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Tidsskrift For Den Norske Laegeforening... Jan 2010Knowledge of biomechanics and the cervical spine's anatomy has become more topical as the incidence of whiplash neck disorders has increased. Unfortunately, injuries... (Review)
Review
BACKGROUND
Knowledge of biomechanics and the cervical spine's anatomy has become more topical as the incidence of whiplash neck disorders has increased. Unfortunately, injuries after traffic accidents are often brought to court, where the medical expert's knowledge is of utmost importance to ensure a correct medical evaluation.
MATERIAL AND METHODS
The article is based on information identified through non-systematic searches of PubMed and on the author's experience as a professor of anatomy.
RESULTS
The cervical spine is particularly vulnerable to forces perpendicular to the length axis. Stability depends largely on the soft tissue. Injuries of soft tissue (especially in ligaments and intervertebral discs) may lead to instability and periosteal reaction with subsequent new formation of bone.
INTERPRETATION
The cervical spine is a relatively weak and vulnerable part of the body. One should consider locally restricted new formations of tissue with corresponding height reduction of the intervertebral disc as a sign of genuine injury.
Topics: Adult; Animals; Biological Evolution; Biomechanical Phenomena; Cervical Vertebrae; Child; Humans; Intervertebral Disc; Ligaments; Odontoid Process; Spinal Injuries
PubMed: 20094120
DOI: 10.4045/tidsskr.09.0296 -
Annals of the Rheumatic Diseases May 2021MAXIMISE (Managing AXIal Manifestations in psorIatic arthritis with SEcukinumab) trial was designed to evaluate the efficacy of secukinumab in the management of axial... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
MAXIMISE (Managing AXIal Manifestations in psorIatic arthritis with SEcukinumab) trial was designed to evaluate the efficacy of secukinumab in the management of axial manifestations of psoriatic arthritis (PsA).
METHODS
This phase 3b, double-blind, placebo-controlled, multi-centre 52-week trial included patients (≥18 years) diagnosed with PsA and classified by ClASsification criteria for Psoriatic Arthritis (CASPAR) criteria, with spinal pain Visual Analogue Score ≥40/100 and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score ≥4 despite use of at least two non-steroidal anti-inflammatory drugs (NSAIDs). Patients were randomised (1:1:1) to secukinumab 300 mg, secukinumab 150 mg or placebo weekly for 4 weeks and every 4 weeks thereafter. At week 12, placebo patients were re-randomised to secukinumab 300/150 mg. Primary endpoint was ASAS20 (Assessment of SpondyloArthritis international Society) response with secukinumab 300 mg at week 12.
RESULTS
Patients were randomly assigned; 167 to secukinumab 300 mg, 165 to secukinumab 150 mg and 166 to placebo. Secukinumab 300 mg and 150 mg significantly improved ASAS20 response versus placebo at week 12 (63% and 66% vs 31% placebo). The OR (95% CI) comparing secukinumab 300 mg and 150 mg versus placebo, using a logistic regression model after multiple imputation, was 3.8 (2.4 and 6.1) and 4.4 (2.7 and 7.0; p<0.0001).
CONCLUSIONS
Secukinumab 300 mg and 150 mg provided significant improvement in signs and symptoms of axial disease compared with placebo in patients with PsA and axial manifestations with inadequate response to NSAIDs.
TRIAL REGISTRATION NUMBER
NCT02721966.
Topics: Adult; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Arthritis, Psoriatic; Axis, Cervical Vertebra; Double-Blind Method; Female; Humans; Male; Middle Aged; Severity of Illness Index; Treatment Outcome
PubMed: 33334727
DOI: 10.1136/annrheumdis-2020-218808 -
The Angle Orthodontist Aug 2002The present study aimed to provide a version of the Cervical Vertebral Maturation (CVM) method for the detection of the peak in mandibular growth based on the analysis...
The present study aimed to provide a version of the Cervical Vertebral Maturation (CVM) method for the detection of the peak in mandibular growth based on the analysis of the second through fourth cervical vertebrae in a single cephalogram. The morphology of the bodies of the second (odontoid process, C2), third (C3), and fourth (C4) cervical vertebrae were analyzed in six consecutive cephalometric observations (T1 through T6) of 30 orthodontically untreated subjects. Observations for each subject consisted of two consecutive cephalograms comprising the interval of maximum mandibular growth (as assessed by means of the maximum increment in total mandibular length, Co-Gn), together with two earlier consecutive cephalograms and two later consecutive cephalograms. The analysis consisted of both visual and cephalometric appraisals of morphological characteristics of the three cervical vertebrae. The construction of the new version of the CVM method was based on the results of both ANOVA for repeated measures with post-hoc Scheffé's test (P < .05) and discriminant analysis. The new CVM method presents with five maturational stages (Cervical Vertebral Maturation Stage [CVMS] I through CVMS V, instead of Cvs 1 through Cvs 6 in the former CVM method). The peak in mandibular growth occurs between CVMS II and CVMS III, and it has not been reached without the attainment of both CVMS I and CVMS II. CVMS V is recorded at least two years after the peak. The advantages of the new version of the CVM method are that mandibular skeletal maturity can be appraised on a single cephalogram and through the analysis of only the second, third, and fourth cervical vertebrae, which usually are visible even when a protective radiation collar is worn.
Topics: Adolescent; Age Determination by Skeleton; Analysis of Variance; Axis, Cervical Vertebra; Cephalometry; Cervical Vertebrae; Chi-Square Distribution; Child; Discriminant Analysis; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Mandible; Multivariate Analysis; Odontoid Process; Statistics as Topic
PubMed: 12169031
DOI: 10.1043/0003-3219(2002)072<0316:AIVOTC>2.0.CO;2 -
The Journal of the American Academy of... Feb 2020Os odontoideum is a rare entity of the second cervical vertebra, characterized by a circumferentially corticated ossicle separated from the body of C2. The ossicle is a... (Review)
Review
Os odontoideum is a rare entity of the second cervical vertebra, characterized by a circumferentially corticated ossicle separated from the body of C2. The ossicle is a distinct entity from an odontoid fracture or a persistent ossiculum terminale. The diagnosis may be made incidentally on imaging obtained for the workup of neck pain or neurologic signs and symptoms. Diagnosis usually can be made with plain radiographs. MRI and CT can assess spinal cord integrity and C1-C2 instability. The etiology of os odontoideum is a topic of debate, with investigative studies supporting both congenital and traumatic origins. A wide clinical range of symptoms exists. Symptoms may present as nondescript pain or include occipital-cervical pain, myelopathy, or vertebrobasilar ischemia. Asymptomatic cases without evidence of radiologic instability are typically managed with periodic observation and serial imaging. The presence of atlantoaxial instability or neurological dysfunction necessitates surgical intervention with instrumentation and fusion for stability.
Topics: Axis, Cervical Vertebra; Child; Humans; Joint Instability; Spinal Fusion
PubMed: 31977608
DOI: 10.5435/JAAOS-D-18-00637 -
Annals of the Rheumatic Diseases Jan 2018Therapeutic targets have been defined for axial and peripheral spondyloarthritis (SpA) in 2012, but the evidence for these recommendations was only of indirect nature....
Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force.
Therapeutic targets have been defined for axial and peripheral spondyloarthritis (SpA) in 2012, but the evidence for these recommendations was only of indirect nature. These recommendations were re-evaluated in light of new insights. Based on the results of a systematic literature review and expert opinion, a task force of rheumatologists, dermatologists, patients and a health professional developed an update of the 2012 recommendations. These underwent intensive discussions, on site voting and subsequent anonymous electronic voting on levels of agreement with each item. A set of 5 overarching principles and 11 recommendations were developed and voted on. Some items were present in the previous recommendations, while others were significantly changed or newly formulated. The 2017 task force arrived at a single set of recommendations for axial and peripheral SpA, including psoriatic arthritis (PsA). The most exhaustive discussions related to whether PsA should be assessed using unidimensional composite scores for its different domains or multidimensional scores that comprise multiple domains. This question was not resolved and constitutes an important research agenda. There was broad agreement, now better supported by data than in 2012, that remission/inactive disease and, alternatively, low/minimal disease activity are the principal targets for the treatment of PsA. As instruments to assess the patients on the path to the target, the Ankylosing Spondylitis Disease Activity Score (ASDAS) for axial SpA and the Disease Activity index for PSoriatic Arthritis (DAPSA) and Minimal Disease Activity (MDA) for PsA were recommended, although not supported by all. Shared decision-making between the clinician and the patient was seen as pivotal to the process. The task force defined the treatment target for SpA as remission or low disease activity and developed a large research agenda to further advance the field.
Topics: Advisory Committees; Arthritis, Psoriatic; Axis, Cervical Vertebra; Consensus; Decision Making; Humans; Severity of Illness Index; Spondylitis, Ankylosing
PubMed: 28684559
DOI: 10.1136/annrheumdis-2017-211734 -
Proceedings of the Royal Society of... Sep 1961
Topics: Axis, Cervical Vertebra; Cervical Atlas; Child; Fractures, Bone; Humans; Infant; Joint Dislocations
PubMed: 14476765
DOI: No ID Found -
International Journal of Spine Surgery Dec 2020Injuries of the upper cervical spine are a major cause of morbidity and mortality due to associated spinal cord and head injuries. The injury patterns of the upper...
BACKGROUND
Injuries of the upper cervical spine are a major cause of morbidity and mortality due to associated spinal cord and head injuries. The injury patterns of the upper cervical spine are numerous, and the neurologic sequelae are diverse. The axis (C2) is the most commonly fractured vertebra in the upper cervical spine; its unique anatomy and architecture pose difficulties in the diagnosis and the management of its fractures.
METHODS
All cases of acute spinal injuries at Prince Mohammed Bin Abdulaziz Hospital in Riyadh, Saudi Arabia, were screened for fractures of C2 vertebrae. These patients underwent computerized tomography (CT) imaging of the cervical spine with special attention paid to the cranio-cervical junction. Magnetic resonance imaging (MRI) and angiography of the neck were performed to exclude ligamentous tears and vascular injuries. Unstable fractures were fixed surgically. In the remaining cases, a conservative trial was given. All patients were followed up once every 3 months for a period of 1 year. During follow-up, some patients underwent additional CT imaging of the cervical spine to monitor the healing of fractures.
RESULTS
Out of 230 spinal trauma patients, 43.5% suffered from cervical spine injury. C2 fractures were recorded in 26% cases, and fractures of the C2 vertebral body, including pedicles, laminae, lateral masses, and articular processes, were found in many cases, followed by odontoid fractures (50%). No case of atlanto-axial or atlanto-occipital dislocation was recorded. Road traffic accidents were found to be responsible for 92% of cases. The majority of patients were young males, and 96% of patients had no neurological deficit. Only 15% of the patients required surgery for their unstable fractures. Half of the patients attended outpatient follow -up appointments, all of whom underwent CT scanning of the cervical spine 9 months after the accident or operation.
CONCLUSIONS
The axis (C2) is the most commonly affected vertebra in cervical spine trauma, and odontoid fractures make up 50% of all C2 fractures. C2 fractures rarely cause any neurological deficit or vascular injury, and the majority of affected patients can be managed conservatively; only a small proportion requires surgical intervention. Surgical intervention leads to early and complete healing.
PubMed: 33560250
DOI: 10.14444/7139 -
Global Spine Journal Aug 2015Study Design Narrative review. Objective To elucidate the current concepts in diagnosis and treatment of traumatic spondylolisthesis of the axis.... (Review)
Review
Study Design Narrative review. Objective To elucidate the current concepts in diagnosis and treatment of traumatic spondylolisthesis of the axis. Methods Literature review using PubMed, Google Scholar, and Cochrane databases. Results The traumatic spondylolisthesis of the axis accounts to 5% of all cervical spine injuries and is defined by a bilateral separation of the C2 vertebral body from the neural arch. The precise location of the fracture line may vary widely. For understanding the pathobiomechanics, the involvement of the C2-C3 disk is essential. Although its synonym "hangman's fracture" suggests an extension moment as primary injury mechanism, flexion moments are also proven to cause such fracture morphology. The axial force vector (distraction versus compression) is thought to have a significant effect on the neurologic involvement. The most widely accepted classifications, according to Effendi and modified by Levine, regard the displacement of the C2 vertebral body and possible locking of the facet joints. For decisions on conservative versus surgical therapy, a definitive statement about the stability is essential. The stability is determined by involvement of the C2-C3 disk and longitudinal ligaments, which frequently cannot be assessed by X-ray or computed tomography alone. The assessment of this soft tissue injury therefore requires additional imaging either by magnetic resonance imaging to display the disk and longitudinal ligaments or dynamic fluoroscopy to assess functional behavior of the C2-C3 motion segment. If stability is proven, an immobilization of the cervical spine in a semirigid cervical collar is sufficient. Unstable lesions require surgical stabilization. The standard procedure is an anterior C2-C3 diskectomy and fusion, because of the lower morbidity of the anterior approach and the motion preservation between C1 and C2. In rare cases (irreducible locked facet joints, the necessity of decompression of the vertebral artery, contraindication for anterior approach), a posterior approach is sometimes necessary. Isolated direct screw osteosynthesis is of little value, because it only makes sense in cases with an intact C2-C3 disk, which is usually regarded as stable and therefore might be treated conservatively. Conclusions Overall, the clinical evidence regarding traumatic spondylolisthesis of the axis is very low and mainly based on small case series, expert opinion, laboratory findings, and theoretical considerations.
PubMed: 26225285
DOI: 10.1055/s-0035-1550343