, which were found to be attributed to a 14 cm cystic lesion originating from the right thyroid lobe and extending into the mediastinum. A diagnosis of mediastinal teratoma with extension to the neck was made. Robot-assisted thymectomy was initiated but was complicated by dense tumor adherence to the superior vena cava and brachiocephalic veins, prompting a switch to a midline sternotomy. Simultaneous resection of the right thyroid lobe was performed due to inflammation. The transition to a midline sternotomy allowed successful excision of the tumor, which was confirmed to be a mature teratoma confined to the thoracic region. The patient's favorable postoperative course led to discharge on day 5 with no recurrence at nine months.ConclusionsEmphasizing the challenges and the importance of prompt intervention in the management of mediastinal teratomas with neck extension.

The avian vocal system: 3D reconstruction reveals upper vocal tract elongation during head motion.

While birds' impressive singing abilities are made possible by the syrinx, the upper vocal system (i.e., trachea, larynx, and beak) could also play a role in sound filtration. Yet, we still lack a clear understanding of the range of elongation this system can undertake, especially along the trachea. Here, we used biplanar cineradiography and X-ray Reconstruction of Moving Morphology (XROMM) to record 15 species of cadaveric birds from 9 different orders while an operator moved the bird's cadaveric heads in different directions. In all studied species, we found elongation of the trachea to be correlated with neck extension, and significantly greater (ranging from 18% to 48% for the whole motion; and from 1.4% to 15.7% for the singing positions) than previously reported on a live singing bird (3%). This elongation or compression was not always homogeneous along its entire length. Some specimens showed increased lengthening in the rostral part and others in both the rostral and caudal parts of the vocal tract. The diversity of elongation patterns shows that trachea elongation is more complex than previously thought. Since tracheal lengthening affects sound frequencies, our results contribute to our understanding of the mechanisms involved in complex communication signals, one of the amazing traits we share with birds.

Effective range of auditory frightening devices based on hearing capabilities and antipredator responses of nuisance blackbirds

AbstractA variety of acoustic strategies have been implemented to disperse wildlife from areas of human‐wildlife conflict. Propane cannons are a popular tool; however, their efficacy based on avian behavior has yet to be fully explored. We collected sound attenuation data for a propane cannon, compared to a rifle and shotgun, with reference to hearing capabilities in birds. We evaluated the behavioral responses of red‐winged blackbirds (Agelaius phoeniceus, RWBL) and brown‐headed cowbirds (Molothrus ater, BHCO) to detonations of a cannon. We placed birds in individual enclosures, void of visual stimuli, at 15–495 m from a cannon and evaluated responses (i.e., relaxed, vigilant, startled) to cannon blasts using 2 approaches: 1) incremental, where individual birds were exposed to a series of detonations at decreasing distances and 2) random assignment, where individual birds were randomly assigned distances and exposed to 2 series of 4 cannon blasts. We found behavioral responses of birds significantly decreased at greater distances (χ2(1) = 127, P &lt; 0.001), regardless of species (χ2(1) = 0.74, P = 0.389), when incrementally approached. The probability of startling (i.e., flinch, wing flap, feather compression, or flight) was greater than vigilance (i.e., increased head turning, sudden head‐up, or neck extension) within 64 m for BHCO and 136 m for RWBL. We found a significant effect of distance (χ2(1) = 97.8, P &lt; 0.001), between species (χ2(1) = 19.6, P &lt; 0.001), and blast number (χ2(3) = 17.6, P &lt; 0.001) when birds were randomly assigned a distance from the cannon. With the first cannon blast, the probability of startling was greater than vigilance or relaxed within 334 m for BHCO and 153 m for RWBL. With subsequent blasts the probability of startling was greater than vigilance and relaxed within 204–221 m of the cannon for BHCO, but startling was never greater than vigilance for RWBL. We note that the estimated range of the cannon is conservative given birds are contained with limited flight ability. Nevertheless, information on effective range and avian responses to repeated blasts informs managers on the potential interstimulus timing and distribution of propane cannons to protect resources from birds.

Measuring the outward migration of the nasotracheal tube at vocal cords with head and neck extension: a novel approach using a flexible bronchoscope in patients undergoing head and neck oncosurgery.

Head and neck extension achieves optimal surgical exposure during head and neck oncosurgeries. However, it can lead to cephalad migration of the tracheal tube, causing complications. Preventing shallow intubation is essential, especially in patients with difficult airway. Using an innovative technique, we aimed to measure the proximal migration of the nasotracheal tube at the vocal cords on neck extension in patients with difficult airway. We enrolled 60 adult patients undergoing head and neck oncosurgeries with a mouth opening of less than 1.5 cm. After nasotracheal intubation using a flexible bronchoscope (FB), the FB was introduced into the adjacent nostril and maneuvered to reach the glottis. The FB was used to view and align the intubation depth mark (IDM) on the tracheal tube (TT) with the vocal cords in the neutral position. The outward migration of the TT at the vocal cords with a 30° to 40° neck extension was measured using the same maneuver. Also, the TT tip-to-carina distance was noted in both neutral and extension using FB. The mean proximal migration of the TT at the vocal cords during neck extension was 3±0.3 mm. The TT tip-to-carina distance increased by a mean of 20±7 mm with extension. The proximal migration contributed 15%, whereas elongation of the trachea contributed 85% to this increase. The major contributing factor for the increase in TT tip-to-carina distance on neck extension was tracheal elongation rather than outward migration of the TT at vocal cords.

Firefighter helmets and cervical intervertebral Kinematics: An OpenSim-Based biomechanical study

The assessment of cervical intervertebral kinematics can serve as the basis for understanding any degenerative changes in the cervical spine due to the prolonged wear of a heavyweight, imbalanced firefighting helmet. Therefore, this study aimed to analyze cervical intervertebral kinematics using the OpenSim musculoskeletal modeling platform in order to provide much-needed insights into how the inertial properties of firefighter helmets affect cervical spinal mobility. A total of 36 firefighters (18 males and 18 females) were recruited to perform static and dynamic neck flexion, extension, and left and right lateral bending tasks for three conditions: 1) no-helmet, 2) US-style helmet with a comparatively superior center of mass (COM), and 3) European-style helmet with relatively higher mass but an inferior COM. Three custom-made OpenSim head-neck models were created to calculate cervical intervertebral kinematics for each helmet condition. Results showed that helmet use significantly (p < 0.001) affects neck and cervical spinal kinematics. Despite its lighter weight, the superior COM placement in the US-style helmet caused more pronounced angular changes and higher velocity of peak flexion and extension angles compared to the European-style helmet across all cervical joints. Moreover, results revealed discrepancies between OpenSim-derived neck and cervical range-of-motion and those reported in previous in-vivo studies. In conclusion, the present study underscores the importance of designing firefighter helmets with a lower profile (less superior COM) to enhance neck range of motion and minimize potential neck injuries.

Increasing neck extension strength may reduce concussion risk in adolescent athletes

Increasing neck extension strength may reduce concussion risk in adolescent athletes

Head-to-head comparison of GA-68 PSMA PET/CT and multiparametric MRI findings with postoperative results in preoperative locoregional staging and localization of prostate cancer.

Accurate staging of prostate cancer (PCa) is essential for determining the appropriate treatment and predicting outcomes. This study is comparing the effectiveness of Gallium-68 Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography (Ga-68 PSMA PET/CT) and multiparametric MRI (mpMRI) in preoperative locoregional staging and localizing PCa. A retrospective analysis was conducted on 78 patients who underwent both mpMRI and Ga-68 PSMA PET/CT scans before surgery. The imaging was reviewed by radiologists and nuclear medicine specialists and compared with the final histopathology, which was reviewed by an experienced uropathologist. mpMRI demonstrated higher sensitivity in detecting extraprostatic extension (EPE) and bladder neck invasion (BNI) compared to Ga-68 PSMA PET/CT (83% vs. 44% and 29% vs. 17%, respectively). Conversely, Ga-68 PSMA PET/CT showed higher sensitivity in detecting seminal vesicle invasion (SVI) and lymph node metastasis (LNM) (75% vs. 55% and 50% vs. 30%, respectively). When both methods were combined, sensitivity increased in detecting both EPE and SVI. The index tumor localization in mpMRI and Ga-68 PSMA PET/CT was found to be in complete agreement with histopathological findings at 36.4% and 41.8%, respectively. When both imaging methods were combined, the agreement with histopathology in predicting index tumor localization reached 72.1%. Both mpMRI and Ga-68 PSMA PET/CT provide valuable and complementary information for tumor localization and locoregional staging. While mpMRI showed higher sensitivity in detecting EPE, Ga-68 PSMA PET/CT demonstrated superior performance in detecting LNM and SVI. The combined use of these imaging modalities enhance accuracy of index tumor localizations.

Chest Tube Placement of Secondary Tracheoesophageal Voice Prosthesis: Overcoming Challenging Anatomy in the Laryngectomy Patient.

Introduction: Total laryngectomy is used to cure advanced larynx cancer in many patients. The removal of the larynx requires the rehabilitation of the patient's ability to communicate, and one common method is to place a tracheoesophageal voice prosthesis (TEP) as a secondary procedure after the patient has completed cancer treatment. The traditional technique utilizes a rigid esophagoscope for access, but this can prove difficult in many patients who have kyphosis, scarring of the neck, or trismus. We describe a technique to allow TEP placement in these challenging patients that does not utilize rigid esophagoscopy to access the tracheoesophageal puncture site. Methods: For more than 15 years, the senior authors of this study have used this technique in patients in whom traditional methods of TEP with rigid esophagoscope were unsuccessful or not attempted due to the anticipated high probability of failure. The ease of this technique has prompted its use for all patients undergoing secondary TEP placement in their practice. The technique is described in detail in the Methods section below. Results: The described method has been successfully utilized to place TEPs in many patients with challenging anatomy. There have been no failed placements, including a patient with severe trismus who was able to have a TEP placed by placing the chest tube and flexible endoscope transnasally. Further, because of precise visualization and ease of the technique, there have been no observed complications of injury to the pharyngoesophageal lumen or creation of a false passage. Conclusion: The use of a chest tube and flexible scope allows for the protection of the pharyngoesophageal lumen, precise visualization and placement of the puncture, and avoidance of a false tracheoesophageal passage, all while minimizing the need for extension of the patient's neck. This has proven ideal for patients suffering the consequences of cancer treatment such as cervical scarring, fibrosis, kyphosis, and trismus.

Effects of Integrating Jaw Opening and Closing Movements with Active Neck Exercises in the Management of Chronic Non-Specific Neck Pain: A Randomized Controlled Trial.

Background and Objectives: It has been seen that jaw opening is associated with neck extension and jaw closing is associated with neck flexion. This natural association between the jaw and neck can be used as a novel approach to treat chronic non-specific neck pain, although the effects of this concept have never been previously evaluated as a treatment strategy. This article intends to study the effects of integrating jaw opening and closing movements along with active neck exercises versus active neck exercises alone in the management of chronic non-specific neck pain. Materials and Methods: A total of 80 patients, aged 20 to 50, with chronic non-specific neck pain were included in a double-blind randomized controlled trial, conducted at the Sindh Institute of Physical Medicine and Rehabilitation, Karachi, Pakistan from 2018 to 2022. The patients were divided into two groups: Group A patients were assigned jaw movements with active neck exercises, while Group B patients were assigned only active neck exercises. Both groups were assigned isometric strengthening exercises and self-resisted strengthening exercises for cervical spine muscles as a home plan. The study used various outcome measures, including the numerical pain rating scale (NPRS), neck disability index (NDI), neck flexion endurance (NFE), neck extension endurance (NEE), the neck proprioception error (NPE): neck flexion proprioception error (NFPE), neck extension proprioception error (NEPE), neck right rotation proprioception error (NRRPE), and neck left rotation proprioception error (NLRPE), with measurements taken at week 1 and week 6, respectively; the mean differences between the groups were measured using a two-way repeated ANOVA. Results: The experimental group showed better improvements compared to the control group, NPRS (73%), NDI (57%), NFE (152%), NEE (83%), NFPE (58%), NEPE (65%), NRRPE (65%), and NLRPE (62%), with a significant difference (p < 0.05). Conclusions: Active neck extension and flexion movements combined with jaw opening and closing are more effective in reducing pain and disability, improving neck muscles endurance and normalizing neck proprioception in patients with chronic neck pain.

Effect of the intraoperative head hypsokinesis on sore throat after thyroid surgery: a randomized controlled trial.

Postoperative sore throat (POST) after thyroidectomy is a major concern.A roll is typically inserted under the shoulder to achieve head hypsokinesis and neck extension to better expose the surgical site during thyroid surgery. However, POST and impaired voice function have been attributed to neck overextension. This study aimed to explore the rational angle of head hypsokinesis that both reduced sore throat intensity and protects voice function after thyroid surgery. A total of 210 patients who underwent thyroidectomy were enrolled and randomized into high-tilt (Group H) and low-tilt angle groups (Group L). The primary outcome was the incidence of POST 6 h after surgery. Secondary outcomes included the severity of postoperative pharyngeal pain, voice function, swallowing pain, and coughing. The incidence of POST 6 h after thyroidectomy was significantly lower in Group L than that in Group H. In addition, the intensity of postoperative sore throat and swallowing pain was more severe in Group H. A lower degree of head hypsokinesis in Group L prevented transient postoperative voice injury. A lower degree of head hypsokinesis effectively mitigated sore throat severity after thyroidectomy and improved postoperative voice function. The trial was registered in the Chinese Clinical Trial Registry on 21 June 2022 (ChiCTR2200061329). The trial is registered at https://www.chictr.org.cn/showproj.html?proj=166254 .

The White Matter Fiber Tract Deforms Most in the Perpendicular Direction During In Vivo Volunteer Impacts.

White matter (WM) tract-related strains are increasingly used to quantify brain mechanical responses, but their dynamics in live human brains during invivo impact conditions remain largely unknown. Existing research primarily looked into the normal strain along the WM fiber tracts (i.e., tract-oriented normal strain), but it is rarely the case that the fiber tract only endures tract-oriented normal strain during impacts. In this study, we aim to extend the invivo measurement of WM fiber deformation by quantifying the normal strain perpendicular to the fiber tract (i.e., tract-perpendicular normal strain) and the shear strain along and perpendicular to the fiber tract (i.e., tract-oriented shear strain and tract-perpendicular shear strain, respectively). To achieve this, we combine the three-dimensional strain tensor from the tagged magnetic resonance imaging with the diffusion tensor imaging (DTI) from an open-access dataset, including 44 volunteer impacts under two head loading modes, i.e., neck rotations (N = 30) and neck extensions (N = 14). The strain tensor is rotated to the coordinate system with one axis aligned with DTI-revealed fiber orientation, and then four tract-related strain measures are calculated. The results show that tract-perpendicular normal strain peaks are the largest among the four strain types (p < 0.05, Friedman's test). The distribution of tract-related strains is affected by the head loading mode, of which laterally symmetric patterns with respect to the midsagittal plane are noted under neck extensions, but not under neck rotations. Our study presents a comprehensive invivo strain quantification toward a multifaceted understanding of WM dynamics. We find that the WM fiber tract deforms most in the perpendicular direction, illuminating new fundamentals of brain mechanics. The reported strain images can be used to evaluate the fidelity of computational head models, especially those intended to predict fiber deformation under noninjurious conditions.

Comprehensive Guide to Transoral Endoscopic Thyroidectomy Vestibular Approach: Step-by-Step Technique

AbstractTransoral endoscopic thyroidectomy vestibular approach (TOETVA) is a minimally invasive surgical technique that offers safety comparable to conventional open thyroidectomy, with the added benefit of superior cosmetic outcomes due to the absence of visible scars. This innovative approach is gaining popularity worldwide as an alternative for patients seeking thyroid surgery without postoperative scarring. TOETVA involves positioning the patient supine with slight neck extension under general anesthesia. The procedure uses three trocars placed via midline and lateral incisions, with a 10-mm 30-degree laparoscope for visualization. Preoperative care includes cleaning the surgical area and administering intravenous antibiotics to prevent infection. The technique mirrors conventional thyroidectomy but utilizes standard laparoscopic instruments. It emphasizes the precise identification and preservation of critical anatomical structures, such as the cricoid cartilage, thyroid isthmus, trachea, carotid artery, superior laryngeal nerve, and recurrent laryngeal nerve. The use of an energy device and careful dissection help minimize bleeding and reduce nerve injury risks. Superior pole management and meticulous handling of the thyroid lobe ensures optimal outcomes. The growing popularity of TOETVA indicates a shift toward minimally invasive thyroid surgery, with TOETVA emerging as a leading method. This paper provides a comprehensive overview of the procedure, highlighting its benefits and critical aspects of its successful implementation.

AN EXPLORATION OF MOVEMENT AND HANDLING BY PHYSIOTHERAPISTS IN A REHABILITATION SETTING: A MOTION ANALYSIS STUDY

Purpose and BackgroundWork-related musculoskeletal disorders (WRMSD) can affect 56–80% of physiotherapists. Patient handling is reported as a significant risk factor for developing WRMSD with the back most frequently injured. Physiotherapists perform therapeutic handling to manually assist and facilitate patients’ movement to aid rehabilitation, which can increase physiotherapists risk of experiencing high forces during patient handling.Methods and ResultsA descriptive cross-sectional study was completed to explore and quantitatively measure the movement of ten physiotherapists during patient handling, over one working day, in a neurological setting. A wearable 3-dimensional motion analysis system, Xsens (Movella, Henderson, NV), was used to measure physiotherapist movement and postures in the ward setting during patient treatment sessions. The resulting joint angles were reported descriptively and compared against a frequently used ergonomic assessment tool, the Rapid Upper Limb Assessment (RULA).Physiotherapists adopted four main positions during patient handling tasks: 1) kneeling; 2) half-kneeling; 3) standing; and 4) sitting. Eight patient handling tasks were identified and described: 1) Lie-to-sit; 2) sit-to-lie; 3) sit-to-stand; facilitation of 4) upper limb; 5) lower limb; 6) trunk; and 7) standing treatments; and 8) walking facilitation. Kneeling and sitting positions demonstrated greater neck extension and greater lumbosacral flexion during treatments which scores highly with the RULA.ConclusionThis research identified that patient treatment tasks were more often performed in kneeling or sitting positions than standing. Current moving and handling guidance teaches moving and handling in a standing position; loading and stresses experienced by the physiotherapists may differ in sitting or kneeling positions.Conflicts of interestNoneSources of fundingNoneThis work has been presented as a poster at the CSP conference Glasgow 2023.

Between-Session Reliability of Field-Based Assessments of Isometric Neck Strength.

The reliability of the fixed-frame dynamometer for measuring isometric neck strength is established, but with limited field-based applications. This study aimed to establish the inter- and intra-session reliability of the peak force for neck flexors, extensors, and side flexors using the VALD ForceFrame and DynaMo and the force-time characteristics in the quadruped position (ForceFrame). Twenty-seven recreationally active males performed three repetitions of isometric neck flexion, extension, and side flexion over two sessions in random order using the VALD ForceFrame and DynaMo. Both devices demonstrated acceptable reliability, with the Forceframe ICC > 0.8 and CV% < 13.8% and the DynaMo ICC > 0.76 and CV% < 13.8%. No systematic or proportional differences were found using the Passing-Bablock procedure, and Bland-Altman analysis confirmed agreement across measures. Reliability was shown for right-side (ICC > 0.76) and left-side (ICC > 0.79) flexion and flexion (ICC > 0.75) across 50, 100, 150, and 200 ms. Statistical parametric mapping indicated no differences in ForceFrame-generated isometric force-time curves between sessions, though the CV was highest in the force development phase. The findings suggest that both tools can reliably assess neck strength, supporting their use in sports and clinical settings. However, assessment methods are not interchangeable, emphasising the need for standardised neck strength assessment approaches.

Difficult Airway Prediction in Infants with Apparently Normal Face and Neck Features.

Background/Objectives: Prediction of a difficult airway during pre-anesthetic evaluation is of great importance because it enables an adequate anesthetic approach and airway management. As there is a scarcity of prospective studies evaluating the role of anthropometric measures of the face and neck in predicting difficult airways in infants with an apparently normal airway, we aimed to identify the aforementioned predictors of difficult facemask ventilation and intubation in infants. Methods: A prospective, observational study that included 97 infants requiring general endotracheal anesthesia was conducted. Anthropometric and specific facial measurements were obtained before ventilation and intubation. Results: The incidence of difficult facemask ventilation was 15.5% and 38.1% for difficult intubation. SMD (sternomental distance), TMA (tragus-to-mouth angle distance), NL (neck length) and mouth opening were significantly lower in the difficult facemask ventilation group. HMDn (hyomental distance in neutral head position), HMDe (hyomental distance in neck extension), TMD (thyromental distance), SMD, mandibular development and mouth opening were significantly different in the intubation difficulty group compared to the non-difficult group. HMDn and HMDe showed significantly greater specificities for difficult intubation (83.8% and 76.7%, respectively), while higher sensitivities were observed in TMD, SMD and RHSMD (ratio of height to SMD) (89.2%, 75.7%, and 70.3%, respectively). Regarding difficult facemask ventilation, TMA showed greater sensitivity (86.7%) and SMD showed greater specificity (80%) compared to other anthropometric parameters. In a multivariate model, BMI (body mass index), COPUR (Colorado Pediatric Airway Score), BOV (best oropharyngeal view) and TMA were found to be independent predictors of difficult intubation, while BMI, ASA (The American Society Physical Status Classification System), CL (Cormack-Lehane Score), TMA and SMD predicted difficult facemask ventilation. Conclusions: Preoperative airway assessment is of great importance for ventilation and intubation. Patient's overall condition and facial measurements can be used as predictors of difficult intubation and ventilation.

Effect of sagittal alignment on spinal cord biomechanics in the stenotic cervical spine during neck flexion and extension.

Spinal cord stress and strain contribute to degenerative cervical myelopathy (DCM), while cervical kyphosis is known to negatively impact surgical outcomes. In DCM, the relationship between spinal cord biomechanics, sagittal alignment, and cord compression is not well understood. Quantifying this relationship can guide surgical strategies. A previously validated three-dimensional finite element model of the human cervical spine with spinal cord was used. Three models of cervical alignment were created: lordosis (C2-C7 Cobb angle: 20°), straight (0°), and kyphosis (- 9°). C5-C6 spinal stenosis was simulated with ventral disk protrusions, reducing spinal canal diameters to 10mm, 8mm, and 6mm. Spinal cord pre-stress and pre-strain due to alignment and compression were quantified. Cervical flexion and extension were simulated with a pure moment load of 2Nm. The Von Mises stress and maximum principal strain of the whole spinal cord were calculated during neck motion and the relationship between spinal cord biomechanics, alignment, and compression was analyzed using linear regression analysis. Spinal cord pre-stress and pre-strain were greatest with kyphosis (7.53kPa, 5.4%). Progressive kyphosis and stenosis were associated with an increase in spinal cord stress (R2 = 0.99) and strain (R2 = 0.99). Cervical kyphosis was associated with greater spinal cord stress and strain during neck flexion-extension and the magnitude of difference increased with increasing stenosis. Cervical kyphosis increases baseline spinal cord stress and strain. Incorporating sagittal alignment with compression to calculate spinal cord biomechanics is necessary to accurately quantify spinal stress and strain during neck flexion and extension.

Using Finite Element Models to Assess Spinal Cord Biomechanics after Cervical Laminoplasty for Degenerative Cervical Myelopathy.

Cervical laminoplasty is an established motion-preserving procedure for degenerative cervical myelopathy (DCM). However, patients with pre-existing cervical kyphosis often experience inferior outcomes compared to those with straight or lordotic spines. Limited dorsal spinal cord shift in kyphotic spines post-decompression and increased spinal cord tension may contribute to poor neurological recovery and spinal cord injury. This study aims to quantify the biomechanical impact of cervical sagittal alignment on spinal cord stress and strain post-laminoplasty using a validated 3D finite element model of the C2-T1 spine. Three models were created based on the C2-C7 Cobb angle: lordosis (20 degrees), straight (0 degrees), and kyphosis (-9 degrees). Open-door laminoplasty was simulated at C4, C5, and C6 levels, followed by physiological neck flexion and extension. The results showed that spinal cord stress and strain were highest in kyphotic curvature compared to straight and lordotic curvatures across all cervical segments, despite similar segmental ROM. In flexion, kyphotic spines exhibited 103.3% higher stress and 128.9% higher strain than lordotic spines and 16.7% higher stress and 26.8% higher strain than straight spines. In extension, kyphotic spines showed 135.4% higher stress and 241.7% higher strain than lordotic spines and 21.5% higher stress and 43.2% higher strain than straight spines. The study shows that cervical kyphosis leads to increased spinal cord stress and strain post-laminoplasty, underscoring the need to address sagittal alignment in addition to decompression for optimal patient outcomes.