scholarly journals Fiberoptic bronchoscopy versus video laryngoscopy guided intubation in patients with craniovertebral junction instability: A cinefluroscopic comparison

2021 ◽  
Vol 12 ◽  
pp. 92
Author(s):  
Sanket Agrawal ◽  
Pravin Salunke ◽  
Shailesh Gupta ◽  
Amlan Swain ◽  
Kiran Jangra ◽  
...  
Keyword(s):  
Cervical Spine ◽  
General Anesthesia ◽  
Spinal Canal ◽  
Fiberoptic Bronchoscopy ◽  
Craniovertebral Junction ◽  
Cervical Spinal Canal ◽  
Bony Landmarks ◽  
Canal Diameter ◽  
Number Of Patients ◽  
Upper Cervical

Background: Manipulation during endotracheal intubation in patients with craniovertebral junction (CVJ) anomalies may cause neurological deterioration due to underlying instability. Fiberoptic-bronchoscopy (FOB) is better than video laryngoscope (VL) for minimizing cervical spine movement during intubation. However, evidence suggesting superiority of FOB in patients with CVJ instability is lacking. We prospectively compared dynamic movements of the upper cervical spine during intubation using FOB with VL in patients with CVJ anomalies. Methods: A prospective, randomized, and clinical trial was conducted in 62 patients of American Society of Anaesthesiologist Grade I-II aged between 12 and 65 years with CVJ anomalies. Patients were randomized for intubation under general anesthesia with either VL or FOB. The intubation process was done with application of skeletal traction and recorded cinefluroscopically. The dynamic interrelationship of bony landmarks (horizontal, vertical, and diagonal distances between fixed points on posterior C1 and C2) was analyzed to indirectly calculate alteration of the upper cervical spinal canal diameter (at CVJ). Atlanto-dental interval (ADI) was calculated wherever possible. Results: The alteration in canal diameter (using bony landmarks) at CVJ during intubation was not significant with the use of either VL or FOB (P > 0.05). In 41 patients, where ADI could be measured, ADI was reduced (increased spinal canal diameter) in a greater number of patients in VL group when compared to FOB group (P < 0.05). Conclusion: Using rigid skull traction, intubation under general anesthesia with VL offers similar advantage as FOB in terms of the spinal kinematics in patients with CVJ anomalies/instability. Nevertheless, greater number of patients intubated with VL may have an advantage of increased cervical spinal canal diameter when compared to FOB.

scholarly journals The relationship between the cervical spinal canal diameter and the pathological changes in the cervical spine

2009 ◽  
Vol 18 (6) ◽  
pp. 877-883 ◽  
Author(s):  
Yuichiro Morishita ◽  
Masatoshi Naito ◽  
Henry Hymanson ◽  
Masashi Miyazaki ◽  
Guizhong Wu ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spinal Canal ◽  
Pathological Changes ◽  
Cervical Spinal Canal ◽  
Canal Diameter ◽  
The Relationship

scholarly journals Computerized Tomography-Based Morphometric Analysis of Cervical Spinal Canal in Central Indian Population

2020 ◽  
Vol 11 (02) ◽  
pp. 274-277
Author(s):  
Ambuj Kumar ◽  
Subhash Sahu ◽  
Shivank Sethi ◽  
Shailendra Ratre ◽  
Vijay Parihar ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Statistical Analysis ◽  
Ct Scan ◽  
Computerized Tomography ◽  
Spinal Canal ◽  
Indian Population ◽  
P Value ◽  
Cervical Spinal Canal ◽  
Canal Diameter ◽  
Significant Difference

Abstract Objective Normal cervical spine canal morphometry is critical for understanding the pathology of certain diseases and for proper preoperative planning. Computerized tomography (CT) scan can replace older conventional radiography techniques by providing more accurate morphometric measurements. This study was aimed to find out various dimensions of the cervical spinal canal of central Indian population. Materials and Methods A prospective study was conducted including 100 consecutive cervical spine CT scan of asymptomatic adult subjects. The anteroposterior sagittal canal diameter (SCD), transverse canal diameter (TCD), canal surface area (CSA), and Pavlov-Torg Ratio (PTR) from C2 to C7 were calculated. Statistical Analysis Data were entered in Microsoft Excel Sheet 2007 and statistical analysis was performed by IBM SPSS statistics 2.0 version. p-Value < 0.05 was considered as significant. Results Age ranged from 18 years to 77 years with mean age 39.5 years. There was no significant difference in all the dimensions (SCD, TCD, CSA) in male and female except at C2 level, where SCD, TCD, and CSA were significant larger in male. The mean SCD, TCD, and CSA is largest at C2 level (14.4 ± 1.63 mm, 21.57 ± 1.59 mm, and 156.20 ± 24.98 mm2, respectively) and smallest at C4 level (12.77 ± 1.48 mm, 20.37 ± 1.72 mm, and 130.42 ± 21.20 mm2). PTR showed very little variation. Conclusion Normal values of cervical spinal canal could serve as a future reference. CT scan provides more accurate measurement. More studies are needed as there could be variations in dimensions in different regions in India.

scholarly journals Estimation of CSF Flow Resistance in the Upper Cervical Spine

2013 ◽  
Vol 26 (1) ◽  
pp. 106-110 ◽  
Author(s):  
K-A. Mardal ◽  
G. Rutkowska ◽  
S. Linge ◽  
V. Haughton
Keyword(s):  
Cervical Spine ◽  
Healthy Volunteers ◽  
Subarachnoid Space ◽  
Spinal Canal ◽  
Flow Resistance ◽  
Upper Cervical Spine ◽  
Csf Flow ◽  
Cervical Spinal Canal ◽  
Upper Cervical ◽  
Chiari I

Chiari I patients have increased CSF velocities in the foramen magnum due hypothetically to increased pressure gradients or reduced flow resistance. We calculated flow resistance in the cervical spinal canal in a group of subjects with and without the Chiari malformation. Eight subjects including healthy volunteers and Chiari I patients were studied. From 3D high resolution MR images of the cervical spine mathematical models of the subarachnoid spaces were created by means of standard programs for segmentation and discretization. Oscillatory flow through the subarachnoid space was simulated. Cross-sectional area of the subarachnoid space was computed at each level from C1 through C4 and the length of this spinal canal segment was measured. Peak caudad CSF flow velocity at each level was plotted against cross-section area. CSF volumetric flux and resistance were calculated for each subject. The correlation between velocity and resistance was calculated. In all subjects, peak velocities increased progressively from C1 to C4 by 0.6 to 0.7 cm/s per level. Spinal canal areas diminished from C1 to C5 in each subject at a rate of 0.25 to 0.29 cm2per level. Resistance averaged 4.3 pascal/ml/s in the eight subjects; 3.8 pascal/ml/s in patients with tonsilar herniation and 6.0 pascal/ml/s in volunteers. Velocity correlated inversely with resistance (R2= 0.6). CSF velocities correlated inversely with the flow resistance in the upper cervical spinal canal. Resistance tends to be lower in Chiari I patients than in healthy volunteers.

Comparison of cervical spinal canal diameter between younger and elder generations of Japanese

2010 ◽  
Vol 15 (1) ◽  
pp. 97-103 ◽  
Author(s):  
Shin-Ichi Goto ◽  
Jutaro Umehara ◽  
Toshimi Aizawa ◽  
Shoichi Kokubun
Keyword(s):  
Spinal Canal ◽  
Cervical Spinal Canal ◽  
Canal Diameter

CFD Modeling for Patient-Specific Analysis of Cerebrospinal Fluid Flow

2007 ◽  
Author(s):  
Alejandro Roldán ◽  
Andrew Wentland ◽  
Oliver Wieben ◽  
Victor Haughton ◽  
Tim Osswald ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Canal ◽  
Chiari Malformation ◽  
Cfd Modeling ◽  
Patient Specific ◽  
Variable Response ◽  
Cervical Spinal Canal ◽  
Upper Cervical ◽  
The Impact ◽  
Cerebellar Tonsils

Chiari malformations are characterized by the cerebellar tonsils extending into the upper cervical spinal canal. Many patients with Chiari malformation experience headaches or develop a cyst in the spinal cord inferior to the cerebellar tonsils. Some symptomatic patients benefit from a surgical procedure to enlarge the foramen magnum and others do not. The causes of symptoms and variable response to surgery remain unknown. Imaging studies have shown that patients with a Chiari malformation exhibit increased cerebrospinal fluid (CSF) velocities compared to subjects without the malformation. Improved methods of analyzing the CSF fluid dynamics are needed to evaluate the impact of increased fluid velocities on pressure differentials in the upper cervical spinal canal and the potential impact of surgery on flow dynamics in patient specific geometries.

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