Effects of Stellate Ganglion Block Through Different Approaches Under Guidance of Ultrasound

ObjectiveThis study aimed to investigate the effects of stellate ganglion block (SGB) through different approaches under guidance of ultrasound.MethodsA total of 130 patients undergoing SGB in our hospital between February 2019 and February 2020 were enrolled as the research subjects. According to the random number table method, these subjects were divided into two groups: a modified 6th cervical vertebra (C6) group (n = 65) and a 7th cervical vertebra (C7) group (n = 65). Under the guidance of ultrasound, the subjects in the modified C6 group were punctured at the level of the C6 transverse process, and the subjects in the C7 group were punctured at the level of the C7 transverse process. The operation duration, number of puncture angle adjustments, block effects, and adverse reactions for SGB were compared between the two groups.ResultsThe modified C6 group showed shorter SGB operation duration and a lower number of puncture angle adjustments than the C7 group, and the differences were statistically significant (P < 0.05). Horner Syndrome occurred in both groups after SGB. The incidence of adverse reactions in the modified C6 group was 4.62%, comprising 1 case of hoarseness and 2 cases of slowed pulse, while that in the C7 group was 6.15%, with 1 case of hoarseness and 3 cases of slowed pulse; the difference between the two groups was not statistically significant (P > 0.05).ConclusionThe operation duration for modified SGB guided by ultrasound puncturing at the C6 transverse process is shorter and requires fewer puncture angle adjustments than puncturing at the C7 transverse process; however, there is no significant difference between the incidence of adverse reactions or the blocking effects of the two methods.

Deep Learning Auto-Segmentation of Cervical Neck Skeletal Muscle for Sarcopenia Analysis Using Pre-Therapy CT in Patients with Head and Neck Cancer

Background/Purpose: Sarcopenia is a prognostic factor in patients with head and neck cancer (HNC). Sarcopenia can be determined using the skeletal muscle index (SMI) calculated from cervical neck SM segmentations. However, SM segmentation requires manual input, which is time-consuming and variable. Therefore, we developed a fully-automated approach to segment cervical vertebra SM. Materials/Methods: 390 HNC patients with corresponding contrast-enhanced computed tomography (CT) scans were utilized (300-training, 90-testing). Ground-truth single-slice SM segmentations at the C3 vertebra were manually generated. A multi-stage deep learning pipeline was developed, where a 3D ResUNet auto-segmented the C3 section (33 mm window), the middle slice of the section was auto-selected, and a 2D ResUNet auto-segmented the auto-selected slice. Both the 3D and 2D approaches trained five sub-models (5-fold cross-validation) and combined sub-model predictions on the test set using majority vote ensembling. Model performance was primarily determined using the Dice similarity coefficient (DSC). Predicted SMI was calculated using the auto-segmentation cross-sectional area. Finally, using established SMI cutoffs, we performed a Kaplan-Meier analysis to determine associations with overall survival. Results: Mean test set DSC of the 3D and 2D models were 0.96 and 0.95, respectively. Predicted SMI had high correlation to the ground-truth SMI in males and females (r>0.96). Predicted SMI stratified patients for overall survival in males (log-rank p = 0.01) but not females (log-rank p = 0.07), consistent with ground-truth SMI. Conclusion: We developed a high-performance, multi-stage, fully-automated approach to segment cervical vertebra SM. Our study is an essential step towards fully-automated sarcopenia-related decision-making.

Course variations of the internal carotid artery and their significance in pharyngeal surgery

The internal carotid artery is one of the major vessels of the neck. It usually originates from the common carotid artery at the level of the 3rd–4th cervical vertebra and continues perpendicularly to the skull base in the neurovascular bundle. During common surgical procedures in the pharynx, such as adenoidectomy or tonsillectomy, the artery is usually in a safe distance from the pharyngeal wall and the risk of injury is low. However, several anatomical variations have been described that may cause medialization of the vessel closer to the pharyngeal wall, which significantly increases the risk of injury and occurrence of life-threatening haemorrhage. Keywords: internal carotid artery – tonsillectomy – haemorrhage – adenoidectomy – vascular anomalies

Treatment strategy for multisegmental cervicomedullary ependymoma: illustrative case

BACKGROUND Сervicomedullary ependymoma (CME) is a rare tumor of the central nervous system. The CME treatment strategy is insufficiently represented in the literature and is a complex task for neurosurgeons. OBSERVATIONS The authors describe an infrequent case of a large multisegmental CME that extended from the medulla oblongata to the cervical spinal cord at the level of the sixth cervical vertebra in a 21-year-old female. Neurological disorders presented with headache, dysphagia, hypophonia, and weakness in the limbs. Subtotal removal of the tumor was performed according to intraoperative neurophysiological monitoring (IONM) results. A wait-and-see approach with patient follow-up was chosen. LESSONS Total tumor removal of the CME is the most important favorable prognostic factor. Subtotal resection can be considered if the borders of the tumor are unclear and the result of IONM is unfavorable. The role of postoperative radiation therapy in the case of subtotal removal of the tumor remains controversial.

"Hand as Foot Teaching Method" Application in Upper Cervical Anatomy and Common Diseases

Background“Hand as Foot teaching method” has been applied to the clinical teaching of various orthopaedic subspecialties and achieved good results, but it has not been carried out in the specialized teaching of spine surgery, especially the upper cervical spine. The orthopedics teaching team of the Second Affiliated Hospital of Harbin Medical University applied this teaching method to the clinical teaching of atlantoaxial anatomical relationships and common atlantoaxial diseases.MethodsThe "Hand as Foot Teaching Method" was used to teach key and difficult points for master students of osteology in the Second Affiliated Hospital of Harbin Medical University, supplemented by PPT + anatomical specimens to assist the teaching process.Results"Hand as Foot Teaching Method" can concretize the complex anatomical structure of upper cervical vertebra, thus deepening students' understanding and memory of difficult points, enhancing teacher-student interaction and activating the teaching atmosphere.Conclusion"Hand as Foot Teaching Method" can be applied to the clinical teaching of atlantoaxial knowledge. Compared with the simple application of PPT + model teaching, this teaching method is more helpful for students to grasp difficulties quickly and in three dimensions, significantly improve the teaching quality, and can even be applied to preoperative doctor-patient communication. It has application and promotion value in clinical teaching of spinal surgery.

Conservative Management of Cervical Rib- A Case Report

Background: An additional rib that develops from the seventh cervical vertebra is known as a cervical rib, a congenital anomaly placed above the typical first rib, affecting 0.2- 0.5 percent of the total population. It may be seen on either the left or right sides. The majority of patients have little or no complaints and are identified by chance during an X-ray or CT scan. Due to the extreme compression on the arteries, veins and nerves caused by the position of the rib, which varies in shape and size, they might develop thoracic outlet syndrome. A cervical rib is a prolonged ossification of the lateral costal segment of the Cervical 7th vertebra. Clinical Presentation: A 18 years old female patient was diagnosed with cervical rib on X-ray due to persistent pain at right hand. Patient concern with reduced mobility of the right upper limb and unable to lift the hand. The patient went physiotherapy treatment which comprise of exercise and electro therapy for 10 weeks which resulted in improvements in pain and range of motion and functional activities Conclusion: The case report suggest that a prompt structured physical rehab let to improving the functional goals progressively and significantly which is a measured aspect leading to a successful recovery.

Morphometric Analysis of V2 Segment of Vertebral Artery in Patients with Symptomatic Neck Pain in South Indian Population – A CT Angiography Based Study

Objectives: The morphometric changes in the vertebral artery are essential for various interventions. Inadequate details about it can lead to risk of vertebral artery injury and other complications. This study explains the normal anatomical course of V2 segment of vertebral artery which is more prone for iatrogenic injury. Materials and Method: 25 adult patients with symptomatic neck pain were involved in the study. Various measurements were made from seventh cervical vertebra (C7) to the third cervical vertebra (C3) that included Distance from midline to VA, Distance from medial margin of Longus Colli to VA, Perpendicular distance from anterior margin of transverse process to center of VA, Horizontal distance from anterior tubercle to VA, sagittal and coronal diameter of the transverse foramen and vertebral artery. Result: Distance from midline, Distance from medial margin of Longus Colli, Perpendicular distance from anterior margin of transverse process to center of VA and Horizontal distance from anterior tubercle were increased towards right compared to left side. The sagittal and coronal diameter of the transverse foramen and vertebral artery decreased from C6 to C3 vertebra. Vertebral artery dominance was seen on left side in all cases. Conclusion: Preoperative assessment by computed tomography angiography helps to know the course of the vertebral artery, understand its patterns and assess various abnormalities thereby aids in preventing complications in future surgeries.

«THE HEADLESS HORSEMAN». THE SKYTHIAN GRAVE IN THE BARROW NEAR KUSTORIVKA VILLAGE

In 2013 near Kustorivka village of Krasnokutsky district, Kharkov region the Scythian burial mound (5th—4th centuries BC.) was excavated. The inserted burial of a beheaded man has been discovered there. Fragments of horse bones, horse harness, numerous arrowheads, the spearhead and knife were unearthed in the grave. Funeral inventory dates the burial to the 2nd half or the end of 5th — the early 4th century BC. The grave goods allowed us to suggest that the man was a horseman and possessed a bow with arrows, javelin or lance. These assumptions have been confirmed by anthropological studies of the development of muscles relief, injuries and specific skeletal markers. The skeleton showed clear signs of a horseman’ and archer’ osteological complexes. The man died at the age of 20—25. The skull, first and second cervical vertebrae were absent in the undisturbed burial. The upper part of the left intervertebral condyle of the 3rd vertebra was cut off by the hit from left behind and below. These signs are evidence of decapitation. In addition, numerous cut marks made with a sharp blade were found on the anterior and lateral surfaces of the 3rd and 4th cervical vertebrae, as well as on the left femur above the knee. Thus could be the signs of the body cleaning of waste tissue for its transportation or in course of the preparation for the burial. Studies of the horse’s remains showed that it has deceased at the age of 10—12 years. The horse was decapitated as well by the hit directed between first and second cervical vertebra. The head was also cut in half and only one part of it was present in the burial. There were also some bones of the animal’s skeleton, which do not belong to the edible parts of the body. The severed head of the horse was located above the place where the man’s head was supposed to be, thus the horse harness was situated on the level of the human skeleton. Traces of the possible preparation of the human body for burial and the location of the remains of a horse over a lost human head along with other changes in the skeleton indicate a certain funeral rite, direct analogies of which have not yet been found in the North Pontic region.