Semispinalis Research Articles

A novel technique to identify and thermally ablate the greater occipital nerve for patients with occipital neuralgia: a retrospective study with cadaveric and ex-vivo validation.

This manuscript presents the challenges of treating various forms of headaches and the potential of interventional techniques targeting the greater occipital nerve (GON) to alleviate the burden on patients. Occipital neuralgia, characterized by stabbing or shooting pain in the base of the skull, is often associated with primary, cervicogenic, or migraine headaches. While occipital nerve blocks offer temporary relief, durable treatment options are limited. Pulsed radiofrequency (PRF) and thermal radiofrequency ablation (TRFA) have shown promise as minimally invasive procedures for long-term treatment. However, GON is not easily identified using ultrasound or fluoroscopic analysis; thereby, minimizing success of proper ablation. Here, the authors provide a percutaneous strategy to localize the GON and maximize lesion performance. We intend to provide an ex-vivo description of staggered bipolar radiofrequency (RF) lesioning and include the use of staggered bipolar lesioning of the GON and stimulation of the semispinalis capitis. We also analyzed the effectiveness and side effects from this ablation, retrospectively. Patients with chronic refractory GON neuralgia were selected for GON TRFA. A novel double needle technique of sequential electrical stimulation was used to localize the GON and approximate needle to nerve distance. Once the needles were positioned adjacent to the GON, TRFA was performed using a bipolar staggered technique. Twenty-two patients with GON were treated with TRFA using a novel double needle technique. Seventy-two percent of these patients reported greater than 50% pain relief at both 1 and 6 months following the procedure. The results of our ex-vivo study demonstrate that performing TRFA using the parallel needle bipolar approach separated 8 mm apart produced the most desirable lesion dimensions that may correlate with effective ablation of the GON. This study demonstrates a new localization and ablation technique to treat refractory headaches. However, larger studies are needed to confirm our findings.

Neck muscle stiffness during craniocervical flexion under functional upper extremity conditions in patients with chronic non-specific neck pain: A shear-wave elastography study

ObjectiveThe primary objective of the present study was to examine the differences and patterns of change in the neck extensor (NE) muscle stiffness during the Cranio-cervical flexion (CCF) task under different functional conditions of the upper extremity between CNSNP participants and asymptomatic controls. MethodsIn the current case-control study, 25 participants with CNSNP and 25 asymptomatic controls were recruited. The stiffness of the superficial (i.e., upper trapezius, splenius capitis, and semispinalis capitis) and deep (i.e., semispinalis cervicis and multifidus) NE muscles was measured at prone resting, sitting resting, and during the CCF task in different functional conditions of upper extremity using shear wave elastography. ResultsThe findings showed that there was a significant main effect of condition in all NE muscles (P < 0.05), as well as a significant main effect of the group on the stiffness of superficial neck muscles (P < 0.05), indicating higher muscle stiffness in participants with CNSNP compared to the control group. There was no significant group-by-condition interaction effect on the stiffness of NE muscles (P > 0.05), except for the upper trapezius muscle (P = 0.00), indicating a different pattern of stiffness changes compared to the other muscles. ConclusionsIndividuals with CNSNP exhibited significantly greater stiffness in the superficial neck extensor muscles compared to healthy controls. Furthermore, the CCF task performed under functional upper extremity conditions, which includes bilateral shoulder scaption and shoulder abduction-external rotation while seated, resulted in increased stiffness of the NE muscles. Additionally, participants with CNSNP exhibited a higher magnitude of stiffness changes in the upper trapezius muscle across different conditions.

A rare presentation of stiff-person syndrome with a nonspecific focal myositis: A case report

Introduction. The stiff-person syndrome (SPS) is a rare disease whose incidence is estimated at approximately 1 in a million individuals in the general population. Diagnosis relies on a combination of clinical, immunological, and electromyographic items. We present the case of a patient diagnosed with the idiopathic SPS, initially misdiagnosed as focal paravertebral myositis. Case presentation. A 36-year-old patient was referred to us for the investigation of subacute dorsal myalgias. The patient reported a severe torticollis seven months ago, which resolved spontaneously after one month, and some episodes of back stiffness. On examination, the patient was afebrile, had hyperlordosis with a paravertebral contracture and tenderness. Neurological and cognitive examinations were normal. C-reactive protein was at 137 mg/l. The rest of laboratory investigations, including creatine phosphokinase (CPK), were within normal range. Spinal MRI revealed T2 hyperintensity in the semispinalis muscle, erector spinae muscle, trapezius muscle, as well as the intervertebral muscles. Therefore, focal paravertebral myositis was suspected. The electromyogram (EMG) revealed the presence of a continuous motor unit activity in agonist and antagonist muscles, suggestive of stiff-person syndrome. Antinuclear antibodies, anti-glutamic acid decarboxylase 65 and onconeuronal antibodies were negative. Analysis of the cerebrospinal fluid, including anti-glutamic acid decarboxylase 65 test, was normal. We noticed that the paravertebral contracture became less noticeable when the patient was commenced on diazepam. Diagnosis of SPS was established according to Dalakas criteria. Investigations for an underlying neoplasm, were normal. Associated autoimmune disorders have been ruled out. The MRI description was rather explained by the continuous contraction of the affected muscles. Treatment included diazepam, baclofen, intravenous immunoglobulin and corticosteroids. The patient showed important signs of improvement. Conclusion. SPS is a rare condition whose diagnosis can be delayed. Recognizing and managing SPS as early as possible is crucial. It is based on clinical reasoning, imaging, biological features and EMG.

Cadaveric study of the ultrasound-guided inter-transversospinalis plane block in dogs for the cervical epaxial musculature region.

Blockage of the dorsal rami of the spinal nerves (DRSN) provides analgesia to the epaxial musculature area in dogs. However, techniques to block the DRSN at the cervical level in dogs haven't yet been investigated. This study aimed to study the anatomy of the cervical area, and to describe a new ultrasound (US)-guided inter-transversospinalis plane (ITP) block technique at the 5th cervical vertebrae (C5). Fourteen adult canine's cadavers were used in this blinded, cadaveric, experimental study. One cadaver for cryo-section, one for anatomical research and twelve to do an ITP injection using 0.3 mL/kg (HV) or 0.15 mL/kg (LV) of dye/contrast solution in each lateral at C5, followed by a computed tomography and anatomical dissection.The HV and LV groups stained a median (range) of 4.67 (3-6) and 3.67 (2-5) DRSN into the ITP, respectively (P<0.017). Stained DRSN in the splenius plane were found in nine (75%) HV and five (41.66%) LV injections, respectively. Spread in the epidural space was found in two dogs using LV. One of them was injected into the ITP (4.33 %) while the other one was done accidentally outside of this plane. The paravertebral spread was found in one injection of each group. There was no dye of the ventral rami of the spinal nerves. The US-guided ITP injection is feasible in dog cadavers. The LV injected just after the medial surface of the semispinalis capitis muscle is recommended to avoid a possible extensive epidural spread.

Invasive wild boar affected feral hog skull evolution over 25 years in Brazilian Pantanal wetland

Abstract The morphological plasticity of the Sus scrofa wild–domestic species complex is evident in both free-ranging morphotypes and domestic breeds. The Brazilian Pantanal feral hog (“porco-monteiro”) evolved after a long-term feralization process and represents a significant proportion of the mammalian biomass in the region. Its coexistence with native fauna brings several ecological impacts, which are mitigated by the Brazilian Pantanal wetland vastness and resource availability. They are a local subsistence game resource but also impact crops and pastures. Around the 2000s to mid-2010s, numerous European wild boar were introduced in Brazil to fulfill a demand for gourmet meat. Wild boar was also introduced to the Brazilian Pantanal as a game species and to breed with porco-monteiro feral hogs in a commercial venture to produce an even more exotic meat. The craze for wild boar meat has since dwindled, but their populations remain widespread and uncontrolled. Moreover, the full impact of the wild boar introduction on feral hog populations is still unknown. This study analyzes the skulls of porco-monteiro feral hogs from the 1990s, 2000s, and 2010s to assess possible morphological and functional variations along with skulls of wild boar and hybrids from Argentina, Uruguay, and Southern Brazil. The results indicate a trend of broadening of feral hog skulls at the coronal plane and a progressive reduction of the semispinalis capitis muscle scars over the decades. Biomechanical analysis denoted a decrease in head-elevation force that could affect the rooting performance of the latest feral hog morphotypes. Taken together, results show that wild boars likely influenced the evolution of the Pantanal feral hog skull. The magnitude of ecomorphological implications of these morphofunctional changes is unknown, as well as its effects in the Brazilian Pantanal wetland ecology.

MyotonPRO as a new valid tool for measuring cervical muscle tension. A reliability study

Objective The main objective of this study is to test the reliability of a non-invasive objective method for the measurement of biomechanical parameters of cervicofacial muscle groups, with the purpose of diagnosis and evaluation of voice disorders’ treatments, especially focused on muscle tension dysphonia. Study design Prospective study. Methods The device used is a handheld myotonometer (MyotonPRO) that measures biomechanical and viscoelastic properties in superficial soft tissues frequency, stiffness, elasticity, relaxation time and creep. It is used in the field of medicine, sport and research. This pilot study includes 10 subjects, who have been measured in the masseter, sternocleidomastoid, orbicularis oris, semispinalis capitis, suprahyoid, infrahyoid and trapezius muscles on each side. Measurements were performed by 2 evaluators to assess inter-evaluator reliability. Subsequently, one of them repeated the measurements to assess intra-evaluator reliability. Results The results revealed good to excellent inter-rater reliability for the masseter, sternocleidomastoid, trapezius and suprahyoid muscles, with lower ICCs for the stiffness and creep properties. Intra-rater reliability was good to excellent for the masseter, sternocleidomastoid, semispinalis capitis and suprahyoid muscles. The lowest ICCs were found in the stiffness and creep properties. Conclusion The use of a myotonometer to measure the mechanical properties of selected cervical and orofacial muscles is a reliable and reproducible method. Future research is needed to establish an association between the properties of these muscles and their role in voice disorders, as well as to determine whether this tool can aid diagnosis with quantifiable and objectifiable indicators, and for monitoring and treatment efficacy.

The semispinalis capitis muscle skull attachment as a superficial external landmark for the location of the transverse dural venous sinuses

IntroductionIdentifiable superficial external landmarks can be used to determine the exact location of the internally located dural venous sinuses, for neurosurgical procedures. Several studies have been conducted to determine a standard method or a consistent reliable landmark, but all reported variations and inconsistencies with the examined landmarks. This study evaluated the relationship between the attachment site of the semispinalis capitis muscles on the external aspect of the skull and the internally located transverse dural venous sinuses. MethodsFifty-one South African skulls were used in this study. The Micro-focus X-ray Radiography and Tomography (MIXRAD) system at Necsa (Nuclear Energy Corporation South Africa) was used to scan and create three-dimensional images of each skull specimen. Pre-determined reference points were placed on the reconstructed images with the VGStudio Max volume rendering software. The relevant distances and locations of the reference points were measured and documented. ResultsThe muscle attachment site was located inferior to the transverse sinuses in all the skulls with a mean distance of 15.99 mm (left side) and 19.43 mm (right side). A statistically significant difference was found between all the measurements comparing the left- and right sides, however, no such difference was found between males and females. ConclusionThe apical attachment of the semispinalis capitis muscle is a good indicator for the internally located transverse dural venous sinus. This study indicates that a point of entry 8–10 mm inferior to this muscle attachment site be used, for safe access to the internal aspect of the posterior cranium.

Hounsfield units of vertebrae as a predictor of cervical deep paraspinal muscles atrophy and neck pain in degenerative cervical myelopathy.

This study investigated the correlation between Hounsfield units (HU) of the cervical vertebrae and atrophy of the cervical deep paraspinal muscles, namely the multifidus and semispinalis cervicis (SCer), in patients diagnosed with degenerative cervical myelopathy (DCM). The authors retrospectively analyzed data from 136 patients aged 50-79 years (81 males and 55 females) who underwent surgical intervention for DCM. HU measurements of the cancellous bone in the C4 vertebra were acquired through standardized techniques. The authors evaluated fatty infiltration (FI); analyzed functional and vertebral cross-sectional area (CSA) of the multifidus and SCer at the C4-5, C5-6, and C6-7 levels; and analyzed the presence of Modic changes (MCs) and the incidence of axial neck pain. Patients were categorized into group A (n = 56) with mean ± SD HU of 293.3 ± 15.6 and group B (n = 80) with mean ± SD HU of 389.5 ± 10.6. Both groups demonstrated significant improvements in postoperative clinical outcomes (p < 0.05); however, no statistically significant difference was observed (p > 0.05). Significant disparities in HU measurements and visual analog scale (VAS) scores for neck pain were observed between the groups (p < 0.05). The highest VAS score correlated with MCs-1 type (i.e., low signal on T1-weighted images and high signal on T2-weighted images). The functional CSA to vertebral CSA ratios of the multifidus and SCer in group A were markedly reduced compared to those of group B (p < 0.05). No significant difference was noted in functional CSA asymmetry between the groups for both muscles (p > 0.05). Lower HU measurements directly correlated with increased FI in the multifidus (p = 0.002) and SCer (p = 0.035). Furthermore, a strong positive association was found between the functional CSA to vertebral CSA ratio of the multifidus and HU values (p = 0.003), whereas HU measurements and VAS scores exhibited a negative correlation (p = 0.020). Among those patients older than 50 years with DCM, those with decreased HU values demonstrated elevated FI levels in the multifidus and SCer muscles. Moreover, these patients presented with pronounced muscle atrophy, which correlated with axial neck pain. A significant relationship was also identified between MCs and diminished HU values.

Relationship between the pH of semispinalis capitis muscle and the quality properties of pork shoulder butt and belly slices

This study investigated the relationship of carcass characteristics such as hot carcass weight and back fat thickness (BFT) and the pH of semispinalis capitis (SC) with the cooking loss (CL) of pork shoulder butt and the CL and Warner–Bratzler shear force (WBSF) of belly. BFT was correlated with the CLs of the butt slices (rs = −0.30) and the belly slices (rs = −0.27 to −0.32). The pH of the SC muscle showed a correlation with the CLs of the butt slices (rs = −0.45) and the belly slices of the 6th and 11th thoracic vertebrae (rs = −0.28 to −0.33). Additionally, the correlations (rs = 0.62 to 0.77) were observed in the CLs among the belly slices. However, the WBSF of the belly slices did not show correlations with others. Therefore, the pH of the SC muscle as well as BFT can be used to obtain information on the CL of shoulder butts and bellies in carcasses.

Effect of castration method on porcine skeletal muscle fiber traits and transcriptome profiles

This study examined the effects of immunocastration and surgical castration on the histomorphometric and transcriptome traits of the porcine skeletal muscle. We hypothesized that the differences in duration of androgen deprivation resulting from different castration methods influence skeletal muscle biology in a muscle-specific manner. This was tested by analyzing samples of m. longissimus dorsi (LD) and m. semispinalis capitis (SSC) from immunocastrated (IC; n = 12), entire male (EM; n = 12), and surgically castrated (SC; n = 12) pigs using enzyme/immunohistochemical classification and histomorphometric analysis of myofibers, quantitative PCR, and RNA sequencing. The results confirmed the distinctive histomorphometric profiles of LD and SSC and the castration method related muscle-specific effects at the histomorphometric and transcriptome levels. Long-term androgen deficiency (surgical castration) significantly reduced the proportion of fast-twitch type IIa myofibers in LD (P<0.05), whereas short-term androgen deprivation (immunocastration) reduced the cross-sectional area of oxidative type I myofibers in SSC (P<0.05). At the transcriptional level, glycolytic LD adapted to long- and short-term androgen deprivation by upregulating genes controlling myoblast proliferation and differentiation to maintain fiber size. In contrast, increased protein degradation through the ubiquitin ligase-mediated atrophy pathway (significantly increased TRIM63 and FBXO32 expression; P<0.05) could underly reduced cross-sectional area of type I myofibers in the oxidative SSC in IC. Potential candidate genes (HK2, ARID5B, SERPINE1, and SCD) linked to specific metabolic profiles and meat quality traits were also identified in IC, providing a foundation for studying the effects of immunocastration on skeletal muscle fiber and carcass/meat quality traits.

Study on the consistency between CT hounsfield units and MRI evaluation of preoperative cervical paraspinal muscular fat infiltration in patients undergoing ACDF

ObjectiveTo explore the feasibility of applying CT Hounsfield Units (HUs) for the assessment of preoperative paraspinal muscle fat infiltration (FI) in different segments in patients who underwent anterior cervical discectomy and fusion (ACDF). To compare the consistency of preoperative paraspinal muscle FI evaluations using MRI and those via CT HUs in patients who underwent ACDF surgery.MethodsNinety-five patients (45 males and 50 females, aged 37‒71 years) who received CT and MRI examinations and underwent ACDF surgery were retrospectively analyzed. In the axial T2-weighted MR images at the median level of the C3/4, C4/5, and C5/6 segments, regions of interests (ROIs) were delineated along the boundaries of the cervical multifidus (MF) and semispinalis cervicis (Scer) muscles. Using the threshold tool in ImageJ software, areas of fat tissue and intermuscular septa within the ROI were quantified. The effective cross-sectional area (ECSA) for each side was obtained by subtracting the areas of fat tissue and intermuscular septa from the total ROI area. The ratio of the fat tissue area to the CSA was then calculated to determine the initial FI value. The depth of subcutaneous fat from the midline spinous process to the epidermis at the median plane of the C4/5 intervertebral disc was measured. The initial FI values were then divided by the depth of fat to determine the post-correction FI value. Using the Picture Archiving and Communication System (PACS), at identical segments and planes, ROIs were delineated using the same method as in MRI under a standard soft tissue window (width of 500 HU, level of 60 HU). The CT HU values were measured within these defined areas. The CT HU values from both sides are summed to obtain the total HU value for the segment. According to whether the measurement results of two sets of data follow a normal distribution, Pearson’s test or Sperman’s test was used to analyze the correlation.ResultsOn MRI, a statistically significant difference was observed in the post-correction FI only at the C3/4 segment compared to the other two segments (P < 0.05). No significant difference in the post-correction FI between the C4/5 and C5/6 segments was noted (P > 0.05). The CT HU results showed a substantial discrepancy between C3/4 and C4/5 segments and between C3/4 and C5/6 segments (P < 0.05), whereas no statistically significant difference was found in the CT HU value between the C4/5 and C5/6 segments (P > 0.05). The consistency analysis revealed a relatively strong correlation between the post-correction FI and CT HU values of the C3/4 and C4/5 segments. Furthermore, a strong correlation was detected in the variations in the measurement outcomes at the C5/6 segment.ConclusionPatients requiring surgical treatment for the cervical spine exhibit varying degrees of FI in paraspinal muscles across different locations and segments. Evaluating the degree of FI in the paraspinal muscles of the cervical spine through CT HU values is feasible. There is considerable consistency between the post-correction FI assessed under MRI and the measurements of CT HU values in evaluating the FI of paraspinal muscles in the cervical spine.

Safety and Preliminary Efficacy of Cervical Paraspinal Interfascial Plane Block for Postoperative Pain after Pediatric Chiari Decompression.

Surgery for lesions of the posterior fossa is associated with significant postoperative pain in pediatric patients related to extensive manipulation of the suboccipital musculature and bone. In this study, we assess the preliminary safety, effect on neuromonitoring, and analgesic efficacy of applying a cervical paraspinal interfascial plane block in pediatric patients undergoing posterior fossa surgery. In this prospective case series, we enrolled five patients aged 2-18 years undergoing surgery for symptomatic Chiari type I malformation. An ultrasound-guided cervical cervicis plane (CCeP) block was performed prior to the incision. A local anesthetic agent (bupivacaine) and a steroid adjuvant (dexamethasone) were injected into the fascial planes between the cervical semispinalis capitis and cervical semispinalis cervicis muscles at the level of the planned suboccipital decompression and C1 laminectomy. Motor-evoked and somatosensory-evoked potentials were monitored before and after the block. Patients were assessed for complications from the local injection in the intraoperative period and for pain in the postoperative period. No adverse events were noted intraoperatively, and there were no changes in neuromonitoring signals. Pain scores were low in the immediate postoperative period, and rescue medications were minimal. No complaints of incisional pain or need for narcotics were noted at the time of the 3-month postsurgical follow-up. In this study, we demonstrate the preliminary safety and analgesic efficacy of a novel application of a CCeP block to pediatric patients undergoing suboccipital surgery. Larger studies are needed to further validate the use of this block in children.

Clinical and Radiological Outcomes in C2 Recapping Laminoplasty for the Pathologies in the Upper Cervical Spine.

To evaluate C2 muscle preservation effect and the radiological and clinical outcomes after C2 recapping laminoplasty. Fourteen consecutive patients who underwent C2 recapping laminoplasty around C1-2 level were enrolled. To evaluate muscle preservation effect, the authors conducted a morphological measurement of extensor muscles between the operated and nonoperated side. Two surgeons measured the cross-sectional area (CSA) of obliquus capitis inferior (OCI) and semispinalis cervicis (SSC) muscle before and after surgery to determine atrophy rates (ARs). Additionally, we examined range of motion (ROM), sagittal vertical axis (SVA), neck visual analogue scale (VAS), Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) score to assess potential changes in alignment and consequent clinical outcomes following posterior cervical surgery. We measured the CSA of OCI and SSC before surgery, and at 6 and 12 months postoperatively. Based on these measurements, the AR of the nonoperated SSC was 0.1% ± 8.5%, the AR of the operated OCI was 2.0% ± 7.2%, and the AR of the nonoperated OCI was -0.7% ± 5.1% at the 12 months after surgery. However, the AR of the operated side's SSC was 11.2% ± 12.5%, which is a relatively higher value than other measurements. Despite the atrophic change of SSC on the operated side, there were no prominent changes observed in SVA, C0-2 ROM, and C2-7 ROM between preoperative and 12 months postoperative measurements, which were 11.8 ± 10.9 mm, 16.3° ± 5.9°, and 48.7° ± 7.7° preoperatively, and 14.1 ± 11.6 mm, 16.1° ± 7.2°, and 44.0° ± 10.3° at 12 months postoperative, respectively. Improvement was also noted in VAS, NDI, and JOA scores after surgery with JOA recovery rate of 77.3% ± 29.6%. C2 recapping laminoplasty could be a useful tool for addressing pathologies around the upper cervical spine, potentially mitigating muscle atrophy and reducing postoperative neck pain, while maintaining sagittal alignment and ROM.

Inferior Trapezius Muscle Agenesis and Scapular Dyskinesis in a 58 Year-Old Black Male Donor: A Cadaveric Case Report

A functionally significant abnormality was observed in a 58 year-old Black male donor with a cause of death of thyroid cancer. He exhibited left inferior trapezius muscle agenesis as well as scapular dyskinesis. The left scapula is shown pressing into the adjacent vertebral bodies of C7 and T1, which resulted in deviations in the location of the left semispinalis capitis, semispinalis cervicis, and splenius cervicis muscles. This resulted in compromise of the left levator scapulae muscle. It is suspected that these abnormalities would have resulted in functional limitations in arm movement, particularly in adduction. A literature review was completed to understand the significance of these abnormalities.

Correlation between degeneration of cervical intervertebral disc and degeneration of paravertebral muscle.

To investigate the relationship between degeneration of cervical intervertebral disc and degeneration of paravertebral muscles[multifidus (MF), cervical semispinalis (SCer), semispinalis capitis (SCap) and splenius capitis (SPL)]. 82 patients with chronic neck pain were randomly selected, including 43 males and 39 females, with 50.73 0.7.51 years old. All patients were scanned by 3.0T MRI Philips Ingenia performed conventional MRI sequence scanning and fat measurement sequence mDIXON-Quant scanning of cervical. Fat infiltration (FI) and cross-sectional area (CSA) of cervical paravertebral muscle (MF, SCer, SCap and SPL) at central level of C5-6 disc were measured by Philips 3.0T MRI image post-processing workstation. According to Pfirrmann grading system, there was no grade I in the included cases. The number of grade IIr IV cases were n=16, 40, 19 and 7 respectively. CSA and FI of cervical paravertebral muscles were compared with t test or one-way ANOVA, Spearman correlation analysis was used to evaluate the correlation between age, disc degeneration, and CSA, FI of cervical paravertebral muscles, and multiple linear regression analysis was used to analyze the independent influencing factors of CSA and FI. CSA of cervical paravertebral muscles in male patients was significantly higher than that in female patients (all P<0.001), but there was no significant difference in FI (all P>0.05). Age was weakly correlated with CSA of MF+SCer, moderately correlated with CSA of SCap and SPL (r=-0.256, -0.355 and -0.361, P<0.05), weakly correlated with FI of SCap and SPL (r= 0.182 and 0.264, P<0.001), moderately correlated with FI of MF+SCer (r=0.408, P<0.001). There were significant differences in FI with disc degeneration (P<0.001, P=0.028 and P=0.005). Further correlation analysis showed that disc degeneration was strongly correlated with FI of MF+SCer (r=0.629, P<0.001), and moderately correlated with FI of SCap and SPL (r=0.363, P=0.001; r=0.345, P=0.002). Multiple linear regression analysis showed that sex and age were the influencing factors of CSA of SCap and SPL, sex was the independent influencing factor of CSA of MF+SCer, and disc degeneration was the independent influencing factor of FI. Age is negatively correlated with CSA and positively correlated with FI. Disc degeneration was correlated with FI of paravertebral muscles, especially with FI of MF and SCer. Sex and age were the influencing factors of CSA, while disc degeneration was the independent influencing factor of FI.

The role of semispinalis capitis muscles in cervical dystonia with goose-neck posture

The role of semispinalis capitis muscles in cervical dystonia with goose-neck posture

The Effect of C2 Muscular Exposure Technique on Radiographic and Clinical Outcomes After C2-T2 Posterior Cervical Fusion.

Retrospective cohort analysis. To determine whether the C2 exposure technique was a predictor of change in cervical alignment and patient-reported outcomes measures (PROMs) after posterior cervical decompression and fusion (PCDF) for degenerative indications. In PCDF handling of the C2 posterior paraspinal musculature during the operative approach varies by surgeon technique. To date, no studies have investigated whether maintenance of the upper cervical semispinalis cervicis attachments as compared with complete reflection of upper cervical paraspinal musculature from the posterior bony elements is associated with superior radiographic and clinical outcomes after PCDF. All adult patients who underwent C2-T2 PCDF for myelopathy or myeloradiculopathy at multi-institutional academic centers between 2013 and 2020 were retrospectively identified. Patients were dichotomized by the C2 exposure technique into semispinalis preservation or midline muscular reflection groups. Preoperative and short and long-term postoperative radiographic outcomes (upper cervical alignment, global alignment, and fusion status) and PROMs (Visual Analog Scale-Neck, Neck Disability Index, and Short Form-12) were collected. Univariate analysis compared patient factors, radiographic measures, and PROMs across C2 exposure groups. A total of 129 patients met the inclusion/exclusion criteria (73 muscle preservation and 56 muscle reflection). Patients in the muscular preservation group were on average younger (P= 0.005) and more likely to have bone morphogenic protein (P< 0.001) and C2 pars screws (P= 0.006) used during surgery. Preoperative to postoperative changes in C2 slope, C2 tilt, C2-C3 segmental lordosis, C2-C3 listhesis, C0-C2 Cobb angle, proximal junctional kyphosis, ADI, C1 lamina-occiput distance, C2 sagittal vertical axis, C2-C7 lordosis, and PROMs at all follow-up intervals did not vary significantly by C2 exposure technique. Likewise, there were no significant differences in fusion status, C2-C3 pseudoarthrosis, C2 screw loosening, and complication and revision rates between C2 exposure groups. Preservation of C2 semispinalis attachments versus muscular reflection did not significantly impact cervical alignment, clinical outcomes, or proximal junction complications in long-segment PCDF. Level III.

A Comprehensive Study of the Potential Compression Points of the Third Occipital Nerve and Its Possible Clinical Interests.

The anatomic features of the third occipital nerve (TON) are the least studied among the occipital nerves. This study aimed to analyze the anatomic features and potential compression points of the TON. The posterior neck and scalp of 39 cadavers were dissected. The TON was carefully followed from the emerging point from C2-C3 vertebrae distally. Its muscular investments were detected. The determined points were marked superficially and measured according to external occipital protuberance with Image J software. The TON revealed 4 different potential entrapment points along its course. The most proximal point was between the C2 and C3 vertebrae. The second and third points were at their piercing points of semispinalis capitis and splenius capitis muscles, respectively. The final point was at its penetrating point of the trapezius muscle. The TON did not pierce the semispinalis capitis muscle on 6 sides, and pierced this muscle from 3 different points by splitting into 3 branches on 1 side. On 5 sides, the TON split into 2 branches and perforated the splenius capitis muscle from 2 different points. There were 4 potential compression points regarding the TON. These entrapment points and variations of the TON may play a significant role in understanding the reason for TON-related headaches and the treatment of headaches caused by the TON.

Fatty infiltration and morphology of cervical muscles in patients with temporomandibular disorders: A case-control study.

Changes in the fatty infiltration and/or muscle volume of neck muscles can alter cervical spine alignment and cranial load distribution, which may cause pain in the orofacial region. The aim of the study was to examine the muscle volume and fatty infiltration of neck muscles in patients with temporomandibular disorders (TMD). This case-control study included 18 patients with TMD and 18 ageand sex-matched controls. The muscle volume and fatty infiltration of the neck muscles of the participants were measured using magnetic resonance imaging (MRI) and ITK-SNAP software. The 3D models of the sternocleidomastoid (SCM), splenius capitis (SPLC), semispinalis cervicis (SC)-semispinalis capitis (SCP), and multifidus (M) muscles within the C3-C7 range were created using ITK-SNAP, a semi-automatic segmentation software. The models were used to determine the volumes and fatty infiltration levels. The Neck Disability Index (NDI) was used to assess neck pain-related disability. The severity of TMD was determined using the Fonseca Anamnestic Index (FAI), while jaw-related disability was measured with the Jaw Functional Limitation Scale-20 (JFLS-20). Pain levels were recorded at rest and during chewing using the numeric rating scale (NRS). There were no statistically significant differences in total muscle volume, fatty infiltration volume and fatty infiltration percentage of the SCM, SPLC, SCP, SC, and M muscles between the 2 groups (p > 0.05). The patient group had higher NDI scores compared to the controls (p < 0.001). The NDI scores correlated positively with the JFLS-20 (r = 0.831, p < 0.001), FAI (r = 0.815, p < 0.001) and NRS scores at rest (r = 0.753, p < 0.001) and during chewing (r = 0.686, p < 0.001). The present study did not identify any significant differences in the neck muscle volume or fatty infiltration between the TMD patients and controls. However, the severity of neck disability was found to correlate with jaw function, pain and TMD levels.

Investigating the Reliability of the Measurement of the Cervical Muscle’s Echo Intensity

Introduction: The skeletal muscle’s echo intensity (EI) is a measurement that can be used to assess the quality of the muscle and any muscle damage caused by training or activity. To determine its reliability, a limited number of studies have investigated the measurement of cervical muscles’ EI. This study determines whether the EI of the cervical muscles can be reliably quantified using the Adobe Photoshop software.&#x0D; Materials and Methods: The mean EI of the cervical muscles was measured using the standard histogram function of Adobe Photoshop CS6 in 20 healthy women.&#x0D; Results: The measurement of EI of cervical muscles using Adobe Photoshop CS6 is reliable in healthy women (intra-class coefficient &gt;0.9). The values of the standard error of measurements of longus coli, sternocleidomastoid, levator scapula, semispinalis capitis, rectus capitis posterior, and oblique capitis superior muscles were 1.81, 2.09, 1.46, 2.02, 1.47 and 1.26, respectively. The values of the smallest detectable difference of longus coli, sternocleidomastoid, levator scapula, semispinalis capitis, rectus capitis posterior, and oblique capitis superior muscles were 7.11, 8.22, 5.74, 7.93, 5.79, and 4.97, respectively.&#x0D; Conclusion: Assessing the EI of the cervical muscles with Adobe Photoshop software is a viable method to determine the quality of the muscles.