|
| ||
|
|
||
Cervical Spine (cervical + spine)
Terms modified by Cervical Spine Selected AbstractsNeurological complications in two children with Lemierre syndromeDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 8 2010BASHEER PEER MOHAMED Lemierre syndrome is a distinct clinical syndrome comprising oropharyngeal sepsis and fever, internal jugular vein thrombosis and remote septic metastases caused by Fusobacterium species. The mortality rate was historically high and although use of antibiotics led to a dramatic fall in incidence, a resurgence has been seen recently. A 14-year-old male developed Lemierre syndrome after tonsillitis. There was extensive leptomeningitis, especially over the clivus, causing 6th and 12th cranial nerve palsies, a clinical feature termed the ,clival syndrome'. He also developed an epidural abscess in the cervical spine, which was unsafe for surgical drainage. Conservative treatment with an extended course of antibiotics and anticoagulation for jugular vein thrombosis led to a good recovery. A 15-year-old female developed Lemierre syndrome after a persistent sore throat lasting 7 weeks. She had palsy of the 12th cranial nerve from clival osteomyelitis. She was treated with a 6-week course of antibiotics and anticoagulants leading to almost full recovery at 3-month review. Awareness of the potential neurological complications of Lemierre syndrome and prompt management are crucial in reducing morbidity and mortality in this ,forgotten disease'. [source] A single high-velocity low-amplitude manipulation of the cervical spine improves pain and mobility compared to control mobilisationFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 1 2007Article first published online: 14 JUN 2010 [source] Torticollis as a sign of cervico-thoracic epidural haematoma in an infant with severe haemophilia AHAEMOPHILIA, Issue 6 2006G. D. E. CUVELIER Summary., We describe the case of a spinal epidural haematoma in an infant with severe haemophilia A. Initial signs and symptoms were non-specific resulting in delay of the diagnosis and more definitive therapy. The patient eventually developed torticollis, acute flaccid paralysis of the upper extremities, and respiratory distress, prompting radiological examination of the spinal cord. The patient was treated with recombinant FactorVIII and laminectomy. Neurological recovery was complete 3 months following the event. We hypothesize that infants with haemophilia may be at higher risk for this rare complication because of their increasing mobility, frequent falls while cruising furniture, and lack of prophylactic factor replacement. Non-specific signs such as irritability without a focus should alert the clinician to this diagnostic possibility. Torticollis should prompt rapid radiological evaluation of the cervical spine with magnetic resonance imaging to avoid delay in diagnosis. [source] Red Ear Syndrome and Migraine: Report of Eight CasesHEADACHE, Issue 2 2002Vincenzo Raieli MD We describe eight idiopathic cases of red ear syndrome in seven children and one adult. All were migraineurs with a history of paroxysmally painful and red ear, unilateral or alternating, in isolation or associated with migraine attacks. The reported duration of these episodes varied from 30 minutes to 1 hour. Neurologic examination, brain MRI and CT scans, and x-rays of the cervical spine were normal. The close temporal relationship between the "red ear episodes" and migraine attacks suggests an association between the two conditions. [source] Osteological features in pure-bred dogs predisposing to cervical spinal cord compressionJOURNAL OF ANATOMY, Issue 5 2001S. BREIT Relative to body size, midsagittal and interpedicular diameters of the cranial and caudal aspects of cervical vertebral foramina (C3,C7) were found to be significantly (P < 0·05) larger in small breeds than in large breeds and Dachshunds, and also larger in Dachshunds (P < 0·05) than in large breeds. This condition increases the risk for spinal cord compression resulting from relative stenosis of the cervical vertebral foramina, especially in large dogs, and this is also exacerbated by the typical shape of the vertebral foramina (i.e. dorsoventrally flattened cranially and bilaterally narrowed caudally). Within large dogs those breeds highly predisposed to cervical spinal cord compression were Great Danes (the breed with the smallest midsagittal vertebral foramen diameters from cranial C6 to cranial T1) and Doberman Pinschers, because of the most strikingly cranially dorsoventrally narrowed cone-shaped vertebral foramina at C6 and C7. The existence of a small midsagittal diameter in the cranial cervical spine was a high risk factor predisposing to spinal cord compression in small breeds and Dachshunds. Remarkable consistency was noted between the spinal level of the maximum enlargement of the spinal cord which previously was reported to be at C6, and the site of maximum enlargement of the vertebral canal currently stated in Dachshunds and small breeds. In large breeds the maximum enlargement of the vertebral canal tended to be located more caudally at the caudal limit of C7. The average age at which large dogs were most susceptible to noxious factors causing abnormal growth of the pedicles was determined to be 16 wk. [source] The optimal technique of tracheal intubation in an immobilized cervical spineACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009R. Garg No abstract is available for this article. [source] Proton MR spectroscopic imaging of the medulla and cervical spinal cord,JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2007Richard A.E. Edden PhD Abstract Purpose To demonstrate the feasibility of quantitative, one-dimensional proton MR spectroscopic imaging (1D-MRSI) of the upper cervical spine and medulla at 3.0 Tesla. Materials and Methods A method was developed for 1D-point-resolved spectroscopy sequence (PRESS)-MRSI, exciting signal in five voxels extending from the pontomedullary junction to the level of the C3 vertebra, and performed in 10 healthy volunteers to generate control data. Results High-resolution 1D-MRSI data were obtained from all 10 subjects. Upper cervical spine concentrations of choline, creatine, and N-acetyl aspartate were estimated to be 2.8 ± 0.5, 8.8 ± 1.8, and 10.9 ± 2.7 mM, respectively, while in the medulla they were 2.6 ± 0.5, 9.1 ± 1.7, and 10.8 ± 0.9 mM. Conclusion Quantitative 1D-MRSI of the upper cervical spine has been shown to be feasible at 3.0 Tesla. J. Magn. Reson. Imaging 2007;26:1101,1105. © 2007 Wiley-Liss, Inc. [source] Distinctive new form of spondyloepimetaphyseal dysplasia with severe metaphyseal changes similar to Jansen metaphyseal chondrodysplasiaJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 1 2005A Al Kaissi Summary We report a boy with a unique, ,new' form of spondyloepimetaphyseal dysplasia. The conspicuous features of the spinal changes were the delay in ossification of the cervical spine and posterior elements of the thoraco-lumbar spine. The vertebral bodies were of abnormal shape but of normal size and well ossified. The hallmark of epiphyseal changes was markedly delayed ossification (bone age). The severely disturbed metaphyseal ossification was similar to Jansen metaphyseal dysplasia. This pattern of changes has not yet been described in spondyloepimetaphyseal dysplasia. [source] The constrictor dorsalis musculature and basipterygoid articulation in SphenodonJOURNAL OF MORPHOLOGY, Issue 3 2010Peter JohnstonArticle first published online: 5 OCT 200 Abstract The constrictor internus dorsalis (CID) trigeminal muscles in vertebrates lie between the braincase and the palatoquadrate bar, and in reptiles they are believed to function in the relative movements between braincase and maxillary segment known as kinesis. In amniote taxa, the presence of a synovial basipterygoid articulation (BPA) correlates with presence of the CID. Previous descriptions of the CID in the tuatara Sphenodon (Rhynchocephalia) are inconsistent regarding presence, size and direction, particularly of the m. protractor pterygoidei. The Sphenodon skull is reported to be akinetic. The CID was investigated in Sphenodon by examination of sectioned embryonic and hatchling material, and by dissection of fixed specimens. Osteological correlates of CID muscles and morphology of the BPA were examined on disarticulated skulls and on CT scan images. The vectors of action of these muscles in relation to the BPA were projected onto CT images. Mm. levator bulbi and levator pterygoidei are found to be similar to most previous descriptions, but m. protractor pterygoidei was found in a different position, lying entirely medial to the palatoquadrate bar. The insertions of mm. levator pterygoidei and protractor pterygoidei are visible on the disarticulated pterygoid bone. The BPA is mobile only by rotation around the horizontal axis of the joints themselves; metakinesis is not possible in the Sphenodon skull. M. protractor pterygoidei appears to either resist or recognize lateral displacement of the BPA. M. levator ptergyoidei is placed to resist dorsal displacement of the braincase at the BPA, or torsion of the braincase around its longitudinal axis. The BPA appears to be a means to direct compressive stress via the base of the braincase and occipital condyle to the cervical spine in Sphenodon, and probably in its direct ancestors. Metakinesis may never have been a feature of the lepidosaur skull. J. Morphol., 2010. © 2009 Wiley-Liss, Inc. [source] The effects of manual therapy and exercise directed at the cervical spine on pain and pressure pain sensitivity in patients with myofascial temporomandibular disordersJOURNAL OF ORAL REHABILITATION, Issue 9 2009R. LA TOUCHE Summary, No studies have investigated the effects of the treatments directed at the cervical spine in patients with temporomandibular disorders (TMD). Our aim was to investigate the effects of joint mobilization and exercise directed at the cervical spine on pain intensity and pressure pain sensitivity in the muscles of mastication in patients with TMD. Nineteen patients (14 females), aged 19,57 years, with myofascial TMD were included. All patients received a total of 10 treatment session over a 5-week period (twice per week). Treatment included manual therapy techniques and exercise directed at the cervical spine. Outcome measures included bilateral pressure pain threshold (PPT) levels over the masseter and temporalis muscles, active pain-free mouth opening (mm) and pain (Visual Analogue Scale) and were all assessed pre-intervention, 48 h after the last treatment (post-intervention) and at 12-week follow-up period. Mixed-model anovas were used to examine the effects of the intervention on each outcome measure. Within-group effect sizes were calculated in order to assess clinical effect. The 2 × 3 mixed model anova revealed significant effect for time (F = 77·8; P < 0·001) but not for side (F = 0·2; P = 0·7) for changes in PPT over the masseter muscle and over the temporalis muscle (time: F = 66·8; P < 0·001; side: F = 0·07; P = 0·8). Post hoc revealed significant differences between pre-intervention and both post-intervention and follow-up periods (P < 0·001) but not between post-intervention and follow-up period (P = 0·9) for both muscles. Within-group effect sizes were large (d > 1·0) for both follow-up periods in both muscles. The anova found a significant effect for time (F = 78·6; P < 0·001) for changes in pain intensity and active pain-free mouth opening (F = 17·1; P < 0·001). Significant differences were found between pre-intervention and both post-intervention and follow-up periods (P < 0·001) but not between the post-intervention and follow-up period (P > 0·7). Within-group effect sizes were large (d > 0·8) for both post-intervention and follow-up periods. The application of treatment directed at the cervical spine may be beneficial in decreasing pain intensity, increasing PPTs over the masticatory muscles and an increasing pain-free mouth opening in patients with myofascial TMD. [source] Is there a relationship between head posture and craniomandibular pain?JOURNAL OF ORAL REHABILITATION, Issue 11 2002C. M. Visscher SUMMARY, An often-suggested factor in the aetiology of craniomandibular disorders (CMD) is an anteroposition of the head. However, the results of clinical studies to the relationship between CMD and head posture are contradictory. Therefore, the first aim of this study was to determine differences in head posture between well-defined CMD pain patients with or without a painful cervical spine disorder and healthy controls. The second aim was to determine differences in head posture between myogenous and arthrogenous CMD pain patients and controls. Two hundred and fifty persons entered the study. From each person, a standardized oral history was taken and blind physical examinations of the masticatory system and of the neck were performed. The participants were only included into one of the subgroups when the presence or absence of their symptoms was confirmed by the results of the physical examination. Head posture was quantified using lateral photographs and a lateral radiograph of the head and the cervical spine. After correction for age and gender effects, no difference in head posture was found between any of the patient and non-patient groups (P > 0·27). Therefore, this study does not support the suggestion that painful craniomandibular disorders, with or without a painful cervical spine disorder, are related to head posture. [source] Neurophysiological and biomechanical characterization of goat cervical facet joint capsulesJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 4 2005Ying Lu Abstract Cervical facet joints have been implicated as a major source of pain after whiplash injury. We sought to identify facet joint capsule receptors in the cervical spine and quantify their responses to capsular deformation. The response of mechanosensitive afferents in C5,C6 facet joint capsules to craniocaudal stretch (0.5 mm/s) was examined in anaesthetized adult goats. Capsular afferents were characterized into Group III and IV based on their conduction velocity. Two-dimensional strains across the capsules during stretch were obtained by a stereoimaging technique and finite element modeling. 17 (53%) Group III and 14 (56%) Group IV afferents were identified with low strain thresholds of 0.107 ± 0.033 and 0.100 ± 0.046. A subpopulation of low-strain-threshold afferents had discharge rate saturation at the strains of 0.388 ± 0.121 (n = 9, Group III) and 0.341 ± 0.159 (n = 9, Group IV). Two (8%) Group IV units responded only to high strains (0.460 ± 0.170). 15 (47%) Group III and 9 (36%) Group IV units could not be excited even by noxious capsular stretch. Simple linear regressions were conducted with capsular load and principal strain as independent variables and neural response of low-strain-threshold afferents as the dependent variable. Correlation coefficients (R2) were 0.73 ± 0.11 with load, and 0.82 ± 0.12 with principal strain. The stiffness of the C5,C6 capsules was 16.8 ± 11.4 N/mm. Our results indicate that sensory receptors in cervical facet joint capsules are not only capable of signaling a graded physiological mechanical stimulus, but may also elieit pain sensation under excessive deformation. © 2005 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Cervical epidural analgesia via a thoracic approach using nerve-stimulation guidance in adult patients undergoing total shoulder replacement surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2007B. C. H. Tsui Background:, Continuous cervical epidural anesthesia can provide excellent peri- and post-operative analgesia, although several factors prevent its widespread use. Advancing catheters from thoracic levels to the cervical region may circumvent these barriers, provided they are accurately positioned. We hypothesize that guiding catheters from thoracic to cervical regions using low-current epidural stimulation will have a high success rate and enable excellent analgesia in adults undergoing total shoulder arthroplasty. Methods:, After Institutional Review Board approval, adult patients were studied consecutively. A 17-G Tuohy needle was inserted into the thoracic epidural space using a right paramedian approach with loss of resistance. A 20-G styletted epidural catheter, with an attached nerve stimulator, was primed with saline and a 1,10 mA current was applied as it advanced in a cephalad direction towards the cervical spine. Muscle twitch responses were observed and post-operative X-ray confirmed final placement. After a test dose, an infusion (2,8 ml/h) of ropivacaine 2 mg/ml and morphine 0.05 mg/ml (or equivalent) was initiated. Verbal analog pain scale scores were collected over 72 h. Results:, Cervical epidural anesthesia was performed on 10 patients. Average current required to elicit a motor response was 4.8 ± 2.0mA. Post-operative X-ray of catheter positions confirmed all catheter tips reached the desired region (C4,7). The technical success rate for catheter placement was 100% and excellent pain control was achieved. Catheters were positioned two to the left, four to the right and four to the midline. Conclusion:, This epidural technique provided highly effective post-operative analgesia in a patient group that traditionally experiences severe post-operative pain and can benefit from early mobilization. [source] A Severe Case of Complex Regional Pain Syndrome I (Reflex Sympathetic Dystrophy) Managed with Spinal Cord StimulationPAIN PRACTICE, Issue 1 2010Bernard Canlas MD Abstract Complex regional pain syndrome is a condition that usually affects the upper or lower extremities. The cause is not clearly understood. We report a case of a severe form of a rapidly progressive complex regional pain syndrome type I developing after a right shoulder injury managed with spinal cord stimulation (SCS). After failed conservative treatments, a rechargeable SCS system was implanted in the cervical spine. Allodynia and dystonia improved but the patient subsequently developed similar symptoms in lower right extremity followed by her lower left extremity. The patient became wheelchair bound. A second rechargeable SCS with a paddle electrode was implanted for the lower extremity coverage. The patient's allodynia and skin lesions improved significantly. However, over time, her initial symptoms reappeared which included skin breakdown. Due to the need for frequent recharging, the system was removed. During explantation of the surgical paddle lead, it was noted by the neurosurgeon that the contacts of the paddle lead were detached from the lead. After successful implantation of another SCS system, the patient was able to reduce her medications and is now able to ambulate with the use of a left elbow crutch. [source] The Prevalence of Facet Joint-Related Chronic Neck Pain in Postsurgical and Nonpostsurgical Patients: A Comparative EvaluationPAIN PRACTICE, Issue 1 2008Laxmaiah Manchikanti MD ,,Abstract Background: Facet (zygapophysial) joints may be clinically important sources of chronic cervical spinal pain. Previous studies have demonstrated the value and validity of controlled, comparative local anesthetic blocks in the diagnosis of facet joint pain, and reported an overall prevalence of 36% to 67% facet joint involvement in cervical spinal pain. The reports of lumbar facet joint-involvement in postsurgery syndrome have been shown to be highly variable with prevalence ranging from 8% to 32%. To date, however, the prevalence of postsurgical facet joint-related pain in the cervical spine has not been evaluated. In light of this, the present retrospective study was conducted to assess and compare the prevalence of chronic postsurgical facet joint cervical spinal pain to nonsurgical, chronic cervical facet joint pain. Methods: Patients presenting with chronic neck pain were studied. The procedures were performed by a single physician in an interventional pain management ambulatory surgery center. The prevalence of cervical facet joint pain in postsurgical patients was assessed and compared to nonsurgical patients. Results: A total of 251 patients (45 postsurgery vs. 206 nonsurgical patients) with chronic persistent neck pain were evaluated using controlled, comparative local anesthetic blocks in accordance with IASP criteria. The prevalence of the cervical facet joint pain and false-positive rate of single blocks in postsurgical patients were 36% and 50% compared with 39% and 43% in nonsurgical patients. Conclusions: Cervical facet joints are clinically important pain generators in a significant proportion of patients with chronic persistent neck pain after surgical intervention(s). The prevalence of cervical facet joint pain was similar in both postsurgical and nonsurgical patients.,, [source] Perioperative care of a patient with Beare,Stevenson syndromePEDIATRIC ANESTHESIA, Issue 12 2005SARA UPMEYER DO Summary Beare,Stevenson syndrome is a craniofacial syndrome consisting of a specific pattern of craniosynostosis resulting in a cloverleaf skull deformity and hydrocephalus, down-slanting palpebral fissures, proptosis, hypertelorism, strabismus, dysmorphic ears, choanal atresia, cleft palate, cutis gyratum, acanthosis nigricans, and abnormal genitalia. Its primary cause has been identified as a single amino acid substitution in fibroblast growth factor receptor 2. Of primary importance to the anesthesiologist are issues related to airway management resulting from midface hypoplasia, choanal atresia, and airway abnormalities (tracheal stenosis). Additional issues affecting airway management include associated cervical spine and foramen magnum abnormalities. The authors present their experience caring for a patient with Beare,Stevenson syndrome and discuss the anesthesia care of these patients. [source] The craniocervical flexion test: intra-tester reliability in asymptomatic subjectsPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2010Gill James Abstract Background and Purpose.,The deep neck flexor muscles (DNFs) stabilize the cervical spine and cervicogenic pain appears to adversely affect their endurance capacity. They are inaccessible to direct palpation, thereby making assessment difficult. However, the cranio-cervical flexion test (CCFT) provides an indirect method of assessing the endurance capacity of the DNFs. The purpose of the present study was to evaluate the intratester reliability of the CCFT in asymptomatic subjects.,Method.,The clinical protocol of the CCFT was measured on two occasions with 7 days between measurements. Prior to testing, participants were trained and compensation strategies were corrected. Nineteen asymptomatic participants (mean age 24.9 years; range 22,36) were recruited.,Results.,The test had excellent intratester reliability (intraclass correlation coefficient = 0.983; standard error of the mean = 8.94; smallest real difference = 24.7). A Bland and Altman's limits of agreement analysis confirmed the high reliability of the test.,Conclusion.,The CCFT results demonstrated excellent intra-tester reliability in asymptomatic subjects, thus contributing to the normative data regarding the test. Copyright © 2010 John Wiley & Sons, Ltd. [source] Are cervical physical outcome measures influenced by the presence of symptomatology?PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2002Michele Sterling Abstract Background and Purpose Outcome measures must be repeatable over time to judge changes as a result of treatment. It is unknown whether the presence of neck pain can affect measurement reliability over a time period when some change could be expected as a result of an intervention. The present study investigated the reliability of two measures, active cervical range of movement (AROM) and pressure pain thresholds (PPTs), in symptomatic and asymptomatic subjects. Method A repeated-measures study design with one week between testing sessions was used. Nineteen healthy asymptomatic subjects and 19 subjects with chronic neck pain participated in the study. The neck movements measured were: flexion, extension, right and left lateral flexion, and axial rotation. PPTs were measured over six bilateral sites, both local and remote to the cervical spine. Results The between-week intra-class correlation coefficients (ICCs2,1) for AROM ranged from 0.67 to 0.93 (asymptomatic group) and from 0.64 to 0.88 (chronic neck pain group). Standard error of measurement (SEM) was similar in both groups, from 2.66° to 5.59° (asymptomatic group) and from 2.36° to 6.72° (chronic neck pain group). ICCs2,1 for PPTs ranged from 0.70 to 0.91 (asymptomatic group) and from 0.69 to 0.92 (chronic neck pain group). SEM ranged from 11.14 to 87.71 kPa (asymptomatic group) and from 14.25 to 102.95 kPa (chronic neck pain group). Conclusions The findings of moderate to very high between-week reliability of measures of AROM and PPTs in both asymptomatic and chronic neck pain subjects suggest the presence of symptomatology does not adversely affect reliability of these measures. The results support the use of these measures for monitoring change in chronic neck pain conditions. Copyright © 2002 Whurr Publishers Ltd. [source] Vertebral artery atherosclerosis: a risk factor in the use of manipulative therapy?PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2002Jeanette Mitchell BSc (Physiotherapy), MSc Senior Lecturer Abstract Background and Purpose Vertebrobasilar insufficiency, a direct result of compromised blood flow in the vertebrobasilar circulation, may be caused by stretching and/or compression of the vertebral arteries, particularly if superimposed on underlying atherosclerosis of the vessels. This is an important consideration when using manipulative therapy techniques. The aim of the present study was to investigate the incidence of atherosclerosis and to calculate the relative associated decrease in blood flow in the third and fourth parts of the vertebral artery, in a sample of the adult population. Method A laboratory-based experimental investigation was used to study 362 vertebral arteries from embalmed adult cadavers that were routinely processed for light microscopic study. The incidence of each grade of atherosclerosis in the vessels was recorded. Atherosclerosis was classified as grades 0,5, where Grade 0 represented no atherosclerosis and Grade 5 a fully developed plaque occluding more than 75% of the vessel lumen. From mean measurements of 188 of these arteries, the estimated decrease in luminal cross-sectional area and the relative decrease in blood flow in the atherosclerotic vessels were calculated. Results The highest incidence of atherosclerosis found was Grade 3 (third part of the vertebral artery (VA3): 42.0%; fourth part of the vertebral artery (VA4): 35.2%). An estimated decrease in artery luminal cross-sectional area to 6.2% of normal in Grade 5 atherosclerosis was found. Because blood flow is proportional to the fourth power of the vessel radius, relative decreases in blood flow in grades 1,5 atherosclerosis from 100% to 0% (with critical closing pressure in vessels), respectively, are likely to occur. Conclusions These data suggest that, as significant numbers of the sample showed marked (Grade 3+) atherosclerosis, concomitant with decreased blood flow in the vertebral arteries, this population is at risk for developing vertebrobasilar insufficiency. Because other Western populations may be similarly at risk, particular care should be taken when considering the use of rotational manipulative therapy techniques in treatments of the cervical spine. Copyright © 2002 Whurr Publishers Ltd. [source] Recovery from Cruciate Paralysis Due to Axial Subluxation from Metastatic Breast Carcinoma: A Case ReportTHE BREAST JOURNAL, Issue 2 2000FACS, Walter J. Faillace MD Abstract: Cruciate paralysis is an uncommon and potentially life-threatening myelopathy thought to arise from injury to the corticospinal tracts at a high cervical spinal level. The authors report on the case of a woman who developed cruciate paralysis secondary to axial subluxation of the cervical spine due to invasion by metastatic breast carcinoma. Correct bedside diagnosis, prompt spinal alignment via halo traction, and surgical spinal decompression with fusion stabilization reversed the paralysis completely. Postoperative antiestrogen medication, spinal radiation, and chemotherapy promoted local tumor control, allowing the patient longevity and good quality pain control. The prompt diagnosis and treatment of cruciate paralysis could effect a good prognosis in a seemingly terminal patient with metastatic spinal breast carcinoma by resolving life-threatening myelopathy, promoting longevity, and assisting with pain control. [source] Assessment of Intraoperative Safety in Transoral Robotic Surgery,THE LARYNGOSCOPE, Issue 2 2006Neil G. Hockstein MD Abstract Introduction: Robotic technology has been safely integrated into thoracic and abdominopelvic surgery, and the early experience has been very promising with very rare complications related to robotic device failure. Recently, several reports have documented the technical feasibility of transoral robotic surgery (TORS) with the daVinci Surgical System. Proposed pharyngeal and laryngeal applications include radical tonsillectomy, base-of-tongue resection, supraglottic laryngectomy, and phonomicrosurgery. The safety of transoral placement of the robotic endoscope and instruments has not been established. Potential risks specific to the transoral use of the surgical robot include facial skin laceration, tooth injury, mucosal laceration, mandible fracture, cervical spine fracture, and ocular injury. We hypothesize that these particular risks of transoral surgery are similar with robotic assistance compared with conventional transoral surgery. Methods: To test this hypothesis, we attempted to intentionally injure a human cadaver with the daVinci Surgical System by impaling the facial skin and pharyngeal and laryngeal mucosa with the robotic instruments and endoscope. We also attempted to extract or fracture teeth and fracture the cadaver's mandible and cervical spine by applying maximal pressure and torque with the robotic arms. Experiments were documented with still and video photography. Results: Impaling the cadaver's skin and mucosa resulted in only superficial lacerations. Tooth, mandible, and cervical spine fracture could not be achieved. Conclusions: Initial experiments performing TORS on a human cadaver with the daVinci Surgical System demonstrate a safety profile similar to conventional transoral surgery. Additionally, we discuss several strategies to increase patient safety in TORS. [source] Stridor and Dysphagia in Diffuse Idiopathic Skeletal Hyperostosis (DISH),THE LARYNGOSCOPE, Issue 2 2006Dominic M. Castellano MD Abstract As otolaryngologists, we are the first consulted for stridor and dysphagia. One must consider both extrinsic and intrinsic etiologies in the differential diagnosis of these symptoms. We report a series of patients with diffuse idiopathic skeletal hyperostosis (DISH) who presented with stridor or dysphagia. We describe the initial presenting symptoms, physical examination/radiographic findings, and discuss the management options. Traditional teaching is that surgery is rarely indicated for DISH of the cervical spine. Recommendations regarding the role of surgery as well as a review of our surgical experience are discussed. [source] Vocal Fold Paralysis After Anterior Cervical Spine Surgery: Incidence, Mechanism, and Prevention of Injury,THE LARYNGOSCOPE, Issue 9 2000Mark D. Kriskovich MD Abstract Objective Vocal fold paralysis is the most common otolaryngological complication after anterior cervical spine surgery (ACSS). However, the frequency and etiology of this injury are not clearly defined. This study was performed to establish the incidence and mechanism of vocal fold paralysis in ACSS and to determine whether controlling for endotracheal tube/laryngeal wall interactions induced by the cervical retraction system could decrease the rate of paralysis. Study Design Retrospective review and complementary cadaver dissection. Methods Data gathered on 900 consecutive patients undergoing ACSS were reviewed for complications and procedural risk factors. After the first 250 cases an intervention consisting of monitoring of endotracheal tube cuff pressure and release of pressure after retractor placement or repositioning was employed. This allowed the endotracheal tube to re-center within the larynx. In addition, anterior approaches to the cervical spine were performed on fresh, intubated cadavers and studied with videofluoroscopy following retractor placement. Results Thirty cases of vocal fold paralysis consistent with recurrent laryngeal nerve injury were identified with three patients having permanent paralysis. With this technique temporary paralysis rates decreased from 6.4% to 1.69% (P = .0002). The cadaver studies confirmed that the retractor displaced the larynx against the shaft of the endotracheal tube with impingement on the vulnerable intralaryngeal segment of the recurrent laryngeal nerve. Conclusion The study results suggest that the most common cause of vocal fold paralysis after anterior cervical spine surgery is compression of the recurrent laryngeal nerve within the endolarynx. Endotracheal tube cuff pressure monitoring and release after retractor placement may prevent injury to the recurrent laryngeal nerve during anterior cervical spine surgery. [source] Tracheal intubation in patients with rigid collar immobilisation of the cervical spine: a comparison of Airtraq® and LMA CTrachÔ devices,ANAESTHESIA, Issue 12 2009Z. I. Arslan Summary The aim of this study was to evaluate the effectiveness of the Airtraq® and CTrachÔ in lean patients with simulated cervical spine injury after application of a rigid cervical collar. Eighty-six consenting adult patients of ASA physical status 1 or 2, who required elective tracheal intubation were included in this study in a randomised manner. Anaesthesia was induced using 1 ,g.kg,1 fentanyl, 3 mg.kg,1 propofol and 0.6 mg.kg,1 rocuronium, following which a rigid cervical collar was applied. Comparison was then made between tracheal intubation techniques using either the AirTraq or CTrach device. The mean (SD) time to see the glottis was shorter with the Airtraq than the CTrach (11.9 (6.8) vs 37.6 (16.7)s, respectively; p < 0.001). The mean (SD) time taken for tracheal intubation was also shorter with the Airtraq than the CTrach (25.6 (13.5) and 66.3 (29.3)s, respectively; p < 0.001). There was less mucosal damage in the Airtraq group (p = 0.008). Our findings demonstrate that use of the Airtraq device shortened the tracheal intubation time and reduced the mucosal damage when compared with the CTrach in patients who require cervical spine immobilisation. [source] The impact of manual in-line stabilisation on ventilation and visualisation of the glottis with the LMA CTrachÔ: a randomised crossover trial*ANAESTHESIA, Issue 8 2009B. S. W. Ng Summary The LMA CTrachÔ (CTrach) enables ventilation, glottis visualisation and tracheal intubation via a laryngeal mask conduit. The CTrach has been successfully used in patients with cervical spine pathology, but it is unclear if cervical spine immobilisation affects its ease of use. In this randomised crossover trial, the CTrach was used once with and once without manual in-line stabilisation of the cervical spine in every patient. With manual in-line stabilisation, the median [IQR] time to achieve ventilation was 22 [16,32] s, compared with 19 [13,30] s without stabilisation (p = 0.065). With manual in-line stabilisation, the time to achieving a glottic views was 42 [30,63] s compared with 39 [25,53] s without stabilisation (p = 0.019). There was no difference in the success rates of achieving ventilation and glottic views. These results suggest that manual in-line stabilisation does not affect use of the CTrach. [source] Clearing the cervical spine in unconscious adult trauma patients: A survey of practice in specialist centres in the UK,ANAESTHESIA, Issue 11 2004P. S. Jones Summary A postal questionnaire survey of neurosurgery and spinal injury departments in the UK was conducted to determine how they assessed the cervical spine in unconscious, adult trauma patients, and at what point immobilisation was discontinued. Of the 32 units contacted, 27 responded (response rate, 84%). Most centres had no protocols to guide initial imaging or when immobilisation devices should be removed. Most responding centres performed fewer than three plain radiographs, and most did not use computerised tomography routinely. Routine use of magnetic resonance imaging or dynamic flexion,extension fluoroscopy was rare, and few units regarded the latter as safe in unconscious patients. There was no consensus on when immobilisation of the cervical spine should be discontinued. Most centres that terminated immobilisation immediately after imaging did so on the basis of plain radiographs alone. Unconscious adult trauma patients remain at risk of inadequate assessment of potential cervical spine injuries. [source] Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screeningANAESTHESIA, Issue 5 2004C. G. T. Morris Summary Cervical spine injury occurs in 5,10% of cases of blunt polytrauma. A missed or delayed diagnosis of cervical spine injury may be associated with permanent neurological sequelae. However, there is no consensus about the ideal evaluation and management of the potentially injured cervical spine and, despite the publication of numerous clinical guidelines, this issue remains controversial. In addition, many studies are limited in their application to the obtunded or unconscious trauma victim. This review will provide the clinician managing unconscious trauma victims with an assessment of the actual performance of clinical examination and imaging modalities in detecting cervical spine and isolated ligamentous injury, a review of existing guidelines in light of the available evidence, relative risk estimates and a proposed management scheme. [source] NS13P A PROSPECTIVE COMPARISON OF TWO CERVICAL INTERBODY FUSION CAGESANZ JOURNAL OF SURGERY, Issue 2007M. A. Hansen Purpose For some time the surgical management of chronic back pain has utilised interbody lumbar cages. Recently interbody cages for use in the cervical spine have been produced. Cervical cages provide initial stability during the fusion process. There is little literature comparing the performance of interbody cage systems due to their relative recent introduction. Methodology Patients with symptomatic cervical degeneration or traumatic lesions were treated with the dynamic ABC 2 Aesculap anterior cervical plating system and either the B-Braun Samarys or Zimmer cage systems. A single surgeon conducted all surgery. Pre- and post-operative radiological examinations were compared. Changes in disc height at affected and adjacent levels, lordosis and evidence of fusion were recorded. Patient outcome was measured with questionnaires. The modified Oswestry neck pain disability and Copenhagen neck disability scale scores were utilised to allow comparison between patients. Results A total of 43 patients were involved in the study (30 with the Zimmer cage system and 13 with the Samarys cage). Patient follow-up has been up to 12 months. Improvement in disability scores was shown in 90% of patients. Follow up imaging did not demonstrate subsidence of the cage or adjacent instability in either group. There was no statistical difference in complication rate between the two groups. Discussion Initial stability was provided by both interbody cervical spine cage system. Rates of fusion and symptomatic relief compared favourably to fusion involving autogenous bone graft without associated morbidity. Longer follow up is necessary to determine whether there is evidence of adjacent level instability or vertebral end-plate subsidence. [source] Clinical Images: Aggressive gouty arthritis with concurrent involvement of the ankle and cervical spineARTHRITIS & RHEUMATISM, Issue 12 2009Yeon-Ah Lee MD No abstract is available for this article. [source] Unusual origin of the omohyoid muscleCLINICAL ANATOMY, Issue 7 2004R. Shane Tubbs Abstract An unusual origin of the right omohyoid muscle was found during cadaveric dissection. The muscle originated from the transverse process of C6 and inserted into the scapula. No other muscular anomalies of the neck were found. Although many anomalies of the omohyoid muscle have been described, a proximal attachment to the cervical spine is apparently quite rare. Knowledge of the many anomalies that can potentially occur in the cervical region is necessary in routine surgical intervention of this area. We believe this to be the first reported instance of the superior belly of the "omo" hyoid originating from the cervical region as we have described. Clin. Anat. 17:578,582, 2004. © 2004 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||