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Study Design: Retrospective medical record review., Objective: The purpose of this study was to describe the incidence of other injuries that commonly occur in conjunction with cervical spine fractures and dislocations., Summary of Background Data: Cervical spine fractures are often associated with other significant traumatic conditions, which may also require prompt diagnosis and management. However, the relative incidences of the injuries that occur in conjunction with various cervical spine fractures have not been well documented., Methods: The radiographic reports of all patients who underwent CT scans of the cervical spine at a single level 1 trauma center over a 10-year period were reviewed. The medical records of individuals with acute, nonpenetrating fractures of the cervical spine were further assessed for any associated traumatic pathology including noncontiguous spine injuries and those affecting other organ systems (i.e., head and neck, intrathoracic, intra-abdominal/pelvic, and nonspinal orthopedic disorders)., Results: A total of 13,896 CT scans of the cervical spine were performed during this 10-year period of which 492 revealed acute fractures and/or dislocations. Of these subjects, 60% had sustained at least one additional injury. Overall, 57% were noted to have extraspinal injuries (34% head and neck, 17% intrathoracic, 10% intra-abdominal/pelvic, and 30% nonspinal orthopedic conditions) and noncontiguous spinal trauma was present in 19% of these cases (8% cervical injuries, 8% thoracic, and 6% lumbar). In general, the rates of associated injuries observed with occipital condyle and C7 fractures were significantly higher than those recorded for other cervical segments., Conclusion: For patients with a known history of cervical spine trauma, the frequencies of associated injuries were similar across all levels of the cervical spine with the exception of the injuries to the craniocervical junctions. In practice, this means that injuries to the cervical spine can likely be grouped together when considering other possible associated injuries. Further elucidation of these injury patterns will likely be useful for facilitating the expedient evaluation and proper management of these individuals.

Study Design: Prospective clinical study., Objective: The purpose of this investigation was to quantify normal cervical range of motion (ROM) and compare these results to those used to perform 15 simulated activities of daily living (ADLs) in asymptomatic subjects., Summary of Background Data: Previous studies looking at cervical ROM during ADLs have been limited and used measuring devices that do not record continuous motion. The purpose of this investigation was to quantify normal cervical ROM and compare these results with those used to perform 15 simulated ADLs in asymptomatic subjects., Methods: A noninvasive electrogoniometer and torsiometer were used to measure the ROM of the cervical spine. The accuracy and reliability of the devices were confirmed by comparing the ROM values acquired from dynamic flexion/extension and lateral bending radiographs to those provided by the device, which was activated while the radiographs were obtained. Intraobserver reliability was established by calculating the intraclass correlation coefficient for repeated measurements on the same subjects by 1 investigator on consecutive days. These tools were employed in a clinical laboratory setting to evaluate the full active ROM of the cervical spines (ie, flexion/extension, lateral bending, and axial rotation) of 60 asymptomatic subjects (30 females and 30 males; age, 20 to 75 y) as well as to assess the functional ROM required to complete 15 simulated ADLs., Results: When compared with radiographic measurements, the electrogoniometer was found to be accurate within 2.3+/-2.2 degrees (mean+/-SD) and the intraobserver reliabilities for measuring the full active and functional ROM were both excellent (intraclass correlation coefficient of 0.96 and 0.92, respectively). The absolute ROM and percentage of full active cervical spinal ROM used during the 15 ADLs was 13 to 32 degrees and 15% to 32% (median, 20 degrees/19%) for flexion/extension, 9 to 21 degrees and 11% to 27% (14 degrees/18%) for lateral bending, and 13 to 57 degrees and 12% to 92% (18 degrees/19%) for rotation. Backing up a car required the most ROM of all the ADLs, involving 32% of sagittal, 26% of lateral, and 92% of rotational motion. In general, personal hygiene ADLs such as washing hands and hair, shaving, and applying make-up entailed a significantly greater ROM relative to locomotive ADLs including walking and traveling up and down a set of stairs (P<0.0001); in addition, compared with climbing up these steps, significantly more sagittal and rotational motion was used when descending stairs (P=0.003 and P=0.016, respectively). When picking up an object from the ground, a squatting technique required a lower percentage of lateral and rotational ROM than bending at the waist (P=0.002 and P<0.0001)., Conclusions: By quantifying the amounts of cervical motion required to execute a series of simulated ADLs, this study indicates that most individuals use a relatively small percentage of their full active ROM when performing such activities. These findings provide baseline data which may allow clinicians to accurately assess preoperative impairment and postsurgical outcomes.

Study Design: Retrospective review and multivariate analysis., Objective: Assess cervical spine segmental range of motion (ROM) with flexion/extension (F/E) radiographs and determine the relation to clinical variables., Summary of Background Data: Previous studies investigated the roles of age and degeneration on cervical ROM with univariate analyses. Multivariate analyses are required to account for multiple factors that may affect ROM and quantify their relative effects., Methods: Radiographs of 195 patients were analyzed, including 133 females and 62 males with ages ranging from 15 to 93 years. Segmental ROM and Kellgren score (KS) of degeneration were assessed for C2-C7. Patient's age and gender were documented. Multivariate analyses were performed for each level. Independent variables evaluated were: (1) KS at the level of interest, (2) KS at the level above, (3) KS at the level below, (4) age, and (5) gender. Significance was defined as P < 0.05., Results: Interobserver reliabilities for assessing KS (intraclass correlation coefficient 0.81) and segmental ROM (intraclass correlation coefficient 0.72) were good to excellent. Age had a significant negative association with ROM at C2-C3, C3-C4, C4-C5, and C5-C6. KS at the level of interest had a significant negative association with ROM at C2-C3, C3-C4, C4-C5, C5-C6, and C6-C7. KS at the inferior segment had a significant positive association with ROM at C2-C3, C3-C4, and C4-C5. Gender had a significant association with ROM only at C2-C3., Conclusion: Age was associated with declining ROM independent of degeneration, amounting to a 5 degrees decrease in subaxial cervical ROM every 10 years. Degeneration was also associated with ROM. For every point increase in KS at a given level, there was an associated 1.2 degrees decrease in ROM at that level, and a 0.8 degrees increase in ROM at the level above. These results provide a framework with which to counsel patients about cervical ROM and a benchmark from which procedure specific changes can be compared.

Study Design: Retrospective cohort of 258 consecutive patients., Objective: The purpose of this study is to determine the: (1) percentage of flexion-extension radiographs that revealed pathology not appreciated on neutral radiographs in the nontrauma population, and (2) frequency that these views led to a change in the management of these patients., Summary of Background Data: The utility of flexion-extension radiographs in the evaluation of the spine trauma or preoperative patient is well accepted, but the role of dynamic radiographs in the degenerative population is not well defined., Methods: Consecutive patients presenting with axial cervical, upper extremity radicular, or myelopathic symptoms underwent upright anteroposterior, neutral lateral, and flexion-extension lateral radiographs. Patients with recent trauma, rheumatoid arthritis, prior cervical fracture, prior cervical surgery, inadequate radiographs, or congenital anomalies were excluded. Three observers reviewed all radiographs after determining the best measurement method by a priori analysis of interobserver reliability., Results: Listhesis was observed on 23 of the neutral lateral images; 6 of these were found to have changes between flexion and extension (2-4 mm). Two patients (1%) had spondylolisthesis on flexion-extension radiographs not visualized on neutral lateral radiographs. A subsequent review of these patients' charts revealed no change in management based on these findings., Conclusions: Cervical flexion-extension radiographs are a method of assessing potential instability. In the degenerative population studied here, 1% had spondylolisthesis noted only on the flexion-extension images, and 3% had a change in spondylolisthesis. None of these, however, led to a changes in clinical management. These data, in conjunction with the extra cost and radiation exposure associated with additional views, led us to no longer regard dynamic radiographs as a useful part of the initial imaging for the patient with degenerative cervical conditions.