Objective Os odontoideum can lead to instability of the atlantoaxial joint and places the spinal cord at significant risk for acute traumatic catastrophic events or chronic neurologic change. The ...purpose of this study was to retrospectively review acute cervical cord injury after minor trauma in 6 pediatric patients with os odontoideum. Methods Between 2012 and 2013, 6 pediatric patients with os odontoideum who suffered acute traumatic cervical cord injury were reviewed retrospectively. Their clinical history, neurologic symptoms, radiological investigations, follow-up period, American Spinal Injury Association (ASIA) impairment classification, and motor score were reviewed. Results There were 2 male and 4 female subjects ranging in age from 4 to 18 years (mean 11.8 years). Before the traumatic injury, 2 cases were asymptomatic and 4 complained of myelopathic feature with unsteadiness on feet. Falls were the most common injury (n = 5), followed by a minor motor vehicle accident (n = 1). Atlantoaxial instability and cord compression were presented in all cases with dynamic cervical lateral radiographs and magnetic resonance imaging. Most patients presented with spinal cord thinning and hyperintensity on T2-weighted sequences in magnetic resonance imaging. Spinal cord compression was anterior in 2 cases and both anterior and posterior in 4. Two patients was classified as ASIA B, 1 as ASIA C, and 3 as ASIA D category on admission. Two patients presented with respiratory failure with mechanical ventilation for over 2 weeks in perioperative period. Postoperatively, all patients improved neurologically and clinically after underwent posterior atlantoaxial fixation and fusion. Conclusions Pediatric patients with asymptomatic or myelopathic atlantoaxial instability secondary to os odontoideum are at risk for acute spinal cord injury even after minor traumatic injury. Sufficient fixation and fusion should be undertaken as prophylactic treatment of developing myelopathy and to improve neurologic symptoms with acute traumatic cervical cord injury in pediatric patients with os odontoideum.
Abstract We retrospectively reviewed acute cervical cord injury after minor trauma in 10 patients with os odontoideum. Their clinical history, neurological symptoms, radiological investigations, ...follow-up period, American Spinal Injury Association impairment classification and motor score were reviewed. Before their traumatic injury, three patients were asymptomatic and seven reported myelopathic symptoms, including four patients with neck pain, two patients with unsteadiness and one patient with dizziness. Falls were the most common cause of injury ( n = 6), followed by minor motor vehicle accidents ( n = 3) and assault ( n = 1). MRI and dynamic cervical lateral radiographs showed that all patients had atlantoaxial instability and cord compression. Most patients had spinal cord thinning and hyperintensity on T2-weighted MRI. Spinal cord compression was posterior ( n = 5), or both anterior and posterior ( n = 5). All patients underwent posterior rigid screw fixation and fusion, including atlantoaxial fusion ( n = 8) and occipitocervical fusion ( n = 2). We conclude that patients with asymptomatic or myelopathic atlantoaxial instability secondary to os odontoideum are at risk for acute spinal cord injury after minor traumatic injury. Fixation and fusion should be undertaken as prophylactic treatment for patients at risk of developing myelopathy and to avoid the neurological deterioration associated with acute traumatic cervical cord injury.
OBJETIVOS: a proposta deste estudo prospectivo, transversal e multicêntrico foi correlacionar as alterações morfológicas das vértebras cervicais C2, C3 e C4, com a idade cronológica e comparar com a ...idade esqueletal dos ossos da mão e punho; e verificar se existem diferenças no padrão de crescimento ósseo entre os gêneros masculino e feminino. METODOLOGIA: a amostra foi constituída por 140 pacientes, 74 do gênero feminino e 66 do masculino. A avaliação das alterações das vértebras cervicais foi feita pelo método de Hassel e Farman modificado por Baccetti, Franchi e McNamara para 5 estágios que se correlacionam com o crescimento puberal em telerradiografias cranianas em norma lateral. As radiografias da mão e punho avaliaram os eventos de ossificação por meio do método de Greulich e Pyle. RESULTADOS: os resultados demonstraram correlação dos estágios de maturação das vértebras cervicais com a idade cronológica; e correlação positiva e moderada, estatisticamente significante entre os dois métodos com r = 0,6326 (IC = 95%) e p < 0,0001. CONCLUSÕES: desta forma, pôde-se concluir que a idade aumenta proporcionalmente em relação aos estágios de maturação, sendo que a maioria dos pacientes da amostra encontrou-se no estágio II, considerado bom para o início da terapêutica ortodôntico/ortopédica. O nível de correlação entre os métodos demonstrou que a avaliação dos estágios de maturação das vértebras cervicais é um método adicional útil e confiável na determinação do estágio de crescimento facial nas crianças em crescimento puberal. O gênero feminino apresentou estágios de crescimento mais precoces que o gênero masculino, atingindo o início e o final do surto de crescimento puberal em idade cronológica mais inferior.
Chondroitinase ABC treatment promotes spinal cord plasticity. We investigated whether chondroitinase-induced plasticity combined with physical rehabilitation promotes recovery of manual dexterity in ...rats with cervical spinal cord injuries. Rats received a C4 dorsal funiculus cut followed by chondroitinase ABC or penicillinase as a control. They were assigned to two alternative rehabilitation procedures, the first reinforcing skilled reaching and the second reinforcing general locomotion. Chondroitinase treatment enhanced sprouting of corticospinal axons independently of the rehabilitation regime. Only the rats receiving the combination of chondroitinase and specific rehabilitation showed improved manual dexterity. Rats that received general locomotor rehabilitation were better at ladder walking, but had worse skilled-reaching abilities than rats that received no treatment. Our results indicate that chondroitinase treatment opens a window during which rehabilitation can promote recovery. However, only the trained skills are improved and other functions may be negatively affected.
The process of patterning along the anterior-posterior axis in vertebrates is highly conserved. The function of Hox genes in the axis patterning process is particularly well documented for bone ...development in the vertebral column and the limbs. We here show that Hoxb6, in skeletal elements at the cervico-thoracic junction, controls multiple independent aspects of skeletal pattern, implicating discrete developmental pathways as substrates for this transcription factor. In addition, we demonstrate that Hoxb6 function is subject to modulation by genetic factors. These results establish Hox-controlled skeletal pattern as a quantitative trait modulated by gene-gene interactions, and provide evidence that distinct modifiers influence the function of conserved developmental genes in fundamental patterning processes.
Abstract Detailed cervical spine models are necessary to better understand cervical spine response to loading, improve our understanding of injury mechanisms, and specifically for predicting occupant ...response and injury in auto crash scenarios. The focus of this study was to develop a C4–C5 finite element model with accurate representations of each tissue within the segment. This model incorporates more than double the number of elements of existing models, required for accurate prediction of response. The most advanced material data available were then incorporated using appropriate nonlinear constitutive models to provide accurate predictions of response at physiological levels of loading. This tissue-scale segment model was validated against a wide variety of experimental data including different modes of loading (axial rotation, flexion, extension, lateral bending, and translation), and different load levels. In general, the predicted response of the model was within the single standard deviation response corridors for both low and high load levels. Importantly, this model demonstrates that appropriate refinement of the finite element mesh, representation at the tissue level, and sufficiently detailed material properties and constitutive models provide excellent response predictions without calibration of the model to experimental data. Load sharing between the disc, ligaments, and facet joints was investigated for various modes of loading, and the dominant load-bearing structure was found to correlate with typical anatomical injury sites for these modes of loading. The C4–C5 model forms the basis for the development of a full cervical spine model. Future studies will focus on tissue-level injury prediction and dynamic response.
Highlights • We report a case of differentiated plasma cell myeloma mimicking a solitary thoracic spine amyloidoma in a 66-year-old female patient. • Plasma cell myeloma may rarely present as a ...solitary amyloidoma in the initial pathological examination. • In case of solitary amyloidoma in spine an early decompression with tumor mass reduction may avoid permanent neurological deficits. • The prognosis is related to coexisting conditions, the type of amyloidosis and possible underlying diseases. • It is mandatory to exclude other possible underlying diseases causing amyloidoma.
Objectives
To compare the short-term effects and advantages of ultrasound-guided selective nerve root block with fluoroscopy-guided transforaminal epidural block for radicular pain in the lower ...cervical spine through assessment of pain relief, functional improvement, and safety.
Methods
A total of 120 patients with radicular pain from cervical spinal stenosis or cervical herniated disc were enrolled. All procedures were performed using a fluoroscopy or ultrasound apparatus. The subjects were randomly assigned to either the fluoroscopy (FL) or ultrasound (US) group. The complication frequencies during the procedures, treatment effects, and functional improvement of the nerve root block were compared at 2 and 12 weeks after the procedures.
Results
Verbal Numeric Pain Scale (VNS) improved 2 weeks and 12 weeks after the injections in both groups. Statistical differences were not observed in VNS, Neck Disability Index (NDI), and effectiveness between the groups. In 21 patients at US, vessels were identified at the anterior aspect of the foramen. Eleven patients had a critical vessel at the posterior aspect of the foramen and five patients had on artery continue medially into the foramen, forming, or joining a segmental feeder artery. In both cases, the vessels might well have been in the pathway of the needle correctly positioned under fluoroscopic guidance. Five cases of intravascular injections were observed only in FL without significant difference between the groups.
Conclusions
The US-guided method may facilitate identifying critical vessels at unexpected locations relative to the intervertebral foramen and avoiding injury to such vessels, which is the leading cause of the reported complications from cervical transforaminal injections. On treatment effect, using either method of epidural injections to deliver steroids for cervical radicular pain, secondary to herniated intervertebral disc or foraminal stenosis, significant improvements in function and pain relief were observed in both groups after the intervention. However, significant difference was not observed between the groups. Therefore, the ultrasound-guided method was shown to be as effective as the fluoroscopy-guided method in pain relief and functional improvement, in addition to the absence of radiation and avoiding vessel injury at real-time imaging.
Amaç: Bu çalışmanın amacı, kronolojik yaş, diş yaşı, servikal vertebra maturasyonu ve el-bilek maturasyonu arasındaki ilişkileri değerlendirmektir. Bireyler ve Yöntem: Çalışmada, yaşları 7-18,10 ...arasında olan 141 Türk bireye (79 kız, 62 erkek) ait panoramik, el-bilek ve sefalometrik röntgenler değerlendirilmiştir. Bireylerin diş yaşı tespiti panoramik röntgenler üzerinde, Demirjian metoduna göre yapılmıştır. Bireylere ait el-bilek röntgenleri üzerinde iskeletsel maturasyon seviyesinin tespiti için Fishman maturasyon indikatörleri kullanılmıştır. Servikal vertebra maturasyonunun değerlendirilmesinde,Bacetti ve ark tarafından geliştirilen metod tercih edilmiştir. Belirtilen değişkenler arasındaki ilişkilerin belirlenmesinde Spearman’ın sıralama korelasyon katsayıları kullanılmıştır. Bulgular: Kronolojik yaş, diş yaşı, servikal vertebra maturasyonu ve el-bilek maturasyonu arasındaki korelasyon katsayıları kızlar ve erkekler için ayrı hesaplandı. Yapılan korelasyon analizinde, Spearman korelasyon katsayısı, hem kız hem de erkek bireyler için, değerlendirilen tüm değişkenler arasında farklı düzeylerde anlamlı, pozitif korelasyon olduğunu gösterdi (P<0.01). Kız ve erkek bireylerde el-bilek ve servikal vertebra arasındaki 0,815 ve 0,792lik korelasyon değerleri, değişkenler arasında mükemmel derecede bir bağıntı olduğunu ortaya koydu. Kızlarda, en düşük seviyede bağıntı el-bilek maturasyonu ve diş yaşı arasında, orta derecede saptandı (rs: 0.472). Erkeklerde ise en düşük seviyede bağıntı servikal vertebra maturasyonu ve diş yaşı arasında, orta derecede saptandı (rs: 0.461). Sonuçlar: Her iki cins için, kronolojik yaş-iskeletsel maturasyon arasındaki korelasyon ve el-bilek maturasyonu-servikal vertebra maturasyonu arasındaki korelasyon yüksek bulunmuştur. Her iki cins için, diş yaşı ve servikal vertebra maturasyonu arasında orta derecede korelasyon bulunmuştur. Diş yaşı ve el-bilek maturasyonu arasında korelasyon, kızlarda orta derecedeyken, erkeklerde iyi derecede bulunmuştur. Pubertal büyüme atılımı döneminin belirlenmesinde geçerli bir metod olan el-bilek maturasyonu tayinine alternatif olarak servikal vertebra maturasyonu kullanılabilir. Bu amaçla, indikatör olarak diş yaşı tayininin güvenirliğinin netleşmesi için daha çok bireyin dahil edileceği gelecek çalışmalara ihtiyaç vardır.
Abstract We report a case of Bartonella henselae , an agent of cat scratch disease, C1-C2 osteoarthritis with osteolysis of the lateral mass of C2 in a 14-year-old boy. Oral antibiotics did not ...successfully treat the infection and surgery was necessary to treat the septic arthritis. The case opens discussion about bacterial osteoarthritis of the cervical spine and bone involvement in disseminated bartonellosis.
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