Isolated traumatic occipital condyle fractures: Is external cervical orthosis even necessary?

Background: Occipital condyle fractures (OCFs) have been reported in up to 4–16% of individuals suffering cervical spine trauma. The current management of OCF fractures relies on a rigid cervical collar for 6 weeks or longer. Here, we calculated the rate of acute and delayed surgical intervention (occipitocervical fusion) for patients with isolated OCF who were managed with a cervical collar over a 10-year period at a single institution. Methods: This was a retrospective analysis performed on all patients admitted to a Level 1 Trauma Center between 2008 and 2018 who suffered traumatic isolated OCF managed with an external rigid cervical orthosis. Radiographic imaging was reviewed by several board-certified neuroradiologists. Demographic and clinical data were collected including need for occipitocervical fusion within 12 months after trauma. Results: The incidence of isolated OCF was 4% (60/1536) for those patients admitted with cervical spine fractures. They averaged 49 years of age, and 58% were male falls accounted for the mechanism of injury in 47% of patients. Classification of OCF was most commonly classified in 47% as type I Anderson and Montesano fractures. Of the 60 patients who suffered isolated OCF that was managed with external cervical orthosis, 0% required occipitocervical fusion within 12 months posttrauma. About 90% were discharged, while the remaining 10% sustained traumatic brain/orthopedic injury that limited an accurate neurological assessment. Conclusion: Here, we documented a 4% incidence of isolated OCF in our cervical trauma population, a rate which is comparable to that found in the literature year. Most notably, we documented a 0% incidence for requiring delayed occipital-cervical fusions.

Type II Odontoid Fractures Case Series: History of Seizures a Risk Factor for Failure of Non-operative Treatment of Type II Odontoid Fractures

Introduction:Odontoid fractures are one of the most common injuries to the cervical spine. Type II odontoid fracture treatment varies depending on age, co-morbidities, and fracture morphology. Treatment ranges from cervical orthosis to surgical intervention. Currently fractures with high non-union rates are considered for operative management which includes displacement of >6 mm, increasing age (>40-60 years), fracture gap >1 mm, delay in treatment >4 days, posterior re-displacement >2 mm, increased angulation, and history of smoking. While re-displacement of >2 mm has been associated with increased risk of non-union;, to the best of our knowledge, no studies have looked at the risk factors for re-displacement. Case Report:We present two 26-year-old male patients who were found to have minimally displaced type II odontoid fractures initially treated in a cervical collar. These two patients were subsequently found to have displaced their odontoid fracture after having a documented seizure. Conclusion:We suggest that a history of seizures be considered a risk factor for re-displacement of non-displaced type II odontoid fractures. Keywords:Operative indications odontoid case report, Type II odontoid fracture, Displacement, Seizure, Odontoid fracture displacement, Nondisplaced type ? odontoid fracture.

Impedance Adaptive Controller for a Prototype of a Whiplash Syndrome Rehabilitation Device

The objective of this study was to design of an output based impedance adaptive controller for a special class of cervical orthoses, a class of biomedical devices for the rehabilitation of neck illnesses. The controller used the adaptive sliding mode theory to enforce the tracking of the reference trajectory if the patient was not resistant to the therapy. If the patient rejects the orthosis activity, a second impedance-based controller governs the orthosis movement allowing the patient to take the leading role in the orthosis sequence of movements. The proposed controller considers a weighted controller combining the tracking and the impedance controls in a single structure. The monitoring of the external force was evaluated on a novel weighting function defining on-line the role of each controller. The proposed orthosis was motivated by the prevalence of whiplash, which is a syndrome that is produced by forced hyperextension and hyperflexion of the neck. This study included the development of a technological prototype of the orthotic type to support the recovery of patients diagnosed with whiplash. The sections that make up the orthotic device are two independent systems that move the patient’s head in the sagittal and frontal planes. For this purpose, the mechanical structure of the cervical orthosis was made up of 7 pieces printed in 3D with polylactic acid (PLA). The operation of the cervical orthosis was evaluated in two sections: (a) using a simulation system, which consists of a spring with an artificial head and the development of a graphic interface in Matlab, and (b) evaluating the controller on the proposed orthosis. With these elements, the follow-up of the trajectory proposed by the actuators was evaluated, as well as its performance in the face of the opposition that a patient generates. The superiority of the proposed controller was confirmed by comparing the tracking efficiency with proportional-integral-derivative and first-order sliding variants.

Predictors of mortality in the elderly patient with a fracture of the odontoid process

Aims Fracture of the odontoid process (OP) in the elderly is associated with mortality rates similar to those of hip fracture. The aim of this study was to identify variables that predict mortality in patients with a fracture of the OP, and to assess whether established hip fracture scoring systems such as the Nottingham Hip Fracture Score (NHFS) or Sernbo Score might also be used as predictors of mortality in these patients. Patients and Methods We conducted a retrospective review of patients aged 65 and over with an acute fracture of the OP from two hospitals. Data collected included demographics, medical history, residence, mobility status, admission blood tests, abbreviated mental test score, presence of other injuries, and head injury. All patients were treated in a semi-rigid cervical orthosis. Univariate and multivariate analysis were undertaken to identify predictors of mortality at 30 days and one year. A total of 82 patients were identified. There were 32 men and 50 women with a mean age of 83.7 years (67 to 100). Results Overall mortality was 14.6% at 30 days and 34.1% at one year. Univariate analysis revealed head injury and the NHFS to be significant predictors of mortality at 30 days and one year. Multivariate analysis showed that head injury is an independent predictor of mortality at 30 days and at one year. The NHFS was an independent predictor of mortality at one year. The presence of other spinal injuries was an independent predictor at 30 days. Following survival analysis, an NHFS score greater than 5 stratified patients into a significantly higher risk group at both 30 days and one year. Conclusion The NHFS may be used to identify high-risk patients with a fracture of the OP. Head injury increases the risk of mortality in patients with a fracture of the OP. This may help to guide multidisciplinary management and to inform patients. This paper provides evidence to suggest that frailty rather than age alone may be important as a predictor of mortality in elderly patients with a fracture of the odontoid process. Cite this article: Bone Joint J 2019;101-B:253–259.

Effects of Minerva Orthosis on Larynx Height in Young, Healthy Volunteers

Background: During speech, larynx is higher in the neck for high-pitched sounds and lower for low-pitched sounds. Patients with different problems in cervical and cervicothoracic spine use cervical orthosis to limit cervical motion. This study aimed to evaluate the effects of Minerva orthosis on larynx height in young, healthy volunteers. Subjects and methods: This study included 18 subjects. Acoustic measurement of frequency variability has been assessed in 3 brace conditions: (1) without brace, (2) with brace, and (3) 30 minutes after wearing the brace. Results: Several statistically significant differences were found in the comparison between Minerva and 30 minutes after Minerva. Conclusion: When planning cervical orthosis treatment, it is important to consider the reduction in larynx height that may result from bracing for those who are already at risk of developing dysphagia and dysphonia.

Vertigo, can it be redefined?

Background & Objectives- Vertigo, a clinical symptom complex is not infrequent in our patients. Its diagnosis too is controversial. Majority of these cases run from hospital to clinics, some times to Otolaryngologists to get rid of this bizarre experience. Sometimes they get benefit but otherwise they experience a destitute life. Our aim was to treat them by Physical Therapy in the light of Cervical Spondylosis that is commonly associated with vertigo. Material & Methods- This is a prospective case study done in PMR department (OPD) of a teaching institute over a period of 6 months time period. 20 OPD patients of both sexes (14 ladies and 6 gents) with definite Cervical Spondylosis along with complain of vertigo or dizziness, pain at cervical spine were accounted for the study. Only extreme aged persons or patients with other major co-morbidity were excluded. These 20 patients were treated with conventional Physical Therapy for CS. Medications were prescribed as and when required. Results- After Physical Therapy, that included lifestyle modification, isometric cervical exercise, intermittent cervical traction, application of Therapeutic Ultrasound (UST) to cervical region and proper posture care of cervical spine along with use of cervical orthosis (where needed), majority of the patients become symptom free. Conclusion- Physical Therapy may be considered as an alternative method of treatment of Vertigo patients, who are otherwise not responding satisfactorily to pharmaceutical agents.