scholarly journals Traumatic injury of the transverse atlantal ligament

2018 ◽  
Vol 20 (3) ◽  
pp. 351-355
Author(s):  
Fabrizio Borges Scardino ◽  
Ricardo Vieira Botelho
Keyword(s):  
Cervical Spine ◽  
Traumatic Injury ◽  
Ligament Injury ◽  
Bony Injury ◽  
Mri Study ◽  
C2 Fixation ◽  
Atlantodental Interval ◽  
Conventional Radiology ◽  
Flexion And Extension ◽  
Transverse Atlantal Ligament

Introduction. In some cases C2 may suffer only rotational dislocation around its own axis (dens), causing no increase in the atlantodental interval (ADI), making it difficult to diagnose the instability in static radiographies. Objective. To report a case of atlanto-axial traumatic subluxation, without bony injury or displacement, in which the diagnosis cannot be achieved through conventional radiology and computed tomography, and discuss the types of transverse ligament injuries, its diagnosis, the instability and their treatment. Methods.A 61-year-old man, victim of head (occipital), complaining neck. Static radiographies and CT scan of cervical spine were performed, demonstrating no abnormalities. Flexion and extension cervical radiography revealed an increase of ADI in flexion, indicating instability and damage to the transverse atlantal ligament (TAL). The MRI of the cervical spine demonstrated the discontinuity of the TAL, configuring an injury to the structure of the ligament. The patient underwent to early surgery with C1-C2 fixation using the Goel-Harms’technique. Results. The diagnosis could be revealed only in dynamic radiographs or MRI study. The patient presented complete improvement of symptoms. Conclusions. The use of cervical dynamic radiography and / or magnetic resonance imaging allowed the diagnosis of instability and visualization of the TAL injury, avoiding the lack of diagnosis with its consequences. The MRI allows a direct view of the ligament injury, their classification and the prognostic evaluation of the injury, guiding the therapy, surgical or conservative.

Mechanical Properties of Injured Human Cervical Spine Ligaments and Corresponding Effect on Spinal Kinematics

2011 ◽  
Author(s):  
P. Devin Leahy ◽  
Christian M. Puttlitz
Keyword(s):  
Cervical Spine ◽  
Soft Tissue ◽  
Dynamic Range ◽  
Traumatic Injury ◽  
Soft Tissue Injuries ◽  
Neurological Impairment ◽  
Cervical Instability ◽  
Cervical Spine Instability ◽  
Tissue Injuries ◽  
Flexion And Extension

The assessment of cervical spine instability following traumatic injury is controversial [1, 4, 5, 8]. Typical definitions of cervical instability are based on the presence of several key detectable injuries using simple radiographs, computed tomography (CT), and magnetic resonance (MR) imaging. Although these imaging modalities have been shown to be relatively reliable for detection of fractures and very large soft tissue injuries, they are largely deficient for determining the presence of smaller soft tissue injuries, such as hyperstrained ligaments [1, 3]. Soft tissue injuries of this nature may be revealed with dynamic range of motion (ROM) assessment, such as a flexion and extension test with radiography. However, these tests are currently inadequate for determining the existence of specific injuries. Cervical soft tissue injuries demand further analysis, given the risk of severe and permanent neurological impairment that may accompany these injuries [2, 5].

Motion Analysis of the Cervical Spine

2004 ◽  
Vol 9 (5) ◽  
pp. 1-11
Author(s):  
Patrick R. Luers
Keyword(s):  
Cervical Spine ◽  
Intervertebral Disk ◽  
Radiographic Evaluation ◽  
Ligamentous Injury ◽  
Pattern Of Injury ◽  
Motion Segment ◽  
Single Pattern ◽  
Compensatory Motion ◽  
Loss Of Motion ◽  
Flexion And Extension

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, defines a motion segment as “two adjacent vertebrae, the intervertebral disk, the apophyseal or facet joints, and ligamentous structures between the vertebrae.” The range of motion from segment to segment varies, and loss of motion segment integrity is defined as “an anteroposterior motion of one vertebra over another that is greater than 3.5 mm in the cervical spine, greater than 2.5 mm in the thoracic spine, and greater than 4.5 mm in the lumbar spine.” Multiple etiologies are associated with increased motion in the cervical spine; some are physiologic or compensatory and others are pathologic. The standard radiographic evaluation of instability and ligamentous injury in the cervical spine consists of lateral flexion and extension x-ray views, but no single pattern of injury is identified in whiplash injuries. Fluoroscopy or cineradiographic techniques may be more sensitive than other methods for evaluating subtle abnormal motion in the cervical spine. The increased motion thus detected then must be evaluated to determine whether it represents normal physiologic motion, normal compensatory motion, motion related to underlying degenerative disk and/or facet disease, or increased motion related to ligamentous injury. Imaging studies should be performed and interpreted as instructed in the AMA Guides.

Multiple subluxations and comminuted fracture of the cervical spine in a sheep

2015 ◽  
Vol 43 (01) ◽  
pp. 44-38
Author(s):  
C.-C. Lin ◽  
K.-S. Chen ◽  
Y.-L. Lin ◽  
J. P.-W. Chan
Keyword(s):  
Cervical Spine ◽  
Pain Perception ◽  
Cervical Vertebrae ◽  
Traumatic Injury ◽  
Spinal Reflexes ◽  
Spine Trauma ◽  
Blunt Force Trauma ◽  
Comminuted Fracture ◽  
History Of ◽  
The Right

SummaryA 5-month-old, 13.5 kg, female Corriedale sheep was referred to the Veterinary Medicine Teaching Hospital, with a history of traumatic injury of the cervical spine followed by non-ambulatoric tetraparesis that occurred 2 weeks before being admitted to the hospital. At admission, malalignment of the cervical spine with the cranial part of the neck deviating to the right was noted. Neurological examinations identified the absence of postural reactions in both forelimbs, mildly decreased spinal reflexes, and normal reaction to pain perception tests. Radiography revealed malalignment of the cervical vertebrae with subluxations at C1–C2 and C2–C3, and a comminuted fracture of the caudal aspect of C2. The sheep was euthanized due to a presumed poor prognosis. Necropsy and histopathological findings confirmed injuries of the cervical spine from C1 to C3, which were consistent with the clinical finding of tetraparesis in this case. This paper presents a rare case of multiple subluxations of the cervical spine caused by blunt force trauma in a young sheep. These results highlight the importance of an astute clinical diagnosis for such an acute cervical spine trauma and the need for prompt surgical correction for similar cases in the future.

A Computer Simulation Study of Fusion Surgery and Artificial Disc Replacement on the Human Cervical Spine

2006 ◽  
Vol 326-328 ◽  
pp. 903-906
Author(s):  
Hyung Soo Ahn ◽  
Il Hyung Park ◽  
Denis DiAngelo
Keyword(s):  
Cervical Spine ◽  
Adjacent Segment ◽  
Artificial Disc ◽  
Spherical Joint ◽  
Rotational Stiffness ◽  
Computer Simulation Study ◽  
Fusion Surgery ◽  
Biomechanical Changes ◽  
Disc Level ◽  
Flexion And Extension

The biomechanical changes brought on by spine fusion and the artificial disc designs to restore physiologic motion were studied by using a cervical spine computer model. Fusion increased the motion compensation at the adjacent segment during flexion and extension. The global rotational stiffness and segmental disc forces were also increased after fusion. Among the three prosthetic disc designs, the PDD-III (5-DOF spherical joint in plane parallel with the C5-C6 disc level) maintained the normal motion and minimized load build up of adjacent segment.

A novel method for measurement of occipital-cervical distance by occiput-C4 distance

2019 ◽  
Author(s):  
Chao Tang ◽  
Sheng Yang ◽  
Ye Hui Liao ◽  
Qiang Tang ◽  
Fei Ma ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Standardized Testing ◽  
Normal Population ◽  
Normal Subjects ◽  
Basilar Invagination ◽  
Shortest Distance ◽  
Novel Method ◽  
Asymptomatic Subjects ◽  
Spine Radiographs ◽  
Flexion And Extension

Abstract Background: To describe and measure the occipital-cervical distance by a novel method utilizing the occiput-C4 distance (OC4D) in normal subjects that can be used to guide the restoration of vertical dislocation of the occipitocervical region in patients with basilar invagination and to perform standardized testing of occipitocervical constructs.Methods: Neutral, flexion, and extension lateral cervical spine radiographs of 150 asymptomatic subjects (73 males and 77 females) judged to be normal were analyzed. The mean age was 48.0±8.4 years old (range 20–69 years; 48.4±10.2 years old for males and 47.6±6.4 years old for females). Analysis consisted of measurement of the OC4D. The OC4D was defined as the shortest distance from the center of the C4 vertebral body to the McGregor’s line. Two spine surgeons measured the OC4D thrice in the normal population and obtained the average values. Height, weight, and body mass index (BMI) of each subject was recorded and analyze its correlation with OC4D.Results: The values of OC4D on neutral, flexion, and extension lateral cervical spine radiographs were 69.0±6.9 mm, 68.9±6.8 mm and 68.1±6.9 mm, respectively. There was no significantly different from the values measured in neutral、flexion and extension (P> 0.05). But the OC4D of males were higher than females in neutral, flexion, and extension (P < 0.001 for all). There was a positive correlation between OC4D and height and weight in neutral、flexion and extension (P <0.001 for all). The correlation between O-C4D and BMI was weak, and no significant in neutral, flexion, and extension (P > 0.05). The ICC values of inter- and intra-observer agreements for the radiographic parameter in all of the cervical positions were more than 0.93.Conclusions: OC4D, a new measurement method for occipital-cervical distance that is not affected by the change in neutral, flexion, and extension positions, should be a valuable parameter and intra-operative tool to guide the vertical restoration during OCF for patients with altered occiput-cervical anatomy.

Atlantoaxial Instability

2018 ◽  
pp. 41-48
Author(s):  
Jonathan M. Parish ◽  
Domagoj Coric
Keyword(s):  
Cervical Spine ◽  
Ct Scan ◽  
Plain Film ◽  
Cord Compression ◽  
Atlantoaxial Instability ◽  
Cervical Cord ◽  
Screw Length ◽  
Cord Injury ◽  
Bony Anatomy ◽  
Atlantodental Interval

There are a number of different imaging modalities that can be used to confirm atlantoaxial instability. Plain film radiographs of the cervical spine can be used to assess the atlantodental interval (ADI). Cervical CT is necessary to assess the atlantoaxial bony anatomy as well as to assess the foramen transversarium at C1 and C2. In particular, CT scan should be used to estimate screw length, medial/lateral and cranial/caudal screw trajectory. MRI can also evaluate the extent of cervical cord compression or cord injury that has occurred due to atlantoaxial instability.

Cervical Spine Clearance in Obtunded Patients After Blunt Traumatic Injury

2015 ◽  
Vol 162 (6) ◽  
pp. 429 ◽  
Author(s):  
Jetan H. Badhiwala ◽  
Chung K. Lai ◽  
Waleed Alhazzani ◽  
Forough Farrokhyar ◽  
Farshad Nassiri ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Traumatic Injury

Spinal Posture Affects Whiplash Biomechanics

2003 ◽  
Author(s):  
Brian D. Stemper ◽  
Narayan Yoganandan ◽  
Frank A. Pintar
Keyword(s):  
Cervical Spine ◽  
Whiplash Injury ◽  
Facet Joint ◽  
Ligament Injury ◽  
Upper Cervical Spine ◽  
Anterior Longitudinal Ligament ◽  
Spinal Posture ◽  
Male Head ◽  
Upper Cervical ◽  
Cervical Facet

The present study implemented the MADYMO 50th percentile male head-neck model to investigate effects of initial spinal posture on cervical spine kinematics in whiplash. The model was altered to three initial postures: lordosis, straight, kyphosis. The three models were exercised under 2.6 m/sec rear impact pulses. Segmental kinematics and ligament strains were investigated during cervical S-curvature and throughout the whiplash event. Anterior longitudinal ligament strains during S-curvature varied from 20 to 47% of maximum strains. Facet joint strains during S-curvature were 42 to 100% of maximum strains. This finding indicates that facet joint ligaments are more susceptible to whiplash injury during S-curvature, while anterior longitudinal ligament injury likely occurs during the extension phase. Kyphosis and straight postures increased anterior longitudinal ligament strains in the upper cervical spine from the lordosis posture. Lower cervical facet joint and anterior longitudinal ligament strains were greater in the lordosis posture. This study shows that spinal posture may affect injury mechanisms and render a specific population more susceptible to whiplash injury.

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