Segmental cervical spine motion during orotracheal intubation of the intact and injured spine with and without external stabilization

2000 ◽  
Vol 92 (2) ◽  
pp. 201-206 ◽  
Author(s):  
Peter J. Lennarson ◽  
Darin Smith ◽  
Michael M. Todd ◽  
Douglas Carras ◽  
Paul D. Sawin ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Orotracheal Intubation ◽  
Segmental Motion ◽  
Content Type ◽  
Spine Motion ◽  
Human Cadavers ◽  
External Stabilization ◽  
Caudal Level ◽  
Video Fluoroscopy ◽  
Fine Print

Object. The purpose of this study was to establish a cadaveric model for evaluating cervical spine motion in both the intact and injured states and to examine the efficacy of commonly used stabilization techniques in limiting that motion. Methods. Intubation was performed in fresh human cadavers with intact cervical spines, following the creation of a C4–5 posterior ligamentous injury. Movement of the cervical spine during direct laryngoscopy and intubation was recorded using video fluoroscopy and examined under the following conditions: 1) without external stabilization; 2) with manual in-line cervical immobilization; and 3) with Gardner—Wells traction. Subsequently, segmental motion of the occiput through C-5 (Oc—C5) was measured from digitized frames of the recorded video fluoroscopy. The predominant motion, at all levels measured in the intact spine, was extension. The greatest degree of motion occurred at the atlantooccipital (Oc—C1) junction, followed by the C1–2 junction, with progressively less motion at each more caudal level. After posterior destabilization was induced, the predominant direction of motion at C4–5 changed from extension to flexion, but the degree of motion remained among the least of all levels measured. Traction limited but did not prevent motion at the Oc—C1 junction, but neither traction nor immobilization limited motion at the destabilized C4–5 level. Conclusions. Cadaveric cervical spine motion accurately reflected previously reported motion in living, anesthetized patients. Traction was the most effective method of reducing motion at the occipitocervical junction, but none of the interventions significantly reduced movement at the subaxial site of injury. These findings should be considered when treating injured patients requiring orotracheal intubation.

Cervical spinal motion during intubation: efficacy of stabilization maneuvers in the setting of complete segmental instability

2001 ◽  
Vol 94 (2) ◽  
pp. 265-270 ◽  
Author(s):  
Peter J. Lennarson ◽  
Darin W. Smith ◽  
Paul D. Sawin ◽  
Michael M. Todd ◽  
Yutaka Sato ◽  
...  
Keyword(s):  
Orotracheal Intubation ◽  
Ligamentous Injury ◽  
Angular Rotation ◽  
Spinal Motion ◽  
Content Type ◽  
Human Cadavers ◽  
Cervical Immobilization ◽  
Cervical Motion ◽  
Video Fluoroscopy ◽  
Fine Print

Object. The purpose of this study was to characterize and compare segmental cervical motion during orotracheal intubation in cadavers with and without a complete subaxial injury, as well as to examine the efficacy of commonly used stabilization techniques in limiting that motion. Methods. Intubation procedures were performed in 10 fresh human cadavers in which cervical spines were intact and following the creation of a complete C4–5 ligamentous injury. Movement of the cervical spine during direct laryngoscopy and intubation was recorded using video fluoroscopy and examined under the following conditions: 1) without stabilization; 2) with manual in-line cervical immobilization; and 3) with Gardner—Wells traction. Subsequently, segmental angular rotation, subluxation, and distraction at the injured C4–5 level were measured from digitized frames of the recorded video fluoroscopy. Conclusions: After complete C4–5 destabilization, the effects of attempted stabilization on distraction, angulation, and subluxation were analyzed. Immobilization effectively eliminated distraction, and diminished angulation, but increased subluxation. Traction significantly increased distraction, but decreased angular rotation and effectively eliminated subluxation. Orotracheal intubation without stabilization had intermediate results, causing less distraction than traction, less subluxation than immobilization, but increased angulation compared with either intervention. These results are discussed in terms of both statistical and clinical significance and recommendations are made.

Cervical Spine Motion with Direct Laryngoscopy and Orotracheal Intubation

1996 ◽  
Vol 85 (1) ◽  
pp. 26-36 ◽  
Author(s):  
Paul D. Sawin ◽  
Michael M. Todd ◽  
Vincent C. Traynelis ◽  
Stella B. Farrell ◽  
Antoine Nader ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Direct Laryngoscopy ◽  
Sagittal Plane ◽  
Human Subjects ◽  
Orotracheal Intubation ◽  
Segmental Motion ◽  
Macintosh Blade ◽  
Spine Motion ◽  
Reproducible Method ◽  
Cervical Motion

Background Cervical spine kinetics during airway manipulation are poorly understood. This study was undertaken to quantify the extent and distribution of segmental cervical motion produced by direct laryngoscopy and orotracheal intubation in human subjects without cervical abnormality. Methods Ten patients without clinical or radiographic evidence of cervical spine abnormality underwent laryngoscopy using a #3 Macintosh blade while under general anesthesia and neuromuscular blockade. Cervical motion was recorded with continuous lateral fluoroscopy. The intubation sequence was divided into distinct stages and the corresponding fluoroscopic images were digitized. Segmental motion, occiput through C5, was calculated for each stage using the digitized data. Results During exposure and laryngoscope blade insertion, minimal displacement of the skull base and rostral cervical vertebral bodies was observed. Visualization of the larynx created superior rotation of the occiput and C1 in the sagittal plane, and mild inferior rotation of C3-C5. C2 maintained nearneutral posture. This pattern of displacement resulted in extension at each motion segment, with the most significant motion produced at the occipitoatlantal and atlantoaxial joints (mean = 6.8 degrees and 4.7 degrees, respectively). Intubation created slight additional superior rotation at the occiput and C1, without substantial alteration in the posture of C2-C5. After laryngoscope removal, position trended toward baseline at all levels, although exact neutral posture was not regained. Conclusions This investigation quantifies the behavior of the normal cervical spine during direct laryngoscopy with a Macintosh blade. With this maneuver, the vast majority of cervical motion is produced at the occipitoatlantal and atlantoaxial joints. The subaxial cervical segments (C2-C5) are displaced only minimally. This study establishes a highly reliable and reproducible method for analyzing cervical motion in real time.

A new technique for exposure of the cervical spine laminae

2002 ◽  
Vol 96 (1) ◽  
pp. 122-126 ◽  
Author(s):  
Tateru Shiraishi
Keyword(s):  
Cervical Spine ◽  
New Technique ◽  
Diverse Range ◽  
Content Type ◽  
Spinous Processes ◽  
Technical Details ◽  
A New Technique ◽  
Fine Print

✓ The author describes a new technique for exposure of the cervical spine laminae in which the attachments of the semispinalis cervicis and multifidus muscles to the spinous processes are left untouched. It provides a conservative exposure through which a diverse range of posterior cervical surgeries can be performed. In contrast to conventional cervical approaches, none of the muscular attachments to the spinous processes is compromised. In this paper the author describes the technical details and discusses the applications of the procedure.

Intradural extramedullary tuberculoma of the cervical spine

1984 ◽  
Vol 60 (1) ◽  
pp. 200-203 ◽  
Author(s):  
Jeff S. Compton ◽  
Nicholas W. C. Dorsch
Keyword(s):  
Cervical Spine ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Ct Scanning ◽  
Nerve Roots ◽  
Content Type ◽  
Vehicle Accident ◽  
Calcified Lesion ◽  
Intradural Extramedullary ◽  
Fine Print

✓ A case is reported of a 45-year-old man who developed quadriplegia following a trivial motor-vehicle accident. Investigation including computerized tomography (CT) of the cervical spine revealed a large calcified lesion displacing the spinal cord and nerve roots, which proved to be a tuberculoma. The case is unusual in regard to the age of the patient, the size, location, and nature of the lesion, the mode of presentation, and the delineation of the lesion by CT scanning.

Delayed intracranial migration of cervical sublaminar and interspinous wires and subsequent cerebellar abscess

2002 ◽  
Vol 97 (1) ◽  
pp. 113-117 ◽  
Author(s):  
Kevin L. Stevenson ◽  
Matthew Wetzel ◽  
Ian F. Pollack
Keyword(s):  
Cervical Spine ◽  
Neurological Injury ◽  
Cervical Fusion ◽  
Content Type ◽  
Cerebellar Abscess ◽  
Delayed Complication ◽  
History Of ◽  
Delayed Complications ◽  
The Wire ◽  
Fine Print

✓ Delayed complications associated with sublaminar and interspinous wiring in the pediatric cervical spine are rare. The authors present a case of delayed complication in which a cervical fusion wire migrated into the cerebellum, causing subsequent cerebellar abscess 2 years after posterior cervical arthrodesis. A craniotomy was required to remove the wire and drain the abscess. Despite their history of safety and successful fusion, procedures involving sublaminar and interspinous wiring carry a risk of neurological injury secondary to wire migration. A thorough neuroimaging evaluation is required in patients who have undergone fusion and who have neurological complaints to detect late instrumentation-related sequelae.

Cervical laminectomy without fusion in patients with rheumatoid arthritis

1999 ◽  
Vol 90 (2) ◽  
pp. 186-190 ◽  
Author(s):  
Dan Christensson ◽  
Hans Säveland ◽  
Stefan Zygmunt ◽  
Kjell Jonsson ◽  
Urban Rydholm
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Cord Compression ◽  
Spinal Instability ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
Fusion Procedure ◽  
Cervical Laminectomy ◽  
Flexion Extension ◽  
Fine Print

Object. The authors performed a prospective study to determine whether cervical laminectomy without simultaneous fusion results in spinal instability. Methods. Because of clinical and radiographic signs of cord compression, 15 patients with rheumatoid arthritis (including one with Bechterew's disease) and severe involvement of the cervical spine underwent decompressive laminectomy without fusion performed on one or more levels. Preoperative flexion—extension radiographs demonstrated dislocation but no signs of instability at the level of cord compression. Clinical and radiological reexamination were performed twice at a median of 15 months (6–24 months) and 43 months (28–72 months) postoperatively. One patient developed severe vertical translocation 28 months after undergoing a C-1 laminectomy, which led to sudden tetraplegia. She required reoperation in which posterior fusion was performed. No signs of additional instability at the operated levels were found in the remaining 14 patients. In three patients increased but stable dislocation was demonstrated. The results of clinical examination were favorable in most patients, with improvement of neurological symptoms and less pain. Conclusions. The authors conclude that decompressive laminectomy in which the facet joints are preserved can be performed in the rheumatoid arthritis-affected cervical spine in selected patients in whom signs of cord compression are demonstrated, but in whom radiographic and preoperative signs of instability are not. Performing a simultaneous fusion procedure does not always appear necessary. Vertical translocation must be detected early, and if present, a C-1 laminectomy should be followed by occipitocervical fusion.

Fracture dislocation of the cervical spine with gross displacement

1975 ◽  
Vol 42 (2) ◽  
pp. 209-211 ◽  
Author(s):  
Ian C. Bailey
Keyword(s):  
Cervical Spine ◽  
Vertebral Body ◽  
Cervical Spine Injury ◽  
Fracture Dislocation ◽  
Spine Injury ◽  
Content Type ◽  
Fine Print

✓ A case of cervical spine injury is presented in which complete displacement of one vertebral body was accompanied by only mild quadriparesis.

The straight sinus

1974 ◽  
Vol 41 (6) ◽  
pp. 724-727 ◽  
Author(s):  
R. C. Saxena ◽  
M. A. Q. Beg ◽  
A. C. Das
Keyword(s):  
Dura Mater ◽  
Posterior Cranial Fossa ◽  
Cerebral Vein ◽  
Content Type ◽  
Straight Sinus ◽  
Sagittal Sinus ◽  
India Ink ◽  
Human Cadavers ◽  
Cranial Fossa ◽  
Fine Print

✓ The dura mater of the posterior cranial fossa of 86 adult human cadavers has been examined grossly after the injection of India ink through the confluence of sinuses in order to visualize the extent, communications, and tributaries of the straight sinus. Variations from the textbook description of formation by the union of the inferior sagittal sinus and the great cerebral vein are described and discussed.

Quadrant anatomy of the articular pillars (lateral cervical mass) of the cervical spine

1995 ◽  
Vol 82 (6) ◽  
pp. 1011-1014 ◽  
Author(s):  
T. Glenn Pait ◽  
Phillip V. McAllister ◽  
Howard H. Kaufman
Keyword(s):  
Anatomical Landmarks ◽  
Cervical Mass ◽  
Content Type ◽  
Bony Landmarks ◽  
Fixation Devices ◽  
Human Cadavers ◽  
Lateral Mass Screws ◽  
Neurovascular Structures ◽  
Lateral Facet ◽  
Fine Print

✓ Knowledge of the relevant anatomy is important when developing a strategy for introducing screws into the lateral masses to secure internal fixation devices. This paper defines key bony landmarks and their relationship to critical neurovascular structures and identifies a location for safe placement of cervical articular pillar (lateral mass) screws. Measurements of anatomical landmarks in 10 spines from human cadavers aged 61 to 85 years were made by caliper and a metric ruler. Landmarks were the lateral facet line, rostrocaudal line, medial facet line, intrafacet line, and medial facet line—vertebral artery line. The average distances and ranges were recorded. Such great variance existed in measurements from spine to spine and within the same spine as to render averages clinically unreliable. Dissection revealed that division of the articular pillar into four quadrants leaves one, the superior lateral quadrant, under which there are no neurovascular structures; this may be considered the “safe quadrant” for placement of posterior screws and plates.

Prognostic significance of magnetic resonance imaging in the acute phase of cervical spine injury

1992 ◽  
Vol 76 (2) ◽  
pp. 218-223 ◽  
Author(s):  
Dale M. Schaefer ◽  
Adam E. Flanders ◽  
Jewell L. Osterholm ◽  
Bruce E. Northrup
Keyword(s):  
Cervical Spine ◽  
Mr Imaging ◽  
Prognostic Significance ◽  
Spinal Segment ◽  
Content Type ◽  
Group 3 ◽  
Group 2 ◽  
Fine Print ◽  
Group 1

✓ Fifty-seven patients with acute cervical spine injuries and associated major neurological deficit were examined within 2 weeks of injury by magnetic resonance (MR) imaging. All patients had abnormal scans, indicating intramedullary lesions. This study was undertaken to determine if the early MR imaging pattern had a prognostic relationship to the eventual neurological outcome. Three different MR imaging patterns were observed in these patients: 21 patients had patterns characteristic of intramedullary hematoma (Group 1); 17 had intramedullary edema over more than one spinal segment, but no hemorrhage (Group 2); and 19 had restricted zones of intramedullary edema involving one spinal segment or less (Group 3). The neurological state was determined using standard motor index scores at admission and at follow-up examination. Characteristically, the patients in Group 1 had admission motor scores significantly lower than the other two groups. At follow-up examination, the median percent motor recovery was 9% for Group 1, 41% for Group 2, and 72% for Group 3. These studies suggest that the MR imaging pattern observed in the acutely injured human spinal cord has a prognostic significance in the final outcome of the motor system. It is only when an accurate prognosis can be given at the outset that useful treatment data might be collected for homogeneous injury groups, and accurately based long-term planning made for the best patient care.

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