scholarly journals Analysis of remaining motion using one innovative upper airway opening cervical collar and two traditional cervical collars

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Matthias K. Jung ◽  
Gregor V. R. von Ehrlich-Treuenstätt ◽  
Holger Keil ◽  
Paul A. Grützner ◽  
Niko R. E. Schneider ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Upper Airway ◽  
Cervical Collar ◽  
Lateral Bending ◽  
Significant Difference ◽  
Airway Opening ◽  
Human Cadavers ◽  
The Mean ◽  
Immobilization Techniques

AbstractThe aim of this study was to compare the remaining motion of an immobilized cervical spine using an innovative cervical collar as well as two traditional cervical collars. The study was performed on eight fresh human cadavers. The cervical spine was immobilized with one innovative (Lubo Airway Collar) and two traditional cervical collars (Stifneck and Perfit ACE). The flexion and lateral bending of the cervical spine were measured using a wireless motion tracker (Xsens). With the Weinman Lubo Airway Collar attached, the mean remaining flexion was 20.0 ± 9.0°. The mean remaining flexion was lowest with the Laerdal Stifneck (13.1 ± 6.6°) or Ambu Perfit ACE (10.8 ± 5.8°) applied. Compared to that of the innovative Weinmann Lubo Airway Collar, the remaining cervical spine flexion was significantly decreased with the Ambu Perfit ACE. There was no significant difference in lateral bending between the three examined collars. The most effective immobilization of the cervical spine was achieved when traditional cervical collars were implemented. However, all tested cervical collars showed remaining motion of the cervical spine. Thus, alternative immobilization techniques should be considered.

scholarly journals Evaluation of external stabilization of type II odontoid fractures in geriatric patients—An experimental study on a newly developed cadaveric trauma model

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260414
Author(s):  
Matthias K. Jung ◽  
Gregor V. R. von Ehrlich-Treuenstätt ◽  
Andreas L. Jung ◽  
Holger Keil ◽  
Paul A. Grützner ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Geriatric Patients ◽  
Odontoid Fracture ◽  
Cervical Collar ◽  
Type Ii ◽  
Lateral Bending ◽  
Odontoid Fractures ◽  
Human Cadavers ◽  
The Mean ◽  
External Stabilization

Background Along with the growing geriatric population, the number of odontoid fractures is steadily increasing. However, the effectiveness of immobilizing geriatric odontoid fractures using a cervical collar has been questioned. The aim of the present study is to analyze the physiological and pathological motion in odontoid fractures and to assess limitation of motion in the cervical spine when applying a cervical collar. Methods Motion analysis was performed with wireless motion tracker on unfixed geriatric human cadavers. First, a new geriatric type II odontoid fracture model was developed. In this model, the type II odontoid fracture is operated via a transoral approach. The physiological and pathological flexion and lateral bending of the cervical spine resulting from this procedure was measured. The resulting motion after external stabilization using a cervical collar was analyzed. Results The new geriatric type II odontoid fracture model was successfully established using seven unfixed human cadavers. The pathological flexion of the cervical spine was significantly increased compared to the physiological flexion (p = 0.027). Furthermore, the flexion was significantly reduced when a cervical collar was applied. In case of flexion the mean remaining motion was significantly reduced (p = 0.0017) from 41° to 14°. For lateral bending the mean remaining motion was significantly reduced (p = 0.0137) from 48° to 18°. Conclusions In case of type II odontoid fracture, flexion and lateral bending of the cervical spine are increased due to spinal instability. Thus, if an odontoid fracture is suspected in geriatric patients, the application of a cervical collar should always be considered since external stabilization can significantly reduce flexion and lateral bending.

scholarly journals Cervical Spine Immobilization in Patients With a Geriatric Facial Structure: The Influence of a Geriatric Mandible Structure on the Immobilization Quality Using a Cervical Collar

2021 ◽  
Vol 12 ◽  
pp. 215145932110218
Author(s):  
Matthias K. Jung ◽  
Paul A. Grützner ◽  
Niko R. E. Schneider ◽  
Holger Keil ◽  
Michael Kreinest
Keyword(s):  
Cervical Spine ◽  
Cervical Collar ◽  
Structure Group ◽  
Facial Structure ◽  
Lateral Bending ◽  
Mandibular Angle ◽  
Emergency Medical Service Personnel ◽  
Significant Difference ◽  
Spine Motion ◽  
The Mean

Introduction: Demographic changes have resulted in an increase in injuries among geriatric patients. For these patients, a rigid cervical collar is crucial for immobilizing the cervical spine. However, evidence suggests that patients with a geriatric facial structure require a different means of immobilization than patients with an adult facial structure. This study aimed to analyze the remaining motion of the immobilized cervical spine based on facial structure. Materials and Methods: This study was performed on 8 fresh human cadavers. Facial structure was evaluated via ascertaining the mandibular angle by computer tomography. A mandibular angle below 130°, belongs to the adult facial structure group ( n = 4) and a mandibular angle above 130°, belongs to the geriatric facial structure group ( n = 4). The flexion and lateral bending of the immobilized cervical spine were analyzed in both groups using a wireless motion tracker system. Results: A flexion of up to 19.0° was measured in the adult facial structure group. The mean flexion in the adult vs. geriatric facial structure groups were 14.5° vs. 6.5° (ranges: 9.0-19.0 vs. 5.0-7.0°), respectively. Thus, cervical spine motion was ( p = 0.0286) significantly more reduced in the adult facial structure group. No ( p = 0.0571) significant difference was oberserved in the mean lateral bending of the adult facial structure group (14.5°) compared to the geriatric facial structure group (7.5°). Conclusion: Emergency medical service personnel should therefore follow current guidelines and recommendations and perform cervical spine immobilization with a cervical collar, including in patients with a geriatric facial structure.

Remaining Cervical Spine Movement Under Different Immobilization Techniques

2020 ◽  
Vol 35 (4) ◽  
pp. 382-387 ◽  
Author(s):  
Davut D. Uzun ◽  
Matthias K. Jung ◽  
Jeronimo Weerts ◽  
Matthias Münzberg ◽  
Paul A. Grützner ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Standard Procedure ◽  
Human Motion ◽  
Cervical Collar ◽  
Vacuum Mattress ◽  
Flexion Extension ◽  
Immobilization Techniques ◽  
Spine Board ◽  
Spine Movement ◽  
Belt System

AbstractBackground:Immobilization of the cervical spine by Emergency Medical Services (EMS) personnel is a standard procedure. In most EMS, multiple immobilization tools are available.The aim of this study is the analysis of residual spine motion under different types of cervical spine immobilization.Methods:In this explorative biomechanical study, different immobilization techniques were performed on three healthy subjects. The test subjects’ heads were then passively moved to cause standardized spinal motion. The primary endpoints were the remaining range of motion for flexion, extension, bending, and rotation measured with a wireless human motion detector.Results:In the case of immobilization of the test person (TP) on a straight (0°) vacuum mattress, the remaining rotation of the cervical spine could be reduced from 7° to 3° by additional headblocks. Also, the remaining flexion and extension were reduced from 14° to 3° and from 15° to 6°, respectively. The subjects’ immobilization was best on a spine board using a headlock system and the Spider Strap belt system (MIH-Medical; Georgsmarienhütte, Germany). However, the remaining cervical spine extension increased from 1° to 9° if a Speedclip belt system was used (Laerdal; Stavanger, Norway). The additional use of a cervical collar was not advantageous in reducing cervical spine movement with a spine board or vacuum mattress.Conclusions:The remaining movement of the cervical spine is minimal when the patient is immobilized on a spine board with a headlock system and a Spider Strap harness system or on a vacuum mattress with additional headblocks. The remaining movement of the cervical spine could not be reduced by the additional use of a cervical collar.

Expandable cylindrical cages in the cervical spine: a review of 22 cases

2006 ◽  
Vol 4 (4) ◽  
pp. 285-291 ◽  
Author(s):  
Kurtis I. Auguste ◽  
Cynthia Chin ◽  
Frank L. Acosta ◽  
Christopher P. Ames
Keyword(s):  
Cervical Spine ◽  
Perioperative Complications ◽  
Posterior Spinal Fusion ◽  
Anterior Fusion ◽  
Graft Material ◽  
Significant Difference ◽  
Flexion Extension ◽  
Functional Scores ◽  
Cage Subsidence ◽  
The Mean

Object Expandable cylindrical cages (ECCs) have been utilized successfully to reconstruct the thoracic and lumbar spine. Their advantages include ease of insertion, reduced endplate trauma, direct application/maintenance of interbody distraction force, and one-step kyphosis correction. The authors present their experience with ECCs in the reconstruction of the cervical spine in patients with various pathological conditions. Methods Data obtained in 22 patients were reviewed retrospectively. A standard anterior cervical corpectomy was performed in all cases. Local vertebral body bone was harvested for use as graft material. Patients underwent pre- and postoperative assessment involving the visual analog scale (VAS), Nurick grading system for determining myelopathy disability, and radiographic studies to determine cervical kyphosis/lordosis and cage subsidence. Fusion was defined as the absence of motion on flexion–extension x-ray films. Sixteen patients presented with spondylotic myelopathy, two with osteomyelitis, two with fracture, one with tumor metastasis, and one with severe stenosis. Fourteen patients underwent supplemental posterior spinal fusion, seven underwent single-level corpectomy, and 15 patients underwent multilevel corpectomy. No perioperative complications occurred. The mean follow-up period was 22 months. In 11 patients with preexisting kyphosis (mean deformity +19°), the mean correction was 22°. There was no statistically significant difference in subsidence between single- and multilevel corpectomy or between 360º fusion and anterior fusion alone. The VAS scores improved by 35%, and the Nurick grade improved by 31%. The fusion rate was 100%. Conclusions The preliminary results support the use of ECCs in the cervical spine in the treatment of patients with various disease processes. No significant subsidence was noted, and pain and functional scores improved in all cases. Expandable cylindrical cages appear to be well suited for cervical reconstruction and for correcting sagittal malalignment.

scholarly journals Comparison of Imaging Softwares for Upper Airway Evaluation: Preliminary Study

2018 ◽  
Vol 11 (4) ◽  
pp. 273-277
Author(s):  
Guilherme dos Santos Trento ◽  
Lucas Borin Moura ◽  
Rubens Spin-Neto ◽  
Philipp Christian Jürgens ◽  
Marisa Aparecida Cabrini Gabrielli ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Digital Imaging ◽  
Upper Airway ◽  
Cone Beam ◽  
Maxillary Expansion ◽  
Accuracy And Precision ◽  
Significant Difference ◽  
Computed Tomography Scans ◽  
The Mean ◽  
Preliminary Study

The interest about upper airway evaluation has increased lately. Therefore, many softwares have been developed aiming to improve and facilitate the analysis of airway volume. The objective of this study was to compare two different softwares packages, Mimics and Dolphin, in their accuracy and precision in upper airway space measurements. Preoperative cone beam computed tomography scans of nine nonsyndromic patients submitted to surgically assisted rapid maxillary expansion were included in this study. The imaging exams were converted to DICOM (digital imaging and communications in medicine) files and imported to the softwares. The mean volume for the Dolphin group (G1) was 10.791 cm3 (SD = 4.269 cm3) and for the Mimics group (G2) was 10.553 cm3 (SD = 4.564 cm3). There was no statistically significant difference between the two groups ( p = 0.105).

Quantification of the coupled motion that occurs with axial rotation and lateral bending of the head-neck complex: An experimental examination

2007 ◽  
Vol 221 (8) ◽  
pp. 913-919 ◽  
Author(s):  
M Senouci ◽  
D FitzPatrick ◽  
J F Quinlan ◽  
H Mullett ◽  
L Coffey ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Full Range ◽  
Axial Rotation ◽  
Spine Injury ◽  
Regression Equations ◽  
Lateral Bending ◽  
Male And Female ◽  
Coupled Motion ◽  
Significant Difference ◽  
Head Neck

The vertebrae of the cervical spine exhibit out-of-plane or coupled motion during axial rotation and lateral bending. Quantifying the range of motion (ROM) of this occurrence can aid the understanding of cervical spine injury mechanisms and disorders, as well as the development of new treatment methods. Previous studies have formulated ratios to describe coupled motion obtained from in-vitro examinations. The aim of the present study was to use in-vivo test data to develop mathematical relationships to quantify the coupled motion that occurs with axial rotation and lateral bending of the head-neck complex. Using a three-dimensional motion analyser it was possible to trace the coupling effect throughout the full range of unrestricted head-neck motion. Values for primary and coupled ROMs were obtained, showing no significant difference between male and female primary ROMs but a small disparity between male and female coupled ROMs. Regression equations were found to quantify coupled motion throughout the range of axial rotation and lateral bending. The present experimental study also examines the range of horizontally fixed axial rotation of the head to determine the minimum amount of coupled lateral bending that takes place, which has not been measured previously.

Comparing Upper Airway Stimulation to Expansion Sphincter Pharyngoplasty: A Single University Experience

2018 ◽  
Vol 127 (6) ◽  
pp. 379-383 ◽  
Author(s):  
Colin Huntley ◽  
David W. Chou ◽  
Karl Doghramji ◽  
Maurits Boon
Keyword(s):  
Success Rate ◽  
Upper Airway ◽  
Upper Airway Stimulation ◽  
Surgical Success ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Expansion Sphincter Pharyngoplasty ◽  
The Mean ◽  
Sphincter Pharyngoplasty ◽  
Surgical Option

Introduction: Expansion sphincter pharyngoplasty (ESP) is a surgical option for patients with obstructive sleep apnea (OSA). Upper airway stimulation (UAS) is an alternative that has shown success in initial outcomes studies. We compare outcomes of a cohort of patients undergoing UAS to ESP. Methods: We compared demographic and polysomnographic data of the UAS to ESP cohorts. We also calculated the proportion of patients achieving surgical success. Results: The ESP cohort consisted of 33 patients. The mean preoperative Apnea-Hypopnea Index (AHI), O2 nadir, Epworth Sleepiness Scale (ESS), and BMI were 36.47 ± 20.01, 82.63 ± 5.37, 10.69 ± 4.42, and 29.6 ± 4.49, which improved to 13.47 ± 18.74, 84.84 ± 5.48, 7.00 ± 5.81, and 29.92 ± 4.59 postoperatively. There was a 63.64% success rate. The UAS cohort consisted of 75 patients. The mean preoperative AHI, O2 nadir, ESS, and BMI were 36.76 ± 20.72, 80.24 ± 8.43, 11.18 ± 4.16, and 29.50 ± 3.96, which improved to 7.25 ± 11.19, 88.71 ± 3.25, 5.36 ± 3.35, and 29.36 ± 3.68 postoperatively. The success rate was 86.67%. We found a significant difference in gender, age, preoperative AHI, postoperative AHI, postoperative O2 nadir, surgical success, and patients reaching an AHI less than 10 and 5. Conclusion: Upper airway stimulation is a new surgical option for select patients with OSA showing comparable or improved outcomes to a cohort of patients undergoing ESP.

Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates

2007 ◽  
Vol 6 (4) ◽  
pp. 298-303 ◽  
Author(s):  
Justin F. Fraser ◽  
Roger Härtl
Keyword(s):  
Cervical Spine ◽  
Fusion Rate ◽  
Anterior Plate ◽  
Chi Square ◽  
Significant Difference ◽  
The Mean ◽  
Cervical Plate ◽  
Disc Level ◽  
Plate System

Object Anterior cervical discectomy (ACD), ACD with interbody fusion (ACDF), ACDF with placement of an anterior plate system (ACDFP), corpectomy, and corpectomy with plate placement are used to fuse the cervical spine. The authors conducted a metaanalysis of studies published after 1990 in which fusion rates achieved with each procedure were reported for patients with degenerative disease at one, two, and three disc levels. Methods Twenty-one papers each included data on at least 25 patients. In each of the 21 studies the average clinical follow up was more than 12 months, and the results were evaluated according to radiographic evidence of fusion and delineated by the number of levels fused. Chi-square and Fisher exact tests were used for comparisons. The mean age of the patients was 46.7 years, 46.6% were female, and the mean follow-up period was 39.6 months. The studies included 2682 patients and the overall fusion rate was 89.5%. For single disc–level disease, fusion rates were 84.9% for ACD, 92.1% for ACDF, and 97.1% for ACDFP (p = 0.0002). For two disc–level disease, fusion rates were 79.9% for ACDF, 94.6% for ACDFP, 95.9% for corpectomy, and 92.9% for corpectomy with plate placement (p = 0.0001). For three disc–level disease, fusion rates were 65.0% for ACDF, 82.5% for ACDFP, 89.8% for corpectomy, and 96.2% for corpectomy with plate placement (p = 0.0001). The use of anterior plates significantly improved fusion for one-level (p < 0.0001), two-level (p < 0.0001), and three-level (p < 0.05) ACDF. There was no significant difference in fusion rates between two-level ACDF and corpectomy with plate placement. Conclusions The anticipated fusion rate is one of several factors that may guide surgical decision making. Anterior cervical decompression and fusion results in high fusion rates. The results of the authors' study show that regardless of the number of levels fused, the use of an anterior cervical plate system significantly increases the fusion rate. For two-disc–level disease, there was no significant difference between ACD with a plate system or corpectomy with a plate system. For three-disc–level disease, however, the evidence suggests that corpectomy with plate placement is associated with higher fusion rates than discectomy with plate placement.

Effect of lower two-level anterior cervical fusion on the superior adjacent level

2007 ◽  
Vol 7 (3) ◽  
pp. 336-340 ◽  
Author(s):  
Dong-Hyuk Park ◽  
Prem Ramakrishnan ◽  
Tai-Hyoung Cho ◽  
Eric Lorenz ◽  
Jason C. Eck ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Intradiscal Pressure ◽  
T Test ◽  
Anterior Cervical Fusion ◽  
Segmental Motion ◽  
Cervical Fusion ◽  
Lateral Bending ◽  
Before And After ◽  
The Mean ◽  
Pressure Changes

Object Symptomatic multisegment disease is most common at the C5–6 and C6–7 levels, and two-level anterior cervical discectomy and fusion (ACDF) is performed most often at these levels. Therefore, it may be clinically important to know whether a C5–7 fusion affects the superior C4–5 segment. A biomechanical study was carried out using cadaveric cervical spine specimens to determine the effect of lower two-level anterior cervical fusion on intradiscal pressure and segmental motion at the superior adjacent vertebral level. Methods Five cadaveric cervical spine specimens were used in this study. The specimens were stabilized at T-1 and loaded at C-3 to 15° flexion, 10° extension, and 10° lateral bending before and after simulated two-level ACDF with plate placement at C5–7. Intradiscal pressure was recorded at the C4–5 level, and segmental motion was recorded from C-4 through C-7. Differences in mean intradiscal pressures were calculated and analyzed using a paired Student t-test. When the maximum calibrated intradiscal pressures were exceeded (“overshot”) during measurements, data from the specimens involved were analyzed using the motion data with a Student t-test. Values for pressure and motion obtained before and after simulated ACDF were compared. Results During flexion, the mean intradiscal pressure changes (± standard deviations) in the pre- and post-ACDF measurements were 1275 (± 225) mm Hg and 2475 (± 75) mm Hg, respectively (p < 0.05). When the results of pre-ACDF testing were compared with post-ACDF results, no significant difference was found in the mean changes in the intradiscal pressure during extension and lateral bending. The maximum calibrated intradiscal pressures were exceeded during the post-ACDF testing in four specimens in extension, three in flexion, and two in lateral bending. Comparison of pre- and post-ACDF data for all five specimens revealed significant differences in motion and intradiscal pressure (p < 0.05) during flexion, significant differences in motion (p < 0.05) but not in intradiscal pressure during extension, and significant differences in intradiscal pressure changes (p < 0.05) but not in motion during lateral bending. Conclusions Simulated C5–7 ACDF caused a significant increase in intradiscal pressure and segmental motion in the superior adjacent C4–5 level during physiological motion. The increased pressure and hypermobility might accelerate normal degenerative changes in the vertebral levels adjacent to the anterior cervical fusion.

Study on the Thicknesses and the Girths of Tendoachilles of Human Cadavers: Study in a Medical College

2020 ◽  
Vol 11 (2) ◽  
pp. 124-129
Author(s):  
Lutfun Nahar ◽  
Ahmad Seraji ◽  
Md Shofiur Rahman ◽  
Md Redwan Ahsanullah
Keyword(s):  
Human Cadaver ◽  
Dhaka City ◽  
Cross Sectional ◽  
Male And Female ◽  
Medical College ◽  
Significant Difference ◽  
Human Cadavers ◽  
The Mean ◽  
The Difference ◽  
Measurement Of Thickness

Study on the Thicknesses and the Girths of Tendoachilles of Human Cadavers. Background: Tendoachilles is the chief planter flexor of the ankle joint. It provides elastic energy storage in walking and running. The present study was planned to collect data to find out possible variations of thickness and girth between right and left leg of both male and female. Materials and methods: A cross sectional analytical type of study was conducted in the department of Anatomy, Dhaka Medical College, Dhaka, from July 2013 to June 2014. The data was collected from both right and left tendoachilles of 60 human cadaver taken from Anatomy Department of different Government and Nongovernment Medical Colleges in Dhaka city. After dissection thickness and girth of tendoachilles was measured and recorded. Results: Among 60 human cadaver, 30 are male and 30 are female. The mean thickness of tendoachilles was greater in right leg than in left leg at its junction with gastrocnemius in male, (P<0.001) at the level of 4 cm above its junction with calcaneus and at the level of its junction with calcaneus in both male and female. No significant difference was observed in the measurement of thickness of right and left tendoachilles at the level of its junction with gastrocnemius in female. Mean girth of tendoachilles was greater in right leg than in left leg at its junction with gastrocnemius, at the level of 4 cm above its junction with calcaneus and at the level of its junction with calcaneus in both male and female. Conclusions: The present study revealed that thickness and girth of tendoachilles was greater in right leg than in left leg which were statistically significant. The difference in thickness and girth can be useful during repair of rupture tendon by orthopaedic and plastic surgeon. J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 124-129

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