Tomodensitometric Bone Anatomy of The Intervertebral Foramen of The Lower Cervical Spine: Measurements and Comparison of Foraminal Volume in Healthy Individuals and Patients Suffering from Cervicobrachial Neuralgia Due to Foraminal Stenosis.

Purpose Degenerative foraminal stenosis of the cervical spine can lead to cervicobrachial neuralgias. Computed tomography (CT)-scan assists in the diagnosis and evaluation of foraminal stenosis. The main objective of this study is to determine the bony dimensions of the cervical intervertebral foramen and to identify which foraminal measurements are most affected by degenerative disorders of the cervical spine. These data could be applied to the surgical treatment of this pathology, helping surgeons to focus on specific areas during decompression procedures. Methods A descriptive study was conducted between two groups: an asymptomatic one (young people with no evidence of degenerative cervical spine disorders) and a symptomatic one (experiencing cervicobrachial neuralgia due to degenerative foraminal stenosis). Using CT scans, we determined a method allowing measurements of the following foraminal dimensions: foraminal height (FH), foraminal length (FL), foraminal width in its lateral part ((UWPP, MWPP and IWPP (respectively Upper, Medial and Inferior Width of Pedicle Part)) and medial part (UWMP, MWMP and IWMP (respectively Upper, Medial and Inferior Width of Medial Part)), and disk height (DH). Foraminal volume (FV) was calculated considering the above data. Mean volumes were measured in the asymptomatic group and compared to the values obtained in the symptomatic group. Results Both groups were made up of 10 patients, and a total of 50 intervertebral discs (100 intervertebral foramina) were analyzed in each group. Comparison of C4C5, C5C6 and C6C7 levels between both groups showed several significant decreases in foraminal dimensions (p< 0,05) as well as in foraminal volume (p <0.001) in the symptomatic group. The most affected dimensions were UWPP, MWPP, UWMP, MWMP and FV. The most stenotic foraminal areas were the top of the uncus and the posterior edge of the lower plate of the overlying vertebra. Conclusion Using a new protocol for measuring foraminal volume, the present study refines the current knowledge of the normal and pathological anatomy of the lower cervical spine and allows us to understand the foraminal sites most affected by degenerative stenosis. Those findings can be applied to foraminal stenosis surgeries. According to our results, decompression of the foramen in regard of both uncus osteophytic spurs and inferior plate of the overlying vertebra might be an important step for nerve roots release.

Tear-drop Fracture of the Axis: Non-operative Treatment of Two Cases : Case Report

Tear-drop fracture of the axis are rare. It is characterized by a fracture of the anterior-inferior corner of the C2 body. The mechanism is usually in extension which is different from the tear-drop of lower cervical spine. We report two cases of adults who sustained a road traffic accident. They did not have any neurological deficit. The diagnosis was made on radiological examination. They both were treated conservatively with rigid immobilization and recovered well. Tear-drop fracture of the axis are usually stable. Imagery is the key of the diagnosis. Neurological deficit is rare. Conservative management usually give good outcome for non-complicated cases.

Finite Element Analysis and Comparative Study of 4 Kinds of Internal Fixation Systems for Anterior Cervical Discectomy and Fusion in Children

Background: Spinal injury in children usually occurs in the cervical spine region. Anterior fixation of lower cervical spine has been applied in the treatment of pediatric cervical spine injury and disease due to its stable and firm mechanical properties. This study performed finite element analysis and comparison of 4 different anterior cervical internal fixation systems for children, and explored more stable methods of anterior cervical internal fixation in children. Methods: A finite element model of 6-year-old children with lower cervical spine C4/5 discectomy was established, and the self-designed lower cervical spine anterior locking internal fixation system ACBLP and the children’s anterior cervical internal fixation system ACOP, ACVLP, ACSLP plate screws were fixed and loaded on the model. 27.42N•m torque load was applied to each internal fixation model under 6 working conditions of anteflexion, backward flexion, left flexion, right flexion, left rotation and right rotation, to simulate the movement of the cervical spine. The activity and stress distribution cloud diagram of each finite element model was obtained. Results: In the four internal fixation models of ACOP, ACVLP, ACSLP, and ACBLP, the mobility of C4/5 segment basically showed a decreasing relationship, and the mobility of adjacent segments increased significantly. In the Mises stress cloud diagram of the cervical spine of the four models, the vertebral body and accessories of the ACBLP model born the least stress, followed by ACSLP; The steel plate and screws in the ACVLP internal fixation model were the most stressed; The stress of the internal fixation system (plate/screw) in all models increased in the order of ACBLP, ACSLP, ACVLP, and ACOP.Conclusions: ACBLP internal fixation system had obvious advantages in anterior internal fixation of lower cervical spine in children, C4/5 had the smallest degree of movement, relative displacement was minimal, the stress on the pedicle was the least while the stress on the plate screw was relatively the smallest.

Nursing Intervention Study of Microscope-assisted Anterior and Posterior Fusion for Lower Cervical Spine Fracture and Dislocation

To explore the nursing intervention measures of microscopy-assisted anterior and posterior fusion in the treatment of lower cervical spine fracture and dislocation.46 patients with fracture and dislocation of lower cervical spine who were treated by microscope-assisted anterior and posterior fusion in our hospital from April 2018 to April 2019 were selected for this study, and divided into observation group and control group according to the different nursing interventions applied by the patients during the treatment. There were 23 patients in the two groups, while the patients in the control group were given routine nursing interventions. The patients in the observation group were given comprehensive nursing interventions. The curative effects of the treatment and nursing interventions in the two groups were observed, sorted out, analyzed and summarized. The changes of psychological status, recovery of spinal cord function, occurrence of complications and quality of life before and after nursing intervention were compared between the two groups.(l) Psychological status: Before nursing intervention, there was no significant difference in psychological status between the two groups, and there was no significant difference (P > 0.05); After nursing intervention, the SDS and SAS scores of patients in the observation group were better than those in the control group, and the difference was statistically significant (P < 0.05); (2) Recovery of spinal cord function: before nursing intervention, there was no significant difference in JOA scores of spinal cord function between the two groups, and the difference was not statistically significant (P > 0.05); After nursing intervention, JOA score of spinal cord function in the observation group was significantly better than that in the control group, the difference was statistically significant (P < 0.05); (3) Complication occurrence: Complication incidence in the observation group was lower than that in the control group, the difference was statistically significant (P < 0.05). (4) Quality of life: before nursing intervention, there was no significant difference in QOL scores between the two groups, and the difference was not statistically significant (P > 0.05); after nursing intervention, the QOL scores of patients in the observation group were better than those in the control group, and the difference was statistically significant (P < 0.05).Through the analysis, it was found that the operation of microscope-assisted anterior and posterior fusion therapy was more complicated and the risk of treatment was greater. The comprehensive nursing interventions throughout the preoperative, intraoperative and postoperative period played a vital role in improving the treatment effect of patients, which was not only conducive to the effective recovery of patients’ spinal cord function. At the same time, it can avoid complications in the treatment process, so as to promote the early recovery of the patient’s condition and improve the quality of life. In general, the application of comprehensive nursing interventions in the treatment of lower cervical spine fracture patients has higher application value, which is worthy of clinical vigorous promotion and.

Variation patterns of cervical alignment in ankylosing spondylitis–related thoracolumbar kyphosis following pedicle subtraction osteotomy in the sitting position: an EOS-based investigation

OBJECTIVE Both unchanged upper cervical lordosis combined with decreased lower cervical lordosis and decreased upper cervical lordosis combined with decreased lower cervical lordosis have been reported to occur after correction surgery for adult spinal deformity. However, variations in cervical alignment after correction surgery in patients with ankylosing spondylitis (AS) have not been investigated. The current study aimed to investigate the variations in cervical alignment following the correction surgery in AS patients with thoracolumbar kyphosis. METHODS Patients with AS who underwent pedicle subtraction osteotomy (PSO) for thoracolumbar kyphosis from June 2016 to June 2019 with a minimum of 1-year follow-up were reviewed. Patients were grouped according to the presence (ossified group) and absence (non-ossified group) of total ossification of the anterior longitudinal ligament (ALL) in the lower cervical spine. Radiographic parameters, including thoracolumbar, craniocervical, and global radiographic parameters, were measured on lateral sitting EOS images. RESULTS Thirty-two patients (27 males and 5 females) with a mean follow-up of 1.5 years were identified. There were 21 patients in the non-ossified group and 11 patients in the ossified group. After PSO, both groups showed a decrease in the occiput–C7 angle (p < 0.001 for both). In the non-ossified group, the C2–7 angle decreased significantly (p < 0.001), while the occiput–C2 angle remained unchanged (p = 0.570). In the ossified group, the occiput–C2 angle decreased significantly (p < 0.001), while C2–7 angle remained unchanged (p = 0.311). In addition, the change in occiput–C2 was correlated with the osteotomy angle in the ossified group (R = 0.776, p = 0.005). CONCLUSIONS The variation patterns of cervical alignment following correction surgery for AS-related thoracolumbar kyphosis were different based on patients with or without total ossification of ALL in the lower cervical spine. When planning PSO for patients in the ossified group, restoration of the physiological upper cervical lordosis angle could be achieved by adjusting the osteotomy angle.

The impact of helicopter emergency medical services and craniocervical traction on the early reduction of cervical spine dislocation in a rural area of Japan

Background Several clinical and basic studies have shown that an association exists between achieving decompression of the spinal cord within a few hours and neurological recovery, even in patients with complete paralysis due to cervical spine dislocation. This study aimed to clarify the impact of helicopter emergency medical services(HEMS)and craniocervical traction using a halo ring on rapid reduction of lower cervical spine dislocation in rural Japan. Methods The success rate of and factors inhibiting closed reduction, time from injury to reduction and functional prognosis of lower cervical spine dislocations treated between July 2012 and January 2020 were retrospectively analysed. Results Fourteen patients were transported by HEMS (group H), seven were by ambulances (group A) and two were by themselves. Although the average travelled distance and injury severity score were significantly higher in group H (64.5 km, 28.0) than in group A (24.7 km, 18.6), there was no significant difference in the average time to admission or the time to start craniocervical traction after admission between group H (159.4 min, 52.2 min) and group A (163.6 min, 53.2 min). The urgent traction could be administered for 20 patients. The success rate of closed reduction was 95%, and neurological deterioration following traction was not observed in any cases. The average traction time and weight for reduction were 30.3 min and 16.3 kg, respectively. Patients’ body size and fracture-dislocation types did not significantly affect the traction time or weight. The rate of reduction within 4 h after injury was higher in group H (79%) than in group A (33%). Herniated discs were found at dislocation levels in five patients by magnetic resonance imaging scans performed after closed reduction, and all cases of inner fixation were treated via the posterior approach an average of 5.7 days after admission. After these treatment, three of nine AIS A patients recovered the ability to walk, and all the three patients underwent successful closed reduction within 4 h after injury. Conclusion HEMS and highly successful closed reduction considerably contributed to the early reduction of cervical spine dislocation and can potentially improve complete paralysis.