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Case: An 86-year-old woman suffered from dropped head syndrome (DHS). As she was not willing to undergo fusion surgery, we proposed a novel nuchal ligament reconstruction surgery, which is not a direct correction of the malalignment but rather a recovery of the function of extensor muscles under local anesthesia. Twelve months after surgery, the patient remains satisfied and is able to maintain a horizontal gaze. Conclusion: This is the first report regarding a less invasive nuchal ligament reconstruction surgery successfully performed for DHS. [ABSTRACT FROM AUTHOR]

This article discusses a case of progressive cervical swelling in a 6-year-old Belgian gelding. The horse presented with bilateral swelling of the caudal poll, and no history of trauma or injury was reported. Diagnostic imaging, including radiographs and ultrasound, revealed ovoid masses with mineral opaque foci and irregularities in the spinous process of the vertebrae. The findings were consistent with cranial nuchal bursitis and secondary osteitis. Bloodwork showed mild leukocytosis and positive titers for Lyme disease. Treatment involved aspiration of fluid from the masses and administration of minocycline and phenylbutazone. The horse showed improvement at the 2-week follow-up. [Extracted from the article]

Background: 40-45 % of the population presents with enlarged external occipital protuberances (EEOPs), which can lead to pain. EEOP occurrence is higher in younger males; however, the reason is debated. We used plane lateral radiographs to investigate how anthropometrics, age, biological sex, head and neck kinematics, and neck strength differ between those with and without an EEOP., Methods: Data was compiled across four study samples, which included lateral radiographs taken in a neutral neck posture (n = 102, 50% females). An enlarged EOP was defined as being longer than 10 mm, and this threshold was used to classify participants as having a presence or absence of an EEOP. Statistical analyses were used to compare outcome measures between those with and without an EEOP presence for age, biological sex, skull angle, intervertebral joint angle (C1-C2 through C6-C7), and neck strength (flexion and extension)., Results: Twenty-four percent of participants (19 males and five females, p = 00.002 for biological sex differences) presented with an EEOP; only one was over 30 years old. There were no significant main effects on the skull and intervertebral joint angles, participant anthropometrics, or neck strength., Conclusions: This study confirmed that enlarged EOPs are more prevalent in males; however, neck posture and other anthropometrics do not differ with the presence or absence of an EEOP., Competing Interests: Declaration of competing interest None to disclose., (Copyright © 2024 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

This study was conducted to describe the morphometrics of nuchal ligament and investigate the effects of different neck and body positions on the nuchal ligament in greyhounds. Nine adult greyhounds cadavers without any locomotion abnormalities were dissected through the neck musculature on the left side to expose the nuchal ligament. Three pins were placed to mark regions of interest on the nuchal ligament: at one cm cranial to the site of origin (the most dorsal point of the spinous process of the first thoracic vertebra), at the midpoint of the nuchal ligament and one cm caudal to the nuchal ligament site of insertion (close to the caudal aspect of the spinous process of the axis). Each cadaver was positioned on a masonite board and placed on a table on the floor in their lateral recumbency and seven different standardized body positions; P1–P7 were mimicked using goniometers and metal wires. Photographs were taken by positioning and fixing the camera above the nuchal ligament region. The length and widths (W1, W2 and W3) of nuchal ligament were measured using Image Pro software (Image‐Pro Express version 5.0) on standardized photographs of each of seven different body and neck positions. The length of nuchal ligament in relation to the neutral position (P1) was less (− 7%, p > 0·05) in P6 (neck elevated) and increased in all other positions (+1%, p > 0·05 for P2, +19%, p < 0·05 for P3, +37%, p < 0·05 for P4, +1%, p > 0·05 for P5, +40%, p < 0·05 for P7). Nuchal ligament width at the middle (W2) decreased significantly with P4 (− 26%, p < 0·05), and P7 (− 32%, p < 0·05). Also, nuchal ligament width at the site of origin (W3) decreased significantly with P4 (− 24%, p < 0·05) and P7 (−35%, p < 0·05). These findings reflect the need for clinical and biomechanical studies to describe in‐depth the gross anatomy of the nuchal ligament in greyhounds. They suggest that different neck and body positions change the shape, and hence, the function of the nuchal ligament during movement. [ABSTRACT FROM AUTHOR]

In recent years, neck pain and stiffness of the upper cervical region have become a commonly recognised cause of reduced performance in jumping and dressage in horses. One of the postulated causes of these clinical signs is the insertional desmopathy of the nuchal ligament. Its aetiology still remains unclear, chiefly due to the limitations associated with providing correct diagnoses in this region and the correct identification of the abnormalities. These lesions may be conductive to limb lameness, dental diseases and neurological changes. Considering that the resulting irreversible pathological changes present as pain and stiffness, patients are usually treated symptomatically. Insertional desmopathies of the nuchal ligament may underlie a lack of progress in training as well as stiffness and limb lameness in their broader sense. Further research is necessary to determine which lesions observed in the radiological examinations are of clinical significance.

ABSTRACT: The gray scale histogram (GSH) makes it possible to measure the amount and distribution of gray shade frequencies, providing quantitative information on both echogenicity and echotexture of tissues. There is a need to diminish the subjectivity of the ultrasound images of the nuchal ligament (NL). This work proposes to evaluate the NL by ultrasound B-mode GSH images in different ages of Quarter horses. It used 15 healthy Quarter horses, which were classified by age into three different groups: “baby” (1), “sobreano” (2) and “adult” (3). The animals were submitted to chemical restraint for the ultrasound examination. Subsequently, the GSH tool was used in each image for statistical analysis. There was a significant difference between Mean and Mode between groups. Group 1 differed significantly when compared to Group 2 and 3. Group 2 presented superior echogenicity to Group 1 and 3. The height of the NL did not vary considerably between groups. GSH indicated that the echogenicity of NL in Quarter horses varies with age.

There is growing evidence of spine injury in abusive head trauma (AHT). Historically, spine injury was considered rare in AHT because of a lack of attributable clinical symptoms or signs and a lack of advanced imaging. Increased use of MRI in AHT has been instrumental in helping identify evidence of ligamentous injuries of the spine. These findings can be difficult to identify on autopsy because of the size and location of the ligaments. Because spinal injury in AHT mostly involves ligamentous and soft tissues and only rarely involves bony fractures, more than 90% of the injury findings are missed on CT or radiography of the spine. Investigation of these findings and the injury patterns should lead to a better understanding of the mechanism of spinal injury. In this pictorial review, we describe the various manifestations of spinal ligamentous injury in AHT, as seen on MRI, in children younger than 48 months. [ABSTRACT FROM AUTHOR]

Paleopathology, or the study of ancient injuries and diseases, can enable the ecology and life history of extinct taxa to be deciphered. Large‐bodied ornithopods are the dinosaurs with the highest frequencies of paleopathology reported to‐date. Among these, the crested hadrosaurid Parasaurolophus walkeri is one of the most famous, largely due to its dramatic elongated and tubular nasal crest. The holotype of Parasaurolophus walkeri at the Royal Ontario Museum, Canada, displays several paleopathologies that have not been discussed in detail previously: a dental lesion in the left maxilla, perhaps related to periodontal disease; callus formation associated with fractures in three dorsal ribs; a discoidal overgrowth above dorsal neural spines six and seven; a cranially oriented spine in dorsal seven, that merges distally with spine six; a V‐shaped gap between dorsal spines seven and eight; and a ventral projection of the pubic process of the ilium which covers, and is fused with, the lateral side of the iliac process of the pubis. These lesions suggest that the animal suffered from one or more traumatic events, with the main one causing a suite of injuries to the anterior aspect of the thorax. The presence of several lesions in a single individual is a rare observation and, in comparison with a substantial database of hadrosaur paleopathological lesions, has the potential to reveal new information about the biology and behavior of these ornithopods. The precise etiology of the iliac abnormality is still unclear, although it is thought to have been an indirect consequence of the anterior trauma. The discoidal overgrowth above the two neural spines also seems to be secondary to the severe trauma inflicted on the ribs and dorsal spines, and probably represents post‐traumatic ossification of the base of the nuchal ligament. The existence of this structure has previously been considered in hadrosaurs and dinosaurs more generally through comparison of origin and insertion sites in modern diapsids (Rhea americana, Alligator mississippiensis, Iguana iguana), but its presence, structure, and origin‐attachment sites are still debated. The V‐shaped gap is hypothesized as representing the point between the stresses of the nuchal ligament, pulling the anterior neural spines forward, and the ossified tendons pulling the posterior neural spines backward. Different reconstructions of the morphology of the structure based on the pathological conditions affecting the neural spines of ROM 768 are proposed. Finally, we review the history of reconstructions for Parasaurolophus walkeri showing how erroneous misconceptions have been perpetuated over time or have led to the development of new hypotheses, including the wide neck model supported in the current research. [ABSTRACT FROM AUTHOR]

This study aimed to investigate nuchal ligament (NL) autograft on experimental tendon defect healing in donkeys. Eight healthy donkeys were used. The left forelimb's superficial digital flexor (SDF) tendon was assigned as treatment, and the right forelimb was allocated as the control group (without surgical intervention). A 3x1.5 cm segment of the funicular part of the NL was excised. A full thickness defect created in the treatment tendon and was grafted with the excised NL. The following parameters were evaluated in 120 days postoperatively: clinical, ultrasonography, radiography, histopathology, biomechanical properties, and scanning and electronic transmission microscopy. There were no significant changes observed in the neck angle so that it was confirmed this treatment regimen preserved the head and neck situation without any considerable neck swelling. Weight-bearing in gait and trot was similar between both forelimbs at the end of the study. Mild to moderate adhesion was detected in the dorsal surface of the SDF tendon. There was no significant difference in the echogenicity and fiber alignment, respectively, on days 90 and 120 after surgery. Treatment significantly amplified the collagen diameter and enhanced the collagen fibril diameter and density considerably compared to the NL. The transplanted tissue was mostly in the remodeling or maturation phase, on day 120 postoperatively. It seems that the NL is biocompatible, almost biodegradable, and effective in tendon healing without metaplasia or tissue rejection. [ABSTRACT FROM AUTHOR]

Congenital partial absence of the trapezius muscle is a relatively common variation. Several cases of partial absence of the trapezius muscle have been reported. However, complete unilateral agenesis of this muscle has not been previously reported. In our case, a complete cadaver dissection of an 87-year-caucasian male was performed at the Department of Anatomy, College of Medicine in Saskatoon, Canada. The entire body dissection revealed a complete agenesis of the left trapezius muscle fibers. No other significant congenital anomalies were found.

Background The upper cervical region is a complex anatomical structure. Myodural bridges between posterior suboccipital muscles and the dura might be important explaining conditions associated with the upper cervical spine dysfunction such as cervicogenic headache. This cadaver study explored the upper cervical spine and evaluated the myodural bridges along with position of spinal cord in response to passive motion of upper cervical spine. Methods A total of seven adult cadavers were used in this exploratory study. The suboccipital muscles and nuchal ligament were exposed. Connections between the Rectus Capitis Posterior major/minor and the Obliquus Capitis minor, the nuchal ligament, posterior aspect of the cervical spine, flavum ligament and the dura were explored and confirmed with histology. The position of the spinal cord was evaluated with passive motions of the upper cervical spine. Outcomes In all cadavers connective tissues attaching the Rectus Capitis Posterior Major to the posterior atlanto-occipital membrane were identified. In the sagittal dissection we observed connection between the nuchal ligament and the dura. Histology revealed that the connection is collagenous in nature. The spinal cord moves within the spinal canal during passive movement. Discussion The presence of tissue connections between ligament, bone and muscles in the suboccipital region was confirmed. The nuchal ligament was continuous with the menigiovertebral ligament and the dura. Passive upper cervical motion results in spinal cord motion within the canal and possible tensioning of nerve and ligamentous connections.

In recent years, neck pain and stiffness of the upper cervical region have become a commonly recognised cause of reduced performance in jumping and dressage in horses. One of the postulated causes of these clinical signs is the insertional desmopathy of the nuchal ligament. Its aetiology still remains unclear, chiefly due to the limitations associated with providing correct diagnoses in this region and the correct identification of the abnormalities. These lesions may be conductive to limb lameness, dental diseases and neurological changes. Considering that the resulting irreversible pathological changes present as pain and stiffness, patients are usually treated symptomatically. Insertional desmopathies of the nuchal ligament may underlie a lack of progress in training as well as stiffness and limb lameness in their broader sense. Further research is necessary to determine which lesions observed in the radiological examinations are of clinical significance. [ABSTRACT FROM AUTHOR]

In recent years, neck pain and stiffness of the upper cervical region have become a commonly recognised cause of reduced performance in jumping and dressage in horses. One of the postulated causes of these clinical signs is the insertional desmopathy of the nuchal ligament. Its aetiology still remains unclear, chiefly due to the limitations associated with providing correct diagnoses in this region and the correct identification of the abnormalities. These lesions may be conductive to limb lameness, dental diseases and neurological changes. Considering that the resulting irreversible pathological changes present as pain and stiffness, patients are usually treated symptomatically. Insertional desmopathies of the nuchal ligament may underlie a lack of progress in training as well as stiffness and limb lameness in their broader sense. Further research is necessary to determine which lesions observed in the radiological examinations are of clinical significance. [ABSTRACT FROM AUTHOR]

Background: The upper cervical region is a complex anatomical structure. Myodural bridges between posterior suboccipital muscles and the dura might be important explaining conditions associated with the upper cervical spine dysfunction such as cervicogenic headache. This cadaver study explored the upper cervical spine and evaluated the myodural bridges along with position of spinal cord in response to passive motion of upper cervical spine. Methods: A total of seven adult cadavers were used in this exploratory study. The suboccipital muscles and nuchal ligament were exposed. Connections between the Rectus Capitis Posterior major/minor and the Obliquus Capitis minor, the nuchal ligament, posterior aspect of the cervical spine, flavum ligament and the dura were explored and confirmed with histology. The position of the spinal cord was evaluated with passive motions of the upper cervical spine. Outcomes: In all cadavers connective tissues attaching the Rectus Capitis Posterior Major to the posterior atlanto-occipital membrane were identified. In the sagittal dissection we observed connection between the nuchal ligament and the dura. Histology revealed that the connection is collagenous in nature. The spinal cord moves within the spinal canal during passive movement. Discussion: The presence of tissue connections between ligament, bone and muscles in the suboccipital region was confirmed. The nuchal ligament was continuous with the menigiovertebral ligament and the dura. Passive upper cervical motion results in spinal cord motion within the canal and possible tensioning of nerve and ligamentous connections. [ABSTRACT FROM AUTHOR]

Summary: This report describes a 10‐year‐old Welsh Section D gelding presented for signs of neck stiffness that was found to have a mineralised lesion in the funicular part of the nuchal ligament overlying the dorsal aspect of the first cervical vertebra using radiography and ultrasonography. Surgical resection of the mass, including a complete removal of the adjacent nuchal ligament, resulted in improvement in the signs of neck stiffness. Histopathological examination identified the mass as calcinosis circumscripta. These lesions do not appear to have been reported at this site nor has outcome following excision of a complete section of the nuchal ligament. [ABSTRACT FROM AUTHOR]

We investigated the effects of extracorporeal shockwave therapy (ESWT) on the rehabilitation of cervical spondylosis with nuchal ligament (NL) calcification under X-ray and ultrasound guidance. Sixty patients with cervical spondylosis and calcification of NL were selected and randomly assigned to three groups: A, B, and C. Patients in Group A received rehabilitation with 20 minutes of hot packs and underwent 15 minutes of intermittent cervical traction three times/week for 6 weeks. Patients in Group B received the same rehabilitation as those in Group A and ESWT (2000 impulses, 0.27 mJ/mm2) over the calcified NL guided by X-ray image. Patients in Group C received the same treatment as those in Group B, but the ESWT was guided by musculoskeletal sonography. The therapeutic effects were evaluated by: changes in range of motion (ROM) of the cervical spine including flexion, extension, lateral bending, and rotation; visual analog pain scale; and Neck Disability Index before and after treatment and at follow up 3 months later. We found a significant reduction in pain in each treated group after treatment and at follow up. However, patients in Groups B and C showed more improvements in ROM and neck pain relief after treatment and a decrease in Neck Disability Index. Furthermore, patients in Group C showed better cervical ROM at follow up than Group B. ESWT is an adjuvant treatment in the management of cervical spondylosis with calcification of NL and ultrasound-guided ESWT results in more functional improvements.

Head trauma is a common injury in young horses. This case report describes a 10-week-old Thoroughbred foal with an open wound following trauma to the poll region, showing abnormal head carriage and depression. A computed tomography ( CT) study was performed under general anaesthetic ( GA). This identified a complete avulsion of the nuchal ligament ( NL) and partial avulsions of the left and right semispinalis capitis ( SS) tendons. Following diagnosis and conservative treatment the foal made a good recovery and 18 months later the filly had no detectable neurological or physical abnormalities. Computed tomography enabled an accurate and rapid diagnosis of a novel injury. [ABSTRACT FROM AUTHOR]

Historically, sauropods have been largely perceived as having vertical, ‘S’-curved necks which were hypothesised to allow them to feed from the canopy of trees. Within the past two decades, this popular perception has been questioned, resulting in a debate over neck posture. The osteological differences between sauropods with horizontal neck posture (Diplodocus), and less horizontally inclined necks (Brachiosaurus) suggest differing life and feeding styles. One differing vertebral feature between these polarised bauplans is the bifurcated neural spine. Regardless of the spine condition, sauropods with and without bifurcated spines have been reconstructed exhibiting the same neck posture. Corroborating histology and morphology in extant taxa highlights the presence of modified vertebral ligaments associated with bifurcated spines. Using these extant taxa to better understand the biomechanics of bifurcated spines, this study proposes alternative soft tissue reconstructions. Previous depictions had the bifurcation trough entirely open or harbouring pneumatic diverticula or muscles; conversely this study proposes that the apices of the bifurcated spines were the anchoring points for a split nuchal ligament, and that the trough of bifurcation was predominantly filled with interspinal ligaments. Ligaments provide energy-efficient elastic rebound, and a paired ligament in the cervical series would aid in prolonged, lateral movement in a horizontal plane (i.e. feeding). [ABSTRACT FROM PUBLISHER]

The presence of Onchocerca guturosa in cattle is responsible for lesions similar to those observed in cases suspected of brucellosis, however, Onchocerca sp. is not a trade barrier, although it is also responsible for economic losses due to the removal of the affected parts of the carcasses. Brucella sp. is a zoonotic agent transmitted to humans through the consumption of contaminated animal products, the contact with infected animals and the handling of carcasses. This agent is also responsible for non-tariff trade barriers. Cervical bursitis is Brucella sp. suggestive lesions in bovine carcasses that requires laboratory tests to confirm the diagnosis. The objective of this study was to record the co-infection of Brucella abortus and Onchocerca sp. as a first report of co-infection of these two agents in the same lesion. The sample constituted of a nuchal bursitis in the cervical ligament, a suggestive lesion common to these two agents, submitted to histopathology and Brucella spp. isolation in the Brucellosis reference laboratory of the Brazilian Ministry of Agriculture, Livestock and Food Supply. Brucellosis serological diagnosis were also performed in the animal's serum sample. B. abortus was isolated from the lesion and filarid nematode structures were identified in histopathology. All serological tests were positive for brucellosis. Further studies are needed, however, to understand the co-infection by Onchocerca sp. and B. abortus. [ABSTRACT FROM AUTHOR]

This is a correlation analysis between severity of the ossification of the nuchal ligament (ONL) and clinical cervical disorders including neck dysfunction, cervical malalignment, and morphologic changes of the cervical neural foramen (CNF). The clinical effects of ONL on active range of motion (AROM) of neck, cervical radiculopathy, abnormal cervical curvature, and the degree of CNF stenosis in patients with painful neck stiffness are investigated. Studies have investigated the predisposing factors to cervical dysfunction and degenerative disorders; however, few studies have examined the influence of the ONL on neck function and cervical spine. A total of 31 participants with painful neck stiffness were recruited. They accepted measurement of cervical AROM and serial cervical radiographs at anterior–posterior view, lateral view, and bilateral oblique views. Parameters of radiographs measurement included cervical lordotic curve, and cross-sectional areas (CSA) of the ONL and CNF (C2–C3, C4–C5, C5–C6, and C6–C7 levels). The ratio of CSA of the lower CNF (C4–C5, C5–C6, C6–C7) to CSA of the upper CNF (C2–C3) was used as a CNF stenosis ratio. The correlations of ONL size, neck symptoms, cervical AROM, lordotic curve, and CNF stenosis ratio were analyzed. More than half of all patients were positive in cervical root signs and prone to have larger ONL. Neck AROM of all participants was significantly below normal average in all directions, and a moderate negative association was found between the ONL CSA and AROM in flexion–extension. Most patients had moderate loss of cervical lordotic curve despite there being no significant correlation between ONL CSA and cervical curvature. Moreover, CNF stenosis ratio significantly negatively correlated with ONL CSA. Patients with larger ONL had more severe cervical radiculopathy, more stiffness in flexion–extension direction, more complex degenerative change of spine, and worse CNF stenosis.

Objective This case series describes the computed tomography ( CT) and surgical findings of nine dogs with dermoid sinuses. Methods Medical records were reviewed and summarised. Results CT with intravenous contrast showed a superficial, peripherally contrast-enhancing, fluid-filled structure with a contrast-enhancing, soft tissue-attenuating tract that extended from the skin through the dorsal midline soft tissues, often to the level of the nuchal ligament. The tract often extended in an oblique direction to the nuchal ligament, but the tract ventral to the nuchal ligament, found at surgery, was not always discernible on CT. The dermoid sinuses were excised from all dogs. At surgery, the tract often extended ventral to the nuchal ligament, terminating on the vertebra. The most ventral aspect of the tracts involved a fibrous strand extension of the sinus, which was not discernible on CT. Conclusion Preoperative CT facilitated the diagnosis of a dermoid sinus and directed surgical planning; however, careful dissection beyond the nuchal ligament is imperative for complete excision. [ABSTRACT FROM AUTHOR]

Objective: There are also few studies demonstrating the relationship between ossification of nuchal ligament (ONL) and ossification of posterior longitudinal ligament (OPLL). We compared the prevalence, location, and type of OPLL between patients with ONL and matched patients without ONL.We also compared the bone mineral densities (BMDs) between the 2 groups. Methods: A total of 124 cervical ONL patients were enrolled in this study. The control group of 124 patients was matched with 124 patients with ONL by age and sex on a 1:1 basis to minimize confounding factors. We reviewed the prevalence, location, and type of OPLL in both groups. Results: The prevalence of OPLL was almost 2.5 times greater in patients with ONL than those without ONL. The mean value of BMD in patients with ONL was greater at the lumbar spine (L1-L4) than in patients without ONL. The mean T score of the lumbar spine was 0.25±1.68 in the patients with ONL and -0.73±1.64 in the patients without ONL. Conclusion: The prevalence of OPLL in patients with ONL was significantly higher than in patients without ONL. Because ONL is innocuous and may be seen more readily than OPLL on simple cervical radiographs, clinicians should consider the possibility of coexisting OPLL when ONL, especially extensive ONL, is detected in patients with neck pain, radiculopathy, or myelopathy, to facilitate proper treatment. [ABSTRACT FROM AUTHOR]

The previous reports suggest that obstructive sleep apnoea ( OSA) is related to metabolic syndrome, mineral metabolism disorders and cardiovascular disease. In addition, a possible relationship between obesity and the calcification of ligaments has been implied. However, the potential link between OSA and the calcification of ligaments has not been directly studied. In this present study, to investigate the potential link between OSA and the calcification of ligaments, we examined the prevalence of the calcification of ligaments in OSA patients and the relationship between these findings and OSA severity. Eighty consecutive patients (60 males, 20 females) diagnosed as OSA or a heavy snorer based on full-night polyso-mnography were retrospectively recruited from May 2006 to July 2008. Each patient underwent cephalometric imaging examination before the arrangement of an oral appliance. One calibrated observer ( YS) reviewed the cephalometric images for the presence of calcification of the nuchal ligament and osteophytes of the cervical spine. The prevalence of calcification of the nuchal ligament in OSA patients and snorers was 46·3% (males: 52%, females: 30%) There was a significant positive correlation between the severity of OSA ( AHI) and the calcification of the nuchal ligament before and after adjusting for BMI. The prevalence of the calcification of the nuchal ligament in OSA subjects and snorers was higher than in previous studies with non- OSA subjects. In addition, it is suggested that the severity of OSA correlates with the presence of calcification of the nuchal ligament. [ABSTRACT FROM AUTHOR]

Controversy surrounds certain head-and-neck positions (HNPs) in sport horses and their potential impact on the nuchal ligament (NL). This study measured the effects of six different HNPs on NL dimensions in five fetal cadavers, specifically funicular length, lamellar width at C4, and the lengths of the five individual lamellar bands. Normalized mean percentage changes in NL dimensions in HNP-2 to HNP-6 were compared with the NL dimensions in HNP-1. The lengths of the funicular and lamellar bands (C2–C6) decreased when the head and neck were raised (HNP-2, HNP-3, and HNP-5), in proportion to the degree of elevation, and increased when the head and neck were lowered (HNP-4 and HNP-6). Not all cervical segments were affected in the same way nor to the same degree. Lamellar width significantly decreased an average of 46% with HNP-4 (rollkur) and 29% with HNP-6 (long and low). Exaggerated poll flexion, as in HNP-3 and HNP-4, showed uneven stretching suggesting that the NL was not working as an integrated unit in these postures. Overall, the results suggest that certain HNPs impose limitations on the cycling of strain energy from head and neck movements during locomotion. Some positions may be associated with an increased chance of damage to either the NL or associated muscles. [ABSTRACT FROM AUTHOR]

Objective: The authors sought to explore the safety and efficacy of an autologous nuchal ligament for dural repair in pediatric patients undergoing tumor resection through a suboccipital midline approach., Methods: Pediatric patients diagnosed with posterior fossa neoplasia who underwent surgery through a suboccipital midline approach were retrospectively reviewed. The patients were divided into artificial graft and autograft groups according to whether artificial duraplasty material or autologous nuchal ligament was used to repair the dura. Postoperative complications were reviewed and analyzed, including CSF leak, pseudomeningocele, and meningitis, during hospitalization and follow-up. Univariate and multivariate logistic regression analyses were used to investigate the relationship between duraplasty material and postoperative complications, as well as other risk factors for postoperative complications. Furthermore, multinomial logistic regression analysis was used to clarify which postoperative complications the autologous nuchal ligament tended to reduce., Results: This retrospective study included 66 pediatric patients who underwent tumor resection through a suboccipital midline approach. The clinical baseline characteristics were comparable between the two groups. The results showed that the autograft group had significantly fewer postoperative complications, especially pseudomeningocele, compared with the artificial graft group. Moreover, the time required to repair the dura in the autograft group was significantly less than that in the artificial graft group. Further results revealed that the duraplasty material, ependymoma, preoperative severe hydrocephalus requiring an external ventricular drain (EVD), and postoperative hydrocephalus exacerbation were independent risk factors for postoperative complications. In particular, the autologous fascia of the nuchal ligament tended to reduce pseudomeningocele more than CSF leak and meningitis. However, compared with pseudomeningocele and CSF leak, both ependymoma and postoperative hydrocephalus exacerbation were more likely to increase the occurrence of meningitis. In contrast, preoperative severe hydrocephalus requiring EVD led to increased rates of postoperative complications., Conclusions: For pediatric patients with intracranial tumors who need to undergo resection through a suboccipital midline approach, dural repair using the nuchal ligament is safe, cost-effective, and time saving and significantly reduces postoperative complications.

Background: Insulin resistance has been associated with risk of laminitis in horses. Genes coding for proinflammatory cytokines and chemokines are expressed more in visceral adipose tissue than in subcutaneous adipose tissue of insulin-resistant (IR) humans and rodents. Hypothesis/Objectives: To investigate adipose depot-specific cytokine and chemokine gene expression in horses and its relationship to insulin sensitivity (SI). Animals: Eleven light breed mares. Methods: Animals were classified as IR (SI = 0.58 ± 0.31 × 10−4 L/min/mU; n = 5) or insulin sensitive (IS; SI = 2.59 ± 1.21 × 10−4 L/min/mU; n = 6) based on results of a frequently sampled intravenous glucose tolerance test. Omental, retroperitoneal, and mesocolonic fat was collected by ventral midline celiotomy; incisional nuchal ligament and tail head adipose tissue biopsy specimens were collected concurrently. The expression of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, plasminogen activator inhibitor-1 (PAI-1), and monocyte chemoattractant protein-1 (MCP-1) in each depot was measured by real-time quantitative polymerase chain reaction. Data were analyzed by 2-way analysis of variance for repeated measures ( P < .05). Results: No differences in TNF-α, IL-1β, IL-6, PAI-1, or MCP-1 mRNA concentrations were noted between IR and IS groups for each depot. Concentrations of mRNA coding for IL-1β ( P= .0005) and IL-6 ( P= .004) were significantly higher in nuchal ligament adipose tissue than in other depots. Conclusions and Clinical Importance: These data suggest that the nuchal ligament depot has unique biological behavior in the horse and is more likely to adopt an inflammatory phenotype than other depots examined. Visceral fat may not contribute to the pathogenesis of obesity-related disorders in the horse as in other species. [ABSTRACT FROM AUTHOR]

A comparative clinical trial was conducted to clarify the importance of preserving the C7 spinous process and attached nuchal ligament for the reduction of the axial symptoms after French-door laminoplasty in cervical spondylotic myelopathy patients. Forty-one cervical spondylotic myelopathy patients were enrolled. French-door laminoplasty from C3 to C7 in 22 patients (group 1), and from C3 to C6 in 19 patients (group 2) was performed. The whole structure of the C7 spinous process and the attached nuchal ligament were preserved in group 2. The pre- and post-operative evaluation regarding severity of clinical symptoms was assessed using the Japanese Orthopaedic Association (JOA) score. Pre-operative and subjective outcome regarding axial symptoms were also assessed using a visual analog pain scale questionnaire (VAS: 10–0, where a higher score indicates greater pain) at 1- and 2-year follow-up. Non-parametric testing (Mann–Whitney’s U test) was used to establish differences between the two groups for categorical data ( P < 0.05). There was no significant difference between the two groups in pre- and post-operative JOA score. The mean VAS was 5.6 ± 1.4 in group 1, 5.4 ± 1.7 in group 2 pre-operatively, and 6.4 ± 1.7 in group 1 and 2.4 ± 1.9 in group 2 at 1-year follow-up. The mean VAS score at 2-year follow-up exhibited 6.2 ± 1.9 in Group 1, 2.3 ± 1.8 in group 2. There was no significant difference in VAS between the two groups before surgery ( P = 0.506), but significant differences were noticed at 1-year and 2-year follow-up ( P < 0.05), indicating the presence of significantly fewer post-operative axial symptoms in group 2. Laminoplasty of the entire C7 structure is not necessary to obtain satisfactory recovery based on JOA score. Preservation of the C7 spinous process and the attached nuchal ligamentous structures is important to reduce post-laminoplasty axial symptoms. [ABSTRACT FROM AUTHOR]