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Search Results for : Cervical Spine Instability
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Immobilization and splinting in mountain rescue. Official Recommendations of the International Commission for Mountain Emergency Medicine, ICAR MEDCOM, Intended for Mountain Rescue First Responders, Physicians, and Rescue Organizations.
Author(s): Ellerton, J; Tomazin, I; Brugger, H; Paal, P
Journal: High Alt Med Biol 2010 Mar 17; Vol. 10, Issue 4; Page(s) 337-42
[Medline ID - 20039814]

Immobilization and splinting of fractures are essential to reduce morbidity and mortality in mountain rescue. Therefore, members of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) debated the results of a literature review carried out by the authors. Focusing on common immobilization and splinting techniques relevant to mountain rescue, a consensus document was formulated. Pain relief of appropriate speed of onset and strength should be available on scene. Spinal immobilization is recommended for all casualties that have sustained head or spine injury. The preferred method is a vacuum mattress with an appropriately sized rigid cervical collar. In such casualties, only those in an unsafe environment or with time-critical injuries should be evacuated before spinal immobilization is performed. In some casualties, the cervical spine may be cleared and a cervical collar may be omitted. In the presence of hemodynamic instability and where there is a suspicion of a fractured pelvis, an external compression splint should be applied. Splinting of a femoral shaft fracture is important to limit pain and life-threatening blood loss. If time allows, extremity fractures should be adequately splinted and, if the practitioner is skilled, a displaced fracture or joint dislocation should be reduced on scene with the use of appropriate analgesia.

An unusual occurrence of chondromyxoid fibroma with secondary aneurysmal bone cyst in the cervical spine.
Author(s): Subach, BR; Copay, AG; Martin, MM; Schuler, TC; Romero-Gutierrez, M
Journal: Spine J 2010 May 4; Vol. 10, Issue 2; Page(s) e5-9
[Medline ID - 20036621]

BACKGROUND CONTEXT: Chondromyxoid fibroma (CMF) and aneurysmal bone cysts (ABCs) are rare bone tumors and even rarer in the spine. To date, no report has been made of CMF with secondary ABC in the cervical spine. PURPOSE: The purpose of this study was to describe the diagnosis and surgical treatment of a case of CMF with secondary ABC of C6, a rare occurrence in an uncommon location. STUDY DESIGN: The study design is a case report. METHODS: A 27-year-old woman presented with numbness with paresthesias of the right upper extremity. Diagnostic imaging revealed diffuse enlargement of the right C6 lamina extending into the pedicle and medial facet joint. Surgical treatment consisted of complete C6 laminectomy, total resection of the extradural cervical mass, posterior lateral fusion at C5-C7, and posterior segmental instrumentation from C5 to C7. Histopathology was consistent with CMF with secondary ABC. RESULTS: Laminectomy and instrumented segmental fusion provided an excellent clinical outcome. The instrumented fusion maintained the sagittal balance of the spine and stabilized across a complete facetectomy. The excision will likely avoid recurrence of the lesion. CONCLUSIONS: Treatment of CMF and ABC is challenging in the spine because of the proximity to neural structures. Aggressive surgical treatment makes recurrence less likely but creates the risk of spinal instability. Adequate surgical treatment needs to provide spinal stability.

Intrathecal administration of recombinant human N-acetylgalactosamine 4-sulfatase to a MPS VI patient with pachymeningitis cervicalis.
Author(s): Mu; ñoz-Rojas, MV; Horovitz, DD; Jardim, LB; Raymundo, M; Llerena, JC; de Magalh; ães, Tde S; Vieira, TA; Costa, R; Kakkis, E; Giugliani, R
Journal: Mol Genet Metab 2010 Jul 14; Vol. 99, Issue 4; Page(s) 346-50
[Medline ID - 20036175]

In mucopolysaccharidosis VI, or Maroteaux-Lamy syndrome, deficiency of N-acetylgalactosamine 4-sulfatase leads to storage of glycosaminoglycans (GAGs) and MPS VI patients often develop spinal cord compression during the course of the disease due to GAG storage within the cervical meninges, requiring neurosurgical intervention, as intravenous (IV) enzyme replacement therapy (ERT) is not expected to cross the blood-brain barrier. We report the use of intrathecal (IT) recombinant human N-acetylgalactosamine 4-sulfatase (arylsulfatase B, or ASB) in a MPS VI child with spinal cord compression whose parents initially refused the surgical treatment. Assessments were performed at baseline, with clinical, neurological and biochemical evaluations, urodynamic studies and MRI of the CNS. Changes on these parameters were evaluated after IT infusions of ASB administered monthly via lumbar puncture (LP) in a IV ERT naive patient. To our knowledge, this was the first MPS VI patient who received IT ERT. Despite significant urodynamic improvement and some neurological amelioration, the patient developed worsening of walking capacity. After IV ERT was started, the patient presented with a generalized hypotonia and a life-saving surgical fixation of the neck was then performed. The results observed on this MPS VI patient suggest that instability of the cervical vertebrae could be unmasked by IV ERT as joint storage is reduced, and the decrease in neck stiffness and stability could confound the expected improvement of SCC manifestations following IT ERT. The study of further patients, if possible in a clinical trial setting, is needed to evaluate the potential of a non-surgical IT ERT treatment of SCC for MPS VI.

The relationship between chronic type III acromioclavicular joint dislocation and cervical spine pain.
Author(s): Gumina, S; Carbone, S; Arceri, V; Rita, A; Vestri, AR; Postacchini, F
Journal: BMC Musculoskelet Disord 2010 Mar 24; Vol. 10; Page(s) 157
[Medline ID - 20015356]

BACKGROUND: This study was aimed at evaluating whether or not patients with chronic type III acromioclavicular dislocation develop cervical spine pain and degenerative changes more frequently than normal subjects. METHODS: The cervical spine of 34 patients with chronic type III AC dislocation was radiographically evaluated. Osteophytosis presence was registered and the narrowing of the intervertebral disc and cervical lordosis were evaluated. Subjective cervical symptoms were investigated using the Northwick Park Neck Pain Questionnaire (NPQ). One-hundred healthy volunteers were recruited as a control group. RESULTS: The rate and distribution of osteophytosis and narrowed intervertebral disc were similar in both of the groups. Patients with chronic AC dislocation had a lower value of cervical lordosis. NPQ score was 17.3% in patients with AC separation (100% = the worst result) and 2.2% in the control group (p < 0.05). An inverse significant nonparametric correlation was found between the NPQ value and the lordosis degree in the AC dislocation group (p = 0.001) wheras results were not correlated (p = 0.27) in the control group. CONCLUSIONS: Our study shows that chronic type III AC dislocation does not interfere with osteophytes formation or intervertebral disc narrowing, but that it may predispose cervical hypolordosis. The higher average NPQ values were observed in patients with chronic AC dislocation, especially in those that developed cervical hypolordosis.

Cervical spine motion generated with manual versus jackson table turning methods in a cadaveric c1-c2 global instability model.
Author(s): Dipaola, CP; Conrad, BP; Horodyski, M; Dipaola, MJ; Sawers, A; Rechtine, GR
Journal: Spine (Phila Pa 1976) 2010 Feb 20; Vol. 34, Issue 26; Page(s) 2912-8
[Medline ID - 20010399]

STUDY DESIGN.: Cadaveric biomechanical study. OBJECTIVE.: To quantify spinal motion created by transfer methods from supine to prone position in a cadaveric C1-C2 global instability model. SUMMARY OF BACKGROUND DATA.: Patients who have sustained a spinal cord injury remain at high risk for further secondary injury until their spine is adequately stabilized. To date, no study has evaluated the effect of patient transfer methods from supine to prone position in the operating room, on atlantoaxial cervical spine motion. METHODS.: A global instability was surgically created at the C1-C2 level in 4 fresh cadavers. Two transfer protocols were tested on each cadaver. The log-roll technique entailed performing a standard 180 degrees log-roll rotation of the supine patient from a stretcher to the prone position onto the operating room Jackson table (OSI, Union City, CA). The "Jackson technique" involved sliding the supine patient to the Jackson table, securing them to the table, and then rotating them into a prone position. An electromagnetic tracking device registered motion between the C1 and C2 vertebral segments. Three different head holding devices (Mayfield, Prone view, and blue foam pillow) were also compared for their ability to restrict C1-C2 motion. Six motion parameters were tracked. Repeated measures statistical analysis was performed to evaluate angular and translational motion. RESULTS.: For 6 of 6 measures of angulation and translation, manual log-roll prone positioning generated significantly more C1-C2 motion than the Jackson table turning technique. Out of 6 motion parameters, 5 were statistically significant (P < 0.001-0.005). There was minimal difference in C1-C2 motion generated when comparing all 3 head holding devices. CONCLUSION.: The data demonstrate that manual log-roll technique generated significantly more C1-C2 motion compared to the Jackson table technique. Choice of headrest has a minimal effect on the amount of motion generated during patient transfer, except that the Mayfield device demonstrates a slight trend toward increased C1-C2 motion.

Endoscopic, endonasal decompression of spinal stenosis with myelopathy secondary to cranio-vertebral tuberculosis: two cases.
Author(s): Puraviappan, P; Tang, IP; Yong, DJ; Prepageran, N; Carrau, RL; Kassam, AB
Journal: J Laryngol Otol 2009 Dec 17; Vol. 124, Issue 7; Page(s) 816-9
[Medline ID - 20003599]

BACKGROUND: Tuberculosis can cause extensive osseo-ligamentous destruction at the cranio-vertebral junction, leading to atlanto-axial instability and compression of vital cervico-medullary centres. This may manifest as quadriparesis, bulbar dysfunction and respiratory insufficiency. AIM: We report two patients presenting with spinal stenosis and cord compression secondary to cranio-vertebral tuberculosis, who were successfully decompressed via an endoscopic, endonasal approach. STUDY DESIGN: Two case reports. METHODS AND RESULTS: Both patients were successfully decompressed via an endoscopic, endonasal approach which provided access to the cranio-vertebral junction and upper cervical spine. CONCLUSION: An endoscopic, endonasal approach is feasible for the surgical management of cranio-vertebral junction stenosis; such an approach minimises surgical trauma to critical structures, reducing post-operative morbidity and the duration of hospital stay.

Misleading appearance of atlantoaxial diastasis in Down syndrome: os odontoideum.
Author(s): Hericord, O; Bosschaert, P; Menten, R; Dembour, G
Journal: JBR-BTR 2010 Jan 7; Vol. 92, Issue 5; Page(s) 261
[Medline ID - 19999333]

ABSTRACT NOT AVAILABLE

[Factors to affect severity of hyperextension injury of cervical spinal cord]
Author(s): Liu, P; Liao, W
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2010 Apr 7; Vol. 23, Issue 11; Page(s) 1338-42
[Medline ID - 19968176]

OBJECTIVE: To explore the factors to affect severity of hyperextension injury of the cervical spinal cord (HEICSC). METHODS: Forty-five patients with HEICSC, 35 males and 10 females, aged 27-67 years old (mean 48.2 years old), were retrospectively analyzed. The disease course was 30 minutes to 16 days. According to modified Frankel grading, there were 6 cases of grade A, 8 cases of grade B, 16 cases of grade C and 15 cases of grade D. Spinal cord injuries (SCI) segments were determined according to SCI plane and high signal change (HSC) in spinal cord on MR images. The whole or large part of HSC segments were supposed to be main injured spinal cord segments (MISCSs) and the staccato or patchy HSC ones were supposed to be common injured spinal cord segments (CISCSs). When the external force acting on head or face suffered was larger, the force produced during high-speed movement or forehead and/or face had severe contused and/or) lacerated wound, the force was defined severe traumatic strength, whereas the reverse was true for slight traumatic strength. According to signal magnitude of the cervical discs on T2-weighted MR images, degeneration of cervical discs and cervical vertebras were classified into 5 grades: grade 0-4. Cervical spinal stenosis were graded to 5 grades according to the width of anterior or posterior cerebrospinal fluid layer to spinal cord on T2-weighted MR images and compressed degree of spinal cord on T1-weighted MR images. The influence of traumatic strength, cervical spinal degeneration or cervical spinal stenosis on SCI were explored. RESULTS: Among the 45 cases, 12 cases were caused by slight traumatic strength, 33 cases were caused by severe one. The cervical spinal cord was injuried more slightly and the patients were older in the slight traumatic strength cases than in the severe ones (P < 0.05). The number of MISCSs were 45 in 40 cases and the 25 segments were located at C3, 4 level. The number of CISCSs were 39 in 21 cases. All the cervical vertebrates of the 45 patients had degenerated. The most were in grade 3 in 22 patients and the severest degenerative segments were mostly located in C5,6 discs in 35 ones. The number of the MISCSs in different degenerative grades of discs was 0 in grade 0, 9 in grade 1, 20 in grade 2, 14 in grade 3, and 2 in grade 4. The ratios of the segment number of injuried spinal cord to the segment number of spinal stenosis in every grade of stenosis were 1/62 in grade 0, 2/11 in grade 1, 27/52 in grade 2, 33/33 in grade 3, 21/22 in grade 4. CONCLUSION: Three main factors including the magnitude of traumatic strength, the degree of instability of cervical vertebrae and the degree of cervical stenosis contribute to development and progress of HEICSC.

Biomechanical assessment of bilateral C1 laminar hook and C1-2 transarticular screws and bone graft for atlantoaxial instability.
Author(s): Guo, X; Ni, B; Zhao, W; Wang, M; Zhou, F; Li, S; Ren, Z
Journal: J Spinal Disord Tech 2010 Mar 6; Vol. 22, Issue 8; Page(s) 578-85
[Medline ID - 19956032]

STUDYDESIGN: In vitro biomechanical test was conducted to compare the stability of 5 different atlantoaxial posterior fusion techniques. OBJECTIVE: To evaluate the biomechanical stability of an atlas laminar hook combined with transarticular (TA) screws relative to 4 different conventional fusion techniques. SUMMARY OF BACKGROUND DATA: The atlantoaxial instability caused by fractures, rheumatoid arthritis, congenital deformity, or traumatic lesions of the transverse ligament often result in acute or chronic spinal cord compression, a possible threat to a patient's life. Posterior atlantoaxial fixations are used to reconstruct the stability of atlantoaxial articulation. Conventional posterior atlantoaxial fixations are associated with high rates of pseudoarthrosis and carry the potential risk of neurologic complication. TA screw fixation can provide an excellent biomechanical stability. As a modified 3-point fixation technique, the bilateral C1-2 TA screws have been combined with C1 laminar hook and bone grafts. This modified technique had carried good clinical outcomes. METHODS: Eight human specimens (C0-C4) were loaded nondestructively with pure moments and the range of motion at the level of C1-C2 was measured. Eight specimens were implanted with each of the following techniques, respectively: Gallie fixation, C1-2 TA screw fixation combined with Gallie fixation, C1-2 TA screw fixation, C1 laminar hook combined with C1-2 TA screw fixation plus bone grafts, and the C1 lateral mass screws in the atlas combined with C2 isthmic screws in axis. RESULTS: Although the C1-2 TA screws best restricted lateral bending and axial rotation, the modified 3-point fixation technique additionally restricted flexion-extension and provided the excellent stability. Differences in axial rotation and lateral bending (with + or - 1.5 Nm load) were observed when the 3-point fixation techniques (TA + Gallie and TA + hook) were compared with atlas lateral mass screws in the atlas combined with isthmic screws in axis. CONCLUSIONS: The modified C1 laminar hook combined with C1-2 TA screws and bone graft fixation provided the best biomechanical stability. The C1 lateral mass screws in the atlas combined with isthmic screws in axis fixation is a sound alternative when the C1-2 TA screw fixation is not feasible.

Load sharing and stabilization effects of anterior cervical devices.
Author(s): Cheng, BC; Burns, P; Pirris, S; Welch, WC
Journal: J Spinal Disord Tech 2010 Mar 6; Vol. 22, Issue 8; Page(s) 571-7
[Medline ID - 19956031]

STUDY DESIGN: Biomechanical human cadaveric cervical flexibility testing with direct load-sharing measurement. OBJECTIVE: To determine if the flexibility and load-sharing characteristics of a functional spinal unit were affected by anterior treatments for cervical pathologies. SUMMARY OF BACKGROUND DATA: With advancements in polymers, anterior cervical plates have used thermoplastics including recent designs from biodegradable polylactide acids. However, the difference in material properties between metal and polymer can be significant. METHODS: Thirteen cervical spine specimens were subjected to 5 treatments at C4-C5. Each treatment for each specimen was subjected to multidirectional flexibility testing. The third cycle was used for treatment comparisons. RESULTS: With the integrated load cell spacer, the mean range of motion for the functional spinal unit measured on average 104% + or - 40% normalized to the intact control. The mean biodegradable and titanium plate were 55% + or - 31% and 40% + or - 36%, respectively. Both plates exhibited statistically lower mean range of motions (P = 0.001 and P < 0.001) compared with spacers. The load transmitted through the interbody space was 54% + or - 20%, 43% + or - 20%, and 33% + or - 15% on average for the spacer, biodegradable, and titanium plate constructs, respectively. No statistically significant difference was detected between the biodegradable plate and spacer (P = 0.214). CONCLUSIONS: From this research, a biodegradable plate offers immediate postoperative stability significantly different than spacer alone treatments but with graft load sharing that is statistically no different. Thus, the intrinsic lower native material modulus of elasticity of biodegradable polymers has biomechanical implications. However, clinical evidence, particularly for long-term outcomes, will be required in understanding the efficacy of biodegradable polymers.
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