The thermoplastic Minerva body jacket: a clinical comparison with other cervical spine splinting techniques.

A retrospective analysis of the efficacy of a variety of external stabilization techniques used in 155 cases of unstable cervical spine injuries is presented. The movement at each intervertebral level was evaluated during thermoplastic Minerva body jacket stabilization in 18 additional patients. Many currently available approaches to external stabilization of the cervical spine were, thus, assessed. Thermoplastic Minerva body jacket stabilization offered superior segmental immobilization compared with published data for the halo. It is concluded that some unstable injuries to the high cervical spine might best be treated with a halo device, whereas mid to low cervical injuries and the remaining upper cervical spine injuries appear to be optimally treated with a Minerva jacket. Lesser injuries may be treated with a variety of available orthoses. The thermoplastic Minerva body jacket offers a superior limitation of intervertebral movement compared with other commonly used braces, including the halo jacket, for most cervical spine injuries. The technique of application of the thermoplastic Minerva body jacket is reviewed.     

单开门颈椎管扩大椎板成形术对颈椎运动的影响

目的：研究单开门颈椎管扩大椎板成形术对颈椎运动功能的影响及相关因素。方法：对52例因脊髓型颈椎病接受单开门颈椎管扩大椎板成形术患者进行回顾性研究，平均随访37．5个月，在颈椎过屈、过伸侧位X线片上比较手术前后颈椎总的运动范围(总活动度)、各椎体间活动度。结果：术后3年颈椎总活动度、总屈曲及总仰伸角度均减小(P≤0．001)，与术前相比平均下降15％，其中42例伴有颈部僵硬、疼痛等症状。颈椎总活动度的改变与神经功能的改善无相关性。各椎体间的屈伸运动范围从C2至C6均明显减小，而C6／7却稍有增加；椎体间滑移在C3／4、C4／5两个节段明显减少(P≤0．05)。结论：单开门颈椎管扩大椎板成形术可以使颈椎总活动度和各椎体间活动度均减少并伴有颈部僵硬和疼痛。术后短期围领制动并早期主动伸、屈颈部的锻炼可能有助于减少颈部僵硬和疼痛的发生。     

A halo jacket for stabilisation of the paediatric cervical spine

Summary Stabilisation of the paediatric cervical spine may be necessary in the management of trauma, infection and deformity. Surgery is technically difficult due to the immaturity of the bony elements and therefore external support is generally preferred. Our experience of halter traction and Minerva casts is that they either fail to achieve stability or are poorly tolerated. Halo pins are associated with significant pin tract complications in children. The technique for application of a plaster halo jacket is presented, together with the results of its use in eight children. Attention is drawn to the ease of application, tolerance by the patients and absence of significant complications.     

Effect of cervical spine motion on the neuroforaminal dimensions of human cervical spine.

A nerve root impingement within a stenotic neuroforamen is a common sequela of cervical degenerative arthritis and herniated nucleus pulposus. Understanding of the effects of cervical position on foraminal size is important in the assessment of pathology and injury, for selection of a provocative maneuver to elicit symptoms and in selecting a position of immobilization for the management of nerve root impingement syndrome. This biomechanical study of human cadaver cervical spines reports the measured variations in the sizes of neuroforamina as a function of cervical positioning. Five fresh frozen adult human cadaver cervical spines (C2-T1) were tested with combinations of flexion-extension and rotational position. Ten pounds of axial load was applied to simulate a normal loading of a cervical spine. The foramina of C5, C6, and C7 were directly measured using a set of finely graded circular probes. Compared to the foraminal diameter at the neutral position, there were statistically significant reductions in the foramen diameter of 10% and 13%, at 20 degrees and 30 degrees of extension respectively (P < 0.01). Conversely, in flexion, there were statistically significant increase of 8% and 10% at 20 degrees and 30 degrees of flexion respectively (P < 0.01). Though there was a reduction in the foraminal size with ipsilateral 20 degrees rotation, and an increase with contralateral 20 degrees rotation, these changes were not significantly different from the mean of the control. Combinations of flexion or extension position with axial rotation did not significantly change the foraminal size compared to the respective sagittal position with no axial rotation.(ABSTRACT TRUNCATED AT 250 WORDS)     

颈椎后路单开门手术对颈椎三维运动及刚性的影响

目的研究颈椎后路单开门椎管扩大成形术对颈椎三维运动及刚性的影响。方法脊髓型颈椎病单开门手术后病例 55例,平均随访 35.9个月,对手术前后的颈部轴性症状、神经功能变化 (JOA评分 )和颈椎动态侧位片进行比较。运用 ZMS－ 1型人体颈椎三维运动及刚度测试仪对颈椎单开门术后组 (12例 )和术前对照组 (10例 )进行活体力学测试。测试内容包括 :(1)颈椎主动及被动运动范围; (2)载荷－位移关系和颈椎刚度; (3)颈椎伸、屈肌群主动等长收缩力矩。结果术后 JOA评分平均改善率 66.2％,优良率 78.2％。术后出现明显或严重颈部轴性症状的病例较术前增加 (P< 0.01);术后颈部轴性症状明显者颈椎弧度较小 (P< 0.01);颈部轴性症状分级与 JOA评分改善率两者差异无显著性意义 (P >0.05)。手术后颈椎区域主动及被动伸屈、旋转和侧屈运动范围减小 (P< 0.05),主要影响中下颈椎。颈椎载荷－位移关系可拟合为指数方程 T=b0e。在颈椎各向运动中侧屈刚度最大,其次为后伸与前屈,旋转刚度最小。术后组颈椎刚度大于术前组。结论单开门手术损害颈椎矢状面的静态力学平衡,并使颈椎运动范围减小、柔韧性下降。颈椎弧度改变同颈部轴性症状轻重相关,而与 JOA评分改善率无关。     

颈椎节段不稳在交感型颈椎病中的作用

目的：探讨颈椎不稳定在交感型颈椎病中的作用及手术治疗的效果。方法：回顾伴有交感型颈椎病表现的混合型颈椎病12例,观察颈椎不稳定、围领制动效果,MRI表现及手术的治疗效果等指标。结果：颈椎X线表现：7例出现颈椎不稳定。围领制动效果：5例经围领制动后症状明显缓解,7例经围领制动后症状轻度缓解。MRI：7例在不稳定节段脊髓可见异常信号。手术效果：7例术后交感神经症状明显缓解,治疗效果为优,7例均为节段不稳的患者;4例术后交感神经症状轻度缓解,治疗效果为良;1例术后交感神经症状稍有缓解,治疗效果为中。结论：颈椎不稳定是交感型颈椎病发病的重要因素,手术治疗颈椎不稳所致的交感型颈椎病有良好的疗效。     

The use of disharmonic motion curves in problems of the cervical spine

Cervical spine motion was investigated by three-dimensional electrogoniometry in 257 asymptomatic volunteers and in 32 patients with cervical disc hernia or whiplash syndrome. Maximal ranges of main and coupled motions were considered. Motion curves were analysed qualitatively and using fitting of sixth degree polynomials. Motion ranges obtained were in agreement with previous observations. Significant differences between patients and volunteers concerned several primary and coupled components but not all. Qualitatively, patients displayed less harmonic curves, with irregularities and plateau-like appearances. Root mean square differences between data and fit were significantly modified in patients. Although cervical spine motion ranges may remain within normal limits in patients, motion patterns were altered qualitatively and quantitatively. Motion pattern analysis might prove a useful discrimination parameter in patients in whom anatomical lesions are not clearly identifiable.     

Posture affects motion coupling patterns of the upper cervical spine

Measurements of motions of the cervical spine are used to help diagnose the problems of clinical instability due to degenerative changes and trauma. For a better interpretation of the three-dimensional motions of the upper cervical spine, knowledge of the effects of posture on these motions is necessary. Seven fresh human cadaveric C0–C3 spinal specimens were utilized. Each specimen was put in three distinct sagital plane postures: full flexion, neutral, and full extension. At each posture, two load types were applied: left and right axial torques, and left and right lateral bending moments up to 1.5 Nm. The resulting three-dimensional relative motions of C0–C1 and C1–C2 were measured, with use of nonconstraining stereophotogrammetry, in the form of load-displacement curves. We found that the curves were nonlinear. The most dramatic change due to modification in posture was found in coupled sagittal plane rotation, which changed from extension at extended posture to flexion at flexed posture at both levels and in response to both load types. For the axial torque, the main axial rotation and coupled lateral bending changed little with posture. For the lateral bending moment, the main lateral bending rotation and coupled axial rotation decreased; the latter changed direction at C1–C2 as the spine was put into flexed posture. The motions for the right and left load applications generally were mirror images, except for the coupled sagittal plane rotations, which did not change with the direction of the load.     

Curvature and range of motion of the cervical spine after laminaplasty

BACKGROUND: The curvature and range of motion of the cervical spine decrease after laminaplasty. However, to our knowledge these changes have not been studied prospectively. Also, the effect of laminaplasty on the mobility of the occipito-atlanto-axial joints has not been studied in detail. The purpose of our study was to prospectively evaluate the range of motion and curvature of the cervical spine, including the occipito-atlanto-axial joints, following laminaplasty. METHODS: We conducted a prospective study of twenty-six patients who underwent cervical laminaplasty. They were followed for a mean of 6.7 years (range, five to nine years). Radiographs were made before the operation and at one, three, and five years after the operation. The curvature index, the angle of each vertebra in the neutral position from the occiput to the seventh cervical vertebra, and the range of motion in the sagittal plane were measured. RESULTS: The curvature index, the angle of the axis and the sixth cervical vertebra, and the angle of the axis and the seventh cervical vertebra in the neutral position were reduced after the operation. The rate of reduction declined between the third and fifth postoperative years. On the other hand, the mean distance between the occiput and the atlas as well as the mean angle of the axis and the atlas did not change significantly. The range of motion of the axis and the seventh cervical vertebra was decreased after the operation, and it continued to decrease slowly over the study period. The range of motion of the occipito-atlanto-axial complex increased slightly, which may represent a compensation for the decreased mobility of the middle and caudad parts of the cervical spine. CONCLUSIONS: Laminaplasty diminishes lordosis and straightens the cervical spine. The range of motion and lordosis continued to decrease, though at a diminishing rate, between the third and fifth postoperative years.     

The effect of multilevel anterior cervical fusion on neck motion

Background

Anterior cervical decompression and fusion (ACDF) procedures are successful in treating multilevel cervical radiculopathy and cervical myelopathy. It was reported that this procedure would result in a loss of cervical range of motion. However, few studies have focused on the exact impact of multilevel (more than 3 levels) ACDF on cervical range of motion.

Methods

29 patients underwent a 3-level or 4-level ACDF. In all the patients, preoperative active cervical ROM measurement was performed, and postoperative measurement was performed at 1-year follow-up by a CROM device. The pre- and postoperative data were compared to each other using paired t tests (α = 0.05).

Results

The patients had significantly less ROM after the surgery in all planes of motion. Major reduction was observed in flexion (39.5%), left and right lateral flexion (25.7 and 25.9%), with relatively minor impact on extension (18.3%), left and right rotation (14.0 and 14.4%) observed. In the three cardinal planes, major reduction was observed in the sagittal plane (28.2%) and coronal plane (25.8%), while minor impact observed in the horizontal plane (14.1%).

Conclusions

The patients of cervical spondylotic myelopathy had an obvious reduction in active cervical ROM following multilevel ACDF. However, patients might not experience great difficulties in performing daily activities with regard to the loss of neck motion after fusion.     

The effect of isometric exercises for cervical spine on blood pressure

Isometric exercises are common modality in the treatment of cervical syndrome. They are based on maximal voluntary contraction for 5-10 seconds. Isometric exercises can significantly rise blood presure. The purpose of the study was to asses the effect of isometric exercises submaximal intesity (60% maximal voluntary contraction) redarding blood pressure. The reults showed that even isometric exercises lower intesity statistically singnificabt rise systolic and diastolic blood pressure immediately after exercises. The blood pressure values reach normal values after 30 minutes.     

Radiological follow-up of motion in the cervical spine after surgery]

The influence of cervical spine in motion after surgery was evaluated by preoperative and postoperative functional radiography. Based on the analysis of postoperative radiograms, the following results were obtained: (1) The motion of cervical spine segments adjacent to the level of the anterior interbody fusion was increased after surgery. The larger the number of fused vertebral bodies, the greater the motion of the adjacent segments. A larger number of anterior fused vertebral bodies may cause more future damage to adjacent intervertebral discs. (2) The motion of the cervical spine was decreased after posterior procedures, especially laminoplasty, which preserves the posterior element. (3) Tilting motion and lordosis of the C 1/2 level was increased after anterior interbody fusion, laminectomy and laminoplasty.     

Dynamic change in the ligmenta flava of the cervical spine in motion

Cervical spine specimen from fresh cadaver of 10 young persons, 8 males and 2 females, aged from 23 to 32 years, were divided right through the midline after frozen under -30 degrees C. Changes in length and thickness of each ligmenta flava were measured in hyperflexion and hyper extension as well as in neutral position. Being stretched long and thin in flex and contracted short and thick in extension, the ligmenta flava stuck into the spinal canal in position of hyperextension, mostly at C5-6 (3.50 +/- 0.34 mm) and then C4-5 (3.25 +/- 0.50 mm), C6-7 (2.96 +/- 0.61 mm) in descending order. This experiment definitely demonstrated that segmental narrowing of spinal canal , due to sticking in of ligmenta flava at each intravertebral level, was fashioned in hyperextension.