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.

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.

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

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.

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.

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.

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.

推拿对颈椎病患者等速运动中最大力矩角度的影响

[目的]探讨正常人和颈椎病患者颈部肌肉最大力矩角度(APT)的特征及推拿干预机制。[方法]采用等速肌力测仪评估等速运动状态颈椎病颈部肌肉APT特性,分颈椎病组(40例)和正常对照组(39例),每组按性别、年龄相匹配分青、中和老年3个亚组。推拿治疗10次,分别在推拿治疗前、第1次推拿后即刻及第10次以后进行评估。[结果]正常人APT值比较恒定,随年龄改变不明显,90°/s角速度前屈和后伸APT多位于距离中立位偏后10°～25°,25°～40°;180°/s角速度前屈和后伸APT多分别位于距离中立位偏后15°～20°,20°～30°;颈椎病患者后伸APT值与正常人有显著差异,其值多位于中立位前后10°左右<推拿可以改善最大力矩角度,尤其是后伸APT值。[结论]正常人可以作为评估颈椎病颈部肌肉功能的有效参数;推拿可以通过改善以整体恢复颈部肌肉的力学平衡。

喉咽颈椎旁迁徙性异物1例

1临床资料 患者,男,62岁。因怀疑颈椎横突间隙异物40 d,于2010-05-17入院。患者2个月前在食鱼后发生咽痛,剧烈咳嗽,没有咳出异物,无咳痰带血,吞咽疼痛明显,在当地医院诊断为喉咽黏膜划伤,口服抗生素治疗。近20 d来发现颈部不适,颈部转动时左侧咽部、颈部刺痛感,无声音嘶哑,间断的口服抗生素治疗。3 d前因转动颈部出现头痛症状来我院就诊入院。查体：一般情况好,心肺无异常发现,

“四天穴”针方对颈椎病模型大鼠外周炎性因子及基质金属蛋白酶表达的影响

[目的]通过观察"四天穴"针方对动静力失衡性颈椎病模型大鼠椎间盘外周炎性因子白细胞介素-1β(IL-1β)、一氧化氮合酶(iNOS)、环氧酶-2(COX-2)及中性蛋白多糖酶(MMP-3)表达的影响,探讨其对颈椎病大鼠椎间盘退变的作用机制。[方法]Wistar大鼠60只,随机分为4组,即假手术组、模型组、四天穴针刺组、夹脊穴针刺组,建立动静力失衡性颈椎病模型,分别给予四天穴及夹脊穴针刺,浓缩型免疫组化染色法(SABC法)检测"四天穴"针方对动静力失衡性颈椎病模型大鼠造模后1周、2周、4周颈椎间盘IL-1β、iNOS、COX-2及MMP-3蛋白表达的影响。[结果]"四天穴"针方能明显抑制椎间盘炎性因子IL-1β、iNOS、COX-2及基质金属蛋白酶MMP-3蛋白的表达。[结论]"四天穴"针方可减缓颈椎间盘退变,其机制可能与抑制外周炎性因子与基质金属蛋白酶表达有关。

改良前路颈椎脊髓减压术中的护理配合

目的探讨改良前路颈椎脊髓减压术中的护理配合。方法对采用改良前路颈椎脊髓减压术中自体骨碎、屑粘合回植收治 5 4例脊髓型颈椎病患者术中的护理配合进行回顾性分析。。结果优良者已恢复工作 5 0例 ,改善者生活能自理或略需人照顾 4例。总有效率为 10 0 %。骨性愈合率 10 0 %。结论改良前路颈椎脊髓减压、碎骨粘合回植术创伤小、易实施、愈合快、更符合生理状态 ,有推广应用价值 ,术中良好的护理配合是手术成功的关键之一。

下颈椎骨折后患者行气管切开

气管切开是建立人工气道的常用途径之一。对于下颈椎即第3～7颈椎之间的完全性脊髓损伤者有可能由于呼吸肌麻痹而造成呼吸困难,肺部痰液无法咳出,导致呼吸衰竭。应尽早行气管切开,机械辅助呼吸。但颈椎骨折后颈部固定,颈部暴露不充分，行气管切开时难度较大。我科2000年4月～2006年12月，对52例下颈椎骨折后患者行气管切开，解除呼吸道梗阻，

综合疗法治疗下颈椎不稳症106例

分析综合疗法治疗下颈椎不稳症 10 6例的临床疗效。 10 6例均采用内服自拟壮骨颈复汤和全天麻胶囊及自我按摩、运动康复等疗法。结果 :随访 10 1例 ,治愈 67例 ,好转 3 2例 ,无效 2例 ,总有效率为 98 0 2 %。目前中医学并无下颈椎不稳症的病名 ,而现代医学亦很少将其视为独立疾病加以诊断。将本病作为独立病症提出并分析其产生的病因、病理及诊断和治疗 ,有着重要的临床意义。说明本病关键在于早期诊断 。

竹罐治疗颈型颈椎病98例临床观察

[目的]以药物竹罐治疗颈型颈椎病,观察其临床疗效。[方法]将98例患者随机分为竹罐组、空罐组。竹罐组将将自制竹罐放于煮沸的药液中煎煮后进行拔罐;空罐组行常规拔罐。观察2组患者临床症状、体征。[结果]竹罐组临床治愈29例,显效11例,有效6例;空罐组临床治愈13例,显效16例,有效12例。[结论]药物竹罐组疗效优于空罐组。