Another Look at Skeletal Maturation Using Hand Wrist and Cervical Vertebrae Evaluation

Introduction and Aims—The Growth stage of a patient can have considerable influence on diagnosis, treatment goals, timing and planning and the eventual outcome of orthodontic/orthopedic treatment. The purpose of this study was to analyze associations between the cervical vertebrae maturation score (CVMS) and skeletal maturation index (SMI). The second objective was to determine the reproducibility of the measurements on lateral cephalograms and hand-wrist radiographs. Materials and Methods—Lateral cephalometric and left hand-wrist radiographs of 92 untreated subjects (44 females and 48 males) aged from 8 to 17 years were obtained from the files of the Columbia University, Division of Orthodontics and measured for growth stage using cervical vertebrae and hand-wrist methods. Results—A high correlation was revealed between the hand-wrist and cervical vertebrae measurements. The Spearman’s rho correlation coefficient was 0.925 and significant at the 0.01 level. The correlation between hand-wrist and age (0.665, p < 0.01) was slightly greater than that of the CVMS (0.611, p < 0.01). Intra rater reliability was high. When the three categorically modified methods of the Fishman’s 11 skeletal maturation stages in hand and wrist analysis were used to compare with CVMS, methods 2 and 3 were both statistically significantly different according to the Wilcoxon signed ranks test and the Sign test at a significance level of less than 0.05. However, for method 1, the tests showed probability scores of 0.028 and 0.151, respectively, showing no significant difference at the 0.01 level in the Wilcoxon Signed Ranks Test, and no significant difference in the 0.01 and 0.05 level in the Signed Test. Conclusions—The Fishman’s hand and wrist skeletal maturation index and Bacetti’s cervical vertebrae maturation stages are both useful tools in evaluating growth stages. Fishman’s hand-wrist method is slightly more accurate.

Effect of AXIS lateral mass screw-plate internal fixation system on functional recovery of spinal cord in fracture of lower cervical vertebrae

AIM:To evaluate the methods and results of the AXIS lateral mass screw plate system in the treating of lower cervical spine injury.METHODS:29 cases of lower cervical vertebrae injury were fixed with AXIS system.All of them were followed up for more than 1 year.RESULTS:All cases had a good bone union without malformation.We found no complication of the injury to the vertebral arteries or nerves.There was no loosening of the plate and screw. CONCLUSION:AXIS lateral mass screw plate system has the characteristic of stable,simple and safe and is suitable for the treatment of lower cervical spine injury.

Removal of the Shadow of Cervical Vertebrae from Panoramic X-Ray Images with a Tomosynthesis Method

The purpose of this study is to remove the shadow of cervical vertebrae from dental panoramic x-ray images with a tomosynthesis method and improve the contrast of details in both the teeth and jaw bones. To measure the shift-amount at each angular position that was required for reconstruction of panoramic x-ray images of the dental arch, strip images of a calibration phantom were acquired. Then, a shift-amount table was prepared from these images, and the other shift-amount table, which was used to reconstruct a panoramic image of the cervical vertebrae, was prepared by inverting the curve of the shift-amount table upside down. Using these two tables, images focused on the dental arch and cervical vertebrae of a patient were made with the original strip data of the patient. The shadow of the cervical vertebrae appearing on the image focused on the dental arch was removed using the two above-mentioned images and blurring functions defined at two focusing geometries. The validity of the proposed method was evaluated with clinically acquired data of two patients. The shadow of the cervical vertebrae was successfully eliminated, and the contrast of the front teeth and detailed structures of the jaw bones was improved. The results of the experiments showed that our proposed method was significantly effective in removing the shadow of the cervical vertebrae from conventional panoramic x-ray images.

MANAGEMENT OF CEREBROSPINAL FLUID LEAKAGE FOLLOWING CERVICAL SPINE SURGERY

Objective To investigate the management and outcome of cerebrospinal fluid leakage(CSFL)after cervical surgery.Methods Medical records of 642 patients who underwent cervical surgery between December 1999 and December 2005 at our hospital were retrospectively reviewed.Five patients complicated by CSFL after surgery were enrolled,of which 4 cases were complicated after ossified posterior longitudinal ligament or posterior vertebral osteophyte resection directly injuring the dura,and 1 case after posterior cervical double-door laminoplasty without observed dural injury during surgery.Of the 5 CSFL cases,4 cases occurred at 1-3 days after operation and 1 case at 9 days after operation.All 5 postoperative CSFL cases were treated through wound drainage removal,wound sutures,prophylactic antibiotics,and continuous subarachnoid drainage in the elevated head position.Results All 5 CSFL cases experienced leakage cessation within 1-3 days and wound healing within 4-8 days,and subarachnoid drainage lasted 11-16 days with an average volume of 320 mL(range,150-410 mL).Four cases experienced headache,nausea and vomiting,1 case suffered from somnolence and hyponatremia,and symptoms subsided after symptomatic treatment and intravenous fluid administration.All patients were followed up for an average of 32 months(range,22-50 months).No occurrence of cerebrospinal fluid cyst or wound infection was observed.CSFL produced no significant negative effects upon neuromuscular function recovery.Conclusion Continuous subarachnoid cavity drainage in combination with elevated head position is a simple and safe non-surgical method in treatment of CSFL following cervical surgery.

Twenty One Cases of Vertebral-Artery-Type Cervical Spondylosis Treated with Acupuncture and Moxibustion

The vertebral-artery-type cervical spondylosis iscommonly encountered in the middle aged and oldpeople.The author has treated 21 cases of vertebral-artery-type cervical spondylosis by acupuncture andmoxibustion,with the other 19 cases treated only byacupuncture as the controls.The results are reportedas follows.Clinical

Dr.Zhang's Experience in Massotherapy for Treatment of Vertebral-Artery-Type Cervical Spondylopathy

Thirty cases of vertebral-artery-type cervical spondylopathy were treated by Dr. Zhang Tao's technique. The cure rate was 50%, and the total effective rate was 100%.The vertebral-artery-type cervical spondylopathy is a commonly-seen condition in the aged people, often accompanied with arteriosclerosis. Based on the techniques performed by Dr. Du Ziming (the late famous TCM physician of our hospital), Dr. Zhang Tao has developed a set of therapeutic techniques for this condition. From June 1997 to April 1998, the author had treated 30 cases of the disease, with satisfactory results reported in the following.

The Establishment and Development of Finite Element Model of Human Cervical Vertebra and Its Application Example

The incidence rate of cervical spondylosis is high,and due to the complicacy of cervical vertebra structure,irregularity of shapes and non-uniformity of components,sometimes it’s difficult to achieve planned objectives by experiments in vitro through stress and strain analysis. Besides,the biomechanical factors are of vital significance in the cause of spinal disorders. In this paper the author makes a summary of the present modeling of human cervical vertebra and describes the major methods of establishing the finite element model of human cervical vertebra through several self-constructed models. With the advance of computer technology,the finite element methods have been rapidly developed in cervical vertebra biomechanical researches and have became a major approach for biomechanical researches to simulate more and more clinical conditions.

The design of a cervical vertebra titanium plate-interbody fusion cage

Objective： To study the biomechanical feature of a newly designed cervical vertebra internal fixation device and its clinical applications. Methods： Some functional spinal units were fixed respectively with titanium plate, fusion cage and new device designed by ourselves, then a controlled biomechanical study including flexion, extension, torsion and lateral bending was performed and the results were analyzed. Results： As to the mechanical performance, fusion cage showed poor performance in extension test and so did the titanium plate in the distortion test. However, the new device showed good performance in every test. Conclusion： Both simple titanium plate fixation and simple fusion cage fixation have biomechanical defaults, but they are complementary. The titanium plate-interbody fusion cage avoids the defaults and has specific advantages.

3D Vector Reconstruction of the Typical Cervical Vertebra from Anatomical Sections of Korean Visible Human at the Laboratory of Clinical and Digital Anatomy of Paris Descartes University

Aim: To carry out a 3D vector reconstruction of the typical cervical vertebra from anatomical sections of the “Korean Visible Human” for educational purposes. Material and Methods: The anatomical subject was a 33-year-old Korean man who died of leukemia. He was 164 cm tall and weighed 55 kg. This man donated his body to science. Her body was frozen and cut into several anatomical sections after an MRI and CT scan. These anatomical sections were made using a special saw called a 0.2 mm thick cryomacrotome. Thus 8100 cuts were obtained. Only the sections numbered 940 to 1200 were used for our study. A segmentation by manual contouring of the different parts of the typical cervical vertebra was made using the software Winsurf version 3.5 on a laptop PC running Windows 7 equipped with a Ram of 8 gigas. Results: Our 3D vector model of the typical cervical vertebra is easily manipulated using the Acrobat 3DPDF interface. Each part of the vertebra accessible in a menu can be displayed, hidden or made transparent, and 3D labels are available as well as educational menus for learning anatomy. Conclusion: This original work constitutes a remarkable educational tool for the anatomical study of the typical cervical vertebra and can also be used as a 3D atlas for simulation purposes for training in therapeutic gestures.

Submandibular retropharyngeal cervical vertebra hook-plate for the treatment of C2 vertebral body tumors

Objective To evaluate the clinical results of sub-mandibular retropharyngeal cervical vertebrahook-plate (RCHP)reconsruction for the treatment of of C2 vertebral body tumors.Methods Nine patents with C2 vertebral body tumors

The Experimental Study:Effect of Traction and Rotationon Pressure of Cervical Nucleus Pulposus

研究不同拔伸和旋转作用时，颈椎髓核内压力的变化，为临床提供依据．方法：１２例颈椎固定在ＭＴＳ上，设置不同牵引旋转（旋转３０°，牵引５０，１００，１５０和２００Ｎ）．应用传感器测量Ｃ３～４，Ｃ４～５，Ｃ５～６节段．结果：随牵引增加，其压力不断下降，牵引２００Ｎ时，压力明显下降，差异显著（Ｐ＜０．０１）．旋转时稍升高，但不及正常水平．旋转后复位中所有标本的压力均有一过性降低．先拔伸后旋转时，其压力下降最明显．结论：颈椎髓核内压力随牵引力的增加而不断下降；较小牵引力对其压力无太大影响；牵引力２００Ｎ时，压力下降明显．临床牵引的重量可能偏小．较大重量的拔伸作用下旋转颈椎，不易使颈髓核突出．目的：研究不同拔伸和旋转作用时，颈椎髓核内压力的变化，为临床提供依据．方法：１２例颈椎固定在ＭＴＳ上，设置不同牵引旋转（旋转３０°，牵引５０，１００，１５０和２００Ｎ）．应用传感器测量Ｃ３～４，Ｃ４～５，Ｃ５～６节段．结果：随牵引增加，其压力不断下降，牵引２００Ｎ时，压力明显下降，差异显著（Ｐ＜０．０１）．旋转时稍升高，但不及正常水平．旋转后复位中所有标本的压力均有一过性降低．先拔伸后旋转时，其压力下降最明显．结论：颈椎髓核内压力?

Application of anterior decompression and reconstruction using titanium mesh with locking plates in the management of cervical spondylotic myelopathy

Objective：To observe the clinical effect of anterior decompression and reconstruction using titanium mesh with locking plates in the treatment of cervical spondylotic myelopathy. Methods：One hundred and twenty patients with cervical spondylotic myelopathy were treated by anterior decompression and reconstruction using titanium mesh with locking plates. There were 66 men and 54 women ranges in age from 37 to 72 Years（mean age, 58.3 years）. The mean Japanese orthopedic surgery association（JOA） scale was 9.6 points before operation. Patients were followed up clinically and radiographically. Results：Having stood surgery well, the operation time ranged between 60-100 min and bleeding during operation ranged between 20-200 ml. There were no case of postoperative infection, recurrent laryngeal nerve palsy, or esophageal or tracheal laceration or rupture. The average follow-up period was 14.3 months（range, 12 to 24 months） in 96 who were followed up. At the last follow-up visit the mean JOA scale had improved to 14.4 points, reflecting an improvement of 4.8 points. The results were considered to be excellent in 87 patients, good in 25, fair in 6, and poor in 2. No hardware-related complications or adjacent segment degenerative changes were encountered during the follow-up periods. Stable bone union was observed in all cases and the average time required for fusion was 5.7 months. Conclusion：Titanium mesh filled with autologous bone graft can avoid the complications associated with harvesting bone from the iliac crest donor site. When combined with cervical anterior locking plate, it can obtain satisfatory clinical results for the treatment of cervical spondylotic myelopathy.

Relationship between bulbocavernosus reflex, patellar reflex and rehabilitation during acute stage of cervical spinal injury

AIM:To investigate the relationship between bulbocavernous reflex(BTR),patellar reflex(PTR) and rehabilitation during acute stage of cervical spinal injury.METHODS: 73 cases of a class frankel cervical spinal injury patients were examined with BTR and PTR and recorded the time of the two reflexes,then follow up after 6 months to monitor recovery situation. RESULTS:There were 28 cases of positive BCR within the first 72 h (38%),7 cases of improved conditions(25%); there were 13 cases of PTR positive (17%),13 cases of improved status(100%). CONCLUSION:BCR and PTR are the sign of improved status and better rehabilitation during the acute stage.

A Variant Maneuver of Acupuncture in Treating Cervical Spondylopathy

Lifting and thrusting with reducing method at acupoint Huatuojiaji (Extra 21) of the affected side was performed to make the limb of the affected side contract involuntarily 1-2 times in 53 cases with cervical spondylopathy. The maneuver produced a much better total effective rate than the routine maneuver (P<0.01).The instant and long-term analgesic effects were also found superior (P<0.01). Probably this is due to the increased serum content of morphine-like substance.

Rehabilitation intervention of cervical spondylotic myelopathy combined with thoracic spinal canal stenosis

Objective To investigate diagnosis and treatment characters of cervical spondylotic myelopathy combined with thoracic spinal stenosis, and to analysis effective pathway of spinal function recovery. Methods We took respective analysis on diagnosis, treatment and recovery results of 12 cases, whose symptoms, signs and MR were explicit. Results Follow ups times were from 9 months to 5 years and 8 months. Nerve function of 8 cases recovered completely or nearly completely; that of 2 cases improved apparently and that of 2 cases improved slightly. Conclusion Detailed disease history collection, particular body examination and MR reading are very important to early diagnosis of cervical spondylotic myelopathy combined with thoracic spinal stenosis. Early operation combined with cervical and thoracic spinal canal decompression at same time or at different stages is the single effective method to patients’ function recovery.

Low Friction Traction for Cervical Spine Dislocation

In order to reduce the magnitude of the force applied to skull for treatment of acute cervical spine dislocation, we developed a method of skeletal traction based on reduction of friction forces under the patient’s head. Traction force was applied to sculls of five patients with cervical fracture-dislocations. A difference in friction interface between the patient’s head and shoulder girdle was created. The traction weight required for the reduction of the vertebral dislocation was significantly lower than an expected minimal traction weight in the commonly used techniques (p = 0.013). The presented method permits an effective and safe reduction of dislocated cervical vertebra by a relatively low traction force.

Cervical Disc Replacement: A Systematic Review of Medline Indexed Literature

Anterior Cervical Discectomy and Fusion (ACDF) currently remains as the gold standard treatment for cervical disc herniation and Degenerative Disc Disease (DDD) refractory to conservative management. Even though anterior cervical fusion provides excellent clinical results, it has been implicated in abnormal kinematic strain on adjacent disc level resulting in symptomatic adjacent segment disease. Anterior cervical disc replacement (ACDR) is an alternative procedure to anterior cervical discectomy and fusion. The aims of cervical disc replacement were to preserve the motion at the index level and to protect the adjacent levels from accelerated symptomatic degeneration. The aim of this systematic review was to evaluate the outcomes of cervical disc replacement published in MEDLINE indexed literature. A literature search was carried out in medical electronic database MEDLINE. Keywords used for the search were Cervical vertebrae, Cervical spine, Neck, Intervertebral disc, Total disc replacement, Arthroplasty, Replacement, Treatment outcome. Two authors reviewed titles and abstracts of all two hundred and thirty six hits. The articles that satisfied the inclusion criteria were critically appraised while remaining articles were discarded. Anterior cervical disc replacement is a relatively new technology in spinal surgery. There are several short and intermediate term follow-up studies to prove the safety and efficacy of ACDR with satisfactory clinical and radiological outcomes. More intermediate to long-term follow-up studies are needed to prove the safety and efficacy of ACDR.

Management of symptomatic cervical facet cyst with cervical interlaminar epidural block: A case report

BACKGROUND Symptomatic cervical facet cysts are relatively rare compared to those in the lumbar region.These cysts are usually located in the 7th cervical and 1st thoracic vertebral(C7/T1)area,and surgical excision is performed in most cases.However,facet cysts are associated with degenerative conditions,and elderly patients are often ineligible for surgical procedures.Cervical interlaminar epidural block has been used in patients with cervical radiating symptoms and achieved good results.Therefore,cervical interlaminar epidural block may be the first-choice treatment for symptomatic cervical facet cysts.CASE SUMMARY A 70-year-old man complained of a tingling sensation in the left hand,focused on the 4th and 5th fingers,for 1 year,and posterior neck pain for over 5 mo.The patient’s numeric rating scale(NRS)score was 5/10.The patient was diagnosed with symptomatic cervical facet cyst at the left C7/T1 facet joint.Fluoroscopyguided cervical interlaminar epidural block at the C7/T1 level with 20 mg triamcinolone and 5 mL of 0.5%lidocaine was administered.The patient's symptoms improved immediately after the block,with an NRS score of 3 points.After 3 mo,his left posterior neck pain and tingling along the left 8th cervical dermatome were relieved,with an NRS score of 2.CONCLUSION A cervical interlaminar epidural block is a good alternative for managing symptomatic cervical facet cysts.

Tenosynovial giant cell tumor involving the cervical spine: A case report

BACKGROUND Tenosynovial giant cell tumors(TGCTs)are a frequent benign proliferative disease originating from the synovial membrane.However,TGCTs rarely occur in the spine.The purpose of this paper is to report a case of TGCT occurring in the cervical spine.Although the disease is rare,it is essential to consider the possibility of TGCT in axial skeletal lesions.Awareness of spinal TGCTs is important because their characteristics are similar to common spinal tumor lesions.CASE SUMMARY A 49-year-old man with a 2-year history of neck pain and weakness in both lower extremities was referred to our ward.Imaging revealed a mass extending from the left epidural space to the C4-5 paravertebral muscles with uneven enhancement.The tumor originated in the synovium of the C4-5 lesser joint and eroded mainly the C4-5 vertebral arch and spine.Puncture biopsy was suggestive of a giant cellrich lesion.The patient had pulmonary tuberculosis,and we first administered anti-tuberculosis treatment.After the preoperative requirements of the antituberculosis treatment were met,we used a posterior cervical approach to completely remove the mass after fixation with eight pedicle screws.The mass was identified as a TGCT by postoperative immunohistochemical analysis.Recurrence was not detected after 1 year of follow-up.CONCLUSION Spinal TGCTs are often misdiagnosed.The radiological changes are not specific.The ideal treatment comprises complete excision with proper internal fixation,which can significantly reduce postoperative recurrence.

Treatment by Electro-Acupuncture and Massage in 172 Cases of Cervical Spondylopathy

The authors have treated 172 cases of cervical spondylopathy by electro-acupuncture and massage in recent 6 years. The results were satisfactory as reported in the following.