单节段人工椎间盘置换加短节段颈前路减压植骨融合术治疗多节段颈椎病

【目的】探讨单节段人工椎间盘置换加短节段颈前路减压植骨融合术治疗多节段颈椎病临床疗效。【方法】湖南省人民医院2007年2月至2011年3月收治的10例多节段颈椎病手术病例,均行单节段人工椎间盘置换加短节段颈前路减压植骨融合术,随访时间为12～15个月,平均随访13．5个月,均摄颈椎磁共振及术前、术后及末次随访时的颈椎正侧位及颈椎过伸过屈位X线片,观察植骨融合、内固定及人工椎间盘的情况,以JOA评分评价神经功能改善情况。【结果】所有病例内置物无松动、移位,植骨融合时间在3～6个月,平均3．7个月。置换间隙术前活动度为（11．8°±5．3°）,术后1年时为（11．2°±5．8°）,与术前比较无统计学差异（P〉0．05）。术前JOA评分平均为9．5分,术后6个月时平均为16．3分,平均改善率为90．7％。【结论】单节段人工椎间盘置换加短节段颈前路减压植骨融合术治疗多节段颈椎病近期疗效满意。     

A comparison of neck movement in the soft cervical collar and rigid cervical brace in healthy subjects

Objective

The soft cervical collar has been prescribed for whiplash injury but has been shown to be clinically ineffective. As some authors report superior results for managing whiplash injury with a cervical brace, we were interested in comparing the mechanical effectiveness of the soft collar with a rigid cervical brace. Therefore, the purpose of this study was to measure ranges of motion in subjects without neck pain using a soft cervical collar and a rigid brace compared with no orthosis.

Methods

Fifty healthy subjects (no neck or shoulder pain) aged 22 to 67 years were recruited for this study. Neck movement was measured using a cervical range of motion goniometer. Active flexion, extension, right and left lateral flexion, and right and left rotation were assessed in each subject under 3 conditions: no collar, a soft collar, and a rigid cervical brace.

Results

The soft collar and rigid brace reduced neck movement compared with no brace or collar, but the cervical brace was more effective at reducing motion. The soft collar reduced movement on average by 17.4%; and the cervical brace, by 62.9%. The effect of the orthoses was not affected by age, although older subjects had stiffer necks.

Conclusion

Based on the data of the 50 subjects presented in this study, the soft cervical collar did not adequately immobilize the cervical spine.     

Movement coordination and differential kinematics of the cervical and thoracic spines in people with chronic neck pain

Background

Research on the kinematics and inter-regional coordination of movements between the cervical and thoracic spines in motion adds to our understanding of the performance and interplay of these spinal regions. The purpose of this study was to examine the effects of chronic neck pain on the three-dimensional kinematics and coordination of the cervical and thoracic spines during active movements of the neck.

Methods

Three-dimensional spinal kinematics and movement coordination between the cervical, upper thoracic, and lower thoracic spines were examined by electromagnetic motion sensors in thirty-four individuals with chronic neck pain and thirty-four age- and gender-matched asymptomatic subjects. All subjects performed a set of free active neck movements in three anatomical planes in sitting position and at their own pace. Spinal kinematic variables (angular displacement, velocity, and acceleration) of the three defined regions, and movement coordination between regions were determined and compared between the two groups.

Findings

Subjects with chronic neck pain exhibited significantly decreased cervical angular velocity and acceleration of neck movement. Cross-correlation analysis revealed consistently lower degrees of coordination between the cervical and upper thoracic spines in the neck pain group. The loss of coordination was most apparent in angular velocity and acceleration of the spine.

Interpretation

Assessment of the range of motion of the neck is not sufficient to reveal movement dysfunctions in chronic neck pain subjects. Evaluation of angular velocity and acceleration and movement coordination should be included to help develop clinical intervention strategies to promote restoration of differential kinematics and movement coordination.     

Cervicocephalic kinesthetic sensibility in patients with chronic, nontraumatic cervical spine pain.

OBJECTIVE: To investigate cervicocephalic kinesthetic sensibility (head repositioning accuracy to subjective straight ahead) in patients with chronic, nontraumatic cervical spine pain. DESIGN: A prospective, 2-group, observational design. SETTING: An outpatient chiropractic clinic in the United Kingdom. PARTICIPANTS: Eleven patients (6 men, 5 women; mean age +/- standard deviation, 41.1 +/- 13.3 yr; range, 18-55 yr) with chronic, nontraumatic cervical spine pain (mean duration, 24 +/- 18 mo), with no evidence of cervical radiculopathy and/or myelopathy or any other neurologic disorder. Eleven asymptomatic, unimpaired volunteers (5 men, 6 women; mean age, 39.3 +/- 10.3 yr; range, 28-54 yr) with no history of whiplash or other cervical spine injury or pain served as controls. MAIN OUTCOME MEASURES: Cervicocephalic kinesthetic sensibility was investigated by testing the ability of blindfolded participants to relocate accurately the head on the trunk, to a subjective straight-ahead position, after a near-maximal active movement of the head in the horizontal or vertical plane. The active cervical range of motion and the duration and intensity of neck pain were also recorded. RESULTS: Mann-Whitney U testing indicated that the patient (P) group was no less accurate in head repositioning than the control (C) group for all movement directions except flexion (median global positioning error [95% confidence interval], P = 5.7 degrees [5.03-9.10], C = 4.2 degrees [3.17-5.32]; p <.05). CONCLUSIONS: Nontraumatic neck pain patients show little evidence of impaired cervicocephalic kinesthetic sensibility. These results contrast with studies of chronic cervical pain patients in which the origin was not controlled or involved a cervical whiplash injury.     

Wireless orientation sensors: their suitability to measure head movement for neck pain assessment

The purpose of this study was to verify the performance and suitability of new generation 3D wireless orientations sensors to measure cervical range of movement against a criterion standard instrument, an electromagnetic motion analysis system (Fastrak-Polhemus). The wireless orientation sensor (InertiaCube 3) consists of 9 motion-sensing elements: 3 accelerometers, 3 angular velocity rate transducers and 3 magnetometers. Measurements of cervical range of motion in each primary plane, left-lateral flexion, flexion and left rotation were directly compared from both systems in 10 normal asymptomatic subjects. Results showed very high cross-correlations (.99–.97) and low average root mean square errors (0.7–2.5°). We conclude that orientation sensors are a valid, accurate and suitable device for obtaining cervical joint ranges of motion in the primary plane of movement.     

Relationship between beat to beat coronary artery motion and image quality in prospectively ECG-gated two heart beat 320-detector row coronary CT angiography

The objective was to investigate the influence of the beat-to-beat movement of the coronary arteries on image quality of multi-segment reconstruction (MSR) images. Although MSR improves temporal resolution, image quality would be degraded by beat-to-beat movement of the coronary arteries. In a retrospectively review, 18 patients (mean age, 67.0 years) who underwent coronary CT angiography using a 320-detector row CT were included. The displacement and diameter of coronary artery segments for each of the identified nine landmarks was recorded. The motion ratio was calculated as the division of displacement by diameter. Image quality (IQ) was graded by a four-point scale. The correlation between MSR IQ score and the motion ratio showed stronger negative correlation than that between MSR IQ score and the displacement (r = −0.54 vs. r = −0.36). The average motion ratio for segments in which half-scan reconstruction (HSR) IQ was better than MSR IQ (29.1%, group A) was higher than that for segments in which MSR IQ was better than HSR IQ (16.0%, group C). The motion ratio in group C was lower than 25%. Difference in IQ scores of the HSR images was more frequent in group A than in the remaining segments in which the motion ratio was lower than 25% (16.7% vs. 66.0%; P < 0.0002). The motion ratio could be a better index than the displacement to evaluate the influence of the motion of coronary arteries on image quality. MSR images would be impaired by a motion ratio larger than 25%. Image impairment of one of the HSR images might also impair MSR images.     

Effects of Cervical Spine Manual Therapy on Range of Motion,Head Repositioning,and Balance in Participants With Cervicogenic Dizziness: A Randomized Controlled Trial

Objective

To evaluate and compare the effects of 2 manual therapy interventions on cervical spine range of motion (ROM), head repositioning accuracy, and balance in patients with chronic cervicogenic dizziness.

Design

Randomized controlled trial with 12-week follow-up using blinded outcome assessment.

Setting

University School of Health Sciences.

Participants

Participants (N=86; mean age ± SD, 62.0±12.7y; 50% women) with chronic cervicogenic dizziness.

Interventions

Participants were randomly assigned to 1 of 3 groups: sustained natural apophyseal glides (SNAGs) with self-SNAG exercises, passive joint mobilization (PJM) with ROM exercises, or a placebo. Participants each received 2 to 6 treatments over 6 weeks.

Main Outcome Measures

Cervical ROM, head repositioning accuracy, and balance.

Results

SNAG therapy resulted in improved (P≤.05) cervical spine ROM in all 6 physiological cervical spine movement directions immediately posttreatment and at 12 weeks. Treatment with PJM resulted in improvement in 1 of the 6 cervical movement directions posttreatment and 1 movement direction at 12 weeks. There was a greater improvement (P<.01) after SNAGs than PJM in extension (mean difference, −7.5°; 95% confidence interval [CI], −13° to −2.0°) and right rotation (mean difference, −6.8°; 95% CI, −11.5° to −2.1°) posttreatment. Manual therapy had no effect on balance or head repositioning accuracy.

Conclusions

SNAG treatment improved cervical ROM, and the effects were maintained for 12 weeks after treatment. PJM had very limited impact on cervical ROM. There was no conclusive effect of SNAGs or PJMs on joint repositioning accuracy or balance in people with cervicogenic dizziness.     

Use of Translatoric Mobilization in a Patient with Cervicogenic Dizziness and Motion Restriction: A Case Report

Abstract

Some physical therapists consider the report of dizziness at end-range cervical extension when coupled with side-bending and rotation to the same side (coupled lower cervical rotation in extension) to be a positive sign of vertebral artery compromise. However, degenerative changes and associated movement abnormalities in cervical motion segments may also produce dizziness. The use of mid-line translatoric joint mobilization in the presence of limited active cervical motion that is accompanied by dizziness during cervical extension, rotation, and coupled rotation in extension has not been addressed in the current literature. This case report describes the examination, evaluation, diagnosis, intervention, and outcomes for a 64-year-old woman who presented with limited cervical mobility and the complaint of dizziness during performance of these movements. Examination included a clinical differentiation process to determine the cause of the movement-related dizziness. Examination findings included increased translatoric joint play, tenderness, and reproduction of dizziness at the C4-C6 segments and decreased translatoric joint play at the C1-C4 and C7-T4 motion segments. Intervention included movement re-education and application of translatoric joint mobilization to the hypomobile segments. After 8 visits, there was complete resolution of dizziness during all active cervical movements and improved cervical mobility, as documented with the CROM. This case report demonstrates that clinical symptoms consistent with cervicogenic dizziness and limited cervical mobility may be treated safely and effectively using translatoric joint mobilization techniques. Confirmatory diagnostic ultrasound analysis of the vertebral artery revealed no compromise in flow velocity during the application of these translatoric mobilization techniques.     

Effects of Restrained Cervical Mobility on Involuntary Eye Movements

Abstract

The presumed connection between cervicogenic dizziness, cervical evoked involuntary eye movements and intervertebral joint blocks of the high cervical spine serves as a starting point for the manual therapist in treating patients suffering from neck pain, headache and dizziness. Cervical evoked involuntary eye movements are of diagnostic importance and proprioceptive cervical positional nystagmus is seen as pathognomic for high cervical intervertebral joint blocks. In a period of two years, 157 patients with neck pain, headache and dizziness were referred to and examined in our department. Thirty eight patients were diagnosed as having functional vertebrobasilar insufficiency and 17 patients presented with benign paroxysmal positional vertigo. These 55 patients were excluded from the study. The remaining 102 patients were included in the study. Passive functional tests of cervical motion segments OCC-C1, C1 through C4 according to Van der EI and Dvorák and Dvorák and the test for cervical evoked involuntary eye movements according to Oosterveld were carried out on the last group. In 84 of the 102 patients (82%) the passive functional tests of OCC-C1, C1 through C4 were evaluated as positive for one or more cervical motion segments in one rotational direction; in 18 of the 102 patients (18%) as positive in two rotational directions. In 13 of 102 patients (13%) the cervical evoked involuntary eye movements were evaluated as present for proprioceptive cervical positional nystagmus (mean latency: 4 sec.; frequency: decreasing); in 89 patients (90%) as absent. In 12 of the 13 patients (92.3%) intervertebral joint blocks were present at four levels of the high cervical spine OCC-C1, C1 through C4. There was a significant correlation between the number and level of the blocked cervical motion segments and the presence of the proprioceptive cervical positional nystagmus (Kendall's tau-b = 0.59; p < 0.05). The results of this study are not comparable with those reported in other studies because of differences in the methods and judgement of the cervical evoked involuntary eye movements (ENG versus visual observation using Frenzel's spectacles) and the function of the high cervical spine (no specific information versus manual diagnostic information per cervical motion segment). The findings suggest the need for further research.     

C_4～C_6颈椎有限元模型的建立和多点力学加载方法

背景：人体颈椎运动是多节段之间相互力学及位移关系的变化,建立多节段有限元模型及多点力学加载方法可以为颈椎生物力学研究提供高精度的模型和科学的计算分析方法。目的：建立人体C4~C6颈椎三维有限元模型,并在此基础上提出多点力学加载方法。方法：以正常人C4~C6颈椎CT图像作为数据源,利用Mimics10.0、Ansys11.0有限元分析软件建立三维有限元模型,对其进行多点力学加载测试,模拟生理状态时颈椎的轴向、屈曲、后伸、侧弯、扭转运动,分析各运动状态下C4~C6颈椎关节突和椎间盘的应力和位移改变。结果与结论：建立的C4~C6颈椎有限元模型几何形态逼真,重现了C4~C6颈椎节段解剖结构外形,整体显示直观,表面无过多简化,建成后的三维有限元模型与实体组织具有良好的几何相似性。应力Se、Sz在不同加载工况时,前屈/后伸〉侧弯〉轴向加载。轴向加载载荷明显小,导致应力位移水平低。提示应用正常人体原始资料构建的C4~C6颈椎有限元模型以及多点力学加载分析的方法科学有效,为颈椎的生物力学研究提供了高精度模型和科学的计算分析方法。     

C4～C6颈椎有限元模型的建立和多点力学加载方法

背景:人体颈椎运动是多节段之间相互力学及位移关系的变化,建立多节段有限元模型及多点力学加载方法可以为颈椎生物力学研究提供高精度的模型和科学的计算分析方法。目的:建立人体C4~C6颈椎三维有限元模型,并在此基础上提出多点力学加载方法。方法:以正常人C4~C6颈椎CT图像作为数据源,利用Mimics10.0、Ansys11.0有限元分析软件建立三维有限元模型,对其进行多点力学加载测试,模拟生理状态时颈椎的轴向、屈曲、后伸、侧弯、扭转运动,分析各运动状态下C4~C6颈椎关节突和椎间盘的应力和位移改变。结果与结论:建立的C4~C6颈椎有限元模型几何形态逼真,重现了C4~C6颈椎节段解剖结构外形,整体显示直观,表面无过多简化,建成后的三维有限元模型与实体组织具有良好的几何相似性。应力Se、Sz在不同加载工况时,前屈/后伸>侧弯>轴向加载。轴向加载载荷明显小,导致应力位移水平低。提示应用正常人体原始资料构建的C4~C6颈椎有限元模型以及多点力学加载分析的方法科学有效,为颈椎的生物力学研究提供了高精度模型和科学的计算分析方法。     

Cervical spine movement during airway management: Cinefluoroscopic appraisal in human cadavers

The objective of this study was to determine which airway maneuvers cause the least cervical spine movement. A controlled laboratory investigation was performed in a radiologic suite, using eight human traumatic arrest victims who were studied within 40 minutes of death. All subjects were ventilated by mask and intubated orally, over a lighted oral stylet and flexible laryngoscope, and nasally. Cinefluoroscopic measurement of maximum cervical displacement during each procedure was made with the subjects supine and secured by hard collar, backboard, and tape. The mean maximum cervical spine displacement was found to be 2.93 mm for mask ventilation, 1.51 mm for oral intubation, 1.65 mm for guided oral intubation, and 1.20 mm for nasal intubation. Ventilation by mask caused more cervical spine displacement than the other procedures studied (ANOVA: F = 9.298; P = .00004). It was concluded that mask ventilation moves the cervical spine more than any commonly used method of endotracheal intubation. Physicians should choose the intubation technique with which they have the greatest experience and skill.     

Three-dimensional analysis of active head and cervical spine range of motion: effect of age in healthy male subjects

OBJECTIVE: To assess the effect of age on active head-cervical range of motion in healthy men. DESIGN: Three-dimensional cervical motion ranges and patterns were measured in 70 men. BACKGROUND: The effect of age on cervical range of motion is still discussed. METHOD: Twenty adolescent (mean age 16 year), 30 young adult (mean age 23 year), and 20 mid-aged (mean age 37 year) men performed maximal head and cervical spine flexion-extension, lateral bending, and axial rotation. Movements were detected using a digital optoelectronic instrument. Maximum head-cervical spine and thoracic motions were separated. RESULTS: Flexion and extension were larger in the adolescents and young adults (130-132 degrees ) than in the mid-aged men (117 degrees ). Thoracic movement increased as a function of age. Lateral bending was symmetric, associated with head-cervical rotation and extension, and larger in adolescents (85 degrees ) than in young (77 degrees ) and mid-aged adults (79 degrees ). Axial rotation was symmetric, associated with flexion-extension and lateral bending, and similar in the three age groups (respectively, 160 degrees, 155 degrees, 153 degrees ). CONCLUSIONS: Active head-cervical range of motion reduced between 15 and 45 years of age in men.Relevance The present data can be used as a reference for cervical range in motion in men between 15 and 45 years.     

Clinical and goniometric evaluation of patients with spasmodic torticollis

BACKGROUND: Patients with cervical dystonia have been evaluated prospectively by the Toronto Western Spasmodic Torticollis Rating Scale and by cervical electrogoniometry. METHODS: Nineteen patients with cervical dystonia were studied. The Toronto Scale interobserver reliability was evaluated by two observers. An electrogoniometer was used to quantify cervical range of motion and velocity. The correlation between goniometric measurements and clinical evaluation was calculated. FINDINGS: The interobserver reliability was excellent for the total score (r(s) = 99) and good for the disability and the pain score (r > 0.88). However, global severity scale was shown to have a moderate reliability (r = 0.63) with r ranging from 0.37 to 0.98 for the individual items. The average loss of range of motion for flexion and extension, lateral bending and rotation was 18%, 12% and 21% respectively. For the velocity of movement, the average loss was proportionately greater than for the range of motion. (41%, 43% and 52% respectively). Correlation between the severity scale and range of motion was moderate but significant (r(s) = -0.52 to -0.67). Correlation between the Toronto severity score and the sum of movement velocities was significant for flexion-extension and lateral bending velocity sums (r(s) = -0.51; r(s) = -0.61). The lateral bending and rotation velocities were significantly correlated with pain and total scores (r(s) = -0.51). No significant correlation was observed for the disability score. INTERPRETATION: Three-dimensional electrogoniometry is helpful to quantify the velocity of neck movements and range of motion in patients with cervical dystonia.     

Immediate Effects of a Single Session of Cervical Spine Manipulation on Cervical Movement Patterns in People With Nonspecific Neck Pain: A Randomized Controlled Trial

ObjectiveThe aim of the present study was to assess the immediate effects of a single session of cervical spine manipulation on cervical movement patterns, disability, and the patient's perceived improvement in people with nonspecific neck pain.MethodsA single-blinded, randomized, sham-controlled trial was carried out at a biomechanics institute. Fifty participants diagnosed with acute and chronic nonspecific neck pain (minimum duration of the symptoms being 1 month) were randomized to an experimental group (EG, n = 25) or a sham-control group (CG, n = 25, 23 of whom completed the study). EG received a single cervical spine manipulation session; CG received a single placebo intervention. Both groups received manipulation or sham from the same physiotherapist. Main outcome measures were neck kinematics (ie, range of motion and movement harmony) during cyclic movements, self-reported neck disability, and impression of change assessed before and 5 minutes after treatment.ResultsThe EG showed no significant improvements (P > .05) in any of the studied biomechanical variables, except for right-side bending and left rotation, in which we found a range of motion significant mean difference of 1.97° and 1.95°, respectively (P < .05). The CG showed enhanced harmonic motion during flexion (P < .05). Both groups showed a significant decrease in self-reported neck disability after treatment (P < .05), and EG participants perceived a significantly larger improvement after manipulation compared with the CG (P < .05).ConclusionsA single session of cervical manipulation provided by a physiotherapist had no impact on cervical motion during cyclic movements, but rather induced self-reported perceived improvement in neck disability and impression of change after treatment in people with nonspecific neck pain.     

颈椎前路螺旋状植骨融合术临床观察及护理

目的:总结在颈椎前路螺旋状植骨融合术中使用带螺纹环锯及配套器械的效果.方法:对30例颈椎痰病患者应用螺旋状植骨.结果:全部融合成功,无1例骨块移位.结论:做好术后护理,观察局部切口,保持颈椎稳定,正确卧位翻身,保持纵轴一致,是保证手术成功的重要措施.     

Acute neck pain: cervical spine range of motion and position sense prior to and after joint mobilization

Despite the relatively high prevalence of cervical spine pain, the efficacy of treatment procedures is limited. In the current study, range of motion and proprioception was assessed prior to and after specific cervical spine mobilisation techniques. A 44-year-old male office worker presented with a history of cervical pain of 1 day duration. He had woken with pain, stiffness and a loss of range of motion. Examination findings indicated pain to be at C5–6 on the left side. Measurement of maximal three-dimensional cervical motion was undertaken using a Zebris system. A position matching task tested the individual's ability to actively reposition their head and neck. The treatment undertaken involved grade III down-slope mobilisations on the left side at C5–6 and C6–7 in supine lying. This technique was then progressed by placing the subject in an upright sitting position, and sustained natural apophyseal glides were performed at C6.Immediately following the treatment, the patient reported a considerable decrease in pain, less difficulty in movement and reduced stiffness. Motion analyses showed the most marked percentage improvements in range of motion after treatment were in flexion (55%), extension (35%), left rotation (56%), and left lateral flexion (22%). Ipsilateral lateral flexion with axial rotation was also notably improved following treatment. No change in proprioceptive ability was found following the treatment. The findings showed that the application of standardised specific mobilisation techniques led to substantial improvements in the range of motion and the restitution of normal coupled motion.