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.

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.

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.

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.

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.

The Accuracy of Patient Specific Three-Dimensional Digital Ostectomy Template for Mandibular Angle Ostectomy

2021 ◽  
Author(s):  
Guoping Wu ◽  
Zhiyang Xie ◽  
Wensong Sahngguan ◽  
Wenwen Zhang ◽  
Shu Wang ◽  
...  
Keyword(s):  
Operating Time ◽  
Three Dimensional ◽  
Patient Specific ◽  
Mandibular Angle ◽  
Significant Difference ◽  
Postoperative Drainage ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Mean Time

Abstract Background Despite the three-dimensional (3D)-printed digital ostectomy template (DOT) helps surgeons perform mandibular angle ostectomy (MAO) more precisely and safely, the clinical application of DOT is problematic. Objectives The aim of this study was to evaluate the accuracy of DOT and improve the precision of MAO. Methods A total of 20 patients with a prominent mandibular angle (PMA) were allocated into two groups with 10 patients in each group. The conventional digital ostectomy template (CDOT), and the novel digital ostectomy template (NDOT) were applied to guide MAO in group A and B, respectively. The mean time taken for curved osteotomy and the volume of postoperative drainage on one side within 24 hours were recorded. The deviations between the simulated and postoperative lower border of the mandible were measured on both sides. Results All the patients were satisfied with the cosmetic outcomes. Statistical results showed that the mean time taken for curved osteotomy in group B was shorter than that of group A, and the volume of postoperative drainage on one side within 24 hours was similar between the two groups. The deviations at the anterior and posterior parts of the inferior border showed the accuracy of osteotomy in group B was higher than that in group A, and there was no significant difference between the two groups in the middle part. Conclusions The NDOT is easy to be located and fixed tightly, which reduced the operating time and increased the safety and precision of the procedures.

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.

Atlantoaxial interlaminar distances in cervical flexion in children

2003 ◽  
Vol 98 (3) ◽  
pp. 271-274 ◽  
Author(s):  
R. Shane Tubbs ◽  
Matthew D. Smyth ◽  
John C. Wellons ◽  
Jeffrey P. Blount ◽  
Paul A. Grabb ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Atlantoaxial Instability ◽  
Entire Group ◽  
Content Type ◽  
Significant Difference ◽  
Full Flexion ◽  
The Mean ◽  
Atlas And Axis ◽  
Fine Print ◽  
Posterior Elements

Object. To the best of the authors' knowledge, no quantitative analysis of the atlantoaxial interlaminar distance in flexion (ILD) in children exists in the medical literature. In this study they sought to determine the age-matched relationship between the posterior elements of the atlas and axis in children in cervical spine flexion, to be used as an adjunct to the atlantodental interval in common clinical use. Methods. Lateral radiographs of the cervical spine in full flexion were analyzed in 74 children. The atlantoaxial ILD was defined as the distance between a midpoint of the anterior cortices of the atlantal and axial posterior arches. The mean ILD for the entire group was 19 mm (range 8–30 mm). No significant difference was seen between male and female patients (p = 0.084). When stratified by age, the mean ILD was 12.3 ± 3 mm (15 cases) in children age 3 years or younger and 20.5 ± 4.7 mm (59 cases) in children age older than 3 years. Further stratification of the groups yielded a mean ILD of 10.4 ± 1.4 [eight cases]) in children age 1 to 2 years, and 14.4 ± 4.7 mm (seven cases) in children age 3 years. In children older than 3 years of age the mean ILD was consistently approximately 20 ± 5 mm regardless of age. Conclusions. Rapid, safe, and accurate diagnosis of the cervical spine is essential in critical care. Knowledge of the distance between the posterior elements of the atlas and axis in flexion should enhance the clinicians' (those who clear cervical spines) ability to diagnose accurately atlantoaxial instability on lateral radiographs obtained in flexion.

Cervical Spine Motion

2009 ◽  
Vol 111 (1) ◽  
pp. 97-101 ◽  
Author(s):  
Timothy P. Turkstra ◽  
David M. Pelz ◽  
Philip M. Jones
Keyword(s):  
Cervical Spine ◽  
Controlled Trial ◽  
Spine Injury ◽  
Medical Systems ◽  
Video Assessment ◽  
Motion Segment ◽  
Significant Difference ◽  
Spine Motion ◽  
Macintosh Laryngoscopy ◽  
Time Required

Background The optimal technique to intubate the trachea in patients presenting with a potential or documented cervical spine (C-spine) injury remains unresolved. Using continuous fluoroscopic video assessment, C-spine motion during laryngoscopy with an AirTraq Laryngoscope (King Medical Systems, Newark, DE) was compared to that with intubation using a Macintosh blade. Methods Twenty-four healthy surgical patients gave written consent to participate in a crossover randomized controlled trial; all patients were subjected to both Macintosh and AirTraq laryngoscopy with manual inline stabilization after induction of anesthesia. The C-spine motion was examined at four areas: the occiput-C1 junction, C1-C2 junction, C2-C5 motion segment, and C5-thoracic motion segment. The time required for laryngoscopy was also measured. Results C-spine motion using the AirTraq was less than that during Macintosh laryngoscopy, averaging 66% less (P &lt; 0.01) at three of the motion segments studied, occiput-C1, C2-C5, and C5-thoracic. There was no difference at the C1-C2 segment. There was no significant difference in the time to accomplish laryngoscopy between the two devices. Conclusions For patients in whom C-spine movement is undesirable, use of the AirTraq Laryngoscope may be useful to limit movement without an increase in the duration of intubation.

scholarly journals Gender Determination Using Mandibular Angle Measurement in Iranian Adult Graphics in a Dental Center

2021 ◽  
Vol 19 (3) ◽  
Author(s):  
Maryam Vasheghani Farahani ◽  
Ramin Mashhadi Ismaeeli ◽  
Iraj Mirzaii-Dizgah ◽  
Mahdi Isazadeh
Keyword(s):  
Adult Population ◽  
Cross Sectional Study ◽  
Angle Measurement ◽  
Hormonal Changes ◽  
Sectional Study ◽  
Mandibular Angle ◽  
Digital Device ◽  
Cross Sectional ◽  
Significant Difference ◽  
The Mean

Background: The mandibular bone is affected by age, metabolic activity, and hormonal changes. Objectives: This study aimed to determine the sex determination using the mandibular angle in the adult population of Iran. Methods: This cross-sectional study enrolled 149 patients (73 men and 76 women) referred to the 600 Army Dental Center in 2016. Graphics were obtained from cephalogram and panorex using a Soredex digital device and Pack software to measure mandibular angles. Results: The mean mandibular angle was 122.19 ± 3.89 in men and 124.72 ± 3.24 in women, with a significant difference based on the independent t test (P < 0.05). Conclusions: It seems that the mandibular angle is higher in women than in men.

Sign in / Sign up

Export Citation Format

Share Document