Posterior Cervical Muscles Research Articles

A case of dropped head syndrome suspected due to Dipeptidyl peptidase (DPP)-4 inhibitor use

There have been a few reports on Dipeptidyl peptidase (DPP)-4 inhibitor-induced dropped head syndrome. However, there has been no known report on temporal changes in MRI findings. The patient described here was a 63-year-old man who was prescribed oral sitagliptin (50mg/day) in February 2019. He experienced a dropped head from mid-January 2020, and in early April that year, he was admitted to our hospital for further evaluation. Weakness of the cervical extensor muscles (MMT 3) was noted, and MRI findings showed that the posterior cervical muscle group was hyperintense on short inversion time inversion recovery (STIR). We suspected sitagliptin to be the cause of his dropped head and discontinued it. On the 10th day of admission, his posture improved to the median position. One month after discontinuation of sitagliptin, MRI findings showed an improvement in the STIR hyperintensity of the posterior cervical muscle. In conclusion, if the initiation of a DPP-4 inhibitor results in dropped head syndrome, discontinuation of the drug should be considered.

The Influence of Deep Tissue Massage on Stresses Related Indexes of Middle-aged Women

The purpose of this study is to understand the effect of deep tissue massage on stress of middle-aged women. Deep tissue massage is performed centering on the upper and posterior cervical muscles of the body, and stress measurement using a device was measured three times in a unit of 30 minutes and 1 hour before the experiment. The results of the study are summarized as follows. The pulse gradient and the sympathetic activity were changed significantly by 30-minute massage but those were not changed significantly after 60 minutes massage. The average pulse was decreased significantly by deep tissue massage. The stress index increased from 49.270 before deep tissue massage to 54.900 after 30 minutes (p=0.005), and 52.270 after 60 minutes.

A New Posterior Extensor Attachment-Point Reconstruction Technique for Cervical Spondylotic Myelopathy Involving C2 Segment: Clinical Outcome and Safety.

Cervical spondylotic myelopathy (CSM) is a common degenerative disease that mainly occurs in elder patients, leading to different degrees of neurological dysfunction. Spinal cord involvement is mainly distributed at the C3-C7 segments, but it may also involve up to the C2 level. This study aimed to assess the clinical efficacy and safety of open-door laminoplasty using a new extensor attachment-point reconstruction technique for treating CSM involving the C2 segment. Fifty-nine patients with CSM involving the C2 segment and undergoing open-door laminoplasty were included in this retrospective study. Based on the titanium plate used in the operation, patients were divided into two groups, a reconstructed titanium plate fixation (RPF) group (n = 28) and a conventional titanium plate fixation (CPF) group (n = 31). Improvements in neurological function, cervical range of motion (ROM), cervical curvature index (CCI), preservation of posterior cervical muscle mass, and axial symptoms were compared between the two groups. There were no significant differences in operative time and intraoperative blood loss between the groups (p > 0.05). The Japanese Orthopaedic Association (JOA) score significantly increased in both groups postsurgery (p < 0.05); the neurological recovery rate was similar between the two groups (64.1 ± 13.3% vs. 65.9 ± 14.7%, p > 0.05). There was no significant loss of cervical ROM in either group (p > 0.05). The anteroposterior dural sac diameter at the C2 level was significantly enlarged in both groups (p < 0.05). Alternatively, CCI was significantly reduced in the CRP group (p < 0.05) but unchanged in the RPF group (p > 0.05). The cross-sectional area of the posterior cervical muscles was also significantly reduced in the CPF group (p < 0.05) but maintained in the RPF group (p > 0.05). Finally, axial symptoms were more severe in the CPF group than in the RPF group (p < 0.05). Laminoplasty is an effective surgical procedure for CSM involving the C2 segment. The reconstructed titanium plate achieved superior maintenance of cervical curvature and reduced both muscle atrophy and severity of axial symptoms compared with titanium conventional plates.

Ultrasound shear wave elastography measurement of the deep posterior cervical muscles: Reliability and ability to differentiate between muscle contraction states

The deep posterior cervical muscles (DPCM), specifically the semispinalis cervicis and cervical multifidus, are often impaired in patients with neck disorders and have been assessed by several imaging techniques. Prior ultrasound shear wave elastography (SWE) imaging and reliability assessments of the DPCM were performed utilizing similar positioning as assessments for the more superficial cervical extensors. Our objectives were to describe an SWE imaging technique for the DPCM, establish intra-rater reliability of DPCM SWE, and compare DPCM shear modulus during rest and submaximal contraction in both prone and seated positions in individuals without spinal pain. In sixteen participants, the DPCM was located using B‐mode ultrasound, then muscle shear modulus was assessed via SWE at both rest and with contraction against a 2‐kg resistance applied at the C2 spinous process. Within‐day intra‐rater reliability was moderate to good (ICC = 0.70–0.88). The DPCM were stiffer during contraction than at rest in the prone position (p = 0.002), and at rest in sitting versus at rest in prone (p = 0.003). Further research is needed to assess DPCM-specific SWE in symptomatic individuals and compare DPCM shear modulus to electromyography across contraction intensities.

Cervical Extensor Muscles Play the Role on Malalignment of Cervical Spine: A Case Control Study With Surface Electromyography Assessment.

A case control study. The aim of this study was to identify the potential impact of cervical spine malalignment on muscle parameters. Muscular factors are associated with cervical alignment. Nevertheless, only muscle dimensions or imaging changes have been evaluated, function of cervical muscles has scarcely been investigated. Thirty-four patients diagnosed as cervical spine degeneration associated with cervical malalignment and 32 control subjects were included in this case control study. Visual analogue scale (VAS) and the neck disability index (NDI) were used. The sagittal alignment parameters and cervical range of motion (ROM) were measured on cervical spine lateral radiographs, included C2-C7 lordosis, C2-C7 sagittal vertical axis (C2-C7 SVA), cervical gravity-sagittal vertical axis (CG-SVA), T1-Slope, and spinal canal angle (SCA). Surface electromyography (SEMG)-based flexion-relaxation ratio (FRR) was measured. The result showed VAS score of the neck significantly lower in controls (P<0.05), C2-C7 lordosis, C2-C7 SVA, CG-SVA, T1-Slope and ROM showed significantly different (P<0.001) between malalignment group and control group, FRR of splenius capitis (FRRSpl) and upper trapezius (FRRUTr) of the malalignment group were lower than in the control group, which correlated well with NDI (rSpl = -0.181 rUTr = -0.275), FRRSpl correlated well with VAS (rSpl = -0.177). FRRSpl correlated strongly with C2-C7 SVA (r = 0.30), CG-SVA (r = 0.32), T1-Slope (r = 0.17), ROM (r = 0.19), FRRUTr correlated with C2-C7 lordosis (r = -0.23), CG-SVA (r = 0.19), T1-Slope (r = 0.28), ROM (r = 0.23). Cervical malalignment patients had more tensional posterior cervical muscle and poor muscle functions. CG-SVA showed advantages in evaluating cervical malalignment.Level of Evidence: 3.

Panoramic Ultrasound Examination of Posterior Neck Extensors in Healthy Subjects: Intra-Examiner Reliability Study

Previous studies analyzing morphometry of posterior cervical muscles with ultrasound (US) imaging have mainly used Brightness mode (B-mode). Our aim was to investigate the intra-examiner reliability of panoramic US imaging for assessing posterior-lateral cervical muscle layers. Panoramic US images of the neck at C4/C5 level were acquired in 25 asymptomatic subjects (40% women; mean age: 24 years) by an experienced assessor. The cross-sectional area (CSA) of the upper trapezius, splenius, semispinalis, multifidi, rotators, and levator scapulae was measured from panoramic US scans on two separate days. Intra-class correlation coefficients (ICC3,1), standard error of measurement (SEM), minimal detectable change (MDC) and mean, absolute and percent errors were calculated. In general, intra-examiner reliability was excellent with ICC3,1 ranging from 0.978 (trapezius) to 0.993 (semispinalis). The SEM ranged from 0.02 (multifidus) to 0.07 (semispinalis/levator), whereas the MDC ranged from 0.05 (cervical multifidus) to 0.19 (levator/semispinalis). Absolute error was lower than 0.11 cm2 (levator/semispinalis). No differences between males and females were found. This study found that intra-examiner/rater reliability of panoramic US imaging was excellent for assessing the CSA of the posterior-lateral neck extensor muscles in asymptomatic subjects. The current findings suggest that panoramic US may be a reliable technique for examining the size of the cervical extensor muscles in both males and females.

Immediate effect of kinesio taping on deep cervical flexor endurance: A non-controlled, quasi-experimental pre-post quantitative study

ABSTRACT Objective Whether Kinesio taping® (KT) might change the endurance of the cervical deep flexor muscles.Methods: Healthy university students were assessed at baseline, immediately after the KT application over the posterior cervical muscles, and at a 24-h follow-up. The clinical assessment of the endurance of the deep cervical flexor muscles using the craniocervical flexion test (CCFT) was performed.Results: Sixty-two students (32 women) with a mean age of 20.4 ± 1.3 years completed the study protocol. Statistically significant pre- to post-taping differences in performance of the craniocervical flexion movement were found between baseline-immediate and baseline-24-h follow-up (p˂0.001). A statistically significant difference in the endurance of the cervical deepflexor muscles was found between baseline-immediate (for stage 2 result and cumulative endurance score), baseline-24-h follow-up (for stage 2result and cumulative endurance score), and immediate-24-h follow-up (for stage 2 result, for cumulative endurance score) p˂0.01.Conclusion: Cervical KT increased endurance for the short term.

Frecuencia de antepulsión cefálica en estudiantes de medicina, factores y síntomas asociados

Introduction: Cephalic antepulsion is defined as a biomechanic alteration of the frontal plane where the head is anteriorized in respect to the trunk and there is hypotonia of the posterior cervical muscles and hyperextension of the upper cervical spine. It is the result of poor posture while doing activities such as sitting down for long periods of time during studying. Materials and methods: Observational, transversal and analytic study. Sample size was 118 medical students from Universidad Nacional de Asuncion, selected using non-probability sampling. The study was based on a survey and kinesiologic evaluation: Kendall’s posture evaluation technique for the diagnosis of cephalic antepulsion. Means, standard deviation, frequencies and percentages were used for the descriptive statistical analysis. For the association study between the presence of cephalic antepulsion and associated factors, X2 test and OR with its respective CI were used. A statistically significant p was considered at values lower than 0.05. Results: 55.1% were men, mean age was 21.25 (±1.40 years). 30.5% of students have assured that they adopt this position while studying for more than 3 hours a day. When applying Kendall’s evaluation technique, it was found that 78% presents cephalic antepulsion, 57% being male students. Regarding most frequent symptoms, 77.1% had back pain; followed by headache (57.6%) and shoulder pain (55.7%). Association analysis showed that antepulsion is associated to study hours (p=0.001), with an OR 1.6 (1.1-2.6). The association increases with study time. However, when conducting an association analysis with symptoms, a relationship between antepulsion and symptoms referred by students could not be proven. Discussion: We found a high frequency of cephalic antepulsion in medical students and a strong correlation between the amount of time spent studying in poor posture and cephalic antepulsion.

Preservation of Deep Cervical Extensor Muscle Volume: Comparison Between Conventional Open-Door and Muscle Preserving Laminoplasty Approaches in the Same Patients

Surgical laminoplasty techniques have been developed to reduce cervical kyphosis and postoperative axial neck pain and preserve the posterior cervical extensor muscles. We compared a unilateral conventional open approach (OA) and a contralateral muscle preserving approach (MPA) for laminoplasty in the same patients to determine differences in the preservation of the posterior cervical muscles after the 2 approaches. This study was a prospective observational study involving 44 patients who underwent laminoplasty with unilateral OA and contralateral MPA for cervical myelopathy from January 2005 to December 2013. The cross-sectional area (CSA) changes in the posterior cervical extensor muscles (multifidus, semispinalis cervicis, and semispinalis capitis muscles) were measured on computed tomography scan, both pre- and postoperatively. Using an OA, the multifidus and semispinalis cervicis muscle preservation was 58.2% and 67.0%, but using an MPA, muscle preservation was 97% and 90.8% (P < 0.001 and P= 0.042), respectively. However, the CSA of the semispinalis capitis muscle did not differ significantly between the 2 groups. In terms of the level, conservation of the multifidus muscle was significantly different according to the approach at all levels, and the conservation of the deep extensor muscles was significantly different at the C3-4 level. MPA was effective in preserving the volume of deep cervical extensor muscles and helping minimize postoperative musculoskeletal complications. In addition, muscle preservation was more effective at the C3-4 level.

Is Cervical Traction Effective in Chronic Nonspecific Neck Pain Patients With Unsatisfactory NSAID Control? A Nomogram to Predict Effectiveness

In this retrospective study, our objective was to establish a nomogram to predict the effectiveness of cervical traction in young and middle-aged chronic nonspecific neck pain (CNNP) patients with unsatisfactory nonsteroidal anti-inflammatory drug (NSAID) control. For CNNP patients with unsatisfactory NSAID control, the effectiveness of cervical traction varies. Neck muscle fat infiltration and clinical features may associate with the effectiveness. A total of 186 suitable patients were classified into a training data set (from August 2015 to July 2018, n= 118) and a validation data set (from August 2018 to June 2019, n= 68) with time sequence. All patients were included to receive magnetic resonance imaging scan to calculate posterior cervical fat and muscle features, then undergoing unified cervical traction in an outpatient clinic. The least absolute shrinkage and selection operator (LASSO) regression model was used to select potentially relevant features to predict effectiveness possibility of cervical traction. Multivariable logistic regression analysis was used to develop the predicting model, presenting with a nomogram. The performance of the nomogram was assessed based on its calibration, discrimination, and clinical utility. Through the LASSO regression model, we identified 4 predictors including sex, good exercise compliance, the ratio of the cross-sectional area (CSA) between fat and muscle on C5 level (C5 fat CSA/muscle CSA), the ratio of CSA between fat and centrum on C5 level (C5 fat CSA/centrum muscle CSA). The nomogram provided good calibration and discrimination in the training cohort, showing an area under the curve (AUC) of 0.704 (95% CI, 0.608-0.799) and good concordance between the predicted and actual probabilities with Spiegelhalter's Z-test (P= 0.835). Discrimination of the model in the validation data set was acceptable, with AUC of 0.691 (95% CI, 0.564-0.817). Decision curve analysis revealed the nomogram to be clinically useful. Male sex, good exercise compliance, lower C5 fat CSA/centrum CSA, and and lower C5 fat CSA/muscle CSA could be favorable features to predict the effectiveness of cervical traction in CNNP patients with unsatisfactory NSAID control.

Effect of Shaoyao Gancao Decoction on Inflammatory Injury of Posterior Cervical Muscle Based on miR-146a Regulation of NF-&amp;kappa;B Signaling Pathway

Effect of Shaoyao Gancao Decoction on Inflammatory Injury of Posterior Cervical Muscle Based on miR-146a Regulation of NF-&amp;kappa;B Signaling Pathway

Impact of Multifidus Muscle Swelling on C5 Palsy After Cervical Laminoplasty.

Retrospective radiological analysis OBJECTIVE.: The aim of this study was to identify the effects of posterior cervical muscle swelling on C5 palsy (C5P) by evaluating early postoperative magnetic resonance (MR) images. Cervical laminoplasty is an established technique, but the risk of C5P after surgery has not been fully resolved. Studies have reported that lateral stretching and postoperative swelling of the multifidus muscle may cause stretching of the medial branches and cervical nerves. A total of 214 C5 nerves of 107 consecutive patients who underwent laminoplasty were examined. We reviewed their demographic and surgical data and radiographic and MR images as parameters, including the axial cross-sectional area (CSA) of the posterior muscles. The patients and C5 nerves were divided into C5P and non-C5P groups. The parameters and changes were compared between the two groups to examine correlations with C5P. In demographic data, age, sex, history of smoking, diabetes mellitus, and preoperative Japanese Orthopedic Association scores were not significantly different between the groups. Only body mass index (BMI) was significantly higher in the C5P group. Regarding the surgical and imaging data, the number of laminoplasty, operative time, decompression trough width, cervical sagittal alignment, preoperative spinal cord rotation, and posterior shift of the spinal cord were not significantly different, but the multifidus CSA change ratio was significantly higher in the C5P group. Multiple logistic regression analyses revealed that the multifidus CSA change ratio and BMI were significant independent factors. Multifidus swelling is associated with C5P, possibly through traction of the C5 nerve via the medial branches of the cervical dorsal rami. The medial branch is the shortest of the dorsal rami and may have the largest effect by traction force. Therefore, a gentle maneuver of the deep posterior muscles during surgery is a potential countermeasure to prevent C5P. 3.

Comparing mastoid and posterior cervical muscles vibration effects on eye movement in normal subjects

Background and Aim: Vibration is a method for stimulating the vestibular system. This met­hod can unmask asymmetry between two vesti­bular systems (such as unilateral peripheral ves­tibular disorders). The occurrence of vibration-induced nystagmus (VIN) in healthy subjects can affect the diagnosis of patients with uni­lateral peripheral vestibular disorders. Thus, the evaluation of VIN in healthy subjects is critical to help the diagnosis of unilateral peripheral vestibular disorders. Methods: This study was carried out on 72 hea­lthy subjects (mean ± SD age: 27.12 ± 4.97 years) in the Auditory and Balance Clinic of Rofeideh Rehabilitation Hospital. Vibration sti­mulation with a frequency of 30 and 100 Hz was used on mastoid and posterior cervical mus­cles (PCMs) and simultaneously eye movements were recorded and analyzed using videonystag­mography. Results: The mastoid vibration with a frequ­ency of 30 and 100 Hz, respectively produced VIN in 16.67% and 27.78% of subjects and VIN observed in PCMs vibration with a frequency of 30 and 100 Hz in 4.17% and 9.72% of the subjects. Conclusion: The occurrence of VIN in healthy subjects was more probable with mastoid vib­ration in 100 Hz. In this study, VIN was pre­dominantly horizontal, its direction was toward the stimulated side, and its slow phase velocity was lower than 5 deg/s. These criteria could be used for differentiation between normal and abnormal subjects.

Congenital myopathy with hanging big toe due to homozygous myopalladin (MYPN) mutation

BackgroundMyopalladin (MYPN) is a component of the sarcomere that tethers nebulin in skeletal muscle and nebulette in cardiac muscle to alpha-actinin at the Z lines. Autosomal dominant MYPN mutations cause hypertrophic, dilated, or restrictive cardiomyopathy. Autosomal recessive MYPN mutations have been reported in only six families showing a mildly progressive nemaline or cap myopathy with cardiomyopathy in some patients.Case presentationA consanguineous family with congenital to adult-onset muscle weakness and hanging big toe was reported. Muscle biopsy showed minimal changes with internal nuclei, type 1 fiber predominance, and ultrastructural defects of Z line. Muscle CT imaging showed marked hypodensity of the sartorius bilaterally and MRI scattered abnormal high-intensity areas in the internal tongue muscle and in the posterior cervical muscles. Cardiac involvement was demonstrated by magnetic resonance imaging and late gadolinium enhancement. Whole exome sequencing analysis identified a homozygous loss of function single nucleotide deletion in the exon 11 of the MYPN gene in two siblings. Full-length MYPN protein was undetectable on immunoblotting, and on immunofluorescence, its localization at the Z line was missed.ConclusionsThis report extends the phenotypic spectrum of recessive MYPN-related myopathies showing: (1) the two patients had hanging big toe and the oldest one developed spine and hand contractures, none of these signs observed in the previously reported patients, (2) specific ultrastructural changes consisting in Z line fragmentation, but (3) no nemaline or caps on muscle pathology.

Application of modified micro titanium plate for extensor attachment point reconstruction in open-door laminoplasty

Objective: To observe the effect of modified micro titanium plate for extensor attachment point reconstruction in open-door laminoplasty. Methods: From January 2016 to February 2017, 26 patients with cervical spondylotic myelopathy underwent open-door laminoplasty+modified micro-titanium plate fixation+extensor muscle attachment point reconstruction at Tianjin Hospital were enrolled in this study. There were 14 males and 12 females in this group, aged (59±18) years. The improvement of neurological function based on the Japanese Orthopedic Association (JOA) score and the changes cervical curvature based on the cervical curvature index (CCI), especially the atrophy of the back muscles and the occurrence axial symptoms were recorded and analyzed. Intra-group comparisons were performed by using repeated measures of variance analysis or paired t-test. Results: The operations were performed well without injury to spinal cord. The operation time was (116±32) min with a blood loss of (196±41) ml. The JOA scores was improved form 7.8±2.1 preoperatively to 13.5±3.4 three months after surgery, and 13.9±3.7 at the final follow up (F=30.619, P<0.05). The improvement rate of neurological function was 66%±13%. The CCI decreased from 14.3%±3.9% preoperatively to 13.7%±3.7% three months after surgery and 13.0%±3.3% at the last follow-up (F=0.829, P>0.05). The cross-sectional area of the posterior cervical muscle was (35.9±7.6) cm(2) before surgery, and it was (33.5±6.7) cm(2) at the last follow-up (t=1.208, P>0.05). The spinal cord drift distance was (2.6±0.5) mm. The axial symptoms occurred in three patients, the incidence rate was 11.5%. Conclusion: In the open-door laminectomy, modified micro titanium plate can maintain the stability of the cervical spine, it also can rebuild the extensor attachment points and reduce the atrophy of the posterior cervical muscles, which avoid the occurrence of kyphotic deformity and reduce the occurrence of axial symptoms.

Trigger Point Sensitivity Is a Differentiating Factor between Cervicogenic and Non-Cervicogenic Headaches: A Cross-Sectional, Descriptive Study.

Purpose: A common factor in all forms of headache is the presence of myofascial trigger points (TrPs). The aim of this study was to compare the presentation of patients with cervicogenic headaches and patients with non-cervicogenic headaches in the sensitivity of TrPs in their upper trapezius, sternocleidomastoid, temporalis, and posterior cervical muscles. Method: This was a descriptive, cross-sectional study. The following variables were compared between patients with cervicogenic (n=20) and patients with non-cervicogenic (n=20) headaches: sensitivity (pain-pressure threshold) of TrPs in the upper trapezius, sternocleidomastoid, posterior cervical, and temporalis muscles (using a handheld, digital algometer); level of disability (using the Henry Ford Hospital Headache Disability Inventory questionnaire); demographics (age, sex); anthropometrics (BMI); and clinical presentation (duration and intensity of symptoms). The independent Student t-test and χ2 test were used to determine the differences between the two groups. Effect sizes (Cohen's d) were calculated when relevant. Results: The two groups were similar in level of disability, demographic and anthropometric data, and clinical presentation. However, TrP sensitivity in the right upper trapezius (p=0.006; Cohen's d=0.96) and the left upper trapezius (p=0.003; Cohen's d=1.06) muscles was higher in the cervicogenic group. Conclusions: Increased sensitivity of TrPs in the upper trapezius muscle may be used as a differentiating factor in the diagnosis of cervicogenic headaches. This finding emphasizes the importance of integrating this muscle into the rehabilitation programs of patients with cervicogenic headache.

Towards defining muscular regions of interest from axial magnetic resonance imaging with anatomical cross-reference: part II - cervical spine musculature

BackgroundIt has been suggested that the quantification of paravertebral muscle composition and morphology (e.g. size/shape/structure) with magnetic resonance imaging (MRI) has diagnostic, prognostic, and therapeutic potential in contributing to overall musculoskeletal health. If this is to be realised, then consensus towards standardised MRI methods for measuring muscular size/shape/structure are crucial to allow the translation of such measurements towards management of, and hopefully improved health for, those with some musculoskeletal conditions. Following on from an original paper detailing methods for measuring muscles traversing the lumbar spine, we propose new methods based on anatomical cross-reference that strive towards standardising MRI-based quantification of anterior and posterior cervical spine muscle composition.MethodsIn this descriptive technical advance paper we expand our methods from the lumbar spine by providing a detailed examination of regional cervical spine muscle morphology, followed by a comprehensive description of the proposed technique defining muscle ROI from axial MRI. Cross-referencing cervical musculature and vertebral anatomy includes an innovative comparison between axial E12 sheet-plastinates derived from cadaveric material to a series of axial MRIs detailing commonly used sequences. These images are shown at different cervical levels to illustrate differences in regional morphology. The method for defining ROI for both anterior (scalenes group, sternocleidomastoid, longus colli, longus capitis) and posterior (multifidus, semispinalis cervicis, semispinalis capitis, splenius capitis) cervical muscles is then described and discussed in relation to existing literature.ResultsA series of steps towards standardising the quantification of cervical spine muscle quality are described, with concentration on the measurement of muscle volume and fatty infiltration (MFI). We offer recommendations for imaging parameters that should additionally inform a priori decisions when planning investigations of cervical muscle tissues with MRI.ConclusionsThe proposed method provides an option rather than a final position for quantifying cervical spine muscle composition and morphology using MRI. We intend to stimulate discussion towards establishing measurement consensus whereby data-pooling and meaningful comparisons between imaging studies (primarily MRI) investigating cervical muscle quality becomes available and the norm.

Recent Surgical Methods of Double-door Laminoplasty of the Cervical Spine (Kurokawa's Method).

Introduction Double-door laminoplasty (DDL) of the cervical spine (Kurokawa's method) was developed as one of posterior decompression surgical methods in the late 1970s and after then has been modified by adding various procedures such as the posterior muscle handling and the use of artificial spacers. There are three principles of DDL: First, to decompress the cervical spinal cord by central splitting of the spinous processes and laminae, preserving those lengths as much as possible and widening the spinal canal space symmetrically. Second, to maintain the widened spinal canal space steadily by fixing spacers made of hydroxyapatite the contour is almost the same as the widened space. Third, to re-suture the semispinalis muscles to the C2 spinous process to restore the strength of the posterior cervical muscles. Technical note The important technical points in performing osteotomy are as follows: At each vertebra, osteotomy is performed from the caudal side and gradually proceeds to the cranial side because there is a space between the lamina and the dura mater at the caudal side and the osteotomy can be safely made. The surgeon must pay attention to the changes in color of the osteotomy site from red of cancellous bone, to white of the inner cortex, and finally to yellow of the yellow ligament and extradural fat tissue. Attention must be paid to the changes in sound and tactile sensation delivered from the air-drill when completing osteotomy of the inner cortex of lamina. By moving an air-drill slowly, tactile sensation can be more sensitive. During osteotomy, the process must be checked frequently by touching the inner cortex of the lamina with a probe. Conclusion At present, DDL is a useful surgical method for cervical myelopathy at multiple level lesions.

Treatment of Trigeminal Neuralgia by Relieving the Posterior Cervical Muscle Stiffness with Parietal Acupoint Therapy: Case Reports

Treatment of Trigeminal Neuralgia by Relieving the Posterior Cervical Muscle Stiffness with Parietal Acupoint Therapy: Case Reports

Effects of Acupotomy Therapy on mRNA Expressions of Bcl-2, Bax, Caspase-3 in Posterior Cervical Extensor Muscles in Cervical Spondylosis Rabbits

To observe the effect of acupotomy therapy on mRNA expressions of Bcl-2, Bax , Caspase-3 in posterior cervical extensor muscles in cervical spondylosis rabbits, and explore its mechanisms for apoptosis of cervical muscles. New Zealand rabbits were randomly divided into normal, model, electroacupuncture (EA) and acupotomy groups, 6 in each group. The cervical spondylosis model was established by forced head-bowing for a long term. After model establishment, acupotomy was used at the trapezius muscle starting point and attachment site of sternocleidomastoid muscle, etc., once a week, total 3 times. EA was used at "Tianzhu" (BL 10), "Jingbailao" (EX-HN 15) and "Dazhu" (BL 11) for 3 weeks, 20 min a time, 3 times a week. Bcl-2, Bax, Caspase-3 mRNA expressions in posterior cervical extensor muscles were detected by real-time PCR. There was no significant difference in the expression of Bcl-2 mRNA among all the groups (P>0.05). Compared with the normal group, Bax mRNA increased in the model group (P<0.01), and that in the acupotomy group was lower than that in the model group (P<0.01). The ratio of Bcl-2/Bax mRNA in the model group decreased significantly compared with that in the normal group (P<0.01); in comparison with the model group, the ratio in the acupotomy group increased (P<0.01); and that in the acupotomy group was higher than the ratio in the EA group (P<0.05). The Caspase-3 mRNA expression in the model group increased compared with that in the normal group (P<0.05), and its expression in the acupotomy group decreased compared with those in the model and EA groups (P<0.05). Acupotomy therapy can regulate the mRNA expressions of Bax and Caspase-3, and retard apoptosis in posterior cervical extensor muscles, therefore the strained muscles are relieved, which may be one of its mechanisms for improving cervical spondylosis.