To describe the treatment of a patient with chronic whiplash-associated disorders (WADs) previously unresponsive to multiple physical therapy and chiropractic treatments, which resolved following ...Clinical Biomechanics of Posture (CBP) rehabilitation methods.
A 40-year-old man involved in a high-speed rear-impact collision developed chronic WADs including cervicothoracic, shoulder, and arm pain and headache. The patient was diagnosed with a confirmed chip fracture of the C5 vertebra and cervical and thoracic disk herniations. He was treated with traditional chiropractic and physical therapy modalities but experienced only temporary symptomatic reduction and was later given a whole body permanent impairment rating of 33% by an orthopedic surgeon.
The patient was treated with CBP mirror-image cervical spine adjustments, exercise, and traction to reduce forward head posture and cervical kyphosis. A presentation of abnormal head protrusion resolved and cervical kyphosis returned to lordosis posttreatment. His initial neck disability index was 46% and 0% at the end of care. Verbal pain rating scales also improved for neck pain (from 5/10 to 0/10).
A patient with chronic WADs and abnormal head protrusion, cervical kyphosis, and disk herniation experienced an improvement in symptoms and function after the use of CBP rehabilitation protocols when other traditional chiropractic and physical therapy procedures showed little or no lasting improvement.
Mathematical modeling, using least squares method, of thoracic kyphosis was constructed as digitized points from radiographs of 50 healthy patients.
To determine a simple geometric model of the ...thoracic kyphosis.
Thoracic kyphosis is an important parameter of health, but geometric models of kyphosis are rare. Few papers report vertebral body and disc height data.
Thoracic vertebral bodies were digitized on lateral radiographs of 50 healthy patients. The average path of the posterior vertebral body corners of T1 through T12 was modeled, in the least squares sense, with a portion of an ellipse. The best-fit ellipse was sectioned with different model partitions using four sets of vertebral body heights and disc heights. Segmental and global angles derived from these four models were compared with reported values in the literature.
A 72 degrees portion of an ellipse, with a minor-to-major axis ratio of 0.69, can closely approximate the path of the posterior body corners from the inferior of T1 to the superior of T12. The posterior vertebral body heights and disc heights have an average ratio of approximately 5:1. Segmental angles from T3-T4 through T11-T12 for all four models are close to other reported values. The thoracic spine has a height-to-length ratio of approximately 0.96.
Thoracic kyphosis from inferior-posterior T1 to superior-posterior T12 can be closely modeled (least squares error per point < 1 mm) with a 72 degrees piece of an ellipse with a minor-to-major axis ratio of 0.69. The major axis is parallel to the posterior body margin of T12, whereas the minor axis passes through the superior endplate of T12. Segmental angles derived from this elliptical modeling are in the range of values from healthy patients.
To determine whether the newly derived interclass and intraclass correlation coefficients (ICCs)would overstate or understate the results from 2 previously published studies, which used better known ...ICCs that assume nested factors, and to determine mean absolute differences of observers' measurements for 3 previous studies.
Retrospective analysis of data from 2 blind studies with repeated-measure design. Two newly derived ICCs, appropriate to situations with 3 random factors (patients, examiners, and occasions) that bear a crossed (as opposed to nested) interrelationship, were applied to data from an experiment with random crossed factors.
Observer reliability is determined with ICCs, 95% CIs, and observer error analysis (mean absolute differences of observers' measurements) for angles and distances derived from Harrison's modified Risser-Ferguson line-drawing method on anteroposterior (AP) lumbar and AP cervical radiographic views. Observer error analysis for angles and distances derived from Harrison's posterior tangent method on lateral cervical views was also determined.
The majority of ICCs for reliability of line drawing on both AP cervical and AP lumbar radiographs were in the high range; 13 of 16 ICCs were greater than 0.88. The other 3 ICC values (0.61, 0.76, 0.78) concerned determining the sacral base on AP lumbar views. The new ICCs underestimated observer reliability compared with previously published results (intraclass ICCs lower by 0.01-0.02 and interclass ICCs lower by 0.03-0.10). For an error analysis on data from both AP views, the mean absolute differences of observers' measurements were 1.1 degrees to 1.8 degrees for angles and 1.2 mm to 2.3 mm for distances. For the lateral cervical analysis, the observer error was in the interval 0.8 degrees to 3.2 degrees for angles and <1 mm for distances.
The ICCs assuming random crossed factors understate reliability compared with previously published ICC results assuming nested factors. Reliability of the Harrison modified Risser-Ferguson method of line-drawing analysis on AP views is in the high range, with the majority of ICCs >0.88. For both the Harrison modified Risser-Ferguson method on AP views and posterior tangent method on lateral cervical views, the mean absolute differences of observers' measurements are small.
Background. The determinants of long-term outcome 15 years or more after porcine valve replacement are poorly documented.
Methods. A retrospective review was performed of patients undergoing valve ...replacement with standard Carpentier-Edwards aortic (n = 531), mitral (n = 492), and tricuspid (n = 96) valves.
Results. Patient survival was 26% ± 3%, 23% ± 2%, and 31% ± 8% 15 years after aortic, mitral, and tricuspid valve replacements, respectively. Independent determinants of impaired long-term survival for aortic or mitral valve replacement were multiple valve replacement, older age, renal disease, lung disease, or coronary disease. Actual (versus actuarial) freedom from reoperation at 15 years was 86% ± 2%, 76% ± 2%, and 95% ± 2% after aortic, mitral, and tricuspid valve replacement, respectively. Risk factors for reoperation were young age for aortic or mitral valve replacement, previous operation for aortic valve replacement, and large valve size for mitral valve replacement. Freedom from thromboembolism was 77% ± 4%, 62% ± 9%, and 80% ± 5%; from hemorrhage, 95% ± 5%, 87% ± 4%, and 82% ± 6%; and from endocarditis, 94% ± 1%, 96% ± 1%, and 89% ± 5% 15 years after aortic, mitral, and tricuspid valve replacement, respectively. Risk factors for thromboembolism or hemorrhage were multiple valve replacement and age.
Conclusions. The standard Carpentier-Edwards bioprosthesis continues to provide relatively low complication rates at 15 years, especially in the aortic and tricuspid positions, and especially in patients older than 60 years or with significant comorbdity.
To present a case of a 41-year-old man with syringomyelia and intractable pain and the subsequent reduction of symptoms.
This patient acquired a traumatically induced syrinx in his upper cervical ...spinal cord after he fell approximately 9 feet and landed on his head, upper back, and neck 9 years before presenting for care. He was diagnosed with a spinal cord cyst (syrinx), located at approximately C2 through C4 after magnetic resonance imaging. In 1995, the patient underwent occipitoatlantal decompression surgery, which improved his symptoms for a short time.
The patient was treated using Clinical Biomechanics of Posture protocol. The patient was seen 26 times over the course of 3 weeks. His scale for pain severity decreased 50% and other subjective complaints decreased. His posture improved based upon pretreatment and posttreatment lateral cervical radiographs, showing a change from a 10° lordosis with midcervical kyphosis to a 30° lordosis. One-year follow-up examination showed stable improvement in the cervical lordosis and pain intensity.
This case represents a change in subjective and objective measurements after conservative chiropractic care. This case provides an example that structural rehabilitation may have a positive effect on symptoms of a patient with syringomyelia.
Current immunosuppressive therapies act on T lymphocytes by modulation of cytokine production, modulation of signaling pathways or by inhibition of the enzymes of nucleotide biosynthesis. We have ...identified a previously unknown series of immunomodulatory compounds that potently inhibit human and rat T lymphocyte proliferation in vitro and in vivo in immune-mediated animal models of disease, acting by a novel mechanism. Here we identify the target of these compounds, the monocarboxylate transporter MCT1 (SLC16A1), using a strategy of photoaffinity labeling and proteomic characterization. We show that inhibition of MCT1 during T lymphocyte activation results in selective and profound inhibition of the extremely rapid phase of T cell division essential for an effective immune response. MCT1 activity, however, is not required for many stages of lymphocyte activation, such as cytokine production, or for most normal physiological functions. By pursuing a chemistry-led target identification strategy, we have discovered that MCT1 is a previously unknown target for immunosuppressive therapy and have uncovered an unsuspected role for MCT1 in immune biology.
It is commonly believed that slight flexion/extension of the head will reverse the cervical lordosis. The goal of the present study was to determine whether slight head extension could result in a ...cervical kyphosis changing into a lordosis. Forty consecutive volunteer subjects with a cervical kyphosis and with flexion in their resting head position had a neutral lateral cervical radiograph followed immediately by a lateral cervical view taken in an extended head position to level the bite line. Subjects were patients at a spine clinic in Elko, Nevada. All radiographs were digitized. Global and segmental angles of the cervical curve were compared for any change in angle due to slight extension of the head. The average extension of the head required to level the bite line was 13.9 degrees. This head extension was not substantially correlated with any segmental or global angle of lordosis. Subjects were categorized into those requiring slight head extension (0 degree-13.9 degrees) and those requiring a significant head extension (> 13.9 degrees). In the slight head extension group, the average change in global angle between posterior tangents on C2 and C7 was 6.9 degrees, and 80% of this change occurred in C1-C4. In the significant head extension group, the average change in global angle between posterior tangents on C2 and C7 was 11.0 degrees, and the major portion of this change occurred in C1-C4. Out of 40 subjects, only one subject, who was in the significant head extension group and had only a minor segmental kyphosis, changed from kyphosis to lordosis. The results show that slight extension of the head does not change a reversed cervical curve into a cervical lordosis as measured on lateral cervical radiographs. Only small extension angle changes (mean sum = 4.8 degrees) in the upper cervical segments (C2-C4) occur in head extension of 14 degrees or less.
Objective. To determine lumbar coupling during lateral postural translations (lumbosacral list) of the thoracic cage relative to a fixed pelvis.
Design. Digitized measurements from anteroposterior ...lumbar radiographs of 17 volunteers were obtained in neutral, maximal left lateral translation and maximal right lateral translation posture of the thoracic cage compared to a fixed pelvis. Subjects were constrained with two sets of clamps at the lateral borders of the pelvis and lower ribs.
Background Data. Clinically, lumbosacral list is a common posture. Range of motion and spinal coupling results have not been reported for the lumbosacral list movement.
Methods. Four vertebral body corners, mid narrow-waisted body margins, superior and inferior pedicle margins, and spinous-lamina junction of T12–L5 were digitized on 51 anterior–posterior lumbar radiographs.
Using the orthogonal axes of positive x-direction to the left,
vertical as positive y,
and anterior as positive z, digitized points were used to measure projected segmental
z-axis rotation,
y-axis rotation, and segmental lateral translations of each vertebra.
Results. Using the displacement of T12, subjects could translate 35–70 mm left or right along the
x-axis with an average of 53.2 mm to the left and 52.1 mm to the right. Using superior endplates to superior sacral base, lateral flexion was largest at L1 and decreased from L1 to L5, but the segmental rotation angles for lateral flexion were largest at L2–L3 (3.9°), L3–L4 (6.2°) and L4–L5 (5.7°) and were in the same direction as the main motion translation. The relative
z-axis rotation of T12 was opposite to the direction of L1–L5. The coupled
y-axis rotations were less than 1° and coupled segmental lateral translations were averaging less than 1 mm.
Conclusions. Thoracic cage
x-axis translations compared to a fixed pelvis are significant, between 35 and 70 mm. The
z-axis lumbar coupled rotation was largest at L2–L3, L3–L4 and L4–L5 and to the same side of the main motion translation in L1–L5, but opposite the main motion direction for T12. All other movements were small, averaging less than 1° or 1 mm.
Relevance
The clinically common posture of lateral translation of the thoracic cage (lumbosacral list) is often associated with disc herniation. Yet normal lumbar coupling patterns and total range of motion of this movement have not been established in the literature. Normal values for lumbar segmental coupling on anterior–posterior lumbo-pelvic radiographs during trunk list might be important for an analysis of segmental instability since segmental translations were determined to be 1 mm or less.
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