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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 -
British Journal of Hospital Medicine... Nov 2022Accurate radiological assessment of the cervical spine is vital in the management of the child presenting with trauma. Compared to an adult's spine, the significant... (Review)
Review
Accurate radiological assessment of the cervical spine is vital in the management of the child presenting with trauma. Compared to an adult's spine, the significant differences in the developmental anatomy (variants or synchondrosis), biomechanics and fracture patterns in the paediatric cervical spine makes assessment difficult, even for experienced radiologists. This review discusses the unique biomechanical factors, developmental anatomy, patterns of injury and imaging strategy in the paediatric population.
Topics: Adult; Humans; Child; Cervical Vertebrae; Radiology; Radiologists; Biomechanical Phenomena; Family
PubMed: 36454066
DOI: 10.12968/hmed.2022.0076 -
Orthopaedics & Traumatology, Surgery &... Feb 2023Malformations of the cervical spine are a challenge in pediatric orthopedic surgery since the treatment options are limited. These congenital anomalies are often... (Review)
Review
Malformations of the cervical spine are a challenge in pediatric orthopedic surgery since the treatment options are limited. These congenital anomalies are often syndrome-related and have multiple repercussions on the function and statics of the cervical spine in all three planes. They are related to developmental abnormalities during the somite segmentation that occurs during the third week of embryonic development. Successful somitogenesis requires proper functioning of a clock regulated by complex signaling pathways that guide the steps needed to form the future spine. There is no specific classification for vertebral malformations at the cervical level. To characterize the progressive nature of a malformation, one must use general classifications. In the specific case of Klippel-Feil syndrome, these malformations can affect several vertebral levels in a continuous or discontinuous manner, but also the vertebral body and vertebral arch in a variable way. Thus, establishing a reliable prognosis in the coronal and sagittal planes is a complex undertaking. While technical mastery of certain osteotomy procedures has led to advances in the surgical treatment of rigid deformities of the cervical spine, the indications are still very rare. Nevertheless, the procedure has become safer and more accurate because of technical aids such as surgical navigation, robotics and 3D printed models or patient-specific guides. Occipitocervical transitional anomalies have embryological specificities that can explain the bony malformations seen at this level. However, most are rare, and the main concern is identifying any instability that justifies surgical stabilization. The presence of a cervical spine anomaly should trigger the search for occipitocervical instability and vice-versa.
Topics: Child; Humans; Klippel-Feil Syndrome; Cervical Vertebrae; Spinal Diseases
PubMed: 36302448
DOI: 10.1016/j.otsr.2022.103459 -
The Pan African Medical Journal 2020Tuberculosis of the cervical spine differs from other vertebral localizations by its extreme rarity, the clinical images are very diversified, the radiological...
Tuberculosis of the cervical spine differs from other vertebral localizations by its extreme rarity, the clinical images are very diversified, the radiological measurements allow a good diagnostic orientation and specifically the MRI which allows a multi-planar study of the various lesions. Only bacteriological evidence can confirm the diagnosis. The treatment is based on a 12-month antituberculosis multidrug therapy and much debate upon the surgical indication. In our case, the patient presented with bilateral cervicobrachialgia with pain on examination at the mobilization of the cervical spine. A standard X-ray, a cervical CT scan, and a cervical MRI were performed, showing a C4 vertebral body compression of a probably infectious origin. The biopsy confirmed the diagnosis of a Cervical Pott's Disease that had been treated with anterior arthrodesis and TB treatment with rehabilitation, the patients' neurological symptoms improved, and he was doing well.
Topics: Adult; Antitubercular Agents; Arthrodesis; Cervical Vertebrae; Drug Therapy, Combination; Humans; Magnetic Resonance Imaging; Male; Radiography; Tomography, X-Ray Computed; Tuberculosis, Spinal
PubMed: 32983325
DOI: 10.11604/pamj.2020.37.7.25226 -
La Radiologia Medica Jan 2023Spinal trauma is an important cause of disability worldwide. Injury to the cervical spine (CS) occurs frequently after major trauma. 5-10% of patients with blunt trauma... (Review)
Review
Spinal trauma is an important cause of disability worldwide. Injury to the cervical spine (CS) occurs frequently after major trauma. 5-10% of patients with blunt trauma have a cervical spine injury. The cervical spine accounts for ~ 50% of all spinal injuries. Determination of CS stability is a common challenge in the acute care setting of patients with trauma. Several issues, indeed, are of particular concern: who needs CS imaging; what imaging should be obtained; when should computed tomography (CT), magnetic resonance imaging (MRI), or flexion/extension (F/E) radiographs be obtained; and how is significant ligamentous injury excluded in the comatose patient. CT and MRI both have roles to play. This article aims to present the different imaging to frame techniques to be used with greater precision in the acute event also for the purpose of planning the next therapeutic process. An overview of the applicability of the same methods in forensic pathology is also provided highlighting possible future biomarker to ease in diagnosis of acute TBI.
Topics: Humans; Spinal Injuries; Tomography, X-Ray Computed; Radiography; Magnetic Resonance Imaging; Wounds, Nonpenetrating; Cervical Vertebrae
PubMed: 36719553
DOI: 10.1007/s11547-022-01578-2 -
Annals of Biomedical Engineering Dec 2022Knowledge of spinal kinematics is essential for the diagnosis and management of spinal diseases. Distinguishing between physiological and pathological motion patterns... (Review)
Review
Knowledge of spinal kinematics is essential for the diagnosis and management of spinal diseases. Distinguishing between physiological and pathological motion patterns can help diagnose these diseases, plan surgical interventions and improve relevant tools and software. During the last decades, numerous studies based on diverse methodologies attempted to elucidate spinal mobility in different planes of motion. The authors aimed to summarize and compare the evidence about cervical spine kinematics under healthy and degenerative conditions. This includes an illustrated description of the spectrum of physiological cervical spine kinematics, followed by a comparable presentation of kinematics of the degenerative cervical spine. Data was obtained through a systematic MEDLINE search including studies on angular/translational segmental motion contribution, range of motion, coupling and center of rotation. As far as the degenerative conditions are concerned, kinematic data regarding disc degeneration and spondylolisthesis were available. Although the majority of the studies identified repeating motion patterns for most motion planes, discrepancies associated with limited sample sizes and different imaging techniques and/or spine configurations, were noted. Among healthy/asymptomatic individuals, flexion extension (FE) and lateral bending (LB) are mainly facilitated by the subaxial cervical spine. C4-C5 and C5-C6 were the major FE contributors in the reported studies, exceeding the motion contribution of sub-adjacent segments. Axial rotation (AR) greatly depends on C1-C2. FE range of motion (ROM) is distributed between the atlantoaxial and subaxial segments, while AR ROM stems mainly from the former and LB ROM from the latter. In coupled motion rotation is quantitatively predominant over translation. Motion migrates caudally from C1-C2 and the center of rotation (COR) translocates anteriorly and superiorly for each successive subaxial segment. In degenerative settings, concurrent or subsequent lesions render the association between diseases and mobility alterations challenging. The affected segments seem to maintain translational and angular motion in early and moderate degeneration. However, the progression of degeneration restrains mobility, which seems to be maintained or compensated by adjacent non-affected segments. While the kinematics of the healthy cervical spine have been addressed by multiple studies, the entire nosological and kinematic spectrum of cervical spine degeneration is partially addressed. Large-scale in vivo studies can complement the existing evidence, cover the gaps and pave the way to technological and clinical breakthroughs.
Topics: Humans; Biomechanical Phenomena; Cervical Vertebrae; Spinal Diseases; Rotation; Range of Motion, Articular
PubMed: 36496482
DOI: 10.1007/s10439-022-03088-8 -
Tomography (Ann Arbor, Mich.) Oct 2021Pedicle screws provide excellent fixation for a wide range of indications. However, their adoption in the cervical spine has been slower than in the thoracic and lumbar... (Review)
Review
Pedicle screws provide excellent fixation for a wide range of indications. However, their adoption in the cervical spine has been slower than in the thoracic and lumbar spine, which is largely due to the smaller pedicle sizes and the proximity to the neurovascular structures in the neck. In recent years, technology has been developed to improve the accuracy and thereby the safety of cervical pedicle screw placement over traditional fluoroscopic techniques, including intraoperative 3D navigation, computer-assisted Systems and 3D template moulds. We have performed a systematic review into the accuracy rates of the various systems. The PubMed and Cochrane Library databases were searched for eligible papers; 9 valid papers involving 1427 screws were found. fluoroscopic methods achieved an 80.6% accuracy and navigation methods produced 91.4% and 96.7% accuracy for templates. Navigation methods are significantly more accurate than fluoroscopy, they reduce radiation exposure to the surgical team, and improvements in technology are speeding up operating times. Significantly superior results for templates over fluoroscopy and navigation are complemented by reduced radiation exposure to patient and surgeon; however, the technology requires a more invasive approach, prolonged pre-operative planning and the development of an infrastructure to allow for their rapid production and delivery. We affirm the superiority of navigation over other methods for providing the most accurate and the safest cervical pedicle screw instrumentation, as it is more accurate than fluoroscopy and lacks the limitations of templates.
Topics: Cervical Vertebrae; Fluoroscopy; Humans; Lumbar Vertebrae; Pedicle Screws; Surgery, Computer-Assisted
PubMed: 34698301
DOI: 10.3390/tomography7040052 -
BMC Musculoskeletal Disorders Mar 2017Upright head and neck position has been frequently applied as baseline for diagnosis of neck problems. However, the variance of the position after cervical motions has...
BACKGROUND
Upright head and neck position has been frequently applied as baseline for diagnosis of neck problems. However, the variance of the position after cervical motions has never been demonstrated. Thus, it is unclear if the baseline position varies evenly across the cervical joints. The purpose was to assess reposition errors of upright cervical spine.
METHODS
Cervical reposition errors were measured in twenty healthy subjects (6 females) using video-fluoroscopy. Two flexion movements were performed with a 20 s interval, the same was repeated for extension, with an interval of 5 min between flexion and extension movements. Cervical joint positions were assessed with anatomical landmarks and external markers in a Matlab program. Reposition errors were extracted in degrees (initial position minus reposition) as constant errors (CEs) and absolute errors (AEs).
RESULTS
Twelve of twenty-eight CEs (7 joints times 4 repositions) exceeded the minimal detectable change (MDC), while all AEs exceeded the MDC. Averaged AEs across the cervical joints were larger after 5 min' intervals compared to 20 s intervals (p < 0.05).
CONCLUSIONS
This is the first study to demonstrate single joint reposition errors of the cervical spine. The cervical spine returns to the upright positions with a 2° average absolute difference after cervical flexion and extension movements in healthy adults.
Topics: Adult; Cervical Vertebrae; Female; Fluoroscopy; Healthy Volunteers; Humans; Joints; Male; Movement; Neck; Patient Positioning; Posture; Range of Motion, Articular; Time Factors; Young Adult
PubMed: 28288610
DOI: 10.1186/s12891-017-1454-z -
Radiologia Apr 2016Imaging techniques provide excellent anatomical images of the cervical spine. The choice to use one technique or another will depend on the clinical scenario and on the...
Imaging techniques provide excellent anatomical images of the cervical spine. The choice to use one technique or another will depend on the clinical scenario and on the treatment options. Plain-film X-rays continue to be fundamental, because they make it possible to evaluate the alignment and bone changes; they are also useful for follow-up after treatment. The better contrast resolution provided by magnetic resonance imaging makes it possible to evaluate the soft tissues, including the intervertebral discs, ligaments, bone marrow, and spinal cord. The role of computed tomography in the study of degenerative disease has changed in recent years owing to its great spatial resolution and its capacity to depict osseous components. In this article, we will review the anatomy and biomechanical characteristics of the cervical spine, and then we provide a more detailed discussion of the degenerative diseases that can affect the cervical spine and their clinical management.
Topics: Cervical Vertebrae; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Spinal Diseases; Tomography, X-Ray Computed
PubMed: 26878769
DOI: 10.1016/j.rx.2015.11.009 -
Journal of Orthopaedic Surgery (Hong... Sep 2021The treatment of adult cervical deformity continues to be complex with high complication rates. However there are many new advancements and overall patients do well...
The treatment of adult cervical deformity continues to be complex with high complication rates. However there are many new advancements and overall patients do well following surgical correction. To date there are now many types of cervical deformity that have been classified and there exists a variety of surgical options. These recent advances have been developed in the last few years and the field continues to grow at a rapid rate. Thus, the goal of this article is to provide an updated review of cervical sagittal balance including; cervical alignment parameters, deformity classification, clinical evaluation, with both conservative and surgical treatment options.
Topics: Adult; Cervical Vertebrae; Humans; Kyphosis; Neck; Radiography
PubMed: 34711100
DOI: 10.1177/23094990211024454