Quantifying Cervical-Spine Curvature Using Bézier Splines

2012 ◽  
Vol 134 (11) ◽  
Author(s):  
Kathleen D. Klinich ◽  
Sheila M. Ebert ◽  
Matthew P. Reed
Keyword(s):  
Cervical Spine ◽  
Quantitative Method ◽  
Advanced Technology ◽  
Spinal Curvature ◽  
Qualitative Assessment ◽  
Spine Injury ◽  
X Rays ◽  
Gender And Age ◽  
Spine Curvature ◽  
Two Parameters

Knowledge of the distributions of cervical-spine curvature is needed for computational studies of cervical-spine injury in motor-vehicle crashes. Many methods of specifying spinal curvature have been proposed, but they often involve qualitative assessment or a large number of parameters. The objective of this study was to develop a quantitative method of characterizing cervical-spine curvature using a small number of parameters. 180 sagittal X-rays of subjects seated in automotive posture with their necks in neutral, flexed, and extended postures were collected in the early 1970s. Subjects were selected to represent a range of statures and ages for each gender. X-rays were reanalyzed using advanced technology and statistical methods. Coordinates of the posterior margins of the vertebral bodies and dens were digitized. Bézier splines were fit through the coordinates of these points. The interior control points that define the spline curvature were parameterized as a vector angle and length. By defining the length as a function of the angle, cervical-spine curvature was defined with just two parameters: superior and inferior Bézier angles. A classification scheme was derived to sort each curvature by magnitude and type of curvature (lordosis versus S-shaped versus kyphosis; inferior or superior location). Cervical-spine curvature in an automotive seated posture varies with gender and age but not stature. Average values of superior and inferior Bézier angles for cervical spines in flexion, neutral, and extension automotive postures are presented for each gender and age group. Use of Bézier splines fit through posterior margins offers a quantitative method of characterizing cervical-spine curvature using two parameters: superior and inferior Bézier angles.

DETECTION OF PEDIATRIC CERVICAL SPINE INJURY

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 700-708 ◽  
Author(s):  
Hugh J.L. Garton ◽  
Matthew R. Hammer
Keyword(s):  
Cervical Spine ◽  
Young Children ◽  
Cervical Spine Injury ◽  
Diagnostic Yield ◽  
Plain Film ◽  
Spine Injury ◽  
Lower Sensitivity ◽  
X Rays ◽  
Flexion Extension ◽  
National Emergency

Abstract OBJECTIVE In evaluating the pediatric cervical spine for injury, the use of adult protocols without sufficient sensitivity to pediatric injury patterns may lead to excessive radiation doses. Data on injury location and means of detection can inform pediatric-specific guideline development. METHODS We retrospectively identified pediatric patients with codes from the International Classification of Diseases, 9th Revision, for cervical spine injury treated between 1980 and 2000. Collected data included physical findings, radiographic means of detection, and location of injury. Sensitivity of plain x-rays and diagnostic yield from additional radiographic studies were calculated. RESULTS Of 239 patients, 190 had true injuries and adequate medical records; of these, 187 had adequate radiology records. Patients without radiographic abnormality were excluded. In 34 children younger than 8 years, National Emergency X-Radiography Utilization Study criteria missed two injuries (sensitivity, 94%), with 76% of injuries occurring from occiput–C2. In 158 children older than 8 years, National Emergency X-Radiography Utilization Study criteria identified all injured patients (sensitivity, 100%), with 25% of injuries occurring from occiput–C2. For children younger than 8 years, plain-film sensitivity was 75% and combination plain-film/occiput–C3 computed tomographic scan had a sensitivity of 94%, whereas combination plain-film and flexion-extension views had 81% sensitivity. In patients older than 8 years, the sensitivities were 93%, 97%, and 94%, respectively. CONCLUSION Younger children tend to have more rostral (occiput–C2) injuries compared with older children. The National Emergency X-Radiography Utilization Study protocol may have lower sensitivity in young children than in adults. Limited computed tomography from occiput–C3 may increase diagnostic yield appreciably in young children compared with flexion-extension views. Further prospective studies, especially of young children, are needed to develop reliable pediatric protocols.

scholarly journals CORRELATION BETWEEN CERVICAL MORPHOLOGY, PAIN, FUNCTIONALITY, AND ROM IN INDIVIDUALS WITH CERVICALGIA

2019 ◽  
Vol 18 (2) ◽  
pp. 101-105
Author(s):  
Mateus Alves Aimi ◽  
Eduardo Gonçalves Raupp ◽  
Emanuelle Francine Detogni Schmit ◽  
Adriane Vieira ◽  
Cláudia Tarragô Candotti
Keyword(s):  
Cervical Spine ◽  
Pain Intensity ◽  
Range Of Motion ◽  
Functional Disability ◽  
Sagittal Plane ◽  
Neck Disability Index ◽  
X Rays ◽  
Level Of Evidence ◽  
Spine Curvature ◽  
The Right

ABSTRACT Objective: To verify if there is a correlation between the morphology of the cervical spine curvature, pain intensity, functional disability, and range of motion in individuals with cervicalgia. Methods: Thirty-nine individuals were evaluated using x-rays in the right sagittal plane (Cobb C1-C7 two-line method), visual analogue scale, Neck Disability Index questionnaire, and fleximeter. Descriptive statistical analysis (percentage, mean and standard deviation) and inferential (independent t-test and Pearson product-moment correlation coefficient, α=0.05) were performed. Results: There were significant correlations, ranging from moderate to high, between functional capacity and pain intensity (r=0.637, p<0.001), and total range of motion (r=-0.568, p<0.001), and extension (r=-0.610, p<0.001), and between pain intensity and range of motion (r=-0.422, p=0.007). Regarding the morphology of the cervical spine curvature, none of the variables showed a significant correlation. Conclusions: Cervical morphology, more specifically related to the curvature in the sagittal plane, does not seem to interfere alone with pain, functionality, and range of motion. In contrast, it is possible to affirm that higher levels of pain generate a smaller range of cervical movement, especially of extension, which, in turn, results in greater functional losses in individuals with neck pain. Level of Evidence II; Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

Legal Update: Use of the Guides Down Under

1998 ◽  
Vol 3 (1) ◽  
pp. 5-5
Author(s):  
Mohammed I. Ranavaya ◽  
Dwight K. Dowda
Keyword(s):  
Cervical Spine ◽  
Lumbar Spine ◽  
Upper Extremity ◽  
Cauda Equina ◽  
Spine Injury ◽  
X Rays ◽  
Loss Of Function ◽  
Unaffected Side ◽  
Radicular Symptoms ◽  
Loss Of Motion

Abstract Evaluations of the cervical and the lumbar spine are similar with the major exception that injury in the cervical spine may cause spinal cord damage that results in long-tract signs (weakness, numbness, or paralysis). The AMA Guides to the Evaluation of Permanent Impairment recognizes eight categories of cervical spine injury, and the first five are similar to those used for the lumbar spine. Category I involves no objective findings. Category II includes objective findings such as true muscle spasm, dysmetria, or nonverifiable radicular symptoms. Category III is radiculopathy and is assessed when the patient shows signs such as the loss of relevant reflexes or unilateral atrophy with a greater than 2-cm decrease in circumference compared with the unaffected side. Category IV is loss of motion segment integrity or multilevel neurologic compromise and indicates 3.5 mm or more translation of one vertebra on another on flexion and extension x-rays. Category V is severe upper extremity neurologic compromise that requires the use of upper extremity external functional or adaptive devices. Categories VI, VII, and VIII reflect a significant change in evaluating method and include long-tract signs in addition to upper extremity involvement. Category VI includes cauda equina–like symptoms without bowel or bladder involvement. Category VII is the same as Category VI but with bowel or bladder involvement. Category VIII is paraplegia, defined as complete or near-complete loss of function in the lower extremities.

Analysis of Cervical Spine Curvature in Patients with Cervical Spondylosis

Neurosurgery ◽  
1988 ◽  
Vol 22 (5) ◽  
pp. 827-836 ◽  
Author(s):  
Ulrich Batzdorf ◽  
Alfred Batzdorff
Keyword(s):  
Cervical Spine ◽  
Computer Aided Design ◽  
Cervical Vertebrae ◽  
Spinal Curvature ◽  
Clear Correlation ◽  
Canal Diameter ◽  
Geometrical Data ◽  
Spine Curvature ◽  
Magnetic Resonance Scanning ◽  
Aided Design

Abstract Computer-aided design techniques were used to analyze the degree of spinal curvature shown on cervical spine radiograms of 28 patients. On films standardized as to size, a geometrical chord was constructed from the 2nd to the 7th cervical vertebrae (C2 to C7), and an arc was drawn along the posterior margin of the vertebrae. The resulting area was used as an index of curvature, and the spinal canal diameter was measured. Severity of myelopathy as well as clinical improvement was related to the geometrical data. There was no clear correlation between severity of the preoperative myelopathy and degree of curvature. Severe myelopathy was seen in association with straight, lordotic, and hyperlordotic spines. Neck pain was most severe in patients with reversed cervical curvature. The degree of curvature, however, seems to relate to the postoperative clinical outcome. Patients with relatively normal curvature showed the greatest improvement in symptoms and signs. Postoperative magnetic resonance scanning confirms that posterior migration of the spinal cord after laminectomy may be inadequate to clear osteophytes in patients with straightened or reversed curvature of the cervical spine. Spinal geometry should be considered in the selection of the best surgical procedure and the extent of laminectomy for patients with spondylotic myelopathy. Significant abnormalities of spinal curvature may account for some instances of poor outcome after laminectomy.

Changes in Cervical Spine Curvature after Uninstrumented One- and Two-level Corpectomy in Patients with Spondylotic Myelopathy

Neurosurgery ◽  
2003 ◽  
Vol 52 (4) ◽  
pp. 799-805 ◽  
Author(s):  
Vedantam Rajshekhar ◽  
Moses Joseph Arunkumar ◽  
Samson Sujith Kumar
Keyword(s):  
Cervical Spine ◽  
Cervical Spondylotic Myelopathy ◽  
Sagittal Alignment ◽  
X Rays ◽  
Kyphotic Angle ◽  
X Ray ◽  
Spine Curvature ◽  
Whole Spine ◽  
Over Time

Abstract OBJECTIVE We studied changes in the cervical spine curvature in patients with cervical spondylotic myelopathy who underwent one- or two-level central corpectomy and iliac bone grafting without the use of instrumentation. METHODS Curvature of the fused segment and of the whole cervical spine was evaluated on preoperative and follow-up x-rays in 93 patients (30 underwent one-level corpectomy, and 63 underwent two-level corpectomy). In 59 patients, the changes in the cervical spine curvature were studied using one follow-up x-ray; in the other 34 patients, the changes were studied on x-rays obtained at two or more follow-up visits. The sagittal alignment of the fused segment was categorized as lordotic (&gt;+5 degrees), straight (+5 to −5 degrees) or kyphotic (&gt;−5 degrees). The whole spine curvature also was recorded as lordotic, straight, or kyphotic. RESULTS At a mean follow-up of 22.2 months (range, 6–71 mo), there was a mean change of −10.4 degrees in the segmental curvature (P&lt; 0.001). The fused segment sagittal alignment also worsened (lordotic angles becoming straight or kyphotic and straight angles becoming kyphotic) in 44 patients (47%)(P&lt; 0.001). However, serial studies in 34 patients (mean first and last follow-ups, 11.9 and 30.8 mo, respectively) did not demonstrate significant worsening of the kyphotic angle or the sagittal alignment over time (P= 0.9). Whole spine curvature worsened in 33 (35%) of the 93 patients (P&lt; 0.001); serial studies did not reveal a significant change (P= 0.9). Patients improved in their functional status from a preoperative mean Nurick grade of 2.9 (range, 1–5) to a follow-up mean Nurick grade of 1.5 (range, 0–4) (P&lt; 0.001). Patients with a kyphotic change in their whole spine curvature (n = 33) and those without such change (n = 60) had a similar functional outcome (mean change in Nurick grade, 1.5 and 1.4, respectively). CONCLUSION Cervical spine curvature tended to undergo a kyphotic change at the fused segment in 47% of patients and a kyphotic change of the whole spine curvature in 35% of patients who underwent one- or two-level uninstrumented central corpectomy. This kyphotic change in the cervical spine, which stabilizes within 1 year after surgery, is not progressive, and it does not affect neurological outcome in these patients.

scholarly journals Projected paediatric cervical spine imaging rates with application of NEXUS, Canadian C-Spine and PECARN clinical decision rules in a prospective Australian cohort

2021 ◽  
Vol 38 (5) ◽  
pp. 330-337
Author(s):  
Natalie Phillips ◽  
Katie Rasmussen ◽  
Sally McGuire ◽  
Kerrie-Ann Abel ◽  
Jason Acworth ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Decision Rules ◽  
Clinical Decision ◽  
Research Network ◽  
Spine Injury ◽  
X Rays ◽  
Clinical Decision Rules ◽  
Paediatric Emergency ◽  
Spine Imaging ◽  
Paediatric Emergency Care

BackgroundClinical decision rules (CDRs) are commonly used to guide imaging decisions in cervical spine injury (CSI) assessment despite limited evidence for their use in paediatric populations. We set out to determine CSI incidence, imaging rates and the frequency of previously identified CSI risk factors, and thus assess the projected impact on imaging rates if CDRs were strictly applied as a rule in our population.MethodsA single-centre prospective observational study on all aged under 16 years presenting for assessment of possible CSI to a tertiary paediatric emergency department over a year, commencing September 2015. CDR variables from the National Emergency X-Radiography Utilization Study (NEXUS) rule, Canadian C-Spine rule (CCR) and proposed Paediatric Emergency Care Applied Research Network (PECARN) rule were collected prospectively and applied post hoc.Results1010 children were enrolled; 973 had not received prior imaging. Of these, 40.7% received cervical spine imaging; 32.4% X-rays, 13.4% CT scan and 3% MRI. All three CDRs identified the five children (0.5%) with CSI who had not received prior imaging. If CDRs were strictly applied as a rule for imaging, projected imaging rates in our setting would be as follows: NEXUS-44% (95% CI 41% to 47.4%), CCR-at least 48.4% (95% CI 45.3% to 51.7%) and PECARN-68% (95% CI 65.1% to 71.1%).ConclusionCSIs were rare (0.5% of our cohort), however, 40% of children received imaging. CDRs have been designed to guide imaging decisions; if strictly applied as a rule for imaging, the CDRs assessed in this study would increase imaging rates. Projected rates differ considerably depending on the CDR applied. These findings highlight the need for a validated paediatric-specific cervical spine imaging CDR.

Selection of Trauma Victims for Cervical Spine Radiological Examination

1985 ◽  
Vol 1 (S1) ◽  
pp. 199-202
Author(s):  
Betty L. Bryson ◽  
Joseph P. Ornato ◽  
Robert R. Farquharson ◽  
Patrick J. Donovan ◽  
Francis G. Palaio
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Medical Center ◽  
Neurological Deficits ◽  
Spine Injury ◽  
Facial Trauma ◽  
X Rays ◽  
Facial Soft Tissue ◽  
Cervical Spine Injuries ◽  
Facial Injuries

Evaluation of the traumatized patient frequently involves consideration of possible cervical spine injury. When neurological deficits, unconsciousness, alcoholic intoxication, severe maxillofacial or head trauma, or local neck pain are present, it is an easy decision to obtain cervical spine x-rays. The dilemma arises in the patient without neck pain who has mild to moderate scalp or facial injuries. Such a patient usually arrives in the emergency department with a cervical collar placed by pre-hospital personnel because of the mechanism of injury and the associated head or facial soft tissue trauma. Due to the association of cervical spine fractures with “significant” facial trauma, neck x-rays have been recommended. What, however, constitutes “significant” facial trauma To delineate such facial injuries, a retrospective analysis of 30 patients with cervicalspine fractures hospitalizedin a five year period at the University of Nebraska Medical Center was performed. Seventeen patients had head, scalp or facial injuries ranging from skull fractures and scalp hematomas to minor abrasions and lacerations. To determine if cervical spine films are being over utilized, a current prospective study of patients undergoing this evaluation will be presented, detailing the facial and head injuries, location, degree of severity, and detection of cervical spine injuries.

Delayed surgery after cervical spine injury: importance of dynamic x-rays and MRI

2007 ◽  
Vol 68 (2) ◽  
pp. 196-197
Author(s):  
J. Goffin ◽  
T. Daenekindt ◽  
B. Depreitere ◽  
M. Didgar ◽  
F. Van Calenbergh ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Spine Injury ◽  
X Rays ◽  
Delayed Surgery
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