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The Impact of Single-Level ACDF on Neural Foramen and Disc Height of Surgical and Adjacent Cervical Segments: A Case-Series Radiological Analysis. Brain Sci 2023; 13:brainsci13010101. [PMID: 36672082 PMCID: PMC9857145 DOI: 10.3390/brainsci13010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/01/2023] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Background: ACDF has become one of the established procedures for the surgical treatment of symptomatic cervical spondylosis, showing excellent clinical results and effective improvements in neural functions and neck pain relief. The main purpose of ACDF is neural decompression, and it is considered by some authors as an indirect result of the intervertebral distraction and cage insertion and the consequent restoration of the disc space and foramen height. Methods: Radiological data from 28 patients who underwent single-level ACDF were retrospectively collected and evaluated. For neural foramen evaluation, antero-posterior (A-P) and cranio-caudal (C-C) diameters were manually calculated; for intervertebral disc height the anterior, centrum and posterior measurement were calculated. All measurements were performed at surgical and adjacent (above and below) segments. NRS, NDI and also the mJOA and Nurick scale were collected for clinical examination and complete evaluation of patients’ postoperative outcome. Results: The intervertebral disc height in all its measurements, in addition to the height (C-C diameter) of the foramen (both right and left) increase at the surgical segment when comparing pre and postop results (p < 0.001, and p = 0.033 and p = 0.001). NRS and NDI radiculopathy scores showed improved results from pre- to post-op evaluation (p < 0.001), and a negative statistical correlation with the improved disc height at the surgical level. Conclusions: The restoration of posterior disc height through cage insertion appears to be effective in increasing foraminal height in patients with symptomatic preoperative cervical foraminal stenosis.
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Sun B, Xu C, Qi M, Shen X, Zhang K, Yuan W, Liu Y. Predictive Effect of Intervertebral Foramen Width on Pain Relief After ACDF for the Treatment of Cervical Radiculopathy. Global Spine J 2023; 13:133-139. [PMID: 33557606 PMCID: PMC9837496 DOI: 10.1177/2192568221993444] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To investigate the relationship between the preoperative width of the intervertebral foramen (WIVF) and the pain relief in patients who underwent anterior cervical discectomy and fusion (ACDF) for the treatment of cervical radiculopathy. METHODS Patients were divided into 2 groups based on pain relief status at the 6-month follow-up (pain relief group: 430 patients; persistent pain group: 108 patients). Possible factors such as age, sex, body mass index (BMI), the symptom duration, the preoperative Japanese Orthopedic Association (JOA) scores, the canal stenosis status, and the graft material were obtained. The C2-C7 Cobb angle, disc space, and width and height of the intervertebral foramen were measured on X-ray and CT 3-dimension reconstruction. Multivariate logistic regression was performed to identify the factors that affected pain relief. A receiver operating characteristic (ROC) curve was drawn for the predictive factors to determine the optimal threshold for foreseeing persistent pain. RESULTS There were significant differences in the preoperative WIVF, symptom duration and ratio of disc space distraction between the 2 groups (each P < 0.05). The regression model showed that pain relief was negatively affected by the symptom duration and ratio of disc space distraction. Besides, an increase in the preoperative width of the intervertebral foramen (WIVF) could significantly decrease the possibility of persistent pain. Based on the ROC curve, the optimal threshold of preoperative WIVF was 4.35 mm. CONCLUSION When the preoperative WIVF is equal to or less than 4.35 mm, the possibility of the occurrence of postoperative persistent pain significantly increased.
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Affiliation(s)
- Baifeng Sun
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Chen Xu
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Min Qi
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Xiaolong Shen
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Ke Zhang
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Wen Yuan
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Yang Liu
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China,Yang Liu, Spine Center, Department of
Orthopedics, Changzheng Hospital, Naval Medical University, 415th Feng Yang
Road, Shanghai 200003, People’s Republic of China.
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Kartha S, Ghimire P, Winkelstein BA. Inhibiting spinal secretory phospholipase A 2 after painful nerve root injury attenuates established pain and spinal neuronal hyperexcitability by altering spinal glutamatergic signaling. Mol Pain 2021; 17:17448069211066221. [PMID: 34919471 PMCID: PMC8721705 DOI: 10.1177/17448069211066221] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Neuropathic injury is accompanied by chronic inflammation contributing to the onset and maintenance of pain after an initial insult. In addition to their roles in promoting immune cell activation, inflammatory mediators like secretory phospholipase A2 (sPLA2) modulate nociceptive and excitatory neuronal signaling during the initiation of pain through hydrolytic activity. Despite having a known role in glial activation and cytokine release, it is unknown if sPLA2 contributes to the maintenance of painful neuropathy and spinal hyperexcitability later after neural injury. Using a well-established model of painful nerve root compression, this study investigated if inhibiting spinal sPLA2 7 days after painful injury modulates the behavioral sensitivity and/or spinal dorsal horn excitability that is typically evident. The effects of sPLA2 inhibition on altered spinal glutamatergic signaling was also probed by measuring spinal intracellular glutamate levels and spinal glutamate transporter (GLAST and GLT1) and receptor (mGluR5, GluR1, and NR1) expression. Spinal sPLA2 inhibition at day 7 abolishes behavioral sensitivity, reduces both evoked and spontaneous neuronal firing in the spinal cord, and restores the distribution of neuronal phenotypes to those of control conditions. Inhibiting spinal sPLA2 also increases intracellular glutamate concentrations and restores spinal expression of GLAST, GLT1, mGluR5, and GluR1 to uninjured expression with no effect on NR1. These findings establish a role for spinal sPLA2 in maintaining pain and central sensitization after neural injury and suggest this may be via exacerbating glutamate excitotoxicity in the spinal cord.
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Affiliation(s)
- Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Prabesh Ghimire
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurosurgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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4
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Gong H, Liu J, Li S, Chen B. Axial-SpineGAN: simultaneous segmentation and diagnosis of multiple spinal structures on axial magnetic resonance imaging images. Phys Med Biol 2021; 66. [PMID: 33887718 DOI: 10.1088/1361-6560/abfad9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 04/22/2021] [Indexed: 11/12/2022]
Abstract
Providing a simultaneous segmentation and diagnosis of the spinal structures on axial magnetic resonance imaging (MRI) images has significant value for subsequent pathological analyses and clinical treatments. However, this task remains challenging, owing to the significant structural diversity, subtle differences between normal and abnormal structures, implicit borders, and insufficient training data. In this study, we propose an innovative network framework called 'Axial-SpineGAN' comprising a generator, discriminator, and diagnostor, aiming to address the above challenges, and to achieve simultaneous segmentation and disease diagnosis for discs, neural foramens, thecal sacs, and posterior arches on axial MRI images. The generator employs an enhancing feature fusion module to generate discriminative features, i.e. to address the challenges regarding the significant structural diversity and subtle differences between normal and abnormal structures. An enhancing border alignment module is employed to obtain an accurate pixel classification of the implicit borders. The discriminator employs an adversarial learning module to effectively strengthen the higher-order spatial consistency, and to avoid overfitting owing to insufficient training data. The diagnostor employs an automated diagnosis module to provide automated recognition of spinal diseases. Extensive experiments demonstrate that these modules have positive effects on improving the segmentation and diagnosis accuracies. Additionally, the results indicate that Axial-SpineGAN has the highest Dice similarity coefficient (94.9% ± 1.8%) in terms of the segmentation accuracy and highest accuracy rate (93.9% ± 2.6%) in terms of the diagnosis accuracy, thereby outperforming existing state-of-the-art methods. Therefore, our proposed Axial-SpineGAN is effective and potential as a clinical tool for providing an automated segmentation and disease diagnosis for multiple spinal structures on MRI images.
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Affiliation(s)
- Hao Gong
- Beijing Institute of Technology, School of Mechanical Engineering, 5 South Zhongguancun Street, Haidian District, Beijing, 100081, People's Republic of China
| | - Jianhua Liu
- Beijing Institute of Technology, School of Mechanical Engineering, 5 South Zhongguancun Street, Haidian District, Beijing, 100081, People's Republic of China
| | - Shuo Li
- University of Western, Department of Medical Imaging and Medical Biophysics, London, ON, N6A 5W9, Canada
| | - Bo Chen
- Western University, School of Health Science, London, ON, N6A 4V2, Canada
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5
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Smith AC, Albin SR, Abbott R, Crawford RJ, Hoggarth MA, Wasielewski M, Elliott JM. Confirming the geography of fatty infiltration in the deep cervical extensor muscles in whiplash recovery. Sci Rep 2020; 10:11471. [PMID: 32651447 PMCID: PMC7351986 DOI: 10.1038/s41598-020-68452-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/22/2020] [Indexed: 02/08/2023] Open
Abstract
Previous preliminary work mapped the distribution of neck muscle fat infiltration (MFI) in the deep cervical extensor muscles (multifidus and semispinalis cervicis) in a small cohort of participants with chronic whiplash associated disorders (WAD), recovered, and healthy controls. While MFI was reported to be concentrated in the medial portion of the muscles in all participants, the magnitude was significantly greater in those with chronic WAD. This study aims to confirm these results in a prospective fashion with a larger cohort and compare the findings across a population of patients with varying levels of WAD-related disability one-year following the motor vehicle collision. Sixty-one participants enrolled in a longitudinal study: Recovered (n = 25), Mild (n = 26) and Severe WAD (n = 10) were studied using Fat/Water magnetic resonance imaging, 12-months post injury. Bilateral measures of MFI in four quartiles (Q1–Q4; medial to lateral) at cervical levels C4 through C7 were included. A linear mixed model was performed, controlling for covariates (age, sex, body mass index), examining interaction effects, and comparing MFI distribution between groups. The recovered group had significantly less MFI in Q1 compared to the two symptomatic groups. Group differences were not found in the more lateral quartiles. Results at 12 months are consistent with the preliminary study, indicating that MFI is spatially concentrated in the medial portions of the deep cervical extensors regardless of WAD recovery, but the magnitude of MFI in the medial portions of the muscles is significantly larger in those with severe chronic WAD.
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Affiliation(s)
- Andrew C Smith
- School of Physical Therapy, Regis University, Denver, CO, USA
| | | | - Rebecca Abbott
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | | | - Mark A Hoggarth
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Marie Wasielewski
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James M Elliott
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Faculty of Medicine and Health, The Northern Sydney Local Health District, The Kolling Institute, The University of Sydney, St. Leonards, NSW, 2065, Australia.
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6
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Hong Y, Wei B, Han Z, Li X, Zheng Y, Li S. MMCL-Net: Spinal disease diagnosis in global mode using progressive multi-task joint learning. Neurocomputing 2020. [DOI: 10.1016/j.neucom.2020.01.112] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Elliott JM, Parrish TB, Walton DM, Vassallo AJ, Fundaun J, Wasielewski M, Courtney DM. Does Overall Cervical Spine Pathology Relate to the Clinical Heterogeneity of Chronic Whiplash? Am J Emerg Med 2019; 38:869-873. [PMID: 31285071 DOI: 10.1016/j.ajem.2019.06.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/25/2019] [Accepted: 06/29/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND PURPOSE There remains limited evidence for the clinical importance of most imaging findings in whiplash. However, it is possible the type and number of findings on Computed Tomography (CT) may contribute to prognostic recovery models. The purpose is to interpret cervical spine pathologies in the context of known factors influencing recovery. MATERIALS AND METHODS This is a secondary analysis from a database of 97 acutely injured participants enrolled in a prospective inception cohort study. Thirty-eight participants underwent standard of care cervical spine CT in the emergency medicine department. All 38 participants were assessed at <1-week, 2-weeks, and 3-months post-injury and classified using percentage scores on the Neck Disability Index (recovered/mild (NDI of 0-28%) or moderate/severe (NDI ≥ 30%)). Between-group comparison of categorical variables (gender (male/female), presence of at least one CT finding (yes/no), and presence of ≥3 pathologies on CT (yes/no)) was conducted using 2-tailed Fisher's exact test. RESULTS Participants from both groups demonstrated at least one observable pathology. The group with persistent moderate/severe symptoms presented with significantly more pathology at baseline than those who later reported recovery or milder symptoms at 3-months post injury (p = 0.02). CONCLUSIONS This preliminary study, which needs replication in a larger cohort, provides foundation that the number of degenerative pathologies seen on initial post MVC CT may be associated with the subsequent clinical course of whiplash.
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Affiliation(s)
- James M Elliott
- The University of Sydney, Faculty of Health Sciences & the Northern Sydney Local Health District, The Kolling Institute, St. Leonards, NSW, Australia; Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Todd B Parrish
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - David M Walton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Amy J Vassallo
- The University of Sydney, Faculty of Health Sciences & the Northern Sydney Local Health District, The Kolling Institute, St. Leonards, NSW, Australia
| | - Joel Fundaun
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Marie Wasielewski
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - D Mark Courtney
- Department of Emergency Medicine Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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8
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Jones CF, Clarke EC. Engineering approaches to understanding mechanisms of spinal column injury leading to spinal cord injury. Clin Biomech (Bristol, Avon) 2019; 64:69-81. [PMID: 29625748 DOI: 10.1016/j.clinbiomech.2018.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 02/16/2018] [Accepted: 03/24/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The mechanical interactions occurring between the spinal column and spinal cord during an injury event are complex and variable, and likely have implications for the clinical presentation and prognosis of the individual. METHODS The engineering approaches that have been developed to better understand spinal column and cord interactions during an injury event are discussed. These include injury models utilising human and animal cadaveric specimens, in vivo anaesthetised animals, finite element models, inanimate physical systems and combinations thereof. FINDINGS The paper describes the development of these modelling approaches, discusses the advantages and disadvantages of the various models, and the major outcomes that have had implications for spinal cord injury research and clinical practice. INTERPRETATION The contribution of these four engineering approaches to understanding the interaction between the biomechanics and biology of spinal cord injury is substantial; they have improved our understanding of the factors contributing to the spinal column disruption, the degree of spinal cord deformation or motion, and the resultant neurological deficit and imaging features. Models of the injury event are challenging to produce, but technological advances are likely to improve these models and, consequently, our understanding of the mechanical context in which the biological injury occurs.
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Affiliation(s)
- Claire F Jones
- Spinal Research Group, Centre for Orthopaedics and Trauma Research, Adelaide Medical School, The University of Adelaide, Australia; School of Mechanical Engineering, The University of Adelaide, Australia
| | - Elizabeth C Clarke
- Institute for Bone and Joint Research, Kolling Institute, Sydney Medical School, University of Sydney, Australia.
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9
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Spine-GAN: Semantic segmentation of multiple spinal structures. Med Image Anal 2018; 50:23-35. [DOI: 10.1016/j.media.2018.08.005] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 08/22/2018] [Accepted: 08/22/2018] [Indexed: 11/21/2022]
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10
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He X, Leung S, Warrington J, Shmuilovich O, Li S. Automated neural foraminal stenosis grading via task-aware structural representation learning. Neurocomputing 2018. [DOI: 10.1016/j.neucom.2018.01.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Han Z, Wei B, Leung S, Nachum IB, Laidley D, Li S. Automated Pathogenesis-Based Diagnosis of Lumbar Neural Foraminal Stenosis via Deep Multiscale Multitask Learning. Neuroinformatics 2018; 16:325-337. [DOI: 10.1007/s12021-018-9365-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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12
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Zhang S, Kartha S, Lee J, Winkelstein BA. Techniques for Multiscale Neuronal Regulation via Therapeutic Materials and Drug Design. ACS Biomater Sci Eng 2017; 3:2744-2760. [DOI: 10.1021/acsbiomaterials.7b00012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Sijia Zhang
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich
Hall, Philadelphia, Pennsylvania 19104, United States
| | - Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich
Hall, Philadelphia, Pennsylvania 19104, United States
| | - Jasmine Lee
- Department of Physics and Astronomy, University of Pennsylvania, 209 S. 33rd Street, David Rittenhouse Laboratory, Philadelphia, Pennsylvania 19104, United States
| | - Beth A. Winkelstein
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich
Hall, Philadelphia, Pennsylvania 19104, United States
- Department
of Neurosurgery, University of Pennsylvania, Stemmler Hall, 3450 Hamilton Walk, Philadelphia, Pennsylvania 19104, United States
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Wang Z, Zhao H, Liu JM, Tan LW, Liu P, Zhao JH. Resection or degeneration of uncovertebral joints altered the segmental kinematics and load-sharing pattern of subaxial cervical spine: A biomechanical investigation using a C2–T1 finite element model. J Biomech 2016; 49:2854-2862. [DOI: 10.1016/j.jbiomech.2016.06.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 06/21/2016] [Accepted: 06/23/2016] [Indexed: 11/26/2022]
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Stein G, Meyer C, Ingenhoff L, Bredow J, Müller LP, Eysel P, Schiffer G. [The biomechanics of hyperextension injuries of the subaxial cervical spine]. Unfallchirurg 2016; 120:590-594. [PMID: 27220520 DOI: 10.1007/s00113-016-0167-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Hyperextension injuries of the subaxial cervical spine are potentially hazardous due to relevant destabilization. Depending on the clinical condition, neurologic or vascular damage may occur. Therefore an exact knowledge of the factors leading to destabilization is essential. In a biomechanical investigation, 10 fresh human cadaver cervical spine specimens were tested in a spine simulator. The tested segments were C4 to 7. In the first step, physiologic motion was investigated. Afterwards, the three steps of injury were dissection of the anterior longitudinal ligament, removal of the intervertebral disc/posterior longitudinal ligament, and dissection of the interspinous ligaments/ligamentum flavum. After each step, the mobility was determined. Regarding flexion and extension, an increase in motion of 8.36 % after the first step, 90.45 % after the second step, and 121.67 % after the last step was observed. Testing of lateral bending showed an increase of mobility of 7.88 %/27.48 %/33.23 %; axial rotation increased by 2.87 %/31.16 %/45.80 %. Isolated dissection of the anterior longitudinal ligament led to minor destabilization, whereas the intervertebral disc has to be seen as a major stabilizer of the cervical spine. Few finite-element studies showed comparable results. If a transfer to clinical use is undertaken, an isolated rupture of the anterior longitudinal ligament can be treated without surgical stabilization.
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Affiliation(s)
- G Stein
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - C Meyer
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - L Ingenhoff
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - J Bredow
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - P Eysel
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - G Schiffer
- Abteilung Unfallchirurgie, Handchirurgie und Orthopädie, Vinzenz-Palotti-Hospital, Bergisch-Gladbach, Deutschland
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Cervical cages placed bilaterally in the facet joints from a posterior approach significantly increase foraminal area. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:2279-85. [PMID: 26869077 DOI: 10.1007/s00586-016-4430-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/09/2016] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Foraminal stenosis is a common cause of cervical radiculopathy. Posterior cervical cages can indirectly increase foraminal area and decompress the nerve root. The aim of this study was to assess the influence of bilateral posterior cervical cages on the surface area and shape of the neural foramen. METHODS Radiographic analysis was performed on 43 subjects enrolled in a prospective, multi-center study. CT scans were obtained at baseline and 6- and 12-months after cervical fusion using bilateral posterior cervical cages. The following measurements were performed on CT scan: foraminal area (A), theoretical area (TA), height (H), superior diagonal (DSI), inferior diagonal (DIS), and inferior diagonal without implant (DISI). Comparisons were performed using R-ANOVA with a significance of α < 0.05. RESULTS Foraminal area, height, TA and DISI were significantly greater following placement of the implant. The mean (SD) A increased from 4.01 (1.09) mm(2) before surgery to 4.24 (1.00) mm(2) at 6 months, and 4.18 (1.05) mm(2) at 12 months after surgery (p < 0.0001). Foraminal height (H) increased from mean (SD) 9.20 (1.08) mm at baseline to 9.65 (1.06) mm and 9.55 (1.14) mm at 6- and 12-months post-operatively, respectively (p < 0.0001). The mean DIS did not change significantly. There was a significant decrease in DSI: 6.18 (1.59) mm pre-operatively, 5.95 (1.47) mm and 5.73 (1.46) mm at 6- and 12-months (p < 0.0001). CONCLUSIONS Implantation of bilateral posterior cervical cages can increase foraminal area and may indirectly decompress the nerve roots. Correlation between increase in foraminal area and clinical outcomes needs further investigation.
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16
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Smith ZA, Khayatzadeh S, Bakhsheshian J, Harvey M, Havey RM, Voronov LI, Muriuki MG, Patwardhan AG. Dimensions of the cervical neural foramen in conditions of spinal deformity: an ex vivo biomechanical investigation using specimen-specific CT imaging. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:2155-65. [PMID: 26831539 DOI: 10.1007/s00586-016-4409-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Patients with cervical spondylosis commonly present with neck pain, radiculopathy or myelopathy. As degenerative changes progress, multiple factors including disc height loss, thoracic kyphosis, and facetogenic changes can increase the risk of neural structure compression. This study investigated the impact of cervical deformity including forward head posture (FHP) and upper thoracic kyphosis, on the anatomy of the cervical neural foramen. METHODS Postural changes of 13 human cervical spine specimens (Occiput-T1, age 50.6 years; range 21-67) were assessed in response to prescribed cervical sagittal malalignments using a previously reported experimental model. Two characteristics of cervical sagittal deformities, C2-C7 sagittal vertical alignment (SVA) and sagittal angle of the T1 vertebra (T1 tilt), were varied to create various cervical malalignments. The postural changes were documented by measuring vertebral positions and orientations. The vertebral motion data were combined with specimen-specific CT-based anatomical models, which allowed assessments of foraminal areas of subaxial cervical segments as a function of increasing C2-C7 SVA and changing T1 tilt. RESULTS Increasing C2-C7 SVA from neutral posture resulted in increased neural foraminal area in the lower cervical spine (largest increase at C4-C5: 13.8 ± 15.7 %, P < 0.01). Increasing SVA from a hyperkyphotic posture (greater T1 tilt) also increased the neural foraminal area in the lower cervical segments (C5-C6 demonstrated the largest increase: 13.4 ± 9.6 %, P < 0.01). The area of the cervical neural foramen decreased with increasing T1 tilt, with greater reduction occurring in the lower cervical spine, specifically at C5-C6 (-8.6 ± 7.0 %, P < 0.01) and C6-C7 (-9.6 ± 5.6 %, P < 0.01). CONCLUSION An increase in thoracic kyphosis (T1 tilt) decreased cervical neural foraminal areas. In contrast, an increase in cervical SVA increased the lower cervical neural foraminal areas. Patients with increased upper thoracic kyphosis may respond with increased cervical SVA as a compensatory mechanism to increase their lower cervical neural foraminal area.
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Affiliation(s)
- Zachary A Smith
- Department of Neurological Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Saeed Khayatzadeh
- Musculoskeletal Biomechanics Laboratory, Edward Hines, Jr. VA Hospital, Hines, IL, 60141, USA
| | - Joshua Bakhsheshian
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael Harvey
- Department of Neurological Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Robert M Havey
- Musculoskeletal Biomechanics Laboratory, Edward Hines, Jr. VA Hospital, Hines, IL, 60141, USA.,Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL, 60153, USA
| | - Leonard I Voronov
- Musculoskeletal Biomechanics Laboratory, Edward Hines, Jr. VA Hospital, Hines, IL, 60141, USA.,Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL, 60153, USA
| | - Muturi G Muriuki
- Musculoskeletal Biomechanics Laboratory, Edward Hines, Jr. VA Hospital, Hines, IL, 60141, USA
| | - Avinash G Patwardhan
- Musculoskeletal Biomechanics Laboratory, Edward Hines, Jr. VA Hospital, Hines, IL, 60141, USA. .,Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL, 60153, USA.
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Leahy PD, Puttlitz CM. Addition of lateral bending range of motion measurement to standard sagittal measurement to improve diagnosis sensitivity of ligamentous injury in the human lower cervical spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:122-126. [PMID: 26162921 DOI: 10.1007/s00586-015-4110-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 07/02/2015] [Accepted: 07/03/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE This study examined the cervical spine range of motion (ROM) resulting from whiplash-type hyperextension and hyperflexion type ligamentous injuries, and sought to improve the accuracy of specific diagnosis of these injuries. METHODS The study was accomplished by measurement of ROM throughout axial rotation, lateral bending, and flexion and extension, using a validated finite element model of the cervical spine that was modified to simulate hyperextension and/or hyperflexion injuries. RESULTS It was found that the kinematic difference between hyperextension and hyperflexion injuries was minimal throughout the combined flexion and extension ROM measurement that is commonly used for clinical diagnosis of cervical ligamentous injury. However, the two injuries demonstrated substantially different ROM under axial rotation and lateral bending. CONCLUSIONS It is recommended that other bending axes beyond flexion and extension are incorporated into clinical diagnosis of cervical ligamentous injury.
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Affiliation(s)
- P Devin Leahy
- Department of Physics and Engineering, Fort Lewis College, 1000 Rim Drive, Durango, CO, 81301, USA.
| | - Christian M Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, 80523, USA
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, 80523, USA
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
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Cronin DS. Finite element modeling of potential cervical spine pain sources in neutral position low speed rear impact. J Mech Behav Biomed Mater 2013; 33:55-66. [PMID: 23466282 DOI: 10.1016/j.jmbbm.2013.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 12/10/2012] [Accepted: 01/08/2013] [Indexed: 11/19/2022]
Abstract
The rate of soft tissue sprain/strain injuries to the cervical spine and associated cost continue to be significant; however, the physiological nature of this injury makes experimental tests challenging while aspects such as occupant position and musculature may contribute to significant variability in the current epidemiological data. Several theories have been proposed to identify the source of pain associated with whiplash. The goal of this study was to investigate three proposed sources of pain generation using a detailed numerical model in rear impact scenarios: distraction of the capsular ligaments; transverse nerve root compression through decrease of the intervertebral foramen space; and potential for damage to the disc based on the extent of rotation and annulus fibre strain. There was significant variability associated with experimental measures, where the range of motion data overlapped ultimate failure data. Average data values were used to evaluate the model, which was justified by the use of average mechanical properties within the model and previous studies demonstrating predicted response and failure of the tissues was comparable to average response values. The model predicted changes in dimension of the intervertebral foramen were independent of loading conditions, and were within measured physiological ranges for the impact severities considered. Disc response, measured using relative rotation between intervertebral bodies, was below values associated with catastrophic failure or avulsion but exceeded the average range of motion values. Annulus fibre strains exceeded a proposed threshold value at three levels for 10g impacts. Capsular ligament strain increased with increasing impact severity and the model predicted the potential for injury at impact severities from 4g to 15.4g, when the range of proposed distraction corresponding to sub-catastrophic failure was exceeded, in agreement with the typically reported values of 9-15g. This study used an enhanced neck finite element model with active musculature to investigate three potential sources of neck pain resulting from rear impact scenarios and identified capsular ligament strain and deformation of the disc as potential sources of neck pain in rear impact scenarios.
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Affiliation(s)
- Duane S Cronin
- University of Waterloo, Mechanical Engineering, 200 University Avenue West, Waterloo, Ontario, Canada N2L 3G1.
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19
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The effects of ligamentous injury in the human lower cervical spine. J Biomech 2012; 45:2668-72. [PMID: 22939289 DOI: 10.1016/j.jbiomech.2012.08.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 08/02/2012] [Accepted: 08/10/2012] [Indexed: 11/20/2022]
Abstract
Damage is often sustained by the anterior longitudinal ligament (ALL) and ligamentum flavum (LF) in the cervical spine subsequent to whiplash or other cervical trauma. These ligaments afford substantial cervical stability when healthy, but the ability of the ALL and LF to stabilize the spine when injured is not as conclusively studied. In order to address this issue, the current study excised ALL and LF tissues from cadaveric spines and experimentally simulated whiplash-type damage to the isolated ligaments. Stiffnesses and toe region lengths were measured for both the uninjured and damaged states. These ligamentous mechanical properties were then inputted into a previously-validated finite element (FE) model of the cervical spine and the kinematic effects of various clinically relevant combinations of ligamentous injury were predicted. The data indicated three and five-fold increases in toe region length for the LF and ALL injury variants, respectively. These toe length distensions resulted in FE predictions of supra-physiologic ranges of motion, and these motions were comparable to spines with no ligamentous support. Finally, a set of cadaveric cervical spine ligament-sectioning experiments confirmed the FE predictions and supported the finding that partial injury to the relevant ligaments produces equivalent cervical kinematic signatures to spines that have completely compromised ALL and LF tissues.
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20
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Davis CG. Mechanisms of chronic pain from whiplash injury. J Forensic Leg Med 2012; 20:74-85. [PMID: 23357391 DOI: 10.1016/j.jflm.2012.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 05/03/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
Abstract
This article is to provide insights into the mechanisms underlying chronic pain from whiplash injury. Studies show that injury produces plasticity changes of different neuronal structures that are responsible for amplification of nociception and exaggerated pain responses. There is consistent evidence for hypersensitivity of the central nervous system to sensory stimulation in chronic pain after whiplash injury. Tissue damage, detected or not by the available diagnostic methods, is probably the main determinant of central hypersensitivity. Different mechanisms underlie and co-exist in the chronic whiplash condition. Spinal cord hyperexcitability in patients with chronic pain after whiplash injury can cause exaggerated pain following low intensity nociceptive or innocuous peripheral stimulation. Spinal hypersensitivity may explain pain in the absence of detectable tissue damage. Whiplash is a heterogeneous condition with some individuals showing features suggestive of neuropathic pain. A predominantly neuropathic pain component is related to a higher pain/disability level.
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21
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Ivancic PC. Cervical neural space narrowing during simulated rear crashes with anti-whiplash systems. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:879-86. [PMID: 22270248 DOI: 10.1007/s00586-012-2159-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 01/03/2012] [Accepted: 01/11/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE Chronic radicular symptoms have been documented in whiplash patients, potentially caused by cervical neural tissue compression during an automobile rear crash. Our goals were to determine neural space narrowing of the lower cervical spine during simulated rear crashes with whiplash protection system (WHIPS) and active head restraint (AHR) and to compare these data to those obtained with no head restraint (NHR). We extrapolated our results to determine the potential for cord, ganglion, and nerve root compression. METHODS Our model, consisting of a human neck specimen within a BioRID II crash dummy, was subjected to simulated rear crashes in a WHIPS seat (n = 6, peak 12.0 g and ΔV 11.4 kph) or AHR seat and subsequently with NHR (n = 6, peak 11.0 g and ΔV 10.2 kph with AHR; peak 11.5 g and ΔV 10.7 kph with NHR). Cervical canal and foraminal narrowing were computed and average peak values statistically compared (P < 0.05) between WHIPS, AHR, and NHR. RESULTS Average peak canal and foramen narrowing could not be statistically differentiated between WHIPS, AHR, or NHR. Peak narrowing with WHIPS or AHR was 2.7 mm for canal diameter and 1.6 mm, 2.7 mm, and 5.9 mm(2) for foraminal width, height and area, respectively. CONCLUSIONS While lower cervical spine cord compression during a rear crash is unlikely in those with normal canal diameters, our results demonstrated foraminal kinematics sufficient to compress spinal ganglia and nerve roots. Future anti-whiplash systems designed to reduce cervical neural space narrowing may lead to reduced radicular symptoms in whiplash patients.
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Affiliation(s)
- Paul C Ivancic
- Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 333 Cedar St, P.O. Box 208071, New Haven, CT 06520-8071, USA.
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Nicholson KJ, Quindlen JC, Winkelstein BA. Development of a duration threshold for modulating evoked neuronal responses after nerve root compression injury. STAPP CAR CRASH JOURNAL 2011; 55:1-24. [PMID: 22869302 DOI: 10.4271/2011-22-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cervical nerve roots are susceptible to compression injuries of various durations. The duration of an applied compression has been shown to contribute to both the onset of persistent pain and also the degree of spinal cellular and molecular responses related to nociception. This study investigated the relationship between peripherally-evoked activity in spinal cord neurons during a root compression and the resulting development of axonal damage. Electrically-evoked spikes were measured in the spinal cord as a function of time during and after (post-compression) a 15 minute compression of the C7 nerve root. Compression to the root significantly (p=0.035) reduced the number of spikes that were evoked over time relative to sham. The critical time for compression to maximally reduce evoked spikes was 6.6±3.0 minutes. A second study measured the post- compression evoked neuronal activity following compression applied for a shorter, sub-threshold time (three minutes). Ten minutes after compression was removed, the discharge rate remained significantly (p=0.018) less than baseline by 58±25% relative to sham after the 15 minute compression, but returned to within 3±33% of baseline after the three minute compression. Axonal damage was evident in the nerve root at day seven after nerve root compression only after a 15 minute compression. These studies demonstrate that even a transient mechanical insult to the nerve root is sufficient to induce sustained neuronal dysfunction and axonal pathology associated with pain, and results provide support that such minor neural tissue traumas can actually induce long-lasting functional deficits.
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Affiliation(s)
- Kristen J Nicholson
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104-6321, USA
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Rothman SM, Nicholson KJ, Winkelstein BA. Time-Dependent Mechanics and Measures of Glial Activation and Behavioral Sensitivity in a Rodent Model of Radiculopathy. J Neurotrauma 2010; 27:803-14. [DOI: 10.1089/neu.2009.1045] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Sarah M. Rothman
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristen J. Nicholson
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Beth A. Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Ebraheim NA, Liu J, Ramineni SK, Liu X, Xie J, Hartman RG, Goel VK. Morphological changes in the cervical intervertebral foramen dimensions with unilateral facet joint dislocation. Injury 2009; 40:1157-60. [PMID: 19486975 DOI: 10.1016/j.injury.2009.01.112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Revised: 01/13/2009] [Accepted: 01/14/2009] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many investigators have conducted studies to determine the biomechanics, causes, complications and treatment of unilateral facet joint dislocation in the cervical spine. However, there is no quantitative data available on morphological changes in the intervertebral foramen of the cervical spine following unilateral facet joint dislocation. These data are important to understand the cause of neurological compromise following unilateral facet joint dislocation. METHODS Eight embalmed human cadaver cervical spine specimens ranging from level C1-T1 were used. The nerve roots of these specimens at C5-C6 level were marked by wrapping a 0.12mm diameter wire around them. Unilateral facet dislocation at C5-C6 level was simulated by serially sectioning the corresponding ligamentous structures. A CT scan of the specimens was obtained before and after the dislocation was simulated. A sagittal plane through the centre of the pedicle and facet joint was constructed and used for measurement. The height and area of the intervertebral foramen, the facet joint space, nerve root diameter and area, and vertebral alignment both before and after dislocation were evaluated. RESULTS The intervertebral foramen area changed from 50.72+/-0.88mm(2) to 67.82+/-4.77mm(2) on the non-dislocated side and from 41.39+/-1.11mm(2) to 113.77+/-5.65mm(2) on the dislocated side. The foraminal heights changed from 9.02+/-0.30mm to 10.52+/-0.50mm on the non-dislocated side and 10.43+/-0.50mm to 17.04+/-0.96mm on the dislocated side. The facet space area in the sagittal plane changed from 6.80+/-0.80mm(2) to 40.02+/-1.40mm(2) on the non-dislocated side. The C-5 anterior displacement showed a great change from 0mm to 5.40+/-0.24mm on the non-dislocated side and from 0mm to 3.42+/-0.20mm on the dislocated side. Neither of the nerve roots on either side showed a significant change in size. CONCLUSIONS The lack of change in nerve root area indicates that the associated nerve injury with unilateral facet joint dislocation is probably due to distraction rather than due to direct nerve root compression.
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Affiliation(s)
- Nabil A Ebraheim
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH 43614, USA
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Siegmund GP, Winkelstein BA, Ivancic PC, Svensson MY, Vasavada A. The anatomy and biomechanics of acute and chronic whiplash injury. TRAFFIC INJURY PREVENTION 2009; 10:101-112. [PMID: 19333822 DOI: 10.1080/15389580802593269] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Whiplash injury is the most common motor vehicle injury, yet it is also one of the most poorly understood. Here we examine the evidence supporting an organic basis for acute and chronic whiplash injuries and review the anatomical sites within the neck that are potentially injured during these collisions. For each proposed anatomical site--facet joints, spinal ligaments, intervertebral discs, vertebral arteries, dorsal root ganglia, and neck muscles--we present the clinical evidence supporting that injury site, its relevant anatomy, the mechanism of and tolerance to injury, and the future research needed to determine whether that site is responsible for some whiplash injuries. This article serves as a snapshot of the current state of whiplash biomechanics research and provides a roadmap for future research to better understand and ultimately prevent whiplash injuries.
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Affiliation(s)
- Gunter P Siegmund
- MEA Forensic Engineers & Scientists, 11-11151 Horseshoe Way, Richmond, BC, Canada.
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26
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Hypoesthesia Occurs in Acute Whiplash Irrespective of Pain and Disability Levels and the Presence of Sensory Hypersensitivity. Clin J Pain 2008; 24:759-66. [DOI: 10.1097/ajp.0b013e3181773b95] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Whiplash (Grade II) and Cervical Radiculopathy Share a Similar Sensory Presentation: An Investigation Using Quantitative Sensory Testing. Clin J Pain 2008; 24:595-603. [PMID: 18716498 DOI: 10.1097/ajp.0b013e31816ed4fc] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lo YL, Tan YE, Fook-Chong S, Boolsambatra P, Yue WM, Chan LL, Tan SB. Role of Spinal Inhibitory Mechanisms in Whiplash Injuries. J Neurotrauma 2007; 24:1055-67. [PMID: 17600520 DOI: 10.1089/neu.2006.0222] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Whiplash injury, commonly encountered in road traffic accidents, is a major cause of morbidity. Its pathophysiology is not well understood, and diagnosis remains clinical. Imaging and electrophysiological methods have not provided objective diagnostic evidence. Availability of a sensitive and specific diagnostic method would be of high clinical interest. We studied 20 consecutive patients with chronic whiplash injury. Despite persistent symptoms, most had minimal neurological findings. Cutaneous silent period (CSP), a nociceptive spinal inhibitory electromyographic reflex, showed 90% sensitivity and 90% specificity for its diagnosis. In contrast, only two patients (10%) had abnormal transcranial magnetic stimulation findings, and another two (10%) showed abnormal electromyography. Magnetic resonance imaging (MRI) showed cervical cord abnormalities in only two of 20 (10%) patients. None of the patients had abnormal somatosensory evoked potential studies. Our findings suggest that neurological dysfunction of whiplash may occur at several possible spinal cord localities in the CSP functional pathway. The use of this simple, quick, and sensitive method is advocated in the diagnostic work up of whiplash injury.
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Affiliation(s)
- Yew-Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore.
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Abstract
STUDY DESIGN A retrospective study of 101 consecutive polytrauma patients with regard to whiplash injury. OBJECTIVES To investigate the incidence and evaluate long-term outcome of whiplash injury following high-energy trauma. SUMMARY OF BACKGROUND DATA Chronic whiplash injury has been widely reported in the literature, following low-energy trauma. Very few studies exist on whiplash injury following high-energy trauma. METHODS A total of 101 consecutive polytrauma patients admitted to our Level I Trauma Center over a 2-year period, fulfilling the inclusion criteria (age >18 years, high-energy trauma [a fall from a height >2 m, road traffic accidents with speed >30 km/h], and Injury Severity Score >16), were assessed. Whiplash injury was defined according to Quebec Task Force guidelines. The study group (n = 13) included patients who developed whiplash injury symptoms and the control group (n = 88) those who did not. The Neck Disability Index was calculated as an outcome measure for patients complaining of whiplash injury symptoms. The mean follow-up was 17 months. The chi2 and Student t tests were used for the statistical analysis (SPSS 12.1; SPSS, Inc., Chicago, IL). RESULTS Only 13 out of 101 patients (1 female/12 male) (13%) complained of whiplash injury. There was a significantly higher rate of neck pain at triage (P < 0.001) and higher combined mean of Abbreviated Injury Score of upper torso (P < 0.0001) in the study group, elucidating the cause of whiplash injury. The Neck Disability Index was <24 points, indicating only mild-to-moderate disability in these patients. Whiplash injury incidence in this study (13%) was similar to the incidence of neck pain in the general population. CONCLUSIONS The incidence of whiplash injury following polytrauma was found to be low in our study. There is no dose-response relation between magnitude of trauma severity and incidence of whiplash injury.
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Affiliation(s)
- Peter V Giannoudis
- Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, United Kingdom.
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Tominaga Y, Maak TG, Ivancic PC, Panjabi MM, Cunningham BW. Head-turned rear impact causing dynamic cervical intervertebral foramen narrowing: implications for ganglion and nerve root injury. J Neurosurg Spine 2006; 4:380-7. [PMID: 16703905 DOI: 10.3171/spi.2006.4.5.380] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT A rotated head posture at the time of vehicular rear impact has been correlated with a higher incidence and greater severity of chronic radicular symptoms than accidents occurring with the occupant facing forward. No studies have been conducted to quantify the dynamic changes in foramen dimensions during head-turned rear-impact collisions. The objectives of this study were to quantify the changes in foraminal width, height, and area during head-turned rear-impact collisions and to determine if dynamic narrowing causes potential cervical nerve root or ganglion impingement. METHODS The authors subjected a whole cervical spine model with muscle force replication and a surrogate head to simulated head-turned rear impacts of 3.5, 5, 6.5, and 8 G following a noninjurious 2-G baseline acceleration. Continuous dynamic foraminal width, height, and area narrowing were recorded, and peaks were determined during each impact; these data were then statistically compared with those obtained at baseline. The authors observed significant increases (p < 0.05) in mean peak foraminal width narrowing values greater than baseline values, of up to 1.8 mm in the left C5-6 foramen at 8 G. At the right C2-3 foramen, the mean peak dynamic foraminal height was significantly narrower than baseline when subjected to rear-impacts of 5 and 6.5 G, but no significant increases in foraminal area were observed. Analysis of the results indicated that the greatest potential for cervical ganglion compression injury existed at C5-6 and C6-7. Greater potential for ganglion compression injury existed at C3-4 and C4-5 during head-turned rear impact than during head-forward rear impact. CONCLUSIONS Extrapolation of present results indicated potential ganglion compression in patients with a non-stenotic foramen at C5-6 and C6-7; in patients with a stenotic foramen the injury risk greatly increases and spreads to include the C3-4 through C6-7 as well as C4-5 through C6-7 nerve roots.
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Affiliation(s)
- Yasuhiro Tominaga
- Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut 06520-8071, USA
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