MOBILITY OF THE UPPER CERVICAL SPINE IN HEALTH AND DISEASE

Four cases of cervical "subluxation" have been presented due to muscle spasm in the cervical region, which occurred during an upper respiratory infection. This syndrome differs from the atlanto-axial subluxation. Roentgenograms in the diagnosis of this condition may lead to erroneous diagnosis and treatment. The normal anatomic and functional ranges of the cervical spine were studied and are discussed. The degree of mobility of the cervical spine is greater than previously assumed.

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Anatomy and clinical relevance of sub occipital soft tissue connections with the dura mater in the upper cervical spine

PeerJ ◽

10.7717/peerj.9716 ◽

2020 ◽

Vol 8 ◽

pp. e9716

Author(s):

Rob Sillevis ◽

Russell Hogg

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Cadaver Study ◽

Cervicogenic Headache ◽

Passive Movement ◽

Cervical Region ◽

Upper Cervical Spine ◽

Posterior Aspect ◽

Upper Cervical ◽

Nuchal Ligament

Background The upper cervical region is a complex anatomical structure. Myodural bridges between posterior suboccipital muscles and the dura might be important explaining conditions associated with the upper cervical spine dysfunction such as cervicogenic headache. This cadaver study explored the upper cervical spine and evaluated the myodural bridges along with position of spinal cord in response to passive motion of upper cervical spine. Methods A total of seven adult cadavers were used in this exploratory study. The suboccipital muscles and nuchal ligament were exposed. Connections between the Rectus Capitis Posterior major/minor and the Obliquus Capitis minor, the nuchal ligament, posterior aspect of the cervical spine, flavum ligament and the dura were explored and confirmed with histology. The position of the spinal cord was evaluated with passive motions of the upper cervical spine. Outcomes In all cadavers connective tissues attaching the Rectus Capitis Posterior Major to the posterior atlanto-occipital membrane were identified. In the sagittal dissection we observed connection between the nuchal ligament and the dura. Histology revealed that the connection is collagenous in nature. The spinal cord moves within the spinal canal during passive movement. Discussion The presence of tissue connections between ligament, bone and muscles in the suboccipital region was confirmed. The nuchal ligament was continuous with the menigiovertebral ligament and the dura. Passive upper cervical motion results in spinal cord motion within the canal and possible tensioning of nerve and ligamentous connections.

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Orofacial myofunctional disorders in children with asymmetry of the posture and locomotion apparatus

International Journal of Orofacial Myology ◽

10.52010/ijom.2005.31.1.3 ◽

2005 ◽

Vol 31 (1) ◽

pp. 26-38

Author(s):

Heike Korbmacher ◽

◽

Lutz Koch ◽

Bärbel Kahl-Nieke

Keyword(s):

Cervical Spine ◽

Vertebral Column ◽

Head Position ◽

Cervical Region ◽

Upper Cervical Spine ◽

Adequate Treatment ◽

Upper Cervical ◽

Tongue Dysfunction ◽

Orofacial Region ◽

Articulation Disorders

352 children radiologically identified with asymmetry in the occipito-cervical region were assessed on a number of myofunctional measures. In all children an orthopedic examination was conducted including a functional test of the upper cervical spine and the iliac joint, the postural test by Matthiass, as well as gait analysis. During a second examination the orofacial myofunctional status was recorded. In general, about 70% of the children revealed orofacial myofunctional disorders. Correlational analysis was conducted in order to determine whether specific myofunctional variables were associated with postural and orthopedic alterations. A weak body posture correlated statistically significantly with all assessed myofunctional variables. On the other hand, all orthopedic items correlated significantly with a reclined head position. A blockade of the iliac spine correlated significantly with persistent habits, articulation disorders and tongue dysfunction, whereas functional asymmetry of the upper cervical spine correlated significantly with incompetent lips. A finding of at least five statistically significant correlations within each orofacial variable underlined the complex symptomatology of myofunctional disorders, so that consideration needs to be given to adequate treatment approaches. The data generated by the present study stress the importance of early interdisciplinary screening in children to ensure a physiological development of the orofacial region and the still growing vertebral column. To help understand the complexity of symptoms influencing orofacial development, an explanatory model of the “interactive functional box system” is given.

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Endonasal Surgery of the Upper Cervical Spine: A Morphometric Analysis

Skull Base ◽

10.1055/s-2008-1093170 ◽

2008 ◽

Vol 18 (S 01) ◽

Author(s):

Harminder Singh ◽

Bartosz Grobelny ◽

Adam Flanders ◽

Marc Rosen ◽

Paul Schiffmacher ◽

...

Keyword(s):

Cervical Spine ◽

Morphometric Analysis ◽

Upper Cervical Spine ◽

Endonasal Surgery ◽

Upper Cervical

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Defining the Nasopalatine Line: Anatomic Limitations for Endoscopic Endonasal Surgery of the Odontoid Process and Upper Cervical Spine

Skull Base ◽

10.1055/s-2008-1093252 ◽

2008 ◽

Vol 18 (S 01) ◽

Author(s):

John de Almeida ◽

Adam Zanation ◽

Ricardo Carrau ◽

Amin Kassam ◽

Carl Snyderman

Keyword(s):

Cervical Spine ◽

Odontoid Process ◽

Upper Cervical Spine ◽

Endoscopic Endonasal Surgery ◽

Endonasal Surgery ◽

Endoscopic Endonasal ◽

Upper Cervical

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A 3D-Printed Model-Assisted Cervical Spine Instrumentation after Tumor Resection in a 4-Year-Old Child: A Case Report

Pediatric Neurosurgery ◽

10.1159/000514248 ◽

2021 ◽

pp. 1-7

Author(s):

Marko Jug

Keyword(s):

Cervical Spine ◽

3D Model ◽

Intraoperative Complications ◽

Tumor Resection ◽

Upper Cervical Spine ◽

Spine Instrumentation ◽

Cord Injury ◽

Spinal Navigation ◽

Upper Cervical ◽

3D Printed

Introduction: In the case of tumor resection in the upper cervical spine, a multilevel laminectomy with instrumented fixation is required to prevent kyphotic deformity and myelopathy. Nevertheless, instrumentation of the cervical spine in children under the age of 8 years is challenging due to anatomical considerations and unavailability of specific instrumentation. Case Presentation: We present a case of 3D-printed model-assisted cervical spine instrumentation in a 4-year-old child with post-laminectomy kyphotic decompensation of the cervical spine and spinal cord injury 1 year after medulloblastoma metastasis resection in the upper cervical spine. Due to unavailability of specific instrumentation, 3D virtual planning was used to assess and plan posterior cervical fixation. Fixation with 3.5 mm lateral mass and isthmic screws was suggested and the feasibility of fixation was confirmed “in vitro” in a 3D-printed model preoperatively to reduce the possibility of intraoperative implant-spine mismatch. Intraoperative conditions completely resembled the preoperative plan and 3.5 mm polyaxial screws were successfully used as planned. Postoperatively the child made a complete neurological recovery and 2 years after the instrumented fusion is still disease free with no signs of spinal decompensation. Discussion/Conclusion: Our case shows that posterior cervical fixation with the conventional screw-rod technique in a 4-year-old child is feasible, but we suggest that suitability and positioning of the chosen implants are preoperatively assessed in a printed 3D model. In addition, a printed 3D model offers the possibility to better visualize and sense spinal anatomy “in vivo,” thereby helping screw placement and reducing the chance for intraoperative complications, especially in the absence of intraoperative spinal navigation.

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