The Y-shaped trabecular bone structure in the odontoid process of the axis: a CT scan study in 54 healthy subjects and biomechanical considerations

Are Whiplash-Associated Disorders and Temporomandibular Disorders in a Trauma Related Cause and Effect Relationship? A Review

Background: Whiplash is associated with a wide variety of clinical manifestations, including headache, neck pain, cervical rigidity, shoulder and back pain, paresthesia, vertigo, and temporomandibular disorders (TMDs). Previous studies reported that TMDs are more common in individuals with chronic whiplash-associated disorders (WAD) than in the general population; however, the pathophysiology and mechanism of this relationship are still not well understood. Methods: A PubMed and Ovid EMBASE review was performed to identify all studies addressing the trauma related cause and effect relationship between WAD and TMDs from January 2003 to March 2023. Results: After screening for eligibility and inclusion criteria, a total of 16 articles met the selection criteria. The various included studies discussed different aspects of the association between WDA and TMDs, including changes in the coordination and amplitude of jaw opening, the severity of the associated symptoms/signs in cases of WAD, the degree of fatigue and psychological stress, difficulty in feeding, cervical and myofascial pain, changes in the MRI signal at various muscle points, muscle tenderness, and quality of life. Conclusions: In this review, we summarized the clinical evidence of any trauma related cause and effect relationship between whiplash and TMDs. An accurate screening of the previous literature showed that, in conclusion, the relationship between whiplash and TMDs is still unclear.

Influence of the Backward Fall Technique on the Transverse Linear Acceleration of the Head during the Fall

BACKGROUND

The formation of large accelerations on the head and cervical spine during a backward fall is particularly dangerous due to the possibility of affecting the central nervous system (CNS). It may eventually lead to serious injuries and even death. This research aimed to determine the effect of the backward fall technique on the linear acceleration of the head in the transverse plane in students practicing various sports disciplines.

METHODS

The study involved 41 students divided into two study groups. Group A consisted of 19 martial arts practitioners who, during the study, performed falls using the side aligning of the body technique. Group B consisted of 22 handball players who, during the study, performed falls using the technique performed in a way similar to a gymnastic backward roll. A rotating training simulator (RTS) was used to force falls, and a Wiva^® Science apparatus was used to assess acceleration.

RESULTS

The greatest differences in backward fall acceleration were found between the groups during the buttocks' contact with the ground. Larger changes in head acceleration were noted in group B.

CONCLUSIONS

The lower changes in head acceleration obtained in physical education students falling with a lateral body position compared to students training handball indicate their lower susceptibility to head, cervical spine, and pelvis injuries when falling backwards as caused by horizontal force.

Brown-Sequard syndrome associated with hangman fracture after blunt trauma: A case report

Background:

The association of Brown-Sequard syndrome (BSS) and hangman fracture (HF) is rarely reported.

Case Description:

We present a case of a 28-year-old female with a HF sustained after a motor vehicle accident and BSS. Diagnosis was established based on typical loass of motor function ipsilaterally and loss of pain and temperature sensation contralaterally. Furthermore, magnetic resonance imaging delineated the location of the injury to the right side of the spinal cord at cervical level 2. Near-complete neurological recovery was achieved after anterior fusion and fixation at cervical level 2–3 after 8 months of follow-up.

Conclusion:

HF from blunt trauma can be directly associated with BSS. Surgery was effective and associated with a near-complete resolution of symptoms.

Virtual Reality in Neurosurgery: Beyond Neurosurgical Planning

Background: While several publications have focused on the intuitive role of augmented reality (AR) and virtual reality (VR) in neurosurgical planning, the aim of this review was to explore other avenues, where these technologies have significant utility and applicability. Methods: This review was conducted by searching PubMed, PubMed Central, Google Scholar, the Scopus database, the Web of Science Core Collection database, and the SciELO citation index, from 1989–2021. An example of a search strategy used in PubMed Central is: “Virtual reality” [All Fields] AND (“neurosurgical procedures” [MeSH Terms] OR (“neurosurgical” [All Fields] AND “procedures” [All Fields]) OR “neurosurgical procedures” [All Fields] OR “neurosurgery” [All Fields] OR “neurosurgery” [MeSH Terms]). Using this search strategy, we identified 487 (PubMed), 1097 (PubMed Central), and 275 citations (Web of Science Core Collection database). Results: Articles were found and reviewed showing numerous applications of VR/AR in neurosurgery. These applications included their utility as a supplement and augment for neuronavigation in the fields of diagnosis for complex vascular interventions, spine deformity correction, resident training, procedural practice, pain management, and rehabilitation of neurosurgical patients. These technologies have also shown promise in other area of neurosurgery, such as consent taking, training of ancillary personnel, and improving patient comfort during procedures, as well as a tool for training neurosurgeons in other advancements in the field, such as robotic neurosurgery. Conclusions: We present the first review of the immense possibilities of VR in neurosurgery, beyond merely planning for surgical procedures. The importance of VR and AR, especially in “social distancing” in neurosurgery training, for economically disadvantaged sections, for prevention of medicolegal claims and in pain management and rehabilitation, is promising and warrants further research.

Influence of the Backward Fall Technique on the Sagittal Linear Acceleration of the Head during a Fall

(1) Background: This research aimed to determine the effect of the backward fall technique on the sagittal linear acceleration of the head in students training in different sports. (2) Methods: The study involved 41 students divided into two study groups. Group A included 19 students training in martial arts who practised falls with side aligning of the body. Group B included 22 handball players who practised falls performed in a way similar to a gymnastic backward roll. A rotating training simulator (RTS) was used to force falls, and Wiva ^® Science apparatus was used to assess acceleration. (3) Results: Significant changes in head acceleration were only obtained between immediate fall tests (IFTs) and forced fall tests (FFTs) in group B. Significant differences were noted between groups for the IFT and FFT. Greater changes in head acceleration were noted in group B. (4) Conclusions: Smaller changes in head acceleration in group A students indicate a lower susceptibility to head, pelvic and cervical spine injuries in falls performed backward with side aligning of the body. This technique in group A limited the differences in head acceleration between IFTs and FFTs. Negative acceleration values obtained in group B confirmed that the head may suffer a moment of force, tilting it backwards, but then forward when the buttocks hit the ground.

Quality of Life and Activities of Daily Living among Patients with Complete Cervical Spinal Cord Injury and Surgical Treatment in Vietnam

Spinal cord injury (SCI) is defined as temporary or permanent changes in spinal cord function and reflex activity. The objective of this study is to evaluate health-related quality of life (HRQoL) and activities of daily living (ADL) among postoperative surgery patients with complete cervical SCI in Vietnam and to explore the factors associated with these indices. A cross-sectional study was conducted on 88 adults in Vietnam from June 2018 to June 2019. The EQ-5D-5L, ADL, and instrumental activities of daily living (IADL) were applied. Multivariate Tobit regression was adopted to determine factors that were associated with HRQOL, ADL, and IADL. Results: Participants who were in American Spinal Cord Injury Association (ASIA) scale group A (ASIA-A) had the lowest ADL, IADL index, and HRQOL score (p < 0.001). HRQoL and ADL were affected by health insurance coverage, occupation, type of fracture, and IADL. Meanwhile, IADL was significantly associated with living areas and ASIA. Low HRQoL among patients suffering from SCI was observed. Attention should be given to outcomes related to a disability during clinical treatment and should be treated effectively in the recovery.

Long-term outcomes of surgical management in subtypes of Chiari malformation

Objective: Chiari malformations (CMs) are a heterogeneous group of disorders defined by anatomic anomalies of the cerebellum, brainstem, and craniovertebral junction (CVJ). The aims of this study are to establish the demographic and clinical features, incidence, surgical procedures, and outcomes in large series of old and new subtypes of CMs.Material and Methods: All patients were evaluated and operated on for CM-0, 1, and 1.5 between 1985 and 2016. The patients were grouped into various subtypes. Demographic data, additional diseases, clinical features, surgical procedures, complications and outcomes were recorded.Results: 191 patients who underwent various surgical procedures were evaluated. Their mean age was 37.21 ± 9.89. We detected 15 cases of CM-0 (7.8%), 121 cases of CM-1 (63.4%), 55 cases of CM-1.5 (28.8%). In total there were 191 cases, and 220 surgical procedures were performed. 29 (13.2%) of all surgical procedure was reoperations and secondary operations. SM Cyst is found to be decreased in 72 (76.5%) patients, unchanged in 14 (14.8%) and increased in 8(8.5%) of 94 patients radiologically. Clinical outcomes are better for 131 (65.8%), same for 31 (16.2%) and worse for 9 (15%).Conclusion: This study with 172 patients is a large series that includes CM-0, 1, and 1.5 subtypes. CM-1.5 also differs for symptom presentation and durations from CM-1. There are more neurological abnormalities in patients with SM. CVD alone are an effective, useful and safe surgical procedure for CM-0, CM-1 and CM-1.5. Surgical procedure, SM existence, and symptom duration have powerful effects on outcomes.

Temporomandibular Disorders and Fibromyalgia: A Narrative Review

Temporomandibular disorder (TMD) and fibromyalgia (FM) have some clinical characteristics in common, for instance the chronic evolution, the pathophysiology incompletely understood and a multifactorial genesis. The incidence and the relationship between TMD and FM patients are the aims of this review. A MEDLINE and Pubmed search was performed for the key words “temporomandibular disorder” AND “fibromyalgia” from 2000 to present. A total of 19 papers were included in our review, accounting for 5449 patients. Ten studies, reporting a total of 4945 patients with TMD, showed that only 16.5% of these patients had diagnosis of FM, whereas 12 studies, reporting a total of 504 patients with FM, demonstrated that 77.0% of these patients had diagnosis of TMD. A comorbid relationship exists between TMD and FM. The complexity of both diseases shows the importance of a multimodal and interdisciplinary.

Multiple Brain Abscesses of Odontogenic Origin. May Oral Microbiota Affect Their Development? A Review of the Current Literature

In the last few years, the role of oral microbiota in the setting of oral diseases such as caries, periodontal disease, oral cancer and systemic infections, including rheumatoid arthritis, cardiovascular disease and brain abscess (BA), has attracted the attention of physicians and researchers. Approximately 5–7% of all BAs have an odontogenic origin, representing an important pathological systemic condition with a high morbidity and mortality. A systematic search of two databases (Pubmed and Ovid EMBASE) was performed for studies published up to 5 January 2021, reporting multiple BAs attributed to an odontogenic origin. According to PRISMA guidelines, we included a total of 16 papers reporting multiple BAs due to odontogenic infections. The aim of this review is to investigate the treatment modality and the clinical outcome of patients with multiple BAs due to odontogenic infections, as well as to identify the most common pathogens involved in this pathological status and their role, in the oral microbiota, in the onset of oral infections. A multidisciplinary approach is essential in the management of multiple BAs. Further studies are required to understand better the role of microbiota in the development of multiple BAs.

Analysis of the Associations between Arthritis and Fall Histories in Korean Adults

(1) Background: the purpose of the present study was to analyze the associations between arthritis and fall histories in Korean adults. (2) Methods: data from the 2015 and 2017 Korean Community Health Survey were analyzed. In total, 322,962 participants aged ≥40 years were included. The participants were divided into two different groups. First, the participants were divided into the ‘arthritis (osteoarthritis or rheumatoid arthritis) for entire life’ and ‘nonarthritis for entire life (comparison I)’ groups. Subsequently, the participants were divided into the ‘current arthritis’ and ‘noncurrent arthritis (comparison II)’ groups. Afterwards, we analyzed the prevalence odds ratios (pORs) of the fall histories of the participants using a logistic regression analysis with the 95% confidence interval (CI). The variables of income, education level, region of residence, smoking status, alcohol consumption, obesity, subjective health status, stress level, physical activity, and sleep hours were adjusted for as covariates. (3) Results: both the arthritis for entire life and current arthritis groups had higher prevalence rates of falls than the comparison I and comparison II groups, respectively (each p < 0.001). The pORs of falling ≥1 time and ≥2 times per year in the arthritis for the entire life group were 1.42 (95% CI = 1.38–1.46) and 1.69 (95% CI = 1.62–1.76), respectively. The adjusted pORs for falling ≥1 time and ≥2 times per year in the current arthritis group were 1.35 (95% CI = 1.31–1.39) and 1.56 (95% CI = 1.50–1.63), respectively. (4) Conclusions: previous arthritis has a significant impact on the risk of falling.

Developing an Adaptive 3D Vertebrae Model of Scoliosis Patients for Customize Garment Design

Scoliosis is one of the most frequently occurring morphological problems in people. People with such an abnormal curve of the spine face a huge problem, not only from the medical point of view but also from that of garment design and production processes. The current paper brings a novel designing technique to develop an adaptive 3D model of the complicated anatomical shape of the human vertebrae using 3D digitization technologies. Even though it is not as accurate as scanning approaches, it is accurate enough for several applications, including visualization and constructing statistical shape models. Thus, the adaptive model will further integrate with the full skeleton and then to the body shapes of scoliosis patients, not only for an easy garment design process but also to produce comfortable and high-performance garments. The model has also the benefit of adjusting for each tissue to all kinds of spine parameters, such as the height and the angles of the bones and disks (especially the three characteristic planes: sagittal, coronal, and transverse). Thus, the full adaptive skeleton model and later its garment design system, considering the current adaptive vertebrae model for fitted, comfortable and well-performing scoliosis patients garment products, could be developed.

Reliability of IMU-Derived Static Balance Parameters in Neurological Diseases

Static balance is a commonly used health measure in clinical practice. Usually, static balance parameters are assessed via force plates or, more recently, with inertial measurement units (IMUs). Multiple parameters have been developed over the years to compare patient groups and understand changes over time. However, the day-to-day variability of these parameters using IMUs has not yet been tested in a neurogeriatric cohort. The aim of the study was to examine day-to-day variability of static balance parameters of five experimental conditions in a cohort of neurogeriatric patients using data extracted from a lower back-worn IMU. A group of 41 neurogeriatric participants (age: 78 ± 5 years) underwent static balance assessment on two occasions 12-24 h apart. Participants performed a side-by-side stance, a semi-tandem stance, a tandem stance on hard ground with eyes open, and a semi-tandem assessment on a soft surface with eyes open and closed for 30 s each. The intra-class correlation coefficient (two-way random, average of the k raters' measurements, ICC2, k) and minimal detectable change at a 95% confidence level (MDC95%) were calculated for the sway area, velocity, acceleration, jerk, and frequency. Velocity, acceleration, and jerk were calculated in both anterior-posterior (AP) and medio-lateral (ML) directions. Nine to 41 participants could successfully perform the respective balance tasks. Considering all conditions, acceleration-related parameters in the AP and ML directions gave the highest ICC results. The MDC95% values for all parameters ranged from 39% to 220%, with frequency being the most consistent with values of 39-57%, followed by acceleration in the ML (43-55%) and AP direction (54-77%). The present results show moderate to poor ICC and MDC values for IMU-based static balance assessment in neurogeriatric patients. This suggests a limited reliability of these tasks and parameters, which should induce a careful selection of potential clinically relevant parameters.

Posture and Health: Are the Biomechanical Postural Evaluation and the Postural Evaluation Questionnaire Comparable to and Predictive of the Digitized Biometrics Examination?

Background: Postural tone alterations are expressions of myofascial and, therefore, of structural, visceral, and emotional disorders. To prevent these disorders, this study proposes a quantitative investigation method which administers a postural evaluation questionnaire and a postural biomechanical evaluation to 100 healthy subjects. Methods: The reliability of the method is studied by comparing both assessments with digitized biometrics. In addition, 50 subjects undergo the biomechanical evaluation form twice, by four different operators, to study the intraoperative repeatability. Results: The results show a satisfactory overlap between the results obtained with the postural evaluation questionnaire and the postural biomechanical evaluation compared to computerized biometrics. Furthermore, intraoperative repeatability in the use of the biomechanical evaluation form is demonstrated thanks to a minimal margin of error. Conclusions: This experience suggests the importance of undertaking this path in both the curative and the preventive sphere on a large scale and on different types of people who easily, and even unknowingly, may face dysfunctional syndromes, not only structural and myofascial but also consequently of the entire body’s homeostasis.

Lower-Extremity Intra-Joint Coordination and Its Variability between Fallers and Non-Fallers during Gait

Falling is one of the most common causes of hip fracture and death in older adults. A comparison of the biomechanics of the gait in fallers and non-fallers older adults, especially joint coordination and coordination variability, enables the understanding of mechanisms that underpin falling. Therefore, we compared lower-extremity intra-joint coordination and its variability between fallers and non-fallers older adults during gait. A total of 26 older adults, comprising 13 fallers, took part in this study. The participants walked barefoot at a self-selected speed on a 10-m walkway. Gait kinematics in the dominant leg during 10 cycles were captured with 10 motion tracking cameras at a sampling rate of 100 Hz. Spatiotemporal gait parameters, namely, cadence, walking speed, double support time, stride time, width, and length, as well as intra-joint coordination and coordination variability in the sagittal plane were compared between the two groups. Results showed that fallers walked with significant lower cadence, walking speed, and stride length but greater double support and stride time than non-fallers. Significant differences in the ankle-to-knee, knee-to-hip, and ankle-to-hip coordination patterns between fallers and non-fallers and less coordination variability in fallers compared to non-fallers in some instants of the gait cycles were observed. The differences in spatiotemporal gait parameters in fallers compared to non-fallers may indicate an adaptation resulting from decreased efficiency to decrease the risk of falling. Moreover, the differences in segment coordination and its variability may indicate an inconsistency in neuromuscular control. It may also indicate reduced ability to control the motion of the leg in preparation for foot contact with the ground and the knee and ankle motions during loading response. Finally, such differences may show less control in generating power during the push-off phase in fallers.

Comparison of Trabecular Bone Mineral Density Measurement Using Hounsfield Unit and Trabecular Microstructure in Orthodontic Patients Using Cone-Beam Computed Tomography

The aim of this study was to measure the bone mineral density of specific regions of maxilla, mandible, and first cervical vertebra using the Hounsfield unit and trabecular microstructure pattern analysis and to compare the two methods. In this study, cone-beam computed tomography (CBCT) images were obtained from 58 patients. Trabecular thickness, trabecular number, trabecular separation, and bone volume fraction were measured in 484 regions for trabecular microstructure parameters and Hounsfield unit was measured for the grayscale value. There was no difference in bone mineral density between the right and left side in every site and between males and females. Trabecular thickness and trabecular number were high in the order of anterior base of the maxilla, mandibular body, first cervical vertebra, and mandibular condyle. Bone volume fraction and Hounsfield unit were high in the order of anterior base of the maxilla, mandibular body, mandibular condyle, and first cervical vertebra (p < 0.05). Trabecular thickness, trabecular number, and bone volume fraction was positively correlated to the Hounsfield unit, and trabecular separation was negatively correlated to the Hounsfield unit (p < 0.005). This study suggests that it is possible to compare the bone mineral density of trabecular bone in various sites using the Hounsfield unit and trabecular microstructure pattern analysis.

Cranio-Vertebral Junction Triangular Area: Quantification of Brain Stem Compression by Magnetic Resonance Images

(1) Background: Most of the currently used radiological criteria for craniovertebral junction (CVJ) were developed prior to the popularity of magnetic resonance images (MRIs). This study aimed to evaluate the efficacy of a novel triangular area (TA) calculated on MRIs for pathologies at the CVJ. (2) Methods: A total of 702 consecutive patients were enrolled, grouped into three: (a) Those with pathologies at the CVJ (n = 129); (b) those with underlying rheumatoid arthritis (RA) but no CVJ abnormalities (n = 279); and (3) normal (control; n = 294). TA was defined on T2-weighted MRIs by three points: The lowest point of the clivus, the posterior-inferior point of C2, and the most dorsal indentation point at the ventral brain stem. Receiver operating characteristic (ROC) analysis was used to correlate the prognostic value of the TA with myelopathy. Pre- and post-operative TA values were compared for validation. (c) Results: The CVJ-pathology group had the largest mean TA (1.58 ± 0.47 cm²), compared to the RA and control groups (0.96 ± 0.31 and 1.05 ± 0.26, respectively). The ROC analysis calculated the cutoff-point for myelopathy as 1.36 cm² with the area under the curve at 0.93. Of the 81 surgical patients, the TA was reduced (1.21 ± 0.37 cm²) at two-years post-operation compared to that at pre-operation (1.67 ± 0.51 cm²). Moreover, intra-operative complete reduction of the abnormalities could further decrease the TA to 1.03 ± 0.39 cm². (4) Conclusions: The TA, a valid measurement to quantify compression at the CVJ and evaluate the efficacy of surgery, averaged 1.05 cm² in normal patients, and 1.36 cm² could be a cutoff-point for myelopathy and of clinical significance.

Clinical Risk and Overall Survival in Patients with Diabetes Mellitus, Hyperglycemia and Glioblastoma Multiforme. A Review of the Current Literature

The relationship between type 2 diabetes mellitus (DM2) and hyperglycemia with cancer patients remains controversial also in the setting of patients with glioblastoma multiforme (GBM), the most common and aggressive form of astrocytoma with a short overall survival (OS) and poor prognosis. A systematic search of two databases was performed for studies published up to 19 August 2020, reporting the OS of patients with DM2 or high blood sugar level and GBM and the clinical risk of diabetic patients for development of GBM. According to PRISMA guidelines, we included a total of 20 papers reporting clinical data of patients with GBM and diabetes and/or hyperglycemia. The aim of this review was to investigate the effect of DM2, hyperglycemia and metformin on OS of patients with GBM. In addition, we evaluated the effect of these factors on the risk of development of GBM. This review supports accumulating evidence that hyperglycemia, rather than DM2, and elevated BMI are independent risk factors for poor outcome and shorter OS in patients with GBM. GBM patients with normal weight compared to obese, and diabetic patients on metformin compared to other therapies, seems to have a longer OS. Further studies are needed to understand better these associations.

Triangular-Shaped Odontoid Process With Chiari 1 Malformation Patient

Several anatomical variations of osseous structures around the craniovertebral junction (CVJ) have been observed in those presenting with Chiari 1 malformation (CM-1) due to the junction’s unique embryology and its pivotal role in neck stability. During a clinic visit, a 14-year-old female presented with the classic symptoms of CM-1. Upon follow-up imaging and confirmation of the inferiorly displaced cerebellar tonsils, a unique triangular-shaped odontoid process was identified. To our knowledge, this osseous malformation of the dens has not been reported in the current literature. This unique deviation may cause ligamentous instability and decreased motion capacity and predispose a patient to axial fractures. Thus, we aim to further discuss this case, cervical vertebrae axis (C2) embryology, and the resulting clinical significance of this observed odontoid process variant.

Os odontoideum: diagnosis and role of imaging

OBJECTIVE

To elucidate the imaging manifestations of os odontoideum, establish the diagnosis and guide surgical therapy.

METHODS

Clinical and imaging data, including X-ray, CT and MR of 24 patients with os odontoideum, were retrieved and reviewed retrospectively.

RESULTS

Os odontoideum with intact cortex was divided into round, conical and blunt tooth types. Four cases of orthotopic and 20 cases of dystopic os odontoideum were included. There was anterior displacement of the base of the dens in six cases, posterior displacement in nine cases and no displacement in nine cases. A widening of anterior atlanto-axial space was shown in 14 patients with varying degrees. Thickening of the soft tissue posterior to the dens was observed in 19 patients, spinal canal stenosis in 21 patients, cervical myelopathy in 10 patients and craniocervical junction malformation in 9 patients. Posterior C1-C2 pedicle screw fixation and fusion was performed in 12 patients and 4 patients underwent posterior occipito-cervical fixation and fusion.

CONCLUSION

Radiographically, os odontoideum is defined as an independent ossicle of variable size with smooth circumferential cortical margins separated from the axis. Imaging can be used to assess atlanto-axial instability, associated normal or abnormal anatomical structures and guide surgical therapy.