RADIOGRAPHIC MEASUREMENT OF THE PREVERTEBRAL SOFT TISSUE OF CERVICAL VERTEBRAE

The radiographic measurement of the prevertebral soft tissue of cervical vertebrae was performed in 87 normal adults. According to the results of the measurement, 10 mm and 20 mm were used as the upper limit normal values of the retropharyngeal and retrotracheal space respectively. We conclude that although the widened soft tissue space is of diagnostic significance, diagnosis should be made on the basis of analysis of the injury history, clinical manifestation and imaging examination.

Radiographic Comparisons between Middle Phalanx of the Third Finger and Cervical Vertebrae Maturation for the Assessment of Skeletal Maturity

Sexual maturation characteristics,chronologic age,dental,and skeletal development are some of the more commonly used means to identify stages of growth.Hand wrist radiograph and cervical vertebrae maturation index(CVMI)are more reliable for skeletal development assessment.This study was conducted to compare the skeletal maturity using the maturational stages of middle phalanx of the third finger(MP3)with cervical vertebrae and then to evaluate the reliability of MP3 as a sole skeletal maturity assessment method.Chronological age group of the 112 subjects was 8-16 years for females and 10-18 years for males were selected for the study.Lateral cephalometry and intra oral peri‑apical radiograph of MP3 of the left hand of each patient were taken.Then,statistically it was correlated which was highly significant.Skeletal maturation of MP3 and cervical vertebrae stages progress with advancing chronological age.Female subjects were advanced on an average of 2 years earlier than male subjects at every stages of growth spurt.These results suggest that MP3 can substitute CVMI for skeletal maturity evaluation to determine optimal treatment time for various orthodontic procedures.The developmental stages of the MP3 could be used as a sole indicator in assessing the skeletal maturity.

Continuous epidural block of the cervical vertebrae for cervicogenic headache

Background Cervicogenic headache （CEH） is caused by a structural abnormality in the cervical spine. Available treatments for CEH include medical therapy, local botulinum toxin injection, cervical epidural corticosteroid injection, and surgery. The objective of this study was to investigate the safety and efficacy of a continuous epidural block of the cervical vertebra. Methods Medical records were retrospectively analyzed for 37 patients diagnosed with CEH treated by a continuous epidural block of the cervical vertebra with lidocaine, dexamethasone, and saline （5 ml/min） for 3-4 weeks and triamcinolone acetonide 5 mg once weekly for 3-4 weeks. Pain was measured via the visual analogue scale （VAS） in combination with quality of life assessment. Outcome measures were patient-reported days with mild or moderate pain, occurrence of severe pain, and the daily oral dosages of non-steroidal anti-inflammatory drug use （NSAID）. Results In the 3 months immediately preceding placement of the epidural catheter, the mean number of days with mild or moderate pain was 22.0±4.3. The mean occurrence of severe pain was （3.20±0.75） times and the mean oral dosage of NSAID was （1267±325） mg. During the first 6 months after epidural administration of lidocaine and corticosteroids, the mean number of days with mild or moderate pain, the mean occurrence of severe pain, and the mean daily oral dosages of NSAIDs were significantly decreased compared to 3-month period immediately preceding treatment （P 〈0.01）. By 12 months post-treatment, no significant difference in these three outcome measures was noted. Conclusions Continuous epidural block of the cervical vertebra for patients with CEH is effective for at least six months. Further research is needed to elucidate mechanisms of action and to prolong this effect.

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.

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.

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.

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.

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

Treatment of cervical dislocation with locked facets

Background Lower cervical dislocation with locked facets is common in cervical injury. The locked facets include unilateral and bilateral types. Different successful closed reduction rates has been achieved between unilateral and bilateral types by using rapid skull traction, which was commonly used to reduce the cervical disiocaUon. It is important to investigate a suitable management specific to patients with different types of cervical locked facets. Methods A total of 38 patients with cervical dislocation with locked facet due to cervical injury treated by rapid skull traction and operation from 1988 to 2005 were reviewed. Rapid skull traction was used in all the patients. Successful closed reduction rate was 88.0% in patients with bilateral cervical locked facets and that was 15.4% in those with unilateral cervical locked facets. These data were then statistically compared by Chi-square test. Patients who were reduced successfully underwent anterior cervical discectomy and fusion at the injured level, and those who failed in closed reduction received posterior open reduction and fixation. Results In this series, there was statistically significant difference （P〈0.05） in the rate of successful closed skull traction reduction between unilateral and bilateral locked facets dislocation. Unilateral cervical locked facets dislocation was not easily reduced by skull traction which was suitable for reduction of bilateral cervical locked facets dislocation. However, unilateral cervical locked facets dislocation can be reduced by posterior open reduction. Conclusions Unilateral cervical locked facets dislocation should be treated immediately with posterior open reduction and instrumentation. Bilateral cervical locked facets dislocation can be reduced by rapid skull traction firstly and anterior cervical discectomy and interbody fusion later.

Multi-slice spiral CT 3-dimensional reconstruction tech-nique to treat multi-segmental degenerative spinal steno-sis with traumatic instability of lower cervical spine

Objective: To study the feasibility of multi-slice spiral computed tomography (MSCT) 3-dimensional reconstruc-tion technique in assisting cervical pedicle screw fixation (PSF) and double-door laminoplasty to treat multi-segmen-tal degenerative spinal stenosis with traumatic instability (MDSTI) of lower cervical spine.Methods: From September 2006 to August 2007, PSF combined with double-door laminoplasty was performed in 9 patients with MDSTI of lower cervical spine. MSCT 3-dimensional reconstruction techniques, including volume rendering (VR) and multi-planar reconstruction (MPR), were used to assist preoperative diagnosis and measurement to guide the procedure. MPR was performed after operation. In coronal view, the degree of screw perforation was mea-sured precisely and the different positions of pedicle screws were divided into three grades according to Richter's method. In axial view, the canal sagittal diameter and trans-verse area of every laminoplasty level were measured.Results: Nine patients with MDSTI of lower cervical spine underwent PSF (total 44 screws). According to the classification of Richter, 72.7% (32/44) was in Grade 1 and 27.3% (12/44) was in Grade 2. No screw perforation occurred in Grade 3 and no screw revision was done for misplacement.No iatrogenic damage was observed. Double-door laminoplasty was performed in total 42 volumes. The post-operative sagittal diameter and transverse area of cervical spinal canal were significantly increased (P<0.05). The confi-dence intervals of mean increased ratio were 23.43%-40.65% in sagittal diameter and 23.18%-42.07% in transverse area. Six months after laminoplasty, based on MSCT axial view, complete union between "open door" and allograft bone was obtained in 76.19% of volumes (32/42), and allograft bone was absorbed partly in 23.81% (10/42). A solid union in bilateral gutters was achieved in all cases. They were followed up from 6 months to 1 year (mean 7.8 months). Post-operative neural function recovery in two cases improved 2 ASIA grade, 5 cases improved 1 grade and 2 cases remained the same as preoperative grade. No cases had lower ASIA grade.Conclusion: Assisted with MSCT 3-dimensional re-construction technique, PSF combined with double-door laminoplasty can be performed more safely and effectively to treat patients with MDSTI of lower cervical spine.

Surgical staged treatment for moderate to severe adolescent cervical kyphosis

Adolescent cervical kyphosis refers to manifestation characterized by loss of physiological cervical lordosis with involvement of multiple cervical vertebrae. There is no standard treatment strategy for this disease, especially in those patients who need surgical intervention. The aim of this study was to evaluate the surgical staged treatment for moderate to severe adolescents cervical kyphosis. Methods A total of 26 adolescent with cervical kyphosis were retrospectively assigned into following two groups according to the magnitude of kyphosis： moderate group （n=17）, the Cobb angle was 46.6°±4.8°. The surgical procedure was that skull traction was first carried out for 5-7 days and then the anterior fusion and instrumentation were performed. Severe group （n=-9）, the Cobb angle was 61.6°±4.8°. The treatment strategy was that the anterior release were first performed, followed by skull traction for 7-10 days, and then anterior fusion were performed. Radiographic evaluation was performed postoperatively. Results Three days after surgery, the X-ray examination showed that the Cobb angle was -8.9°±6.8° in the moderate group and -6.0°±6.3° in the severe group. The deformed appearance was obviously corrected, with neck pain and neurologic function improved significantly. Further magnetic resonance imaging （MRI） indicated the physiology curvature of the cervical spine had been reconstructed. Conclusion Surgical staged treatment may be an ideal therapeutic intervention for cervical kyphosis patients with a Cobb angle exceeding 35° in adolescents.

Applied anatomy of the lower cervical pedicle screw insertion

Objective: To ascertain an accurate approach to inserting the pedicle screw into C3-C7 segments of the cervical vertebra.Methods: Anatomic morphology of lateral mass and pedicle, and their anatomic relationship with the adjacent tissue were observed on C3-C7 segments of 25 adult embalmed cadavers (50 sides).Results: 1 ) The inferior edge of the base of the posterior tubercle of the transverse process and the inferior edge of the pedicle were connected with each other on 25 adult embalmed cadavers (50 sides ). The transverse section which passed through the median point between the superior edge and the inferior edge of the base of the posterior tubercle of the transverse process, and the transverse section which passed through the central axis between the superior edge and the inferior edge of the pedicle, were in the same horizontal plane. The superior and inferior position of placing the pedicle screw was determined by this transverse section, which passed through the median point between the superior and the inferior edge of the base of the posterior tubercle of the transverse process. 2 ) There was a directed internaldownwards "triangular sulcule" between the base of the posterior tubercle of the transverse process and the anterolateral edge of the inferior articular process. The anterior wall of the triangular sulcule was the base of the posterior tubercle of the transverse process, the posterior wall was the anterolateral edge of the inferior articular process, and the bottom of the sulcule was connected with the interior edge of the pedicle. The vertical length between the top of triangle and the planes of inferior edge of the pedicle was (2.78 ± 1.71 ) mm. The inferior edge of the cervical pedicle could be detected using a blunt probe along the "triangular sulcule" between the base of the posterior tubercle of the transverse process and the anterolateral edge of the inferior articular process in surgical operation. 3 )The lateral fovea of the articular process was observed on all lateral masses (50 sides ). The internal and external position of the entrance point could depend on anatomic landmarks: the lateral edge of the lateral fovea of the articular process. The horizontal length between the lateral fovea of the articular process and the entrance point was (3.14 ± 1.45 ) mm. 4 ) The diameter of pedicle screw,about (2.78 ± 1.71 ) mm, was the transverse diameter of the cancellous bone of the greatest narrow part of the cervical pedicle.Conclusions: The median point between the superior edge and the inferior edge of the base of the posterior tubercle of the transverse process, the lateral fovea of the articular process, and the triangular sulcule between the base of the posterior tubercle of the transverse process and the anterolateral edge of inferior articular process, are easy to be exposed and identified in surgical operation. The pedicle screw can be precisely inserted through this method.

The Prevention and Cure of Cervical Vertebra Disease

CERVICAL vertebra problems are common and usually occur in middleaged and elderly people, especially those who often bend over. The symptoms patients might encounter are dizziness, headache, neck and shoulder pain and numbness, and even viscera trouble. The following exercises are a simple and convenient way to prevent and cure cervical vertebra problems. If you continue doing the exercises, you can prevent and cure them. Here are the exercises step by step:

Sex-specific differences in ossification patterns of the atlas and axis:a computed tomography study

Background We investigated the sex-specific differences in ossification patterns of the first two cervical vertebrae in Chinese children.Methods A retrospective computed tomography(CT)study was performed between June 2016 and December 2020.Patients younger than 16 years with cervical CT images acquired<1.5 mm slice thickness were included.All eligible patients were stratified into 2 sex groups and 16 age groups based on 1-year intervals.The ossification status of each synchondrosis and ossification variants were evaluated.Results A total of 910 subjects(518 males and 392 females)were included in the study.For the Cl vertebra,the neurocentral synchondroses closed at a median age of 8 years in males and 6.3 years in females,and the posterior synchondrosis fused at 5.4 years in males and at 4.4 years in females.Multifocal anterior arch ossification centers were present in 74 of 411(18%)subjects,whereas posterior arch variants were observed in 18 of 258(7%)subjects.For the C2 vertebra,the sequence of complete fusion was as follows:posterior synchondrosis,neurocentral synchondroses,and dentoneural synchondrosis.Uniquely,a fusion line was observed in the dentocentral synchondrosis through adolescence.Anterior arch variants of the C2 vertebra occurred in 17 of 248(6.9%)subjects.There was no significant difference between the sexes in ossification variants.Conclusions All synchondroses of the first two cervical vertebrae fuse slightly earlier in females.The sequence of fusion follows a posterior-to-anterior and caudal-to-cephalad pattern in both sexes.Congenital variants are not rare and should not be confused with trauma.