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BACKGROUND: Degenerative cervical myelopathy (DCM) is a progressive chronic spinal cord injury estimated to affect 1 in 50 adults. Without standardised guidance, clinical research studies have selected outcomes at their discretion, often underrepresenting the disease and limiting comparability between studies. Utilising a standard minimum data set formed via multi-stakeholder consensus can address these issues. This combines processes to define a core outcome set (COS)-a list of key outcomes-and core data elements (CDEs), a list of key sampling characteristics required to interpret the outcomes. Further how these outcomes should be measured and/or reported is then defined in a core measurement set (CMS). This can include a recommendation of a standardised time point at which outcome data should be reported. This study defines a COS, CDE, and CMS for DCM research. METHODS AND FINDINGS: A minimum data set was developed using a series of modified Delphi processes. Phase 1 involved the setup of an international DCM stakeholder group. Phase 2 involved the development of a longlist of outcomes, data elements, and formation into domains. Phase 3 prioritised the outcomes and CDEs using a two-stage Delphi process. Phase 4 determined the final DCM minimal data set using a consensus meeting. Using the COS, Phase 5 finalised definitions of the measurement construct for each outcome. In Phase 6, a systematic review of the literature was performed, to scope and define the psychometric properties of measurement tools. Phase 7 used a modified Delphi process to inform the short-listing of candidate measurement tools. The final measurement set was then formed through a consensus meeting (Phase 8). To support implementation, the data set was then integrated into template clinical research forms (CRFs) for use in future clinical trials (Phase 9). In total, 28 outcomes and 6 domains (Pain, Neurological Function, Life Impact, Radiology, Economic Impact, and Adverse Events) were entered into the final COS. Thirty two outcomes and 4 domains (Individual, Disease, Investigation, and Intervention) were entered into the final CDE. Finally, 4 outcome instruments (mJOA, NDI, SF-36v2, and SAVES2) were identified for the CMS, with a recommendation for trials evaluating outcomes after surgery, to include baseline measurement and at 6 months from surgery. CONCLUSIONS: The AO Spine RECODE-DCM has produced a minimum data set for use in DCM clinical trials today. These are available at https://myelopathy.org/minimum-dataset/. While it is anticipated the CDE and COS have strong and durable relevance, it is acknowledged that new measurement tools, alongside an increasing transition to study patients not undergoing surgery, may necessitate updates and adaptation, particularly with respect to the CMS.

STUDY DESIGN: Cross-sectional survey. OBJECTIVE: Currently there is limited evidence and guidance on the management of mild degenerative cervical myelopathy (DCM) and asymptomatic spinal cord compression (ASCC). Anecdotal evidence suggest variance in clinical practice. The objectives of this study were to assess current practice and to quantify the variability in clinical practice. METHODS: Spinal surgeons and some additional health professionals completed a web-based survey distributed by email to members of AO Spine and the Cervical Spine Research Society (CSRS) North American Society. Questions captured experience with DCM, frequency of DCM patient encounters, and standard of practice in the assessment of DCM. Further questions assessed the definition and management of mild DCM, and the management of ASCC. RESULTS: A total of 699 respondents, mostly surgeons, completed the survey. Every world region was represented in the responses. Half (50.1%, n = 359) had greater than 10 years of professional experience with DCM. For mild DCM, standardised follow-up for non-operative patients was reported by 488 respondents (69.5%). Follow-up included a heterogeneous mix of investigations, most often at 6-month intervals (32.9%, n = 158). There was some inconsistency regarding which clinical features would cause a surgeon to counsel a patient towards surgery. Practice for ASCC aligned closely with mild DCM. Finally, there were some contradictory definitions of mild DCM provided in the form of free text. CONCLUSIONS: Professionals typically offer outpatient follow up for patients with mild DCM and/or asymptomatic ASCC. However, what this constitutes varies widely. Further research is needed to define best practice and support patient care.

Thoracic hyperkyphosis could affect mobility and independence of older adults. However, there was no clear evidence on the use of the seventh cervical vertebra wall distance (C7WD), a practical measure for thoracic hyperkyphosis, to indicate mobility deficits relating to independence of these individuals. This study explored the ability of C7WD to determine mobility impairments in 104 older adults. Participants (average age of 74.1 ± 7.4 years) with various degree of thoracic kyphosis were cross-sectionally measured for their C7WD, mobility, and Cobb angle. The findings indicate that participants with thoracic hyperkyphosis (Cobb angle = 46.1 ± 5.2°) had significantly poorer mobility than those without thoracic hyperkyphosis (Cobb angle = 32.8 ± 5.9°, p <.05). A C7WD of ≥7.8 cm could indicate mobility deficits of the participants (sensitivity = 71%–92%, specificity = 75%–94%, and area under the curve >0.80). The findings confirm the ability of C7WD that could be clinically measured using rulers to indicate mobility deficits of older adults. [ABSTRACT FROM AUTHOR]

Cerebrospinal fluid (CSF) in the subarachnoid space around the brain has long been known to drain through the lymphatics to cervical lymph nodes1-17, but the connections and regulation have been challenging to identify. Here, using fluorescent CSF tracers in Prox1-GFP lymphatic reporter mice18, we found that the nasopharyngeal lymphatic plexus is a major hub for CSF outflow to deep cervical lymph nodes. This plexus had unusual valves and short lymphangions but no smooth-muscle coverage, whereas downstream deep cervical lymphatics had typical semilunar valves, long lymphangions and smooth muscle coverage that transported CSF to the deep cervical lymph nodes. α-Adrenergic and nitric oxide signalling in the smooth muscle cells regulated CSF drainage through the transport properties of deep cervical lymphatics. During ageing, the nasopharyngeal lymphatic plexus atrophied, but deep cervical lymphatics were not similarly altered, and CSF outflow could still be increased by adrenergic or nitric oxide signalling. Single-cell analysis of gene expression in lymphatic endothelial cells of the nasopharyngeal plexus of aged mice revealed increased type I interferon signalling and other inflammatory cytokines. The importance of evidence for the nasopharyngeal lymphatic plexus functioning as a CSF outflow hub is highlighted by its regression during ageing. Yet, the ageing-resistant pharmacological activation of deep cervical lymphatic transport towards lymph nodes can still increase CSF outflow, offering an approach for augmenting CSF clearance in age-related neurological conditions in which greater efflux would be beneficial.

BACKGROUND: Detailed descriptions of clinical signs associated with radiological findings of the caudal cervical vertebral column are not available. OBJECTIVES/HYPOTHESES: Describe the clinical features associated with neck pain or stiffness, neck-related thoracic limb lameness, proprioceptive ataxia consistent with a cervicothoracic spinal cord or nerve lesion, and their frequency of occurrence compared with control horses. ANIMALS: A total of 223 Warmblood horses. METHODS: Case-control study. Controls and cases were recruited prospectively. All horses underwent predetermined lameness and neurologic examinations. The frequency of occurrence of each clinical feature was compared between cases and controls and relative risk (RR) were calculated. RESULTS: Ninety-six cases and 127 controls were included. Forty-seven (49%) of the cases were classified as neurologic, 31 (32.3%) had thoracic limb lameness, and 18 (18.7%) had neck stiffness or pain or both. Focal caudal cervical muscle atrophy (46, 47.9%), hypoesthesia (38, 39.6%), patchy sweating (16, 16.7%), hyperesthesia (11, 11.5%), and pain upon firm pressure applied over the caudal cervical articular process joints and transverse processes (58, 60.4%) were only observed in cases (P

Purpose To evaluate and report the performance of the winning algorithms of the Radiological Society of North America Cervical Spine Fracture AI Challenge. Materials and Methods The competition was open to the public on Kaggle from July 28 to October 27, 2022. A sample of 3112 CT scans with and without cervical spine fractures (CSFx) were assembled from multiple sites (12 institutions across six continents) and prepared for the competition. The test set had 1093 scans (private test set: n = 789; mean age, 53.40 years ± 22.86 [SD]; 509 males; public test set: n = 304; mean age, 52.51 years ± 20.73; 189 males) and 847 fractures. The eight top-performing artificial intelligence (AI) algorithms were retrospectively evaluated, and the area under the receiver operating characteristic curve (AUC) value, F1 score, sensitivity, and specificity were calculated. Results A total of 1108 contestants composing 883 teams worldwide participated in the competition. The top eight AI models showed high performance, with a mean AUC value of 0.96 (95% CI: 0.95, 0.96), mean F1 score of 90% (95% CI: 90%, 91%), mean sensitivity of 88% (95% Cl: 86%, 90%), and mean specificity of 94% (95% CI: 93%, 96%). The highest values reported for previous models were an AUC of 0.85, F1 score of 81%, sensitivity of 76%, and specificity of 97%. Conclusion The competition successfully facilitated the development of AI models that could detect and localize CSFx on CT scans with high performance outcomes, which appear to exceed known values of previously reported models. Further study is needed to evaluate the generalizability of these models in a clinical environment. Keywords: Cervical Spine, Fracture Detection, Machine Learning, Artificial Intelligence Algorithms, CT, Head/Neck Supplemental material is available for this article. © RSNA, 2024.

The upper cervical spine has a complex anatomical structure, making anterior surgical approaches challenging and prone to complications. This study aims to explore the use of bilateral submandibular incisions to provide safer and more convenient exposure of the upper cervical spine and to assess the feasibility of this approach for anterior surgical treatment of complex upper cervical diseases. From November 2019 to August 2021, three patients with malignant tumors of the upper cervical spine were subjected to an anterior–posterior combined approach for cervical tumor resection. The cohort consisted of one male and two females, aged between 41 and 51 years. The anterior approach began with a submandibular incision, followed by blunt dissection through the prevertebral muscles to expose the diseased vertebra. Subsequently, the diseased vertebra was excised, and either a titanium cage or a pre‐customized 3D‐printed artificial vertebral body was implanted anteriorly. Then, posterior fixation of the cervical spine was performed using pedicle screws to provide additional stability. Follow‐up ranged from 8 to 34 months. All patients experienced varying degrees of pain relief within 24 hours post‐operation. Frankel grading showed improvement by at least one grade in all three cases. Regular X‐ray and magnetic resonance imaging examinations revealed no tumor recurrence or involvement of adjacent vertebrae in the surgical area. The anterior bilateral submandibular horizontal incision approach offers comprehensive exposure of the anatomical structures of the upper cervical spine. This approach introduces a new option for the anterior treatment of upper cervical spine diseases. [ABSTRACT FROM AUTHOR]

Background: Reliability of the six-stage cervical vertebrae maturation method to evaluate skeletal growth was evaluated on the combined male and female samples and revealed diverse results. The current study aimed to determine the reliability of the modified three-stage cervical vertebrae maturation method for estimating the skeletal growth of males and females. Methods: Pretreatment lateral cephalometric radiographs of 137 orthodontic patients were utilized to evaluate the intra- and inter-observer reliability of a modified cervical vertebrae maturation method. Four independent examiners categorized each radiograph into one of the three skeletal growth stages according to the cervical vertebrae morphology: (1) a pre-peak group (combining the CS1 and CS2 stages), (2) a peak group (combining the CS3 and CS4 stages), and (3) a post-peak group (combining the CS5 and CS6 stages). The Kappa index and the Fleiss multirater Kappa test were carried out to determine the reproducibility of this method. Results: The studied sample included cephalometric radiographs of 68 males (49.6%) and 69 females (50.4%) aged between 7 and 58 years; no significant age difference was found between the sexes (p = 0.189). The overall inter-observer reliability was 0.689 (p < 0.001), and the inter-observer reliability for the post-peak stage showed only Kappa = 0.896 (p < 0.001). The Kappa values were significantly greater in males than in females during the peak stage (0.626 and 0.488, respectively). Conclusions: A modified three-stage cervical vertebrae maturation method showed substantial overall inter-examiner agreement; however, differential reliability for diverse skeletal maturation stages and sexes was found. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare the clinical efficacy of the full-endoscopic posterior cervical foraminotomy (FE-PCF) and the unilateral biportal endoscopic posterior cervical foraminotomy (UBE-PCF) in the treatment of cervical spondylotic radiculopathy (CSR). Methods: Patients who underwent posterior cervical spine surgery in our hospital from January 2020 to December 2022 were retrospectively analyzed. According to the surgical method, the patients were divided into two groups: FE-PCF group and UBE-PCF group. Perioperative data included operation time, Intraoperative blood loss and postoperative hospital stay were collected. The Visual Analog Scale (VAS)-arm, VAS-neck, and Neck Diability Index (NDI) was used to evaluate the clinical outcomes at preoperative, postoperative 1 week and Last follow-up. Serum creatine phosphokinase (CPK) and C-reactive protein (CRP) levels were recorded to evaluate surgical invasiveness. Results: A total of 160 patients were included, including 89 cases of FE-PCF and 71 cases of UBE-PCF. The demographic and preoperative data showed no significant differences between the two groups (P > 0.05). The mean operating time was significantly shorter in the UBE-PCF group compared to FE-PCF group (P < 0.05). Serum CRP and CPK levels of the two groups both exhibited a pattern of rising and then falling, peaking one day following surgery and decreasing to near normal values three days after the operation. Compared with preoperative, both groups showed significant improvement in postoperative VAS and NDI scores, with a statistically significant difference (P < 0.05). However, the differences in results between the groups were not significant. Conclusions: Both UBE-PCF and FE-PCF are secure and efficient methods for treating CSR by continuous visualization. UBE-PCF offers predictable and adequate decompression within a reduced surgical duration, facilitated by its separate observation and operation channels. [ABSTRACT FROM AUTHOR]

Summary Background Objective Study design Methods Results Main limitations Conclusions Several perineural injection techniques have been described to medicate the cervical spinal nerves of horses with suspected radiculopathy due to lesions at the intervertebral foramen (IVF). The technique and outcome have never been described in live, standing horses with suspected clinical disease.To assess the safety and efficacy of medication of the ventral rami of the cervical spinal nerves (VRCSNs) for the treatment of cervical radiculopathy in horses.Case series.Horses that underwent ultrasound‐guided perineural injection of the VRCSNs following radiographic and/or computed tomography (CT) evaluation of the cervical spine were included. Perineural injection with corticosteroids was performed using a standardised technique under ultrasound guidance as previously described. Outcome data were collected by clinical record review and unstructured follow‐up telephone conversations.Forty‐seven injections of the VRCSNs were performed in 12 horses with only two self‐limiting adverse reactions noted. All horses that underwent CT examination had at least one site of IVF narrowing with the foramina at the C6/C7 articulation most frequently affected. Nine horses improved following medication of the VRCSNs with eight returning to their previous levels of exercise. All seven horses that underwent CT of the cervical spine had an initial improvement in clinical signs. Six horses were in full work and still performing at their intended level of exercise at a median of 21.5 months post injection.Lack of definitive diagnosis of spinal nerve compression without histopathology of the spinal nerves which is not possible in the live horse.Medication of the VRCSNs is a safe treatment option which may provide benefit to horses with suspected spinal nerve compression but should be reserved for horses that have undergone a detailed clinical examination and CT evaluation of the cervical spine. [ABSTRACT FROM AUTHOR]

Background: The evolution of minimally invasive spine surgery, propelled by microscopy and endoscopy techniques, has reshaped the landscape of spinal interventions. The anterior approach to the cervical spine is widely recognized for its reproducibility and effectiveness in treating pathologies leading to radiculopathy or myelopathy. Apart from the traditional transdiscal approach, this study delves into the anterior transcorporeal approach, a minimally invasive technique, exploring its applicability in various cervical spinal pathologies. Purpose: The objective is to comprehensively illustrate the anterior transcorporeal approach, exploring its historical development, biomechanical underpinnings, technical nuances, and clinical applications in managing cervical spine disorders. Methods: We conducted a comprehensive review using PubMed, Embase, Cochrane Library, and Web of Science, adhering to PRISMA guidelines. The search was focused on the minimally invasive anterior transcorporeal approach for cervical pathologies, with an emphasis on evaluating the methodological evolution, technical execution, and clinical outcomes across diverse studies. Results: The review identified a significant body of literature supporting the efficacy of the minimally invasive anterior transcorporeal approach. Over the past two decades, this approach has demonstrated encouraging clinical outcomes, suggesting its potential as an alternative strategy for specific cervical spine diseases. The evolution of this technique is tightly linked to the advancements in medical equipment and the innovative endeavors of surgical pioneers. Conclusions: The anterior transcorporeal approach marks a milestone in minimally invasive cervical spine surgery. Its development reflects ongoing efforts to refine surgical techniques for better patient outcomes. While offering a promising alternative for treating certain cervical spine conditions, the approach demands precise case selection and is influenced by the rapid progression of medical technology. Future research and technological advancements are expected to further enhance the efficacy and safety of this approach, potentially expanding its indications in spinal surgery. [ABSTRACT FROM AUTHOR]

This case study discusses a 47‐year‐old Caucasian male with a past medical history of dyslipidemia, gastroesophageal reflux disease, previous cervical spine surgery, and anxiety who developed a neck hematoma postrevision of a C5–6 cervical spine fusion. Emergent neck exploration and evacuation of the hematoma were performed, and ventilation was restored. The patient was transferred to the intensive care unit and extubated on postoperative day 5 with a stable wound and no residual bleeding. At the 3‐week follow‐up appointment, the patient was noted to be doing well, with a chest radiograph showing no effusion or hematoma. This report elucidates the challenges posed by acute clinical symptoms and their correlation with the underlying cause, as well as the subsequent management and outcomes of a neck hematoma complication following cervical spine surgery. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions Limited evidence exists to guide the management of children with possible spinal injuries in the prehospital setting. As a first step to address this, we set out to describe the epidemiology and management of children <18 years presenting with possible cervical spinal injuries to EMS in Victoria, Australia.Retrospective case record review of all children with concerns of head or neck trauma and/or documented cervical spine collar use presenting to the statewide Ambulance Victoria (AV) EMS service, Victoria, Australia, between 1 July 2019 and 30 June 2020. Demographic, clinical features, mechanism of injury and spinal immobilisation practices were extracted.2100 children were included; 61% were male and the median age was 13 years (interquartile range: 9–15). Over half of the children were transported to suburban (32.2%) and rural/regional (22.9%) EDs, with 37.5% taken to designated trauma centres. The most common mechanisms of injury were sports/activity, motor vehicle accidents and falls in 35.4%, 27.9% and 26.3%, respectively. Spinal precaution use was recorded in 93.7% of cases; cervical collar use was the most common procedure recorded (87.1%). Younger age groups were less likely to have spinal precautions initiated; 51% of children aged 0–3 years, compared to 96.3% of children aged 12 and older (odds ratio = 23.8; 95% confidence interval = 14.5–37; P < 0.001).Prehospital spinal precautions were initiated commonly in children, with use increasing with age, and most were transported to suburban, regional and rural hospitals, not trauma centres. These data will inform the integration of emerging paediatric‐specific evidence into prehospital guidelines to risk stratify children. [ABSTRACT FROM AUTHOR]

Background: Detecting vertebral structural damage in patients with ankylosing spondylitis (AS) is crucial for understanding disease progression and in research settings. Objectives: This study aimed to use deep learning to score the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) using lateral X-ray images of the cervical and lumbar spine in patients with AS in Asian populations. Design: A deep learning model was developed to automate the scoring of mSASSS based on X-ray images. Methods: We enrolled patients with AS at a tertiary medical center in Taiwan from August 1, 2001 to December 30, 2020. A localization module was used to locate the vertebral bodies in the images of the cervical and lumbar spine. Images were then extracted from these localized points and fed into a classification module to determine whether common lesions of AS were present. The scores of each localized point were calculated based on the presence of these lesions and summed to obtain the total mSASSS score. The performance of the model was evaluated on both validation set and testing set. Results: This study reviewed X-ray image data from 554 patients diagnosed with AS, which were then annotated by 3 medical experts for structural changes. The accuracy for judging various structural changes in the validation set ranged from 0.886 to 0.985, whereas the accuracy for scoring the single vertebral corner in the test set was 0.865. Conclusion: This study demonstrated a well-trained deep learning model of mSASSS scoring for detecting the vertebral structural damage in patients with AS at an accuracy rate of 86.5%. This artificial intelligence model would provide real-time mSASSS assessment for physicians to help better assist in radiographic status evaluation with minimal human errors. Furthermore, it can assist in a research setting by offering a consistent and objective method of scoring, which could enhance the reproducibility and reliability of clinical studies. [ABSTRACT FROM AUTHOR]

In the present study, the most commonly observed types of occipital condyles were oval, followed by circular and two-portioned shapes. Occipital condyles are small bilateral extensions of the occipital bone that hold crucial implications for neurosurgical practice due to their association with various disease processes affecting the craniovertebral junction. A comprehensive understanding of the bony anatomy and variations in occipital condyles is imperative for optimising neurosurgical approaches. The primary objective of this study is to conduct an in-depth investigation of occipital condyles. We examined 40 dry human skulls, meticulously measuring various parameters such as length, breadth, anterior, and posterior intercondylar distances. The shapes of occipital condyles were classified into distinct types: oval, circular, eight-shaped, kidney-shaped, deformed, two-portioned, oval convex, and pyramid. The documented parameters of occipital condyles and their variations are poised to serve as invaluable guidelines for future surgeons. Possessing a thorough understanding of occipital condyle morphometry can significantly facilitate the instrumentation process, mitigating the risk of neurovascular damage. We firmly believe that the outcomes of our research will establish a comprehensive reference database, aiding in the development of implants and the formulation of optimal surgical approaches tailored to the intricacies of occipital condyles. [ABSTRACT FROM AUTHOR]

The use of biomodels in the laboratory for studying and training cervical laminoplasty has not yet been reported. We propose the use of a cervical spine biomodel for surgical laminoplasty training. This is an experimental study. Ten 3D identical cervical spine biomodels were printed based on computed tomography (CT) and magnetic resonance imaging scans of a patient diagnosed with spondylotic cervical myelopathy. The additive manufacturing method used fused deposition modeling and polylactic acid (PLA) was selected as the raw material. The sample was divided into 2 groups: control (n = 5; the biomodels were submitted to CT scanning) and open-door (n = 5; the biomodels were submitted to open-door laminoplasty and postoperative CT). The area and anteroposterior diameter of the vertebral canal were measured on CT scans. Printing each piece took 12 hours. During the surgical procedure, there was sufficient support from the biomodels to keep them immobilized. Using the drill was feasible; however continuous irrigation was mandatory to prevent plastic material overheating. The raw material made the biomodel CT study possible. The vertebral canal dimensions increased 24.80% (0.62 cm2) in area and 24.88% (3.12 mm) in anteroposterior diameter The cervical spine biomodels can be used for laminoplasty training, even by using thermosensitive material such as PLA. The use of continuous irrigation is essential while drilling. [ABSTRACT FROM AUTHOR]

Endoscopic posterior approach can effectively decompress cervical root and cord secondary to posterior compression. We present our experience in 229 patients using tubular retractor, and the relevant literature is reviewed. Retrospective analysis of multilevel myelopathy and or radiculopathy was performed. Indications for posterior approach was primary posterior compressions at cord and or root. Combined compression from posterior side and mild to moderate anterior pressure with acceptable lordosis were also decompressed. Bilateral cord decompression and foraminotomy for radiculopathy was performed using tubular retractor. Myelopathy and radiculopathy were present in 220 and 9 patients, respectively. A total of 53 foraminotomy procedures were performed in 36 patients. All patients showed improvement, with the mean preoperative Nurick grade decreasing from 2.72 ± 0.799 to 0.78 ± 0.911 after surgery. There was significant improvement in postoperative Nurick grades compared with preoperative grades (Z-value = 13.306, P < 0.0001). Operative results were better in patients with good preoperative Nurick grades (grades 1 and 2) compared with those with poorer grades (grades 3 and 4). Minor bleeding, small dural tear, and root injury were observed in 42, 4, and 8 patients, respectively. Endoscopic approach was effective and safe for root and cord decompression. This study was limited by its single-center, retrospective design, exclusion of some eligible patients, a short postoperative Nurick grade assessment period of 6 months, and absence of a comprehensive long-term postoperative biomechanical assessment. To validate these results, a prospective multicenter study addressing these limitations is needed. [ABSTRACT FROM AUTHOR]

To elucidate the effect of global spinal alignment on cervical degeneration in patients with degenerative lumbar scoliosis (DLS). This study included 117 patients with DLS and 42 patients with lumbar spinal stenosis as a control group. Patients with DLS (study group) were categorized according to the Scoliosis Research Society–Schwab classification. Spinopelvic parameters were measured in cervical and full-length spine radiographs. Cervical degeneration was assessed using the cervical degeneration index (CDI) scoring system. There were significant differences in C2-C7 sagittal vertical axis, T1 slope, thoracic kyphosis, lumbar lordosis (LL), and pelvic tilt between DLS and control groups. Although the DLS and control groups did not differ significantly with regard to CDI scores, a striking difference was noted when sagittal spinopelvic modifiers were considered individually. Patients with a pelvic incidence (PI)–LL mismatch modifier grade of ++ had significantly higher CDI scores than patients with grade 0, and patients with a PI-LL or sagittal vertical axis modifier grade of ++ had significantly higher CDI scores than the control group. Disk narrowing scores were highest in patients with a PI-LL modifier grade of ++ followed by patients with a grade of +. Additionally, CDI scores were more associated with LL rather than cervical lordosis. Patients with DLS may be at greater risk of cervical spine degeneration, especially patients with a PI-LL or sagittal vertical axis modifier grade of ++. A surgical strategy for patients with DLS should be carefully selected considering the restoration of LL. [ABSTRACT FROM AUTHOR]

Chronic risk factors of posterior circulation ischemic strokes remain unknown. There is, however, evidence that anatomical variations within the vertebrobasilar system could potentially lead to the development of posterior circulation strokes. We investigated the association of forward head posturing (FHP), a chronic anatomical change seen in patients with cervicalgia, with posterior circulation strokes. In this case-control study, we identified adult patients diagnosed with cervicalgia and ischemic posterior circulation infarcts from 2007 to 2023. Cases were paired with controls with cervicalgia without posterior circulation stroke and matched for known risk factors. C0-C2 angle, C2-C7 angle, and sagittal vertical axis shift were measured as metrics for FHP severity on lateral cervical spine x-rays. Paired t tests were applied to compare stroke risk factors and FHP between groups. Participants included 206 patients (103 cases and 103 controls) with a mean age of 64.4 years; 51.5% were female. There were no statistically significant differences between risk factors for stroke, including hypertension, hyperlipidemia, diabetes, smoking, hypercoagulable state, and atrial fibrillation. There were statistically significant differences in C0-C2 angle (30.7° vs. 23.2°, P = 0.002) and sagittal vertical axis shift (35.4 mm vs. 25.3 mm, P < 0.001). This case-control matched-pair study found that in adults with cervicalgia, posterior circulation ischemic stroke was associated with more severe FHP as noted in C0-C2 angle and sagittal vertical axis shift measurements. Further, this association may be due to chronic changes in circulation flow dynamics within the vertebrobasilar system with the postural change. [ABSTRACT FROM AUTHOR]

Background: This study aimed to elucidate the specificity of the radiological features of Dropped head syndrome (DHS) from both reginal and global aspects. Methods: We enrolled 53 patients with DHS (8 men, 45 women; mean age 73.5 years), and captured their lateral spinopelvic radiographs in standing position. We also selected 21 age- and sex-matched controls with cervical spondylosis. Radiological parameters were measured and compared between two groups. Compensatory and decompensatory sites were also listed for each patient. Results: Radiological factors such as sagittal vertical axis (SVA), clivo-axial angle (CAA), C2–7 angle, C2–7 SVA, anterior slippage of the vertebra, alignment. C1, C2, C3, C4, C5, C6 slopes, and T1 slope-C2–7 angle showed statistically significant differences between the groups. Multivariate logistic regression showed that SVA, C2–7 SVA, T1-slope-C2–7 angle, and C1 slope were the most important factors specific to DHS. Sole cervical spine and involvement of both cervical and thoracic spine accounted for 22% and 29% of the decompensatory sites in DHS respectively. Notably, 24% of the patients did not show decompensation of the cervical spine. While, 93% exhibited compensation at the craniovertebral junction. The thoracic spine contributed 70% to DHS compensation. Conclusions: This study indicated the radiological features of DHS from both regional and global aspects. Compensatory and decompensatory DHS mechanisms varied among individuals. Compensation was likely to be developed at the neighboring sites, with the craniovertebral and thoracic junctions as the proximal and distal parts for DHS, respectively. [ABSTRACT FROM AUTHOR]

Purpose: In patients with traumatic, infectious, degenerative, and neoplastic surgical indications in the cervical spine, commonly the anterior approach is used. Often these patients require a tracheostomy necessary due to prolonged mechanical ventilation. The limited spinal mobility and proximity to the surgical site of anterior cervical spine fixation (ACSF) could pose an increased risk for complications of percutaneous dilational tracheostomy (PDT.) Importantly, PDT might raise wound infection rates of the cervical spine approach. The aim of this study is to prove safety of PDT after ACSF. Methods: We performed a retrospective, single-center study comparing patients with and without ACSF who underwent Ciaglia-single step PDT. After propensity score matching using logistic regression, we compared intra- and postprocedural complication rates. Furthermore, surgical site infections were evaluated. Putensen's definitions of complications and Clavien-Dindo's classification were used. Results: A total of 1175 patients underwent PDT between 2009 and 2021. Fifty-seven patients underwent PDT following ACSF and were matched to fifty-seven patients without ACSF. The mean interval between ACSF and PDT was 11.3 days. The overall complication rate was 19.3% in the ACSF group and 21.1% in the non-ACSF group. The mean follow-up was 388 days (± 791) in the ACSF group and 424 days (± 819) in the non-ACSF group. Life-threatening complications (Clavien-Dindo IV to V) were found in 1.8% of ACSF patients and 3.5% of non-ACSF patients. There were no significant differences in complication rates. No surgical site infection of the anterior spine access was detected. Conclusion: PDT is a feasible and safe procedure in patients after ACSF. Complication rates are comparable to patients without ACSF. Surgical site infections of ACSF are very rare. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to quantify and evaluate morphology of intervertebral space between neighboring cervical units using radiographic imaging indices, to help spine surgeons when performing anterior cervical discectomy and fusion (ACDF) surgery on the Chinese population. Methods: The background and imaging parameters of the subjects were assessed. Cervical lateral radiographs were employed to measure the intervertebral height (IH), intervertebral height index (IHI), and segmental lordosis (SL). Endplate parameters measurements were conducted on sagittal T2-weighted magnetic resonance imaging (MRI), including endplate sagittal diameter (ESD), and endplate concavity depth (ECD). All individuals were divided into three age groups: individuals aged 20–35 were in group A, individuals aged 36–50 were in group B, and individuals aged over 50 were in group C. A comparison of the variables was conducted among the three groups. Additionally, these radiographic parameters were also compared between males and females. Results: A total of 102 individuals were included in this study. IH was greater at C6/7 than those at other segmental levels (p < 0.001). The largest SL values were found at C6/7, while the least were found at C3/4. The superior ESD (ESDs) and ECD (ECDs) of the intervertebral space were significantly greater than those of the inferior endplates (p < 0.05). The ESD and ECD values were the largest at C6/7, while the least at C3/4. Additionally, age and gender had an influence on several parameters. IH was significantly lower in group A compared to group B (p < 0.05) and group C (p < 0.05) from C3/4 level to C6/7 level. ECDs were lower in group A compared to group B (p < 0.05) and group C (p < 0.05) at each level. IH and ESD in males were generally significantly greater than those in females at all levels (p < 0.05). Conclusion: The current study found that C6/7 had the greatest IH, SL, ESD, and ECD values in asymptomatic Chinese. SL gradually increased from C3/4 to C6/7 levels. IH and ECD were significantly associated with age. Males had greater IH and ESD values than females. These findings provide baseline information for planning for selection of anterior screws and intervertebral implants. [ABSTRACT FROM AUTHOR]

Introduction: Children with cervical or cervicothoracic congenital scoliosis are limited in their ability to compensate for the main curve of the deformity because there are only a few mobile segments in their cervical spine. Over the years, we have frequently observed coronal atlantoaxial dislocation (CAAD) in a lateral direction (from left to right or vice versa) in these patients. It was anticipated that CAAD might compensate for the horizontal position of the head, and it is hypothesized that CAAD depends on the degree of scoliotic deformity. Thus, the aim of our study was to investigate whether there is a correlation between CAAD and scoliosis parameters in these patients. Methods: Retrospective analysis was performed based on CAT scans and preoperative X-rays of patients with cervical and cervicothoracic scoliosis with an apex between C4 and T6. Seventeen patients, with a mean age of 7.25 years, who were 9 girls and 8 boys, and who were treated between 2006 and 2022 were included. Cobb's angle of the main curve (CA-MC), Cobb's angle of the secondary curve (CA-SC), and T1-, C2- and UEV (upper end vertebra) tilt were measured on whole-spine radiographs in the standing position. The CAAD was measured via coronal CAT scan reconstruction and defined as the difference in the distances of the lateral masses to the midline of the axis. Pearson's linear correlation coefficients (r) were determined using SPSS to evaluate correlations between CAAD and the measured parameters. p < 0.05 indicated statistical significance. Results: CAAD toward the convex region in patients with scoliosis was typically observed; the mean CAAD was 3 mm ± 3.7 mm. The mean CA-MC was 46° ± 13°, the mean CA-SC was 16° ± 9.6°, the mean T1 tilt was 17° ± 8.8°, the mean C2 tilt was 9°± 8.8°, and the mean UEV tilt was 24° ± 7.2°. There was a strong linear correlation between CAAD and CA-MC (r = 0.784, p < 0.001), C2 tilt (r = 0.745; p < 0.001), and UEV tilt (r = 0.519; p = 0.033). There was no correlation between CAAD and either CA-SC or T1 tilt. Discussion: Children with cervical or cervicothoracic scoliosis tend to have a CAAD toward the convexity of the scoliosis that correlates to CA-MC, C2-tilt, and UEV-tilt. CAAD may be seen as a compensatory mechanism to keep the head in a horizontal position. Severe or progressive CAAD may result in destruction of the atlantoaxial joint, including severe complaints, thus necessitating close follow-up and possibly early surgical treatment. Moreover, CAAD might be a useful additional radiographic parameter to be checked in future scoliosis studies. Key Points: Children with cervical or cervicothoracic scoliosis may have CAAD toward the convexity of scoliosis. The CAAD in this group of patients strongly depended on the CA-MC, C2 tilt, and UEV tilt but not on the CA-SC or T1 tilt. Close clinical and radiographic follow-up examinations are mandatory for these patients to evaluate if and when correction and fixation within the scoliotic deformity should be performed to prevent these patients from further damage within the atlantoaxial joint. CAAD might be an additional radiographic parameter to be used in future studies dealing with scoliosis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the anatomical indexes and anatomical positional indexes of the atlantoaxial synchondroses in normal Chinese Han children aged 1–6 years, and to analyze the changing law of the atlantoaxial cartilage union with the growth and development of age and its influence on the atlantoaxial ossification in children. Methods: A retrospective collection of CT imaging of 160 cases of normal cervical spine in children aged 1 to 6 years old was conducted. The cases were divided into six age groups, with each group representing a one-year age range. Measure the morphological anatomical indicators and anatomical positional indicators of the atlantoaxial synchondroses. Record and statistically analyze the measurements of each indicator. Results: Measurements were taken on various parameters of the atlantoaxial synchondroses. TD, SD, height, area, and perimeter all gradually decreased among the groups. Distance between bilateral atlantal anterolateral synchondroses increased gradually from Group A to Group F, while the angle formed along the long axis in the cross-section showed a decreasing trend. Distance between the axoid dentolateral synchondroses and between the neurocentral synchondroses increased gradually from Group A to Group F, with the angle value in the cross-section showing a gradual decrease, and distance from the odontoid apex increasing from Group A to Group F. Conclusions: The atlantoaxial synchondroses gradually decrease in size with age, and ossification levels increase with age, with faster ossification occurring during a 1–2 years-old period. The anterolateral synchondroses, dentolateral synchondroses, and neurocentral synchondroses all gradually ossify towards the lateral direction with increasing age. [ABSTRACT FROM AUTHOR]

Purpose: The global population is ageing rapidly. As a result, an increasing number of older patients with traumatic spine injuries are seen in hospitals worldwide. However, it is unknown how the incidence of traumatic spinal injury has developed over the past decade. Therefore, this study aimed to determine the incidence and characteristics of traumatic spinal injury in patients aged under and above 65 years. Methods: During three time periods: 2009–2010, 2014–2015 and 2019–2020, all adult patients with traumatic spinal injury in the Netherlands were identified from the Dutch National Trauma Registry. Patient-related characteristics and 1-year mortality were collected from a subgroup of patients treated at a level-1 trauma centre, and patients aged ≥ 65 years were compared to patients aged < 65 years. Results: In the Dutch National Trauma Registry 25,737 patients with traumatic spinal injury were identified. The incidence of spine injury in patients > 65 years was 49.5/100,000/yr in 2009–2010, 68.8 in 2014–2015 and 65.9 in 2019–2020. The percentage of patients ≥ 65 years increased from 37% in 2009–2010, to 43% in 2014–2015, and to 47% in 2019–2020. In the subgroup of 1054 patients treated in a level-1 trauma centre, a similar increasing incidence was seen in patients aged ≥ 65 years. In these patients low energy falls were the most common trauma mechanism and the cervical spine was the most commonly injured region. Moreover, patients ≥ 65 years had significantly higher 1-year mortality compared with patients aged < 65 years, 22.7% versus 9.2%. Conclusion: The incidence of traumatic spinal injury in older patients in the Netherlands has increased over the last 12 years. Almost half of the patients with traumatic spinal injury are currently aged ≥ 65 years. The increasing incidence and the high 1-year mortality highlight the need to modify existing treatment protocols for these patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Hydrated nucleus pulposus extrusion (HNPE) is a well-known pathological condition in veterinary neurology. Any breed of middle-aged or older dogs (median 9 years old) can be affected; it has an acute spontaneous onset, is rarely exercise-associated, and commonly affects the cervical region, causing tetraparesis or tetraplegia and mild cervical hyperesthesia. This study presents the first documented case of double cervical adjacent HNPEs in a small breed dog. A 9-year-old 6 Kg intact male Yorkshire terrier was referred for an acute onset of non-ambulatory tetraparesis. MR examination of the cervical spine showed two concurrent HNPEs at sites C3-C4 and C4-C5. The dog had a remission of symptoms with conservative therapy and physiotherapy. A 9-year-old Yorkshire terrier was brought to the emergency department for inability to maintain the correct station with acute onset. Neurological examination showed a non-ambulatory tetraparesis, spontaneous proprioceptive deficit in all limbs, and decreased flexor reflex in the forelimbs. The neurological symptoms suggested a cranial cervical spinal cord with suspicion of spinal shock. The clinical differential diagnoses included degenerative (intervertebral disc extrusion), vascular, inflammatory, or neoplastic disease. No pathological findings were evident in the hematobiochemical tests or in the radiograph examination. MRI examination of the cervical spine showed the presence of two adjacent hydrated nucleus pulposus extrusions at C3-C4 and C4-C5 tracts. Treatment included analgesic and non-steroidal anti-inflammatory therapy; movement restriction was initially necessary, followed by physiotherapy. Follow-up at 4 weeks showed complete recovery. A telephone follow-up after 3 months with the owner confirmed the absence of symptoms. This article reports the first double cervical HNPE case in a dog, adding the possibility that the disease may present in this form and the success of conservative treatment as described in the literature. [ABSTRACT FROM AUTHOR]

Background: This study estimated the predictive accuracy of the mandibular growth potential based on cervical vertebral bone age using digital lateral cephalograms in a sample of the Saudi population. Methods: This study included digital lateral cephalograms of eighty subjects aged 10–21 years divided into adult and young groups. Cervical vertebral age was calculated by tracing and measuring the third and fourth cervical vertebrae on lateral cephalograms, and the mandibular growth potential was estimated using the Mito et al. regression equation. The accuracy of the calculated CVB age was verified via comparison with the chronological age. The data analyses included independent sample t-tests for testing the differences in mean values and Pearson correlation coefficients to examine the relationship between dependent and independent variables. Results: A significant difference was noted between the mean cervical vertebral age and chronological age in the young group for both males (p = 0.0003) and females (p = 0.033). The correlation coefficient between cervical vertebral age and chronological age in the young male group was higher (r = 0.934) than that in the young females (r = 0.254). Conclusions: The mandibular growth potential prediction based on CVB age using the regression equation of Mito et al. was applicable only to the young Saudi males. Further studies are needed to develop new multiple regression models to obtain cervical vertebral age more accurately for both genders in the Saudi population. [ABSTRACT FROM AUTHOR]

Objective: The C4 is the transition point between the upper and lower cervical vertebrae and plays a pivotal role in the middle of the cervical spine. Currently, there are limited reports on large‐scale sample studies regarding C4 anatomy in children, and a scarcity of experience exists in pediatric cervical spine surgery. The current study addresses the dearth of anatomical measurements of the C4 vertebral arch and lateral mass in a substantial sample of children. This study aims to measure the imaging anatomy of the C4 vertebral arch and lateral mass in children under 14 years of age across various age groups, investigate the growth and development of these structures. Methods: We measured 12 indicators, including the size (D1, D2, D3, D4, D5, D6, D7, and D8) and angle (A, C, D, and E) of the C4 vertebral arch and lateral mass, in 513 children who underwent cervical CT examinations at our hospital. We employed the aggregate function for statistical analysis, conducted t‐tests for difference statistics, and utilized the least squares method for regression analysis. Results: Overall, as age increased, there was a gradual increase in the size of the vertebral arch and lateral mass. Additionally, the medial inclination angle of the vertebral arch decreased, and the lateral mass flattened gradually. The rate of change decreased gradually with age. The mean value of D1 increased from 2.31 mm to 3.88 mm, of D2 from 16.75 mm to 29.2 mm, of D3 from 2.21 mm to 4.92 mm, and of D4 from 7.34 mm to 11.84 mm. Meanwhile, the mean value of D5 increased from 5.2 mm to 9.71 mm, of D6 from 10.19 mm to 16.16 mm, of D7 from 2.53 mm to 5.67 mm, and of D8 from 6.11 mm to 11.45 mm. Angle A ranged from 49.12° to 54.97°, angle C from 15.28° to 19.83°, angle D from 39.91° to 53.7°, and angle E from 18.63° to 28.08°. Conclusion: Prior to cervical spine surgery in children, meticulous CT imaging anatomical measurements is essential. The imaging data serves as a reference for posterior C4 internal fixation, aids in designing posterior cervical screws for pediatric patients, and offer morphological anatomical references for posterior cervical spine surgery and screw design in pediatric patients. [ABSTRACT FROM AUTHOR]

Purpose: The management of odontoid fractures in adult patients has been widely described. However, there is sparse literature about this injury in the pediatric population. This study aimed to review published literature regarding the management and outcomes of pediatric odontoid fractures to develop a stepwise treatment algorithm. Methods: A literature review was conducted using PRISMA guidelines on PubMed to identify studies between 1960 and 2023 that reported on the management and outcomes of odontoid fracture in pediatric patients. Studies were included if they were published in English and if their sample included at least four patients aged 0–18, minimum follow-up of 6 weeks, and outcomes for each patient clearly differentiated. Results: In total, 15 studies including 125 pediatric patients with odontoid fractures were included. Treatment options varied from non-operative management with immobilization in rigid collars, halo vests, cervicothoracic orthosis, or soft collars to surgical management with fixation and/or arthrodesis. There were 73 patients initially treated nonoperatively, 47 initially treated surgically, 2 who healed with observation alone, and 3 who died acutely of concomitant injuries. The nonunion rate for nonoperative management was 5.5%. Surgery was successful, demonstrating bony union at final follow-up, in 94.6% of cases treated via a posterior approach and 85.7% of cases treated with an anterior approach. Conclusions: Odontoid fractures must be considered in pediatric patients with cervical spine trauma. This is the largest literature review of pediatric odontoid fractures. Various management strategies exist and can be considered. The proposed algorithm offers an evidence-based framework for the management of pediatric odontoid fractures. [ABSTRACT FROM AUTHOR]

Trauma to the neck can produce catastrophic results as neck houses plethora of vital structures and is relatively an unprotected anatomical territory. Blunt trauma to the neck, excluding cervical spine injuries, represents only 5% of all neck trauma, but can be very challenging to assess since its presentation is often delayed. Penetrating injuries, on the other hand, are more common, and even when they seem to be only superficial and minor, always need thorough investigation and observation. Primary stabilization of the patient followed by an extensive evaluation needs to be done in all cases of neck trauma. CECT neck and thorax along with fibreoptic laryngoscopy remain the main modalities of diagnosis following a neck trauma. The initial approach to any kind of neck injury, whether penetrating or blunt, is performed according current Advanced Trauma Life Support (ATLS) or European Trauma Course (ETC) protocols, which both use the structured 'ABCD' approach. A motor vehicle accident (MVA) remains the most common cause of blunt neck injury, causing direct pressure to the anterior neck from the dashboard, steering wheel or airbag deployment. Direct pressure to the neck is transduced to the trachea and causes compression of the oesophagus against the cervical spine. Laryngotracheal trauma continues to be a rare entity and is the second most common cause of death in patients with head and neck trauma after intracranial injury. Only 0.5% of multiple trauma patients were reported to have injury to the airway at any level. Stabilize the airway first. Immediate surgical airway procedure can be necessary in less familiar circumstances and environments. If possible, define landmarks before the procedure. Defining anatomical zones is useful in penetrating injuries, although these do not guide diagnostic or therapeutic management completely. In unstable patients, elective surgical exploration is recommended instead of extensive diagnostic work-up. Unstable patients still need immediate exploration, whereas all stable patients will first be assessed with clinical examination and CT angiography and fibreoptic laryngoscopy. Thus the take home message is to consider all neck injuries an emergency and proceed with the diagnosis and management without delay. [ABSTRACT FROM AUTHOR]

Mucoepidermoid carcinoma (MEC) is a malignant locally invasive tumour of salivary glands, presumed to arise from reserve cells of salivary gland ducts. It accounts approximately 35% of all malignancies of major and minor salivary glands [1]. MEC arising in minor salivary glands can be located in different areas such as palate, retromolar trigone, floor of mouth, buccal mucosa, lips and tongue. MEC of tongue base are not common but they constitute around 50% of malignant lesions of salivary glands in this region. It presents in fifth and sixth decades of life mostly [1]. We present a rare case of 29 year old woman with low grade mucoepidermoid carcinoma of base of tongue operated by the Trotter procedure with harmonic scalpel – median labio-mandibular glossotomy approach. It's an interesting approach first described by William Trotter in 1920s. It's used by head and neck surgeons for accessing tongue base lesions, pharyngeal wall and cervical spine. [ABSTRACT FROM AUTHOR]

Background: Modified Anterior Cervical Discectomy and Fusion with specific resection ranges is an effective surgical method for the treatment of focal ossification of the posterior longitudinal ligament (OPLL). Herein, we compare and analyse the static stress area distribution by performing different cuts on an original ideal finite element model. Method: A total of 96 groups of finite element models of the C4–C6 cervical spine with different vertebral segmentation ranges (width: 1–12 mm, height: 1–8 mm) were established. The same pressure direction and size were applied to observe the size and distribution area of stress following various ranges of excision of the C5 vertebral body. Results: Different cutting areas had similar stress aggregation points. As the contact area decreased, the stress and the bearing above area increased. The correlation of stress area variation was highest between the 1–2 MPa and 6 MPa–Max regions (Rho = − 0.975). In the surface visualisation model fitting, the width and height were of different ratios in different stress regions. The model with the best fitting degree was the 1–2 MPa group, and the equation fitting (Rho = 0.966) was as follows: Area = 908.80 − 25.92 × Width + 2.71 × Height. Conclusion: Modified Anterior Cervical Discectomy and Fusion with different resection ranges exhibited different stress areas. In a specific resection range of the cervical spine (1–12 mm, 0–8 mm), area conversion occurred at a threshold of 4 MPa. Additionally, the stress was concentrated at the contact points between the vertebral body and the rigid fixator. [ABSTRACT FROM AUTHOR]

Background: The actual significance of prehospital immobilization of the cervical spine in severely injured trauma patients remains unclear. In view of possible negative implications, such as an increase in intracranial pressure due to the application of a rigid cervical spine orthosis, the long-term use must be critically questioned. Further studies are required to justify the long-term use of a rigid cervical spine orthosis in the prehospital setting. Objective: Comparative measurements of the mobility of the cervical spine during immobilization using a vacuum mattress with or without the additional application of a rigid cervical spine orthosis after positioning on the stretcher were carried out. Material and methods: Biomechanical measurements of the movement of the cervical spine were carried out by attaching inertial measurement units to a test person during the loading and unloading process in a modern ambulance and during the journey along a predefined parkour. The test person on whom the measurements were carried out was immobilized on a vacuum mattress with the option of lateral fixation of the head and chin and forehead strap on an electrohydraulic stretcher. The complete standard monitoring was set up to simulate as realistic a transport of a severely injured patient as possible. A total of 30 test runs were realized. In one half of the tests, the cervical spine was additionally immobilized using a rigid orthosis and in the other half a cervical spine orthosis was not used. For each of the 30 tests, the angles, axial rotation, lateral bending and flexion/extension as well as the first and second derivatives were considered for loading, transport and unloading and the parameters mean deviation from the zero position, size of the swept angle range and maximum were calculated for each test run. Results: Statistically significant differences were only found for some biomechanical parameters in the sagittal plane (flexion and extension). No significant differences were found for the measured parameters in the other directions of movement (axial rotation, lateral flexion). In general, only very small angular deflections were measured both in the tests with the cervical spine orthosis and without the cervical spine orthosis (on average in the range of 1–2° for axial rotation and flexion/extension and up to 3° for lateral flexion). Conclusion: If immobilization is carried out correctly using a vacuum mattress with the option of lateral stabilization of the head and chin and a forehead strap on an electrohydraulic stretcher with a loading system, there are no relevant advantages with respect to the restriction of movement of the cervical spine by the additional use of a rigid cervical spine orthosis for the loading and unloading process or during the transport in a modern ambulance. It could therefore be advantageous to remove the rigid cervical spine orthosis initially applied for the rescue of the patient at the scene after the patient has been positioned on the vacuum mattress and stretcher to avoid potential negative effects of the rigid cervical spine orthosis for the period of transportation to the hospital. [ABSTRACT FROM AUTHOR]

The Toarcian (upper Lower Jurassic) strata of the world-renowned Posidonia Shale of Central Europe have yielded diverse assemblages of marine vertebrates. Some of them, such as those of the Holzmaden area in southwestern Germany, are among the best-preserved specimens of Lower Jurassic vertebrate taxa. Here, we provide a reassessment of 'Plesiosaurus' bavaricus, a long-overlooked plesiosaur taxon from the Posidonia Shale of northern Bavaria (southern Germany), established based upon two isolated cervical centra and a caudal vertebra. The cervical material exhibits an intriguing character combination, providing evidence for the presence of a distinct plesiosaur taxon in the upper Lower Jurassic of the Posidonia Shale of Germany. Additionally, we report another isolated cervical vertebra, likewise from the Posidonia Shale of Bavaria, that shows striking similarities to the type cervicals of 'P'. bavaricus. Following our study of the Bavarian specimens, we hypothesise that, despite their substantial incompleteness, it seems likely that the material belonged to the same taxon, either species or a group of species, distinct from other plesiosaurs known from the Posidonia Shale. [ABSTRACT FROM AUTHOR]

We present a case of a 58-year-old male who presented following 4 months of progressively worsening right upper extremity pain. Initial pathology demonstrated pleomorphic chondroblasts with increased mitotic activity indicating an intermediate grade (Grade 2) clear cell chondrosarcoma of the proximal humerus. Following surgical resection, the primary lesion demonstrated aggressive behavior and early metastasis to the cervical and thoracic spine. The patient unfortunately expired 30 months after initial presentation. Although clear cell chondrosarcoma has been historically regarded as low grade, we present a unique example of an aggressive clinical course of clear cell chondrosarcoma. [ABSTRACT FROM AUTHOR]

Spinal cord stress and strain contribute to degenerative cervical myelopathy (DCM), while cervical kyphosis is known to negatively impact surgical outcomes. In DCM, the relationship between spinal cord biomechanics, sagittal alignment, and cord compression is not well understood. Quantifying this relationship can guide surgical strategies. A previously validated three-dimensional finite element model of the human cervical spine with spinal cord was used. Three models of cervical alignment were created: lordosis (C2–C7 Cobb angle: 20°), straight (0°), and kyphosis (− 9°). C5–C6 spinal stenosis was simulated with ventral disk protrusions, reducing spinal canal diameters to 10 mm, 8 mm, and 6 mm. Spinal cord pre-stress and pre-strain due to alignment and compression were quantified. Cervical flexion and extension were simulated with a pure moment load of 2 Nm. The Von Mises stress and maximum principal strain of the whole spinal cord were calculated during neck motion and the relationship between spinal cord biomechanics, alignment, and compression was analyzed using linear regression analysis. Spinal cord pre-stress and pre-strain were greatest with kyphosis (7.53 kPa, 5.4%). Progressive kyphosis and stenosis were associated with an increase in spinal cord stress (R2 = 0.99) and strain (R2 = 0.99). Cervical kyphosis was associated with greater spinal cord stress and strain during neck flexion–extension and the magnitude of difference increased with increasing stenosis. Cervical kyphosis increases baseline spinal cord stress and strain. Incorporating sagittal alignment with compression to calculate spinal cord biomechanics is necessary to accurately quantify spinal stress and strain during neck flexion and extension. [ABSTRACT FROM AUTHOR]

Background: Disorders of the cervical spine are some of the costliest musculoskeletal conditions to manage globally. Joint mobilization and manipulation have been shown to be an effective treatment for neck pain. However, the generalizability and clinical translation depends on the nature of the trial designs that inform its use. The extent to which randomized control trials (RCTs) assessing manual therapy treatments for cervical spine disorders fall on the efficacy (explanatory) -effectiveness (pragmatic) spectrum often informs how the findings are translated into clinical practice. Objective: The aim of this systematic review was to determine where RCTs of manual therapy for neck disorders fall on the efficacy-effectiveness spectrum. Methods: A search of three electronic databases including PubMed, CINAHL, and CENTRAL were completed for trials published from inception to May 2023. RCTs in which joint mobilization or manipulation were used to treat cervical spine disorders were assessed on the effectiveness-efficacy spectrum using the Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool and risk of bias using the Revised Cochrane Risk of Bias tool. Results: A total of 174 trials met eligibility. RITES domain two trial setting (71.3% vs 16.1%), domain three flexibility of intervention(s) (62.1% vs 23%), and domain four clinical relevance of experimental and comparison intervention(s) (51.7% vs 29.3%) all favored efficacy over effectiveness. Domain one participant characteristic(s) had a slightly greater emphasis on effectiveness compared to efficacy (36.8% vs 44.8%). Most studies (96%) had at least some risk of bias. Conclusion: Over half of the RCTs assessing the treatment effect of joint mobilization and manipulation for neck pain favor efficacy (explanatory) over effectiveness (pragmatic) designs. Future RCTs on this topic should consider a greater emphasis on pragmatic trial design components in order to better reflect real-world translation to clinical practice. [ABSTRACT FROM AUTHOR]

Synopsis: This report of a dumbbell spinal neurofibroma in pregnancy provides insights into hormonal influence on its occurrence and highlights the use of the seated‐up position for surgery. [ABSTRACT FROM AUTHOR]

Study design. Multicenter case-control study. Objective. To identify imaging characteristics of the cervical spine in patients with retro-odontoid pseudotumor (ROP) without rheumatoid arthritis (RA) and determine the pathogenesis of ROP. Background. ROP results from proliferative changes in the soft tissue of the atlantoaxial junction surrounding the region of the transverse ligament, and is commonly seen in RA patients. However, the pathogenesis of ROP caused by mechanical instability of the upper cervical spine in patients without RA is yet to be explained. Materials and Methods. We collected imaging data [preoperative radiographs, magnetic resonance imaging (MRI), and computed tomography (CT)] of patients who underwent surgery between April 2011 and March 2022 at the three university hospitals for ROP (cases) and cervical spondylotic myelopathy (as age, sex, and institution matched controls). The two groups were compared for different parameters on cervical dynamic radiographs, MRI, and CT. Results. The ROP group consisted of 42 patients, and the control group comprised 168 patients. C2-C7 range of motion was significantly smaller in the ROP group (25.8 ± 2.6°) compared with the control group (33.0 ± 1.0°). C2-C7 sagittal vertical axis was significantly larger in the ROP group than the control group (39.3 ± 3.6 vs. 32.2 ± 1.3 mm). MRI and CT assessment showed progressive degeneration at all intervertebral levels in the ROP group. A significant positive correlation was observed between the thickness of the soft tissue posterior to the dental process and the atlantodental interval in the flexion position (r = 0.501). Conclusions. The development of ROP was associated with degeneration of facet joints and intervertebral disks in the middle and lower cervical spine. Our findings suggest that decreased mobility of the middle and lower cervical spine may cause instability in the upper cervical spine, leading to the formation of ROP. [ABSTRACT FROM AUTHOR]

Transoral penetrating foreign body injury of the neck involving the cervical spine is a rare condition. We present an injury caused by transoral penetration of a broken piece of a wooden plank into the neck with injury to the upper cervical spine in a 31-year-old male patient. The foreign body was removed transorally with the patient making a full recovery under close observation and was discharged and followed up with no complications. This paper highlights the types of neck injuries, the key points to be considered in zone III neck injury in light of existing literature and a discussion on the management of these patients. [ABSTRACT FROM AUTHOR]

Background: Xanthogranulomatous Osteomyelitis is a rare form of chronic inflammation described in a handful of cases in the reported literature involving the long bones of the axial skeleton. To the authors knowledge it has not been reported in the spinal column. Case: We report a case of a 65 year old female presenting with features of metastatic cord compression and an expansile lesion affecting the 5th -7th cervical vertebrae. She underwent vertebrectomy, insertion of an expandable cage and plating to good effect. A histological diagnosis of Xanthogranulomatous Osteomyelitis was made. Conclusions: We report what the authors believe to be the first case in the literature of xanthogranulomatous osteomyelitis affecting the spine. In this case the patient was managed with a vertebrectomy without the need for antibiotics. [ABSTRACT FROM AUTHOR]

Surgery to expose the anterior occiptocervical junction (OCJ) is exacting, and optimal approaches are debatable. The close proximity of vital structures and difficult surgical access present a unique challenge to treat lesions in this area. Routine access to the upper anterior cervical spine remains limited. The authors present a modified retropharyngeal approach and instrumentation in order to resect an exceptionally rare atypical rhabdoid teratoid tumor involving the craniovertebral junction. The technical aspects of this approach in anatomical perspectives are discussed in this article. [ABSTRACT FROM AUTHOR]

Traumatic subaxial cervical spine fractures are a significant public health concern due to their association with spinal cord injuries (SCI). Despite being mostly caused by low-energy trauma, these fractures significantly contribute to morbidity and mortality. Currently, research regarding early mortality based on the choice of treatment following these fractures is limited. Identifying predictors of early mortality may aid in postoperative patient monitoring and improve outcomes. This study aimed to identify predictors of 30-days, 90-days, and 1-year mortality in adults treated for subaxial fractures. A retrospective review of the nationwide Swedish Fracture Register (SFR). All adult patients in the SFR who underwent treatment for a subaxial cervical fracture (n = 1,963). Analyzed variables included age, sex, injury mechanism, neurological function, fracture characteristics, and treatment type. The primary endpoints were 30-days, 90-days, and 1-year mortality. About 1,963 patients in the SFR, treated for subaxial cervical fractures between 2013 and 2021, were analyzed. Surgical procedures included anterior, posterior, or anteroposterior approaches. Nonsurgical treatment included collar treatment or medical examinations without intervention. Stepwise regression and Cox regression analysis were used to determine predictors. Model performance was tested using the area under the receiver operating characteristic curve (AUC). A total of 620 patients underwent surgery and 1,343 received nonsurgical treatment. Surgical cases had primarily translation fractures, with 323 (52%) displaying no neurological deficits. Mortality rates at 30 days, 90 days, and 1 year were 22/620 (3.5%), 35/620 (5.6%), and 53/620 (8.5%), respectively. Age and SCI were predictors of mortality. Nonsurgically treated patients mostly had compression fracture, with 1,214 (90%) experiencing no neurological deficits. Mortality rates at 30 days, 90 days, and 1 year were 41/1,343 (3.1%), 71/1,343 (5.3%), and 118/1,343 (8.7%). Age, male sex, SCI and fractures occurring at the C3 or C6 levels were predictors of mortality. An intact neurological function was a positive predictor of survival among nonsurgically treated patients (AUC >0.78). Age and SCI emerged as significant predictors of early mortality in both surgically and nonsurgically treated patients. An intact neurological function served as a protective factor against early mortality in nonsurgically treated patients. Fractures at C3 or C6 vertebrae may impact mortality. [ABSTRACT FROM AUTHOR]

Prolonged opioid therapy following spine surgery is an ongoing postoperative concern. While prior studies have investigated postoperative opioid use patterns in the elective cervical surgery patient population, to our knowledge, opioid use patterns in patients undergoing surgery for traumatic cervical spine injuries have not been elucidated. The purpose of this study was to compare opioid use and prescription patterns in the postoperative pain management of patients undergoing traumatic and elective cervical spine fusion surgery. Retrospective cohort study. Adult patients with traumatic cervical injuries who underwent primary anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF) during their initial hospital admission. The propensity matched, control group consisted of adult elective cervical fusion patients who underwent primary ACDF or PCDF. Demographic data, surgical characteristics, spinal disease diagnosis, location of cervical injury, procedure type, operative levels fused, and Prescription Drug Monitoring Program (PDMP) data. PDMP data included the number of opioid prescriptions filled, preoperative opioid use, postoperative opioid use, and use of perioperative benzodiazepines, muscle relaxants, or gabapentin. Opioid consumption data was collected in morphine milligram equivalents (MME) and standardized per day. A 1:1 propensity match was performed to match traumatic injury patients undergoing cervical fusion surgery with elective cervical fusion patients. Traumatic injury patients were matched based on age, sex, CCI, procedure type, and cervical levels fused. Pre- and postoperative opioid, benzodiazepine, muscle relaxant, and gabapentin use were assessed for the traumatic injury and elective patients. T- or Mann-Whitney U tests were used to compare continuous data and Chi-Squared or Fisher's Exact were used to compare categorical data. Multivariate stepwise regression using MME per day 0 – 30 days following surgery as the dependent outcome was performed to further evaluate associations with postoperative opioid use. A total of 48 patients underwent fusion surgery for a traumatic cervical spine injury and 48 elective cervical fusion with complete PDMP data were assessed. Elective patients were found to fill more prescriptions (3.19 vs 0.65, p=.023) and take more morphine milligram equivalents (MME) per day (0.60 vs 0.04, p=.014) within 1 year prior to surgery in comparison to traumatic patients. Elective patients were also more likely to use opioids (29.2% vs 10.4%, p=.040) and take more MMEs per day (0.70 vs 0.05, p=.004) within 30 days prior to surgery. Within 30 days postoperatively, elective patients used opioids more frequently (89.6% vs 52.1%, p<.001) and took more MMEs per day (3.73 vs 1.71, p<.001) than traumatic injury patients. Multivariate stepwise regression demonstrated preoperative opioid use (Estimate: 1.87, p=.013) to be correlated with higher postoperative MME per day within 30 days of surgery. Surgery after traumatic injury was correlated with lower postoperative MME use per day within 30 days of surgery (Estimate: −1.63 p=.022). Cervical fusion patients with a history of traumatic spine injury consume fewer opioids in the early postoperative period in comparison to elective cervical fusion patients, however both cohorts consumed a similar amount after the initial 30-day postoperative period. Preoperative opioid use was also a risk factor for higher consumption in the short-term postoperative period. These results may aid physicians in further understanding patients' postoperative care needs based on presenting injury characteristics and highlights the need for enhanced follow-up care for traumatic cervical spine injury patients after fusion surgery. [ABSTRACT FROM AUTHOR]

Clinical trials have demonstrated that cervical disc arthroplasty (CDA) is an effective and safe alternative treatment to anterior cervical discectomy and fusion (ACDF) for cervical degenerative disc disease in the appropriately indicated patient population. Various devices for CDA exist, differing in the level of device constraint. To investigate outcomes following Anterior Cervical Discectomy and Fusion (ACDF) versus CDA stratified based on the level of device constraint: Constrained, Semiconstrained, and Unconstrained. Systematic review and network meta-analysis. A total of 2,932 CDA patients (979 Constrained, 1,214 Semiconstrained, 739 Unconstrained) and 2,601 ACDF patients from 41 studies that compared outcomes of patients undergoing CDA or ACDF at a single level at a minimum of 2 years follow-up. Outcomes of interest included the development of adjacent segment degeneration (ASD), index and adjacent segment reoperation rates, range of motion (ROM), high-grade heterotopic ossification (HO, McAfee Grades 3/4), and patient-reported outcomes (NDI/VAS). CDA devices were grouped based on the degrees of freedom (DoF) allowed by the device, as either Constrained (3 DoF), Semiconstrained (4 or 5 DoF), or Unconstrained (6 DoF). A random effects network meta-analysis was conducted using standardized mean differences (SMD) and log relative risk (RR) were used to analyze continuous and categorical data, respectively. Semiconstrained (p=.03) and Unconstrained CDA (p=.01) demonstrated a significantly lower risk for ASD than ACDF. All levels of CDA constraint demonstrated a significantly lower risk for subsequent adjacent segment surgery than ACDF (p<.001). Semiconstrained CDA also demonstrated a significantly lower risk for index level reoperation than both ACDF and Constrained CDA (p<.001). Unconstrained devices retained significantly greater ROM than both Constrained and Semiconstrained CDA (p<.001). As expected, all levels of device constraint retained significantly greater ROM than ACDF (p<.001). Constrained and Unconstrained devices both demonstrated significantly lower levels of disability on NDI than ACDF (p=.02). All levels of device constraint demonstrated significantly less neck pain than ACDF (p<.05), while Unconstrained CDA had significantly less arm pain than ACDF (p=.02) at final follow-up greater than 2 years. CDA, particularly the unconstrained and semiconstrained designs, appears to be more effective than ACDF in reducing the risk of adjacent segment degeneration and the need for further surgeries, while also allowing for greater range of motion and better patient-reported outcomes. Less constrained CDA conferred a lower risk for index level reoperation, while also retaining more range of motion than more constrained devices. [ABSTRACT FROM AUTHOR]

Purpose: The current supraomohyoid neck dissection (SOHND) is performed above the omohyoid muscle to dissect levels I, II, and III in the levels of cervical lymph nodes. However, the anatomical boundary between levels III and IV is the inferior border of the cricoid cartilage. We investigated the anatomical relationship between the omohyoid muscle and cricoid cartilage using contrast-enhanced CT (CE-CT) images to assess the validity of the current SOHND. Methods: CE-CT images of the head and neck regions in patients were reviewed. The patients were divided into two groups: "malignant tumors" and "others". The vertebral levels corresponding to the positions of anatomical structures such as the intersection of the omohyoid muscle and internal jugular vein (OM-IJ), and the inferior border of the cricoid cartilage (CC), were recorded. Results: The OM-IJ was located around the seventh cervical to the first thoracic vertebra. There was a significant difference between the malignant tumor and others groups in females (p = 0.036). The CC was located around the sixth to seventh cervical vertebrae. There was a significant sex difference in each group (malignant tumor: p < 0.0001; others: p = 0.008). Both sexes tended to have lower OM-IJ than CC, and females had significantly lower OM-IJ than males. Conclusion: This study provides clear anatomical evidence showing the difference between the SOHND dissection area and levels I, II, and III. It could be considered that in most cases SOHND invades level IV, not just levels I, II, and III, especially in female patients. [ABSTRACT FROM AUTHOR]

Lumbar spine pathologies have been linked independently to both neutral zone (NZ) properties and facet joint anatomical characteristics; however, the effect of facet joint orientation (FO) and tropism (FT) on NZ properties remains unclear. The aim of the present study was to investigate how axial plane FO and FT relate to NZ range and stiffness in the human lumbar spine and porcine cervical spine. Seven human lumbar functional spine units (FSUs) and 94 porcine cervical FSUs were examined. FO and FT were measured, and in vitro mechanical testing was used to determine anterior-posterior (AP) and flexion–extension (FE) NZ range and stiffness. FO and FT were found to have no significant relationship with AP and FE NZ range. Increases in FT were associated with greater FE and AP NZ stiffness in human FSUs, with no FT-NZ stiffness relationship observed in porcine specimens. A significant relationship (p < 0.001) between FO and FE NZ stiffness was observed for both porcine and human FSUs, with a more sagittal orientation of the facet joints being associated with decreased FE NZ stiffness. Given the link between NZ stiffness and pathological states of the lumbar spine, further research is warranted to determine the practical significance of the observed facet joint anatomical characteristic-NZ property relationship. [ABSTRACT FROM AUTHOR]

Background: Cardiac pacemaker implantation may be indicated in patients with refractory bradycardia following a cervical spinal cord injury (CSCI). However, evidence about the impact of this procedure on outcomes is lacking. We planned a study to assess whether the implantation of a pacemaker would decrease mortality and hospital resource utilization in patients with CSCI. Methods: Adult patients with CSCI in the Trauma Quality Improvement Program (TQIP) database between 2016 and 2019 were retrospectively analyzed. Patients were divided into "pacemaker" and "non-pacemaker" groups, and their baseline characteristics and clinical outcomes were analyzed. Results: A total of 6774 cases were analyzed. The pacemaker group showed higher in-hospital rates of cardiac arrest, myocardial infarction, and longer duration of mechanical ventilation and ICU stay than the non-pacemaker group. Nevertheless, pacemaker placement was associated with a significant decrease in mortality (4.2% vs 26.0%, P < .01). Conclusions: Patients with CSCI requiring a pacemaker placement had better survival than those treated without a pacemaker. Pacemaker implantation should be highly considered in patients who develop refractory bradycardia after CSCI. [ABSTRACT FROM AUTHOR]

Background: Skydiving is an increasingly popular recreational activity in the United States and worldwide. While it is considered a high-risk sport, the United States Parachute Association reported a fatality of .28 per 100 000 jumps in 2022. Although mortality rates are low, the true rate of survivable injuries is unknown. Injuries requiring hospitalization are not uncommon and may be underreported in the literature. Anticipating these injuries and analyzing short-term outcomes following parachuting accidents would be useful for the development of mitigation strategies and to increase the safety of jumpers. Methods: A retrospective cohort review of 126 consecutive patients presenting to a Level II Trauma Center after skydiving accidents between 2016 and 2023. Patient baseline characteristics, patterns of injury, surgical procedures, and in-hospital outcomes were reviewed. Results: A total of 126 patients were included. One hundred and seventeen patients (93%) presented immediately following the accident, 65 (51.6%) were trauma activations, and 14 (11.1%) patients experienced loss of consciousness. Fractures of the lower extremity occurred in 57 (45%), fractures of the spine 48 (38%), upper extremity 13 (10%), pelvis 11 (9%). Of the spinal injuries, 10 injuries occurred in the cervical spine, 16 thoracic, 22 lumbar, 5 sacral, and 3 coccygeal spine. Eleven patients (9%) suffered multilevel spine injuries. Mean injury severity score was 7 (range 0-75). A third of patients required at least 1 surgical procedure (n = 43, 34%). Median length stay was 2 days (IQR 1, 5). Of patients who survived to our trauma center, there were two mortalities, both due to catastrophic intracranial hemorrhage. Discussion: Although the 30-day mortality rate for patient who presented to our trauma center is low, it can bear significant risks including major injury. The most common injuries were lower extremity and spinal in origin with a third of patients overall requiring at least one operation. [ABSTRACT FROM AUTHOR]