Personalised gravitational loading of the cervical spine from biplanar X-rays for asymptomatic and clinical subjects in neutral standing position

Background: Detailed knowledge of cervical canal and transverse foramens’ morphometry is critical for understanding the pathology of certain diseases and for proper preoperative planning. Lateral x-rays do not provide the necessary accuracy. A retrospective morphometric study of the cervical canal was performed at the authors’ institution to measure mean dimensions of sagittal canal diameter (SCD), right and left transverse foramens’ sagittal (SFD) and transverse (TFD) diameters and minimum distance between spinal canal and transverse foramens (dSC-TF) for each level of the cervical spine from C1-C7, using computerized tomographic scans, in 100 patients from the archives of the Emergency Room. Results: Significant differences for SCD were detected between C1 and the other levels of the cervical spine for both male and female patients. For the transverse foramen, significant differences in sagittal diameters were detected at C3, C4, C5 levels. For transverse diameters, significant differences at C3 and C4 levels. A significant difference of the distance between the transverse spinal foramen and the cervical canal was measured between left and right side at the level of C3. This difference was equally observed to male and female subjects. Conclusion: CT scan can replace older conventional radiography techniques by providing more accurate measurements on anatomical elements of the cervical spine that could facilitate diagnosis and preoperative planning, thus avoiding possible trauma to the vertebral arteries during tissue dissection and instrument application.

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What a Pain in the Neck!

Pediatric Traumatic Emergencies ◽

10.1093/med/9780190946623.003.0002 ◽

2020 ◽

pp. 13-22

Author(s):

Walter Wiswell ◽

Bryan McCarty

Keyword(s):

Decision Making ◽

Emergency Department ◽

Cervical Spine ◽

Neck Pain ◽

Pediatric Patient ◽

Ct Scans ◽

X Rays ◽

Pros And Cons ◽

Current Guidelines ◽

Patient Presentation

The chapter on cervical spine controversies in children describes what initial steps need to be taken in assessing a pediatric patient with neck pain after trauma, and discusses the decision-making process that goes into further evaluation and testing. Clinical actions and assessments of the patient on-scene, whether to pursue imaging once in the emergency department setting, and what imaging is most appropriate depending on the patient presentation are discussed. Indications and contraindications for cervical spine immobilization and spinal positioning, including proper techniques based on a patient’s age and whether or not such steps are necessary. It also discusses the pros and cons of x-rays, CT scans, and MRIs in the context of pediatric neck trauma, and current guidelines that should be followed when deciding to order such studies.

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Computed Tomography- and Radiography-Based Morphometric Analysis of the Lateral Mass of the Subaxial Cervical Spine in the Indian Population

Asian Spine Journal ◽

10.4184/asj.2018.12.1.18 ◽

2018 ◽

Vol 12 (1) ◽

pp. 18-28

Author(s):

Nirmal D Patil ◽

Sudhir K Srivastava ◽

Sunil Bhosale ◽

Shaligram Purohit

Keyword(s):

Computed Tomography ◽

Cervical Spine ◽

Indian Population ◽

Tertiary Care ◽

X Rays ◽

Lateral Mass ◽

Cross Sectional ◽

X Ray ◽

Subaxial Cervical Spine ◽

Screw Length

<sec><title>Study Design</title>This was a double-blinded cross-sectional study, which obtained no financial support for the research.</sec><sec><title>Purpose</title>To obtain a detailed morphometry of the lateral mass of the subaxial cervical spine.</sec><sec><title>Overview of Literature</title>The literature offers little data on the dimensions of the lateral mass of the subaxial cervical spine.</sec><sec><title>Methods</title>We assessed axial, sagittal, and coronal computed tomography (CT) cuts and anteroposterior and lateral X-rays of the lateral mass of the subaxial cervical spine of 104 patients (2,080 lateral masses) who presented to a tertiary care public hospital (King Edward Memorial Hospital, Mumbai) in a metropolitan city in India.</sec><sec><title>Results</title>For a majority of the parameters, males and females significantly differed at all levels (<italic>p</italic><0.05). Females consistently required higher (<italic>p</italic><0.05) minimum lateral angulation and lateral angulation. While the minimum lateral angulation followed the order of C5<C4<C6<C3, the lateral angulation followed the order of C3<C5<C4<C6. The lateral mass becomes longer and narrower from C3 to C7. In axial cuts, the dimensions increased from C3 to C6. The sagittal cut thickness and diagonal length increased and the sagittal cut height decreased from C3 to C7. The sagittal cut height was consistently lower in the Indian population at all levels, especially at the C7 level, as compared with the Western population, thereby questioning the acceptance of a 3.5-mm lateral mass screw. A good correlation exists between X-ray- and CT-based assessments of the lateral mass.</sec><sec><title>Conclusions</title>Larger lateral angulation is required for Indian patients, especially females. The screw length can be effectively calculated by analyzing the lateral X-ray. A CT scan should be reserved for specific indications, and a caution must be exercised while inserting C7 lateral mass screws.</sec>

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Cervical Spine ROM Measurements: Optimizing the Testing Protocol by Using a 3D Ultrasound-Based Motion Analysis System

Cephalalgia ◽

10.1111/j.1468-2982.2005.00970.x ◽

2005 ◽

Vol 25 (12) ◽

pp. 1133-1145 ◽

Cited By ~ 31

Author(s):

N Strimpakos ◽

V Sakellari ◽

G Gioftsos ◽

M Papathanasiou ◽

E Brountzos ◽

...

Keyword(s):

Motion Analysis ◽

Intraclass Correlation ◽

Reliability And Validity ◽

3D Ultrasound ◽

Standing Position ◽

X Rays ◽

Passive Measurement ◽

Smallest Detectable Difference ◽

Analysis System ◽

Flexion And Extension

The aim of this study was to evaluate the intra- and inter-examiner reliability and validity of neck range of motion (ROM) measurements. Thirty-five healthy subjects were assessed in all neck movements from two initial positions, sitting and standing, actively (open and closed eyes) and passively by using a 3D ultrasound-based motion analysis device (Zebris). Three tests were employed to assess intra-examiner reliability and two examiners used for the inter-examiner reliability. X-rays in neck flexion and extension were used to validate the Zebris system. The standing position yielded higher intraclass correlation coefficient (ICC) values (>0.86) with less error [smallest detectable difference (SDD) < 13.8%] than sitting (ICC > 0.79, SDD < 14%). Passive assessment of neck ROM presented better reproducibility than active assessment with open or closed eyes in both positions. The inter-examiner reliability was moderate (ICC = 0.43-0.68). The correlation between the Zebris system and X-rays was high in both flexion and extension movements. The results showed that the most reliable protocol for assessment of neck ROM is a passive measurement in the standing position. The measurements were well validiated against X-rays and the experience of the investigators must be considered before any comparison among studies is employed.

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Cervical Spine Movement Sequencing During Flexion-Extension

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53694 ◽

2011 ◽

Author(s):

William J. Anderst ◽

Michelle Schafman ◽

William F. Donaldson ◽

Joon Y. Lee ◽

James D. Kang

Keyword(s):

Cervical Spine ◽

Range Of Motion ◽

Daily Living ◽

X Rays ◽

Clinical Tool ◽

Normal Range ◽

Kinematic Data ◽

Flexion Extension ◽

Functional Movements ◽

Spine Movement

Static flexion-extension x-rays are the most common clinical tool used to assess abnormal motion of the cervical spine. Despite their widespread use (over 168,000 cases per year), the clinical efficacy of flexion-extension radiographs of the cervical spine has yet to be proven1. Limitations of static flexion-extension x-rays include data collection during static positions that may not accurately represent dynamic behavior, and the fact that data is collected at end range of motion positions, not in more frequently encountered mid-range positions. Consequently, static x-rays may not reveal movement abnormalities that occur during activities of daily living and lead to pain and degeneration. Therefore, it may be advantageous to analyze cervical spine kinematic data collected during dynamic, functional movements performed through an entire range of motion (not just the endpoints). Furthermore, the literature confirms there is substantial variability in “normal” range of motion and translation during flexion-extension1, making it difficult to reliably identify abnormal motion. Therefore, it may also be beneficial to evaluate alternative motion parameters that may reliably identify abnormal motion.

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PARAMETERIZED LOWER CERVICAL SPINE MODELING FOR RECONSTRUCTION FROM BIPLANAR X-RAYS

Journal of Biomechanics ◽

10.1016/s0021-9290(12)70619-x ◽

2012 ◽

Vol 45 ◽

pp. S618

Author(s):

Zacaria ESSAÏDI ◽

Marc Antoine ROUSSEAU ◽

Sébastien LAPORTE ◽

Thomas JOUBERT ◽

Wafa SKALLI

Keyword(s):

Cervical Spine ◽

X Rays ◽

Lower Cervical Spine ◽

Spine Modeling

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The Management of Unstable Cervical Spine Injuries

Clinical Medicine Insights Trauma and Intensive Medicine ◽

10.4137/cmtim.s12263 ◽

2014 ◽

Vol 5 ◽

pp. CMTIM.S12263

Author(s):

Venu M. Nemani ◽

Han Jo Kim

Keyword(s):

Cervical Spine ◽

Medical Condition ◽

Treatment Plan ◽

Neurological Status ◽

Patient Specific ◽

X Rays ◽

Mechanism Of Injury ◽

Imaging Studies ◽

Cervical Spine Injuries ◽

Spine Injuries

Injuries to the cervical spine can cause potentially devastating morbidity and even mortality. In this review we discuss the anatomy and biomechanics of the cervical spine. The evaluation and treatment of cervical spine injuries begins with the prompt immobilization of suspected injuries in the field. Once an assessment of the patient's neurological status is made, imaging studies are obtained, which can include X-rays, CT, and MRI. Careful scrutiny of the imaging studies for bony and/or ligamentous injury allows the physician to determine the mechanism of injury, which guides treatment. The ultimate treatment plan can consist of non-operative or operative management, and depends on patient specific factors (medical condition and neurological status), the mechanism of injury, and the resultant degree of instability. With prompt diagnosis and appropriate management, the morbidity of these injuries can be minimized.

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Surgical management of metastatic tumors of the cervical spine

Folia Medica ◽

10.2478/folmed-2013-0026 ◽

2013 ◽

Vol 55 (3-4) ◽

pp. 39-45 ◽

Cited By ~ 2

Author(s):

Atanas N. Davarski ◽

Borislav D. Kitov ◽

Christo B. Zhelyazkov ◽

Stefan D. Raykov ◽

Ivo I. Kehayov ◽

...

Keyword(s):

Cervical Spine ◽

Tumor Resection ◽

Pain Syndrome ◽

University Hospital ◽

X Rays ◽

Stabilization System ◽

Spine Metastases ◽

Anterior Corpectomy ◽

Nerve Root Decompression ◽

Postoperative State

ABSTRACT OBJECTIVE: To present the results from the clinical presentation, the imaging diagnostics, surgery and postoperative status of 17 patients with cervical spine metastases, to analyse all data and make the respective conclusions and compare them with the available data in the literature. PATIENTS AND METHODS: The study analysed data obtained by patients with metastatic cervical tumours treated in St George University Hospital over a period of seven years. All patients underwent diagnostic imaging tests which included, separately or in combination, cervical x-rays, computed tomography scan and magnetic-resonance imaging. Severity of neurological damage and its pre- and postoperative state was graded according to the Frankel Scale. For staging and operating performance we used the Tomita scale and Harrington classification. RESULTS: Seven patients had only one affected vertebra, 4 patients - two vertebrae, one patient - three vertebrae, 2 patients - four vertebrae, and in the other 3 patients more than one segment was affected. Surgery was performed in 12 patients. One level anterior corpectomy was performed in 6 patients, three patients had two-level surgery, and one patient - three-level corpectomy; in the remaining 2 cases we used posterior approach in surgery. Complete corpectomy was performed in 4 patients, subtotal corpectomy was used in 6 patients and partial - in 2 patients. Anterior stabilization system ADD plus® (Ulrich GmbH & Co. KG, Ulm, Germany) was implanted in 2 patients; in 8 patients anterior titanium plate and bone graft were used, and in 1 patient - posterior cervical stabilization system. CONCLUSIONS: Because of the pronounced pain syndrome and frequent neurological lesions as a result of the cervical spine metastases use of surgery is justified. The main purpose is to maximize tumor resection, achieve optimal spinal cord and nerve root decompression and stabilize the affected segment.

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