Cervical Spine Research Articles

Overview of Traditional Chinese Medicine Treatment for Four Common Cervical Diseases

Cervical diseases refer to various clinical syndromes caused by damage or degeneration of the bones, joints, intervertebral discs, and soft tissues around the vertebrae of the cervical spine, which, under certain triggering conditions, result in dislocation of spinal joints, protrusion of intervertebral discs, calcification of ligaments, or bone hyperplasia, directly or indirectly stimulating or compressing the spinal nerve roots, vertebral arteries and veins, spinal cord, or sympathetic nerves. Cervical headache, cervical tinnitus, cervical hypertension, and cervical periarthritis are four common types of cervical diseases in clinical practice. These diseases are mostly treated with traditional Chinese medicine methods, which have achieved good therapeutic effects. However, the focus of treatment varies depending on the main clinical manifestations.

Representative Organ Doses from Computed Tomography (CT) Exams from a Large International Registry.

Estimation of absorbed organ doses used in computed tomography (CT) using time-intensive Monte Carlo simulations with virtual patient anatomic models is not widely reported in the literature. Using the library of computational phantoms developed by the University of Florida and the National Cancer Institute, we performed Monte Carlo simulations to calculate organ dose values for 9 CT categories representing the most common body regions and indications for imaging (reflecting low, routine, and high radiation dose examinations), stratified by patient age (in children) and effective diameter (in adults, using "diameter" as a measure of patient size). Our sample of 559,202 adult and 103,423 pediatric CT examinations was prospectively assembled between 2015-2020 from 156 imaging facilities from 27 healthcare organizations in 20 U.S. states and 7 countries in the University of California San Francisco International CT Dose Registry. Organ doses varied by body region and exam type. For example, the mean brain dose associated with head CT was 20 mGy [standard deviation (SD) 14] for head low dose, 46 mGy (SD 21) for head routine dose, and 64 mGy (SD 31) for head high dose scan protocols. The mean colon doses associated with abdomen and pelvis CT were 19 mGy (SD 12), 32 mGy (SD 28), and 69 mGy (SD 42) for low, routine, and high dose examinations, respectively. Organ doses in general varied modestly by patient diameter, and for many categories the organ doses among the largest quartile of patients were no more than 10% higher than doses in the smallest quartile. For example, for abdomen and pelvis high dose, the colon dose increased from 67 to 74 mGy from the smallest to the largest patients (10% increase). With few exceptions, pediatric organ doses also varied relatively little by patient age, except for the youngest children who, on average, had higher organ doses. Thyroid dose, however, tended to increase with age in neck or cervical spine and chest CT. Overall, the highest organ doses were to the skin, thyroid, brain, and eye lens. Mean organ doses differ substantially by site. The organ dose values included in this report are derived from empirical clinical exams and offer useful, representative values. Large inter-site variations demonstrate areas for radiation dose reduction.

Comparison of osteopathic and refl exotherapeutic diagnostic results in patients with cervical dorsopathy

Introduction. The main direction of conservative treatment of patients with dorsopathies remains drug therapy, but most clinicians agree that even the «best» drug therapy does not always help to achieve the desired results, and in addition is not without a number of known problems — allergic reactions, side effects, polypragmasy, impossibility of use due to the presence of comorbid pathology. Therefore, in recent years there has been an increase in interest in various non-medicamentous methods of treatment of dorsopathies: massage, physical therapy, physiotherapy, manual therapy and osteopathy, refl exotherapy. Previous work has demonstrated the clinical effectiveness of both refl exotherapy and osteopathic correction in the treatment of patients with dorsopathies. Both osteopathy and refl exology are disciplines that actively position a holistic approach to the human body and subsequent treatment. But at the same time, the question of coincidence or inconsistency of the results of diagnostic protocols of the two «fundamental» non-medicinal approaches has not been studied before. All of the above predetermined the purpose of this study.The aim of the study: to compare the results of osteopathic and refl exotherapeutic diagnostics in patients with dorsopathy of the cervical spine.Materials and methods. The cross-blind study was conducted on the basis of the medical clinic LLC «Mokhov Institute of Osteopathy» (Saint-Petersburg) in the period from September 2018 to December 2022. 110 patients (68 women and 42 men) with dorsopathy of the cervical spine were under observation. All patients underwent a one-stage assessment of osteopathic status and electropuncture diagnosis according to the method of I. Nakatani, and the level of pain syndrome was measured. All measurements were performed by different specialists, which allowed «blinding» the results obtained.Results. Somatic dysfunctions (SD) of the global level were revealed in 19 (17 %) people and were represented mainly by the disorder of cranial rhythmic impulse production and psychovisceral-somatic disorder. SD of the regional level were revealed in the majority of the examined patients (98 people, 89 %). The most typical were dysfunctions of the following regions: neck (structural component), thoracic (structural component), pelvis (structural and visceral components), dura mater. Local SD were diagnosed in all examined patients (110 patients, 100 %). Among local SD the most frequently revealed were dysfunctions of separate vertebralmotor segments, separate joints of the skull, sacrum, knee joint, ankle joint. Pain syndrome of moderate severity was characteristic for the examined patients. Electropuncture diagnostics according to the methods of I. Nakatani allowed to estimate the state of acupuncture meridians in the so-called representative points. According to the data obtained for the examined patients the most typical were hypofunction of lung meridian and hyperfunction of heart, bladder and kidney meridians. In accordance with the set goal we evaluated the conjugation between the results of osteopathic and refl exotherapeutic diagnostics. A medium association was found between: Lung SD and hypofunction of the corresponding meridian (conjugation coeffi cient 0,58), small intestine SD and hypofunction of the corresponding meridian (conjugation coeffi cient 0,52). A high strength association was found between: pericardial ligament SD and hypofunction of the corresponding meridian (contiguity coeffi cient 0,78), liver SD and hypofunction of the corresponding meridian (contiguity coeffi cient 0,74), kidney SD and hypofunction of the corresponding meridian (contiguity coeffi cient 0,8).Conclusion. Patients with cervical dorsopathy are primarily characterised by SD of regional and local levels. The connections between separate SD (both local independent and in the «structure» of regional biomechanical disorders) and hypofunction of corresponding meridians revealed in the course of this work potentially allow us to speak about comparability of separate results of osteopathic and refl exotherapeutic diagnostics. At the same time, it is interesting that the manual fi ndings are comparable only with hypofunction of meridians.

Desmoid Fibromatosis Post-Cervical Spine Surgical Intervention

Abstract Desmoid tumors are rare benign tumors that show locally aggressive and invasive features leading to potential complications. They can be quite challenging for the treating surgeon if they occur adjacent to neurovascular structures. The etiology of these tumors is still unclear, but the incidence is higher in females and in patients with a history of trauma or surgical procedures raising the possibility of genetic and hormonal factors as well as post-traumatic or postoperative inflammatory changes promoting the formation of desmoid fibromatosis. We report a case of a 34-year-old Asian female who presented to our hospital with a history of difficulty in swallowing due to an enlarging lump on the left side of her neck. Patient had a past medical history of previous cervical spinal disc surgery due to a herniated disc. Diagnostic imaging showed a large soft tissue mass centered between the left common carotid artery and the cervical vertebrae displacing the trachea and esophagus to the right side. Biopsy was obtained and histopathological examination was suggestive of a desmoid tumor. Patient underwent surgical resection of the tumor but returned later with recurrence and had to undergo the surgery again to achieve full cure.

Evaluate the Risk of Multilevel Non-Contiguous Spinal Fractures in Patients with Traumatic Cervical Spine Injury: A 12-Year Retrospective Study

Objective: To understand the risk factors and incidence of multilevel non-contiguous spinal fractures is crucial for improving diagnosis, management, and outcomes. Materials and Methods: The 12-year retrospective observational study included 588 patients with traumatic cervical spine fractures admitted at Maharaj Nakorn Chiang Mai Hospital between January 2011 and December 2022. Patients were categorized into two groups, those with multilevel non-contiguous spine fractures and those without multilevel non-contiguous spine fractures. Outcomes were analyzed using multivariable analysis. Results were presented as adjusted odd ratio (AOR) and 95% confidence interval (CI). Results: Among 588 patients, the incidence of multilevel non-contiguous spine fractures was 17.01% (100 out of 588 patients). Independent factors associated with multilevel non-contiguous spine fractures were motor weakness (AOR 1.89, 95% CI 1.19 to 3.01, p=0.007), intracranial injuries (AOR 2.61, 95% CI 1.61 to 4.23, p=0.000), intrathoracic injuries (AOR 2.88, 95% CI 1.77 to 4.69, p=0.040), and intraabdominal injuries (AOR 1.91, 95% CI 1.03 to 3.55, p=0.000). Conclusion: The present study identified critical risk factors for multilevel non-contiguous spine fractures in patients with traumatic cervical spine fracture. Those risk factors were motor weakness, intracranial injuries, intrathoracic injuries, and intraabdominal injuries. These findings can help guide clinical decision-making and improve patient outcomes. Keywords: Risk factor; Multilevel non-contiguous spinal fractures; Cervical spine injury

Management of Type III Occipital Condyle Fractures

Background/Objectives: Occipital condyle fractures (OCFs) can be seen in around 4–19% of patients who suffer from cervical spine trauma. Anderson and Montesano system type III OCFs, which are avulsion fractures, are potentially unstable and operative. This study evaluates the management of type III OCFs at our institution over a 22-year period. Methods: This retrospective study reviewed all cases of type III OCFs at our institution from July 2001 to March 2023, identified via imaging reports. Using the in-house radiology imaging informatics system “Doris” (Dig Our Radiology Information System), reports containing the terms subluxation, avulsion, unstable, or type 3/III with occipital condyle, occipital condylar, occipital fx, or occipital fracture were collected. We also searched for Montesano type III/3 fracture. Electronic medical records were used to collect clinical and demographic data. Patients evaluated by the neurosurgical team with at least 1 month of follow-up were included in the analysis. Results: A total of 563 patients were identified with type III OCFs. A total of 56 patients met the inclusion criteria. The majority (91%, 51/56) were treated conservatively with cervical orthosis. A small subset (8.9%, 5/56) underwent occipito-cervical fusion. Three had concomitant unstable C1 fractures, while the other two had significant coronal deformity associated with their type III OCF. Conclusions: At our institution, type III OCFs are predominantly managed with cervical orthosis. Only those with an associated malalignment of the occipito-cervical joint underwent fusion. These findings suggest that most type III OCFs can be treated conservatively with orthosis once stability is confirmed with an upright radiograph.

Determination of cervical vertebral maturation using machine learning in lateral cephalograms

Background. The accurate timing of growth modification treatments is crucial for optimal results in orthodontics. However, traditional methods for assessing growth status, such as hand-wrist radiographs and subjective interpretation of lateral cephalograms, have limitations. This study aimed to develop a semi-automated approach using machine learning based on cervical vertebral dimensions (CVD) for determining skeletal maturation status. Methods. A dataset comprising 980 lateral cephalograms was collected from the Department of Orthodontics, Shahid Beheshti Dental School in Tehran, Iran. Eight landmarks representing the corners of the third and fourth cervical vertebrae were selected. A ratio-based approach was employed to compute the values of C3 and C4, accompanied by the implementation of an auto_error_reduction (AER) function to enhance the accuracy of landmark selection. Linear distances and ratios were measured using the dedicated software. A novel data augmentation technique was applied to expand the dataset. Subsequently, a stacking model was developed, trained on the augmented dataset, and evaluated using a separate test set of 196 cephalograms. Results. The proposed model achieved an accuracy of 99.49% and demonstrated a loss of 0.003 on the test set. Conclusion. By employing feature engineering, simplified landmark selection, AER function, data augmentation, and eliminating gender and age features, a model was developed for accurate assessment of skeletal maturation for clinical applications.

The impact of physical exercise on cervical spine dysfunction in college students: the mediating effect of mobile phone dependence and the regulatory effect of education level

The impact of physical exercise on cervical spine dysfunction in college students: the mediating effect of mobile phone dependence and the regulatory effect of education level

Thinking outside the shoulder: A systematic review and metanalysis of kinetic chain characteristics in non-athletes with shoulder pain.

The kinetic chain is important in the proximal-distal energy transfer along body segments. Although biomechanical impairments in components of the kinetic chain have already been reported in athletes with shoulder pain, such investigations in non-athlete individuals have not yet been synthesized. To systematically review the literature and analyze the quality of evidence on the characteristics of the kinetic chain of non-athletes with shoulder pain compared to asymptomatic individuals. Studies published until February 2024 (without language restrictions) that quantitatively assessed outcomes related to the kinetic chain of non-athlete individuals were searched in five databases (MEDLINE, CINAHL, Web of Science, EMBASE, and SCOPUS). The risk of bias and quality of evidence were analyzed using the Joanna Briggs Institute Critical Appraisal Tool for Analytical Cross-Sectional Studies and the Grading of Recommendations, Assessment, Development, and Evaluation approach, respectively. To summarize the findings, meta-analyses with random-effects models were performed. Six cross-sectional studies (n = 562 [282 with shoulder pain], mean age = 48.7 ± 8.1 years) with low risk of bias were included in this review. Very low-quality evidence suggests that individuals with shoulder pain may present a lower active range of motion and muscular endurance/strength in the cervical spine, thoracolumbar region, and hip, as well as deficits in neuromuscular control of the lower extremities. Findings related to thoracic spine posture were conflicting and no differences were found in cervical spine isometric muscular strength between individuals with and without shoulder pain. Individuals with shoulder pain may present alterations in active mobility, muscular endurance, and neuromuscular control in kinetic chain segments. These findings suggest that broader physical assessments considering components of the kinetic chain may be clinically relevant in this population. However, based on the very low quality of evidence, the findings of this review should be interpreted with caution.

Nonspecific cervical spine pain/neck pain/in medical personnel of north-eastern Poland—A cross-sectional study

Both mechanical and psychological overload are inherent to the work of nurses and paramedics, resulting spondylogenic pain.Aim of the studyTo identify potential risk factors influencing the prevalence of non-specific cervical spine pain in professionally active nurses and paramedics.Material and methods324 nurses (53.2% of the total) and 285 paramedics (46.8%) were included in the study−609 people in total. The study was carried out using an auditorium survey technique supervised by the researchers. The methods used were: Nordic Musculoskeletal Questionnaire, a spinal pain questionnaire validated according to IEA guidelines, a short version of the IPAQ and the author's survey questionnaire, concerning sociodemographic data, chronic diseases including metabolic syndrome (MetS). A univariate logistic regression model was used in the statistical analysis. The level of statistical significance was taken as p < 0.05.ResultsRecurrent NP was significantly more common in paramedics compared to nurses (29.5 % vs. 9.3 %; p < 0.0001). In a univariate logistic regression model, the risk of NP was significantly increased by: length of service > 15 years (p < 0.024), presence of: low back pain (p < 0.0001), type 2 diabetes (p = 0.013), hypertension (p < 0.001), depression (p < 0.01). Of the modifiable factors, the risk of NP was significantly increased by high physical activity and short sleep <7 h (p < 0.001).

A review article on the Ayurvedic aspects of Manyastambha

In today’s era, because of the stressful and fast lifestyle people are suffering from various degenerative diseases. Manyastambha is one of the lifestyle disorders which have a very high prevalence at present. Manyastambha is the clinical entity in which the back of the neck becomes stiff or rigid, painful, Stambh in the cervical region, and neck movement are hampered. Manyastambha has been enumerated in eighty Vataja Nanatmja Vyadhis as well as Urdhwajatrugata Vikaras. It can be clinically co-related with cervical Spondylosis in modern medicine. Cervical Spondylosis is a degenerative condition of the cervical spine. Ruk and Stambha are the primary symptoms. It may cause pressure on nerve roots with subsequent sensory or motor disturbances if severe. The prevalence of cervical spondylosis is rising due to the increase in a busy, professional, and social life, poor sitting posture in offices, continuous work, working long hours on computers, night jobs, watching hours of television, sleeping on abnormally soft mattresses and pillows, and placing the bare minimum importance on healthy physical, mental, and dietary habits.

Validity of Pleth Variability Index to Predict Fluid Responsiveness in Patients Undergoing Cervical Spine Surgery in the Modified Prone Position

Background and Objective: The modified prone position, which is an alteration of the standard prone position, reduces cardiac preload. Dynamic variables including stroke volume variation (SVV), pulse pressure variation (PPV), and pleth variability index (PVI) are reliable predictors for fluid responsiveness during surgery. To the best of our knowledge, no studies assessing dynamic variables for fluid responsiveness have been conducted in the modified prone position. This study aimed to evaluate the ability of PVI to predict fluid responsiveness in the modified prone position during cervical spine surgery. Materials and Methods: PVI, SVV, and PPV were recorded at the following times: before and after a 4 mL/kg crystalloid load in the supine position (T1, T2); after placement in the modified prone position (T3); and before and after a 4 mL/kg crystalloid administration in the modified prone position (T4, T5). Fluid responsiveness was defined as stroke volume (SV) ≥ 15%, assessed by the FloTrac/Vigileo™ (Edwards Lifesciences Corp, Irvine, CA, USA). Receiver operating characteristic (ROC) curves were analyzed to identify changes in each dynamic variable that could predict fluid responsiveness in the modified prone position. Results: Data from a total of 43 subjects were analyzed. In the supine position, 21 subjects were responders. After subjects were placed in the modified prone position, SV significantly decreased, while PVI, SVV, and PPV significantly increased (p < 0.001 for all). In the modified prone position, 13 subjects were responders, and the areas under the ROC curves for ΔPVI, ΔSVV, and ΔPPV after fluid loading were 0.524 (95% confidence interval [CI] 0.329–0.730, p = 0.476), 0.749 (95% CI 0.566–0.931, p = 0.004), and 0.790 (95% CI 0.641–0.938, p < 0.001), respectively. Conclusions: Crystalloid pre-loading could not mitigate the decrease in SV caused by the modified prone position. Changes in PVI were less reliable in predicting fluid responsiveness in the modified prone position.

Deep learning models for MRI-based clinical decision support in cervical spine degenerative diseases

PurposeThe purpose of our study is to develop a deep learning (DL) model based on MRI and analyze its consistency with the treatment recommendations for degenerative cervical spine disorders provided by the spine surgeons at our hospital.MethodsIn this study, MRI of patients who were hospitalized for cervical spine degenerative disorders at our hospital from July 2023 to July 2024 were primarily collected. The dataset was divided into a training set, a validation set, and an external validation set. Four versions of the DL model were constructed. The external validation set was used to assess the consistency between the DL model and spine surgeons’ recommendations about indication of cervical spine surgery regarding the dataset.ResultsThis study collected a total of 756 MR images from 189 patients. The external validation set included 30 patients and a total of 120 MR images, consisting of 43 images for grade 0, 20 images for grade 1, and 57 images for grade 2. The region of interest (ROI) detection model completed the ROI detection task perfectly. For the binary classification (grades 0 and 1, 2), DL version 1 showed the best consistency with the spine surgeons, achieving a Cohen’s Kappa value of 0.874. DL version 4 also achieved nearly perfect consistency, with a Cohen’s Kappa value of 0.811. For the three-class classification, DL version 1 demonstrated the best consistency with the spine surgeons, achieving a Cohen’s Kappa value of 0.743, while DL version 2 and DL version 4 also showed substantial consistency, with Cohen’s Kappa values of 0.615 and 0.664, respectively.ConclusionWe initially developed deep learning algorithms that can provide clinical recommendations based on cervical spine MRI. The algorithm shows substantial consistency with experienced spine surgeons.

A Solitary Osteochondroma Originating from the Spinous Process of the Third Cervical Vertebra: A Case Report and Comprehensive Literature Review

Background Osteochondroma is one of the most common solitary bone lesions. Multiple lesions are possible only in some genetic abnormalities, such as hereditary multiple exostoses (HME). Half of spinal osteochondroma is documented at the cervical level, although there are some levels and locations where it is rare to find an osteochondroma. Methods An advanced search of the PubMed database was performed for case reports and case series of spinal cervical osteochondroma. After data extraction, information was organized in one table and many figures to facilitate data comprehension. Result Osteochondroma was common in younger patients, with 26% of all cases in the literature being in those aged 18 to 35 years, and 24% of patients were aged 36 to 50. Over half (55%) of cases were in males. The most common presentation among all patients was neck pain and swelling or lump sensation. Moreover, 38% of cases were osteochondroma at the C1 level, and 33% were noted to affect the posterior arch. The majority of the cases had a favorable prognosis as most of them underwent total surgical resection of the tumor and decompression of the neural compartment. Conclusion Solitary cervical osteochondroma is a bony, benign lesion that can have devastating sequelae such as severe painful radiculopathy and quadriplegia if it is not approached correctly. History, examination, and radiological investigation are all crucial to making the best clinical judgment for the patients.

Effect of stabilizer pressure biofeedback on post-thyroidectomy neck pain in postmenopausal women: a randomized controlled trial

IntroductionTo investigate the effect of stabilizer pressure biofeedback on post-thyroidectomy neck pain, disability, endurance capacity of deep cervical flexors (DCFs), and cervical range of motion (ROM) in women after menopause.MethodsThirty-six women aged 50–65 years with post-thyroidectomy neck pain were incorporated in this study. Participants were assigned randomly into two groups. Each group was comprised of 18 women. Group A underwent active stretching exercises of the neck muscles. Group B underwent cranio- cervical flexion training using stabilizer pressure biofeedback in addition to active stretching exercises. Q1: The treatment interventions were administered 3 times per week for six weeks. A stabilizer pressure biofeedback device was utilized to evaluate the endurance capacity of the DCFs. A digital goniometer was used to measure the cervical spine ROM. The Neck Pain and Disability Scale (NPDS) was utilized to assess neck pain and disability levels prior to and following six weeks of treatment.ResultsGroup A had no significant improvement over group B in the endurance capacity of the DCFs. Both groups (A and B) showed significant increases in cervical ROM and decreases in NPDS. However, comparing the two groups post-treatment, group B showed a statistically significant improvement in all outcome measurements.ConclusionsStabilizer pressure biofeedback is efficacious in enhancing the endurance of DCFs and ROM, in addition to reducing neck pain and disability in postmenopausal women who experience neck pain after thyroidectomy.

Transosseous lacerations in the ankylosed cervical spine

Transosseous lacerations represent aparticular type of discoligamentous injury of the cervical spine and occur in ankylosing diseases of the spine, with ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH) being the primary entities. The altered biomechanics of the spine due to the underlying disease pose special challenges in the diagnostics and treatment. Even low-energy trauma can cause severe injuries of the cervical spine, which are often difficult to accurately diagnose due to the difficult assessability of the conventional projection radiography used in the primary diagnostics. In addition to a correct diagnosis a differentiated treatment concept is crucial as treatment courses can be complicated by pre-existing comorbidities, which are present in the majority of cases. Due to ahigh rate of secondary neurological deficits without adequate stabilization, surgical stabilization is generally recommended. Unlike the treatment of "classical" discoligamentous injuries in the mobile cervical spine, long segment dorsal instrumented spondylodesis is the standard of care for these cases, whereby ventral stabilization is also of value, either as astand-alone or possibly additive procedure. The intraoperative site, which deviates from that of anormal patient, can present an additional challenge.

Quantitative assessment of cervical disc degeneration using disc signal intensity index.

The assessment of disc degeneration remains a significant challenge in clinical research. Pfirrmann grade is a frequently used classification for lumbar disc degeneration on MRI. However, there has been no gold standard for cervical spine disc degeneration. Recently, we introduced the Disc Signal Intensity Index (DSI2) as a quantitative disc assessment for the lumbar spine, which is easily measurable in the cervical spine. The aim of this study was to apply DSI2 in the cervical intervertebral disc and investigate the factors associated with the cervical disc degeneration. Cross-sectional study using retrospectively collected data. Cervical MRIs from a database of patients undergoing ACDF between 2015 and 2018 were retrospectively reviewed. Demographic variables included age, sex, body mass index (BMI), race, smoking status, and comorbidities such as diabetes, chronic kidney disease, and coronary artery disease. DSI2 measurements were performed on midsagittal T2-weighted MRI images by determining the intensity within regions of interest (ROI). One ROI was set in the cerebrospinal fluid (CSF) and three ROIs were set per disc at the anterior, middle, and posterior third. The mean of the three measurements per disc was then divided by that of the CSF to calculate the DSI2 score. Multivariable linear regression analyses with mixed model were conducted to determine the potential contributing factors for disc degeneration. A total of 149 patients and 770 discs were included in the final analysis. Ninety-three patients (37.6%) were female and the mean (SD) age was 55.6 (11.7) years. The distribution of DSI2 scores among the different Pfirrmann grades was as follows: Grade 1: 0.259±NA; Grade 2: 0.226±0.090; Grade 3: 0.175±0.070; Grade 4: 0.136±0.060; Grade 5: 0.131±0.050. Multivariable linear mixed-effect regression analysis, setting with DSI2 as the objective variable, demonstrated that age (β= -0.130, p< 0.05), BMI (β= -2.06, p< 0.05), Modic changes (Type1 β= -2.70, p<0.01) were independent contributors to disc degeneration. The segments C4/5 and C7/T1 were less prone to disc degeneration (C4/5: β=1.37, p<0.001; C7/T1: β= 2.63, p<0.001) and the history of diabetes (β=5.31, p<0.01) was associated with high DSI2.(p<0.01) CONCLUSIONS: The present study provides valuable insights for identifying risk factors in degenerative cervical conditions utilizing the DSI2. The DSI2 method emerges as a promising alternative for future disc research, excelling in the detection of subtle progressions of degeneration and distinguishing itself from the subjective Pfirrmann grading system.

Conservative treatment of injuries to the cervical spine : Mobilization or immobilization

Many injuries to the cervical spine can be treated conservatively. Treatment options include early functional, mobilizing and immobilizing procedures. If astructural injury can be ruled out by morphological imaging, early functional mobilization should be performed in combination with adequate analgesia according to the World Health Organization (WHO) step by step scheme to avoid chronification. If astructural injury to the cervical spine is present, astability test is crucial for the decision on treatment. Stable fractures include, for example, typesI, II and Vfractures of the atlas according to Gehweiler, typesI and IIIfractures of the dens axis according to Anderson and D'Alonzo and type Afractures of the subaxial cervical spine according to the AO. If the results of the imaging examination are inconclusive, functional imaging should be performed. If the injury is stable, external immobilization can be used for conservative treatment. Semirigid and rigid cervical orthotic devices as well as Minerva corsets and the halo fixator are available for this purpose. The degree of immobilization increases with the invasiveness of the procedure. Immobilization should be carried out under clinical and radiological monitoring until the injury has healed. An increase or persistence of symptoms during conservative treatment indicates treatment failure and should result in follow-up imaging. Immobilizing treatment should also be accompanied by isometric physiotherapeutic exercise and adequate analgesic treatment. In adult patients the external stabilization should be gradually reduced through physiotherapeutic exercise after completion of the immobilization treatment.

Decreased isometric neck strength is a risk factor for head, neck and face injuries in professional rugby league players

ABSTRACT Head, neck and face injuries are a concern in contact sports. This exploratory study aimed to establish 1) injury risk factors for head, neck and face injuries and 2) clinical cut-off values related to strength, endurance and proprioception of the cervical spine in a team of professional rugby league players. Pre-season assessments of isometric strength of the flexor, extensor and lateral flexor muscles, endurance of the flexor muscles and joint position error were conducted. Injuries resulting in games missed were recorded. Cross-tabulations were used to determine the unadjusted odds ratios for the measures as risk factors for playing season injuries. The unadjusted odds ratio (OR) values indicated that if a player had weaker extensors of the neck (<36.4 kg, p = 0.014; <3.4N/kg, p = 0.014) or asymmetry of isometric strength of their lateral flexor muscles (left-to-right ratio <0.91, p = 0.005), their odds of games missed due to season head, neck and face injuries was increased (OR extensors = 8; 95% CI = 1.5-42.5 OR asymmetry of lateral flexor muscles OR = 12.6; 95% CI = 2.0-79.4). As muscle strength is modifiable, the clinical application of this study would involve targeting players in the team beneath the clinical cut-off value.

Postoperative complications across different cervical spine surgical procedures: a systematic review and meta-analysis

Postoperative complications across different cervical spine surgical procedures: a systematic review and meta-analysis