Philadelphia Collar Research Articles

The performance of C-MAC videostylet versus D-Blade during tracheal intubation in patients with simulated cervical immobilization: A randomized comparative trial

ABSTRACT Background Concerning patients with suspected cervical spine (C-spine) fractures or other cervical pathologies, tracheal intubation must be done very carefully to avoid injury to the spinal cord. Methods Fifty-two patients within a range of 20–60 years old, and arranged for elective surgery, were indiscriminately allocated into two groups; Group S was intubated with the C MAC Videostylet (VS), whereas Group L was intubated by D blade Video Laryngoscope (VL) during cervical immobilization by Philadelphia collar. The first successful attempt duration, total number of intubation attempts, the total duration of the intubation, haemodynamic parameters, stress response of intubation, the degree of C-spine movement and complications were evaluated in both groups. Results Group L showed substantially shorter times for the first successful attempt (p-value <0.001) and the whole intubation procedure (p-value <0.001) compared to Group S. Group S had a significantly more total number of intubation attempts (p-value = 0.010). The haemodynamic parameters did not significantly differ throughout the measurements among groups. Regarding the blood cortisol measurements at different periods, there were statistically insignificant changes among the groups. Concerning the greatest alteration in C-spine angulation at the occiput-C1, C1-C2, and C2-C5 segments during laryngoscopy and intubation, there were statistically insignificant differences among groups. Conclusion The C MAC D-blade VL is superior to the VS in terms of the number and duration of intubation attempts during C-spine immobilization. Conversely, the VS showed comparable results to the D blade regarding C-spine motion and stress response.

Prehospital care and interfacility transfer of trauma patients before reaching the emergency of a level-1 trauma care center.

Management of trauma patients includes prevention, prehospital care, appropriate resuscitation at a hospital, definitive treatment, and rehabilitation. Timely and adequate care for a trauma patient is paramount, which can dramatically impact survival. This study was planned to assess the proportion of patients who failed to receive adequate prehospital care before reaching our institute. A retrospective study was conducted in the trauma and emergency department of a level-1 trauma center in eastern India from February to April 2022. The demographic profile, vital parameters, injury, mode of transport, travel duration, referring hospital, and any interventions as per airway/breathing/circulation/hypothermia were collected. The records of a hundred-two patients who were brought to the trauma and emergency department in the study period were reviewed. Road traffic accident involving two wheelers was the leading cause of injury. Eighty-three percent of the patients were referred from other health centers, of which 49 were referred from district headquarters hospitals. Only three patients out of 14 had been provided with an oropharyngeal airway for whom endotracheal intubation was indicated. Only one among the 41 patients needing Philadelphia collar actually received. Sixteen patients were provided supplemental oxygen out of the 35 for whom it was indicated. Out of 68 patients in whom intravenous cannulation and fluid administration were indicated, only 35 patients had received it. Out of 31 patients with fractures, none were provided immobilization. The care of the trauma patients with respect to airway, breathing, circulation, and fracture immobilization was found to be grossly inadequate, emphasizing the need of structured and protocol based prehospital trauma care.

Comparison of the Intubation Success Rate in Video Laryngoscopy versus Direct Laryngoscopy in Patients with Philadelphia Collar: A Randomized Clinical Trial

Background: Video laryngoscopy (VL) and direct laryngoscopy (DL) are two approaches to provide secure airway for patients with compromised airways. This study aims to compare the intubation success rate in video laryngoscopy versus direct laryngoscopy in patients with Philadelphia collars.&#x0D; Methods: 172 patients with cervical collars who have undergone general anesthesia were enrolled. After induction of anesthesia for all patients, an oral airway was used to facilitate the ventilation. A VL approach in Group A and DL approach in Group B were used. In order to evaluate the effectiveness of each method, we considered related parameters, including intubation time, the number of intubation attempts, Cormack-Lehane (CL) score, orodental injuries, heart rate, and blood pressure 3 minutes after intubation, oxygen saturation, neck circumference, and BMI.&#x0D; Results: The ratio of first-attempt intubations was not different among the two groups (P = 1.00). The mean [SD] time for intubation was shorter with DL vs VL (p&lt;0.0001). There were almost equal rates of CL grades 1 and 2 (67.5% and 29%) using the VL than with the. The mean [SD] mean arterial pressure in VL vs DL was 86.17 mmHg vs 90.88 mmHg (p = 0.086).&#x0D; Conclusion: According to our results, there was no significant difference in complications and hemodynamic changes after intubation in both groups, but the intubation duration was significant shorter in DL group.

A CASE REPORT ON: MANAGEMENT AND COMPLICATION OF HANGING

Background: The process of breathing, or the exchange of air between the atmosphere and the lungs' alveoli, is impaired in cases of hanging by a neck rope, which results in asphyxia and death. Main symptoms and important findings: A 27-year-old male was admitted to a rural hospital with complaints of hanging from a fan at home after a fight with his wife, with unconscious state, and one episode of seizure associated with up rolling off the eyeball, frothing from the mouth, and tonic-clonic movement. There was previous deliberate self-harm. Given low GCS, the patient was immediately intubated with ET TUBE 7.5 and taken on mechanical ventilation on volume control mode with peep 5, RR 16, Spo2 100%, TV 360 ml. rapid antigen test was done which came out to be negative and ECG done and show sign of tachycardia. Chest and spine X-RAY was done. CT brain done and the finding was normal. EEG was done and show the finding was beta activity and no epileptiform changes. An orthopedic physician's opinion was taken and to continue Philadelphia collar for 4 weeks was advised. The main diagnosis, therapeutic interventions, and outcomes: After a physical examination and investigations doctor diagnosed a case of hanging with depression. Medical management was provided with Inj. Ceftriaxone 1 gm intravenous twice a day for 9 days, Inj. Pan 40 mg intravenous once a day, Inj. Emset 4 mg three times a day, Inj. Levipril 500 mg twice a day, Inj. Dexa 6 mg once a day for 5 days, Nebulization With Duolin And Budecort three times a day, intravenous fluids given. Now his outcomes were good. His complications were reduced. Conclusion: Hanging is a complicated case and produces more complications but early diagnosis management can secure the life of a patient and reduce the complication of hanging.

Comparative Study Between the Results of Anterior Cervical Discectomy and Fusion Using Philadelphia or Soft Collar Postoperatively

Background data: Anterior cervical discectomy and fusion (ACDF) is a well-known operative technique for treating cervical disc diseases causing myelopathy and/or radiculopathy. Postoperative immobilization with a rigid cervical brace is widely followed after ACDF using a standalone cage and soft braces frequently. Some authors have recommended using postoperative cervical braces while others do not, and among surgeons who agree with postoperative collar usage, the type of cervical orthoses and the duration of use are also issues of debate. Purpose: This study aims to compare between results of ACDF by using the Philadelphia collar and soft collar postoperatively. Study design: A prospective study. Patient and Methods: This study included 60 patients with ACDF: 28 used Philadelphia collar (group I) and 32 used soft collar (group II). Cases with single-level ACDF to 4 levels are included, and revision and deformity cases are excluded. For one year, both groups were followed up regarding fusion rate, subsidence, cage migration, neck disability index (NDI), and visual analog score (VAS) of the neck and arm pain. Results: Neck and arm pains using VAS scores preoperatively and 3 months, 6 months, and 12 months postoperatively also showed no significant difference between both groups. Subsidence was noticed among two patients (7.1%) in group I and one patient in group II (3.1%). No significant differences in fusion rates were found between both groups. After a 12-month follow-up in more than two-level procedures, the NDI score among group II was significantly lower (p = 0.045). Linear regression analysis revealed that preoperative NDI, age, BMI, and operation level were the predictors of postoperative NDI, excluding the presence of diabetes mellitus (DM) and brace type. Conclusion: Cervical brace after ACDF either by Philadelphia or soft collar does not affect the fusion rate, cage subsidence, or outcomes of the neck and arm pain. (2021ESJ255)

Surgical management of os odontoideum: An Algerian center experience.

ABSTRACTBackground:Os odontoideum (OO) is a craniovertebral junction malformation of unknown origin. In most times, this lesion is highly unstable demanding surgical management. We present our series of OO surgical management and we discuss clinical, radiological, and management aspects of this pathology via our experience and literature opinions.Methods:This is a retrospective study of patients operated on at our department between May 2014 and May 2021 for OO. All patients were explored with plane X-rays and computed tomography (CT). In some cases, magnetic resonance imaging (MRI) was necessary. Posterior C1–C2 or C1-C3 fixation with polyaxial screws and rod fixation was used. In postoperative, the patient is asked to put Philadelphia collar for 3 months. Hospitalization periods vary between 3 and 7 days. After discharge, all our patients are followed up regularly in consultation. Control radiographs of the occipito cervical region were performed. After 3 months postoperatively, the CT scan is performed on all our patients to assess the quality of fusion. Patient's follow-up ranges from 4 months to 6 years.Results:Fifteen patients were included in this study; nine males (60%) and six females (40%); with mean age of 32.5 years old. Ten patients (67%) presented motor weakness, three patients (20%) with neck pain, one patient (6.5%) with torticollis, and one patient (6.5%) presented vertigo. No notable cervical trauma was present in six patients (40%) and in nine patients (60%), a remote history of traumatism was noted. All cases of our series presented mobile OO. Normal thickness of the C2 pedicle was noted in nine patients (60%). In two patients (13%), there was hypoplasia of one pedicle and in four patients (27%) both pedicles. MRI showed direct signs of spinal cord aggression: simple compression, myelomalacia, strangulation, or hypotrophy. C1 lateral mass screw fixation was performed in all patients; and according to C2 morphology: nine patients underwent C1-C2 pedicular fixation, in one patient, bilateral crossing C2 laminar screws technique, in three patients, we skipped C2 to perform a C1-C3 articular fixation, and in two patients, C1-C2-C3 fixations were performed. All patients improved clinically. In one patient, we noted an infection resulting in bad wound healing this infection was successfully treated with no complications. In the patient with bilateral crossing C2 laminar screws technique, CT control objectified 4 mm exceeding of one screw; the patient was reoperated and the screw was slightly pulled back. No other complications were noted.Conclusion:Congenital origin of OO is always evoked. C1-C2 fixation according to Goel and Harms technique with grafting proved its safety, providing high fixation quality with the acceptable biodynamic outcome. Once treated, the prognostic of OO is in general good, and improvement is observed in most patients with few complications.

Surgical management of traumatic spondylolisthesis of the axis

Purpose: AThe optimal treatment modality for traumatic spondylolisthesis (TSA) of the axis (second cervical vertebra) remains controversial. Many conservative and anterior techniques have been used to treat these injuries.&#x0D; Case report: We describe a 29– year–old woman who presented to the emergency department with severe neck pain after falling down a flight of stairs. Cervical plain radiographs and computer tomography (CT) scan demonstrated a major C2 body anterior dislocation with bilateral C2 pedicle fractures. A Crutchfield extension was applied, with four kilograms of traction initially, with the neck in slight extension. After two hours of traction, plain radiographs showed near–anatomical reduction. The same day the patient underwent an anterior C2/C3 discectomy and autologous bone fusion with a cervical spine locking plate (CSLP). There were no neurological deficits postoperatively and the patient was asymptomatic. She was discharged home on postoperative day eight with a Philadelphia collar for 6 weeks.&#x0D; Conclusion: Anterior C2/C3 discectomy and fusion may be feasible and safe in unstable TSA, with the benefit of high primary stability, anatomical reduction, a high union rate, and favorable clinical outcome

Management of C2 odontoid peg fragility fractures – A UK survey of spinal surgeons

PurposePatients sustaining fragility fractures of the C2 odontoid peg have 30-day mortality rates as high as 10% rising up to 34.1% at 1 year. Substantial controversy exists regarding optimal management of these fractures and there is a lack of national guidance to inform best practice.The aim of this study was to determine current practice in the management of these fractures throughout the United Kingdom. MethodsA UK wide, cross sectional survey was conducted, asking 10 questions regarding the initial management, imaging and follow-up of an elderly patient with a type 2 fragility odontoid peg fracture. This was publicised through the British Orthopaedic Association website and sent to all members of the Society of British Neurological Surgeons (SBNS) via email. Results107 Responses were received. 56% from orthopaedic consultants, 29% from neurosurgical consultants and 15% from senior spine fellows.86% (92) of respondents choose treatment with a cervical orthosis, with 84% (77) of these opting for a semi rigid Aspen or Philadelphia collar compared to 16% (15) opting for a soft cervical collar. Three (3%) opted for operative intervention with a further three (3%) choosing Halo fixation. Nine respondents (8%) opted for no orthosis and treatment with analgesia alone.Length of immobilisation in cervical orthosis ranged from 6 to 12 weeks. Initial follow-up ranged from 1 week to 6 weeks, with 6% (6) discharged without follow up.There was also marked variation in the use of follow-up imaging with 17% (18) using plain radiographs, 62% (66) requesting lateral flexion / extension radiographs, 10% (11) using CT and 11% (12) not performing any imaging at final follow up.In 60% (64) of cases respondents did not change subsequent management as a result of imaging. ConclusionType-2 fragility peg fractures have high morbidity and mortality. There is marked variation in the treatment modalities used, follow-up regime and use of imaging throughout the UK.Given the rapidly increasing incidence of these injuries and the associated mortality this should be a high priority field for further research. Further large scale studies are urgently required to inform best practice and standardise management of these injuries.

Periodontoid pseudotumoral lesions

Background: Periodontoid pseudotumoral lesions (PPL) are an uncommon cause of cervical pain and myelopathy. In addition, they may be associated with atlantoaxial instability (AAI).Case Description: Two patients over 60 years of age presented with neck pain alone. Their MR scans showed expansive lesions involving the odontoid process. One patient with AAI required an occipitocervical arthrodesis, while the other patient without instability was managed with an external orthosis (Philadelphia collar). Both of them experienced full resolution of pain and remained neurologically intact an average 36 months later (range 24–48).Conclusion: Here, we discussed the clinical, MR, and non-surgical (without AAI) versus surgical management (with AAI) for different types of PPL.

Comparison of peek cage vs bone graft only in anterior cervical discectomy and fusion

Anterior Cervical Discectomy and Fusion (ACDF) is the most frequently performed surgical treatment for several cervical spinal diseases. Including herniated disc, trauma and degenerative diseases [5, 8]. We have collected data of 31 patients admitted and operated between November 2017 to June 2019 having degenerative cervical disc disease who underwent ACDF reinforced with anterior cervical plate [11, 20]. All ACDF operations were performed using Smith-Robinson anteromedial approach using a surgical microscope [5, 16]. Approach Philadelphia collar were applied for 1 month post operatively. In our study we observed that ACDF achieves favourable radiologic results. The whole study data shows that there is a significant change in alignment of affected cervical spine after performing ACDF. Surgery related complications were not observed. No graft malposition, migration or mechanical failure of instruments. Objective: To evaluate radiologic result of anterior cervical discectomy and fusion. Methods: Retrospective review of clinical and radiological data of 31 patients. Cobb’s angle, C1-C2 angle, C2-C7 angle, Vertebral height were measured and followed.

Non-Operative Treatment of Odontoid Peg Fractures

Objective: The aim of this study was to review the results of non-operative treatment of odontoid fractures in Steve Biko Academic Hospital, Pretoria. Methods: Records for all patients treated for odontoid fractures from 2008 to 2018 were reviewed. 28 patients met the study criteria. Demographic data, mechanism of injury, associated injuries, neurology, imaging studies and treatment were reviewed. Results: There were 23 males and 5 females. The average age at presentation was 39.5 years. 25 patients were injured in road traffic accidents. Associated injuries were present in 21 patients, mostly involving the spine and head. 18 fractures were classified as Type II and 15 as Type III. Fracture comminution (5), angulation (6) and translation (10) were noted. Primarily treatment modalities were cones callipers, Philadelphia collar or halo vest. Fracture union was assessed radiologically at 3, 6 and 9 months. Type II and III fractures had high union rates at 6 and 9 months. Significantly displaced fractures had a statistically lower union rate (p = 0.0285) at 6 months. Conclusion: Minimally displaced odontoid Type II and III fractures can be effectively treated non-operatively in young adults. Extent of fracture displacement is the single important factor in non-union rate.

Surgical Treatment of Stenosis of Spinal Canal and Dural Sac at the Craniovertebral Junction

The paper presents the results of surgical treatment of 12 patients with stenosing processes of the vertebral canal at the craniovertebral transition due to chronic, unstable type 2 injuries of the C odontoid process (classification of fractures of odontoid process proposed in 1974 by Anderson and D’Alonzo). Patient examination included clinical-neurologic examination, review spondylograms of the cervical spine in 2 projections, MSCT, MRI. All patients were admitted to the clinic with external fixators (cervical support collar or Philadelphia collar). In the preoperative period, all patients were divided into 2 groups according to indications and contraindications for the application of the HALO-device. The first group consisted of 7 people, with cervical spine still fixed with the cervical support collar or Philadelphia collar, and the second group consisted of 5 patients with CII fracture fixed and corrected in the preoperative period by the HALO-device. All patients underwent surgical intervention – posterior approach decompression of the spinal canal and dural sack in the craniovertebral passage by CI laminectomy, partial resection of the posterior margin of the occipital aperture followed by the implementation of atlanto-axial occipitospondylodesis (a clamp with shape-memory effect for posterior occipitospondylodesis, OOO “MITS SPF”, Novokuznetsk, Russia). A comparative analysis of the results of surgical treatment of posttraumatic stenoses of the vertebral canal with and without the use of the HALO-traction device was performed. The results was better in the second group, which makes it possible to consider the second variant of surgical treatment more pathogenetically justified. Thus, HALO-traction restors anatomo-topographic relationships in the craniovertebral zone creating hard external fixation, helping to avoid intraoperative complications.

Axial chordoma of the cervical spine managed by a trans-mandibular trans-oral approach

Abstract Chordomas are low-grade but locally aggressive malignant neoplasms derived from notochordal remnants. These lesions are best treated by en bloc however this is especially challenging in the upper cervical spine due to the proximity of vital structures. We present a 46 year old male whom presented to our unit complaining of progressive upper cervical axial neck pain aggravated by neck rotation, of 4 months duration. He had no symptoms of myelopathy. Examination revealed high posterior spinal tenderness and resistance to neck rotation however the patient's motor and sensory examinations were normal and he had normal gait. An inter-disciplinary team comprising Orthopedics, Neurosurgery, Maxillofacial surgery and Otorhinolaryngology took the patient for surgery. The first stage of the procedure comprised Otorhinolaryngology performing a tracheostomy and thereafter a combined Orthopedic Neurosurgical procedure involving a posterior instrumented C1–C3/C4 fusion and biopsy of the lesion. The second stage involved the maxillofacial surgeons dividing the patient's mandible to increase operative exposure. Thereafter the Orthopedic and Neurosurgical surgeons proceeded to perform a transmandibular transoral en bloc resection of the body and odontoid process of C2 which was replaced by a cage construct. The vertebral arteries were preserved and no dural breech occurred. Post operatively the patient showed no new neurology and was ambulant. He was maintained in a Philadelphia collar for 6 weeks until his fusion was complete. In conclusion this difficult case was managed successfully by thorough pre-operative planning and inter-departmental co-operation. Fortunately the lesion was isolated to the body and odontoid process of C2 which was in the patients favor lending the case towards a favorable outcome.

Open-design collar vs. Conventional Philadelphia collar regarding user satisfaction and cervical range of motion in asymptomatic adults

Cervical collars are often prescribed to minimize physiologic loads and movements between the head and thorax by limiting cervical motion; they are also used for supporting a patient's head and reducing the risk of cervical injury resulting from additional spinal movements. One of the problems in orthotic treatment is the unpleasant appearance of the orthosis, which could impede the patient from continuing treatment. Currently, it is essential to consider the importance of the psychologic effect of rehabilitative treatment. The current study aimed to compare the Philadelphia collar and an open-design cervical collar with regard to user satisfaction and cervical range of motion in asymptomatic adults. Seventy-two healthy subjects (36 women, 36 men) aged 18 to 29 years were recruited for this study. Neck movements, including active flexion, extension, right/left lateral flexion, and right/left axial rotation, were assessed in each subject under 3 conditions—without wearing a collar and while wearing 2 different cervical collars—using a dual digital inclinometer. Subject satisfaction was assessed using a 5-item self-administered questionnaire. Both Philadelphia and open-design collars significantly reduced cervical motions ( P < 0.05). Compared with the Philadelphia collar, the open-design collar more greatly reduced cervical motions in three planes and the differences were statistically significant expects for limiting flexion. Satisfaction scores for Philadelphia and open-design collars were 15.89 ± 3.87 and 19.94 ± 3.11, respectively. This study demonstrated that the open-design collar is more cosmetically acceptable as a semirigid cervical collar compared with the Philadelphia collar, at least for subjects aged under forty years, while it also has optimal restriction potential. Further studies are needed to investigate its effectiveness in restricting cervical intervertebral motion and long-term compliance.

The assessment of relation of movability of the cervical spine after the odontoid vertebra dens fracture since the time of wearing the orthopedic collar

The aim of the article is to evaluate kinetic efficiency of a cervical spine taking into consideration the range of active motion as well as to assess the relation of movability range of the cervical spine since the day of wearing the Philadelphia collar, as well as the level of the strength of pain, and age. Forty-one individuals surgically or conservatively treated at the Neurosurgery Ward and subjected to a post-hospital observation at the Neurosurgery Outpatient Clinic of Provincial Hospital in Tarnów participated in the study. The control group consisted of 41 individuals without a clinically diagnosed cervical spine disease. The study of the range of motion of the spine in the cervical section was performed by means of Multi Cervical Unit (MCU) appliance. The strength of the pain was evaluated by means of VAS - the Visual Analogue Pain Scale. The individuals after the odontoid vertebra fracture are characterised by a limited motion range in case of all types of motion, except for bending and extension. In the study extremely significant differences of the range of motion of the study group in comparison with the control group were discovered. In case of the time of wearing the orthopedic collar, statistically significant negative correlations related to entire motion apart from side bending. The strongest correlation was obtained for rotation ( r = −0.36). The patients after the odontoid vertebra fractures have statistically significant limitations of the range of active motion of the cervical spine. Age, strength of the spine ache as well as the time of wearing the Philadelphia collar are negatively correlated in a significant manner with the movability range of the cervical section of the spine of individuals after the odontoid vertebra fracture.

Nonoperative management of C-2 dens fractures: Single center experience and review of the literature

ObjectiveThe demographic change in the population leads to a rising number of patients presenting with fractures of the cervical spine, especially C-2, due to falls. With an increase of co-morbidities in these elder patients, the risk for intra- and postoperative complications is increased likewise. Thus, an alternative strategy instead of operative management of these fractures should be taken into account whenever possible. Conservative management of dens fractures in the elderly is still a subject of great controversy despite numerous studies on this topic.The aim of this study was to analyze the rate of successful osseous consolidation of C-2 fractures with conservative treatment by wearing a semi-rigid collar or halo thoracic vest without further surgical intervention. Patients and methodsWe analyzed the medical records and CT-scan of the cervical spine of 254 patients with C-2 fractures retrospectively, who were admitted to our department between January 1990 and September 2015. Fractures were diagnosed by CT-scan of the cervical spine and classified according to the Anderson - D`Alonzo classification. 183 patients were submitted to surgery as treatment of choice. In 71 patients a conservative management with external immobilization was chosen. The latter group was subjected to study analysis. Results71 patients (mean age 74.08 years ± 16.06 years) were diagnosed with C-2 fractures (Typ I: 4; Typ II 36; Typ III: 31) and treated conservatively using a Philadelphia collar (n = 57), or a halo-thoracic vest (n = 14), respectively. 12 patients were lost to follow up and excluded from further analysis. Conservative treatment of the fractures was deemed successful when a bony consolidation of the fracture in follow-up CT scans was seen (45 of 59 patients; 76.3%). 20 patients with a Type II fracture (20/28, 71.4%) showed a successful ossification. In 14 patients (overall 23.7%; Typ I: 1 (7.14%), Typ II: 8 (57.14%), Typ III: 5 (35.71%)) external immobilization failed to achieve primary stability. These patients were submitted to consecutive surgery. ConclusionFrom our data it can be concluded that elderly patients, presenting with non-dislocated Type II fractures of the axis without accompaining neurological deficits, will have a more than 70% chance for a bony consolidation by conservative management. Consolidation rates may be estimated even higher in Type I and III fractures. Therefore, we suggest that external immobilization might be a valuable option to treat elderly patients with these fractures under certain circumstances.

Tascope – Innovative Intubation Aid

First of all thanks to Dr. Pallavi Lande and Dr. Shiv Kumar Singh Sir for inviting me to write this article. The Anaesthetist Society (TAS) is the major contributor and driving force behind successful development of TASCOPE. Well, TASCOPE is a video intubation aid to help passage of tube in difficult airways. It involves the use of endoscope or borescope camera (5.5 mm diameter HD camera) which is either connected to laptop/or even compatible mobiles or tablet, and the camera is attached on our customized TASCOPE blades. Thus, the laptop or mobile becomes screen for our intubation. Now with the help to WiFi box, even iPhone, iPad, and other noncompatible devices can also be used as screen. We have also customized channel for insertion of bougie. Then, endotracheal tube is railroaded over bougie under vision. Tascope history Having been working in neurotrauma center and facing difficult intubation, cervical spine injuries, and faciomaxillary trauma, we felt the definite need of a device which is affordable, easy to use, and lightweight for difficult intubation. Thus, initially fixing larger endoscope camera to extended tongue retractor, we gradually developed design with much anatomical curve and hyperacute angle for vision for difficult intubation and also found insertion of bougie initially easier than guiding styletted tube into larynx. Now, we also have design to enter even in one finger mouth opening in cases with restricted mouth opening and have developed TASCOPE PEDIA for pediatric intubation. Intubation technique Intubation technique remains much similar as other intubation devices such as midline insertion, pushing blade over base tongue further to visualize epiglottis, reaching up to glossoepiglottic fold, then little lift up and visualization of larynx, insertion of bougie into larynx, and then railroad tube into larynx under vision. Sometimes difficulty faced in inserting bougie, as sometime bougie might be coming out of its channel in ABS (plastic) adult blade, in which case giving proper shape (curve) to bougie and inserting it in 11 o’clock position gently will solve the issue, some friends also find the use of cut suction catheter attached over edge of blade useful. Furthermore, there can be impingement of tube bevel between arytenoids, in which tube is not getting pushed inside larynx, in these cases counterclockwise rotation of tube from 90 to 180 degrees will solve the problem. Journey so far I, myself, have intubated &gt;600 difficult intubation cases with TASCOPE in the past 5 years, with 99% success, which include patient with ankylosis, fixed neck, with Philadelphia collar, and with faciomaxillary injury and fractured mandible, obese, short neck, in anticipated difficult intubation. Friends across India and abroad are using our device and find it useful in difficult intubation. At present, we have two types of adult blade (metal and ABS plastic) and three sizes pediatric blades available.

Kinematic Effects of Cervical Laminoplasty for Cervical Spondylotic Myelopathy on the Occipitoatlantoaxial Junction.

A retrospective evaluation of sagittal angular motion from cervical spinal flexion to extension. To evaluate the kinematic effects of cervical laminoplasty for cervical spondylotic myelopathy (CSM) on the occipitoatlantoaxial junction. The kinematic effects of cervical laminoplasty for CSM on the occipitoatlantoaxial junction remain controversial. A total of 65 CSM patients who were treated with cervical laminoplasty ranging from the C3 to C7 vertebrae were included in the study. After surgery, all patients wore a Philadelphia collar for the first week and began cervical range of motion exercises as soon as possible. Functional plain radiographs were obtained preoperatively and at 1 and 3 years postoperatively. Sagittal angular motion from cervical spinal flexion to extension was measured using the Cobb technique at 7 cervical segments (Oc-C1, C1-C2, C2-C3, C3-C4, C4-C5, C5-C6, and C6-C7). We defined the contribution of each segment's mobility to the total angular mobility of the cervical spine as percent segmental mobility. Total cervical angular mobility significantly decreased after cervical laminoplasty. There were no significant differences in Oc-C2 angular mobility; however, C2-C7 angular mobility had significantly decreased by 3 years postoperatively. No significant differences in percent segmental mobility were observed at 1 year postoperatively except at the C3-C4 segment. By 3 years postoperatively, percent mobility at the Oc-C1 and C1-C2 segments had significantly increased, whereas that at the C3-C4 and C5-C6 segments had significantly decreased. Our results suggest that, although the contribution of occipitoatlantoaxial junctional mobility to total cervical mobility increases, dynamic mechanical stress to the occipitoatlantoaxial junction does not increase following laminoplasty, and no adjacent segmental disorder at the occipitoatlantoaxial junction was observed within 3 years postoperatively. We hypothesized that early removal of the cervical collar and early cervical range of motion exercises may contribute to these kinematic changes.

Features and treatments of teardrop fracture of the axis

Objective To investigate the features and treatments of teardrop fracture of the axis. Methods Of the 17 consecutive patients with teardrop fracture of the axis who had been managed between January 2008 and January 2016 at our trauma center, 13 were included in this study according to our research criteria. On their lateral X-ray films of the skull base, the height, width, lateral displacement and rotation of the fracture fragments were measured. Continuity of the anterior longitudinal ligament and instability of C2-3 and posterior ligamentous complex were evaluated on their cervical MRI images. Seven patients were immobilized for 3 months with the Philadelphia collar or Halo-vest device and 6 ones underwent anterior C2-3 cervical surgery. Results For patients receiving conservative and operative treatments, at the sagittal view, the height, width, lateral displacement, anterior rotation and posterior displacement of the fracture fragments aver-aged 12.0 mm versus 14.8 mm, 6.85 mm versus 8.33 mm, 7.07 mm versus 8.50 mm, 20.0° versus 30.1°, and 1.71 mm versus 3.0 mm, respectively. One patient suffered C2 disc injury and 6 ones C3 disc injury. All the patients were followed up for an average of 26.4 months (from 12 to 36 months). Complications included uncomfortable swallowing in 3 cases and mild residual neck pain in one. There was no delayed union, nonunion, or vertebral instability. At last follow-ups, the mean visual analogue score for pain was 1.7 and the Japanese Orthopaedic Association scores were 17 in 11 patients and 16 in 2 patients. Conclusions Most teardrop fractures can be treated conservatively because their small fracture fragments and minor displacements can be reduced after traction. However, those with large fragments and C2-3 vertebral injury and instability should be treated by anterior cervical discectomy and fusion. Key words: Axis; Fracture, bone; Spinal fusion; Indication

Collar Fixation Is Not Mandatory After Cervical Laminoplasty: A Randomized Controlled Trial.

Prospective randomized controlled study. To determine the effect of collar-aided fixation on outcomes after laminoplasty for cervical compressive myelopathy. Patients are often placed in a Philadelphia collar for weeks after cervical laminoplasty. However, the benefit of postoperative collar use remains controversial. We hypothesized that treatment outcomes in postoperative pain in patients without collars would not be inferior to the outcomes in patients using Philadelphia collars for 2 weeks. This trial analyzed 74 patients (52 males, 22 females, mean age 72.7 years) with cervical compressive myelopathy who had undergone double-door laminoplasty. Before surgery, we randomly assigned patients to the collar-fixation (CF) group (postoperative Philadelphia collar for 2 weeks) or the no-collar (NC) group. The primary outcome was the visual analog scale (VAS) for cervical pain up to 1 year after surgery. Secondary outcomes were Japanese Orthopedics Association score, Short Form 36 score (SF-36), cervical range of motion (ROM), lordotic angle, and complications. VAS scores up to 1 year after operation were similar with or without collar fixation (P = 0.487, two-way ANOVA). JOA scores improved significantly in both groups (P = 0.002 in CF, P < 0.001 in NC). There was no statistically significant difference between groups with regard to the improvement of JOA scores (54.9% in CF, 47.0% in NC, P = 0.80). The improvement in SF-36 was similar in both groups. Loss of ROM and lordotic angle of the cervical spine did not differ between groups (P = 0.61 in CF, P = 0.82 in NC). The incidence of complications was similar in both groups. The VAS scores of cervical pain with the postoperative treatment without collar fixation were not inferior to those when using Philadelphia collars for 2 weeks. Moreover, other outcomes such as JOA scores, SF-36, ROM, lordotic angle, and complications were similar in both groups. 2.