Clinical Relationship of Degenerative Changes between the Cervical and Lumbar Spine

Yuichiro Morishita,Zorica Buser,Anthony D’Oro,Keiichiro Shiba,Jeffrey C. Wang 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.2

Study Design: Retrospective, observational, case series. Purpose: To elucidate the prevalence of degenerative changes in the cervical and lumbar spine and estimate the degenerative changes in the cervical spine based on the degeneration of lumbar disc through a retrospective review of magnetic resonance (MR) images. Overview of Literature: Over 50% of middle-aged adults show evidence of spinal degeneration. However, the relationship between degenerative changes in the cervical and lumbar spine has yet to be elucidated. Methods: A retrospective review of positional MR images of 152 patients with symptoms related to cervical and lumbar spondylosis with or without a neurogenic component was conducted. The degree of intervertebral disc degeneration (IDD) was assessed on a grade of 1–5 for each segment of the cervical and lumbar spine using MR T2-weighted sagittal images. The grades across all segments were summed to produce the degenerative disc score (DDS) for the cervical and lumbar spine. The patients were divided into two groups based on the IDD grade for each lumbar segment: normal (grades 1 and 2) and degenerative (grades 3–5). Results: DDSs for the cervical and lumbar spine were positively correlated. Significant differences in cervical DDSs between the groups were observed in all lumbar segments. Although there were no significant differences in cervical DDSs among the degenerative lumbar segment, cervical DDSs at the L1–2 and L2–3 segments tended to be higher than those at the L3–4, L4–5, and L5–S degenerative segments. Conclusions: Our study shows that participants with degenerative changes in the upper lumbar segments are more likely to have a certain amount of cervical spondylosis. This information could be used to lower the incidence of a missed diagnosis of cervical spine disorders in patients presenting with lumbar spine symptomology.

스마트폰 사용시간이 목뼈 및 허리뼈의 굽힘각도와 목뼈의 재현오차에 미치는 영향

김양곤(Yang-gon Kim),강민혁(Min-hyeok Kang),김지원(Ji-won Kim),장준혁(Jun-hyeok Jang),오재섭(Jae-seop Oh) 한국전문물리치료학회 2013 한국전문물리치료학회지 Vol.20 No.1

The purpose of this study was to assess the influence of the duration of smartphone usage on cervical and lumbar spine flexion angles and reposition error in the cervical spine. The study included 18 healthy smartphone users (7 males and 11 females). We measured the kinematics of the upper and lower cervical and lumbar spine flexion angles and the reposition error of the upper and lower cervical spine after 3 s and 300 s smartphone use in sitting. A paired t-test was used to compare the effects of the duration of smartphone usage on the kinematics of cervical and lumbar spine flexion angles and reposition error. The flexion angles of the lower cervical and lumbar spine and the reposition error in the upper and lower cervical spine were significantly increased after 300 s smartphone of use (p<.05). However, the flexion angle of the upper cervical spine was not significantly different between the 3 s and 300 s smartphone of use (p>.05). These findings suggest that prolonged use of smartphones can induce changes in cervical and lumbar spine posture and proprioception in the cervical spine.

Cervical Deformity Arising From Upper Thoracic Malalignment

Ibrahim Obeid,Louis Boissiere,Anouar Bourghli 대한척추신경외과학회 2020 Neurospine Vol.17 No.3

This study aims to describe the surgical management of cervical deformity arising from outside the cervical spine because of upper thoracic malalignment, using pedicle subtraction osteotomy (PSO). Cervical spine deformity is a complex topic and it can be generally divided into 2 categories, the first category is when the primary deformity is inside the cervical spine and the treatment will focus on the cervical spine itself, whereas the second category is when the primary deformity is outside the cervical spine usually in the adjacent upper thoracic area, the cervical deformity is a compensation for the adjacent malalignment, and thus in this situation, the management will occur in the upper thoracic area. Description of a single surgeon’s technique for performing PSO to treat rigid upper thoracic deformity. PSO in the upper thoracic spine is a safe and effective procedure and can result in satisfying clinical and radiological outcome with indirect correction of the compensatory cervical deformity. Cervical deformity arising from upper thoracic malalignment should be dealt with by treating the problem at its origin outside the cervical spine by performing a PSO in the upper thoracic spine.

Effect of Cervical Corrective Exercises on Pain, Neck Posture, and Intersegmental Motion of Cervical Spine in a Patient With Cervical Radiculopathy: A Case Report

Sung joon Yun,Moon hwan Kim,Jong hyuck Weon,Oh yun Kwon 한국전문물리치료학회 2015 한국전문물리치료학회지 Vol.22 No.4

This case report describes the effectiveness of cervical corrective exercises in a patient with cervical radiculopathy (CR) who experienced radicular pain, upper limb paresis, and limited functional activity. A 39-year-old male with cervical radiculopathy performed the cervical corrective exercises for reducing pain. Pain intensity, cervical posture, and active range of motion of cervical intersegmental spine motion were measured baseline, after 4 weeks, and after 8 weeks with self-reported questionnaire and radiographs. After 8 weeks of intervention, the patient demonstrated alleviated radicular symptoms, improved neck posture and active range of flexion and extension of the cervical intersegmental spine. Especially in the angle between the cervical vertebra 6 and 7, the angle was changed from -4.69° to 3.30° during resting position after intervention. The present case indicates that the cervical corrective exercises might be a possible treatment to effectively reduce radicular symptoms, improve neck posture, and active cervical intersegmental motion for patient with CR.

Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations

Salman Sharif,Muhammad Yassar Jazaib Ali,Ibet Marie Y. Sih,Jutty Parthiban,Óscar L. Alves 대한척추신경외과학회 2020 Neurospine Vol.17 No.4

To formulate specific guidelines for the recommendation of subaxial cervical spine injuries concerning classification, management, posttraumatic locked facets and vertebral artery injury. Computerized literature was searched on PubMed and google scholar database from 2009 to 2020. For classification, keywords “Sub Axial Cervical Spine Classification,” resulting in 22 articles related to subaxial cervical spine injury classification system (SLICS) system and 11 articles related to AO (Arbeitsgemeinschaft für Osteosynthesefragen, German for “Association for the Study of Internal Fixation”) Spine system. The literature search yielded 210 and 78 articles on “management of subaxial cervical spine injuries” and the role of “SLICS” and “AO Spine” respectively. Keywords “management of traumatic facet locks” were searched and closed reduction, traction, approaches and techniques were studied. “Vertebral artery injury and cervical fracture” exhibited 2,328 references from the last 15 years. The objective was to identify the appropriate diagnostic tests and optimal treatment. Up-to-date information was reviewed, and statements were produced to reach a consensus in 2 separate consensus meetings of World Federation of Neurosurgical Societies (WFNS) Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method. Based on the most relevant literature, panelists in Moscow consensus meeting conducted in May 2019 drafted the statements, and after a preliminary voting session, the consensus was identified on various statements. Another meeting was conducted at Peshawar in November 2019, where in addition to previous statements, few other statements were discussed and voted. Specific recommendations were then formulated guiding classification, management, locked facets and vertebral artery injuries. This review summarizes the WFNS Spine Committee recommendations on subaxial cervical spine injuries.

Treatment and Prevention of Abnormality with Lateral Flexion and Rotation in Cervical Spine

Hyun-Chang Lee(이현창),Seong-Yoon Shin(신성윤),Ki-Hong Park(박기홍) 한국컴퓨터정보학회 2019 韓國컴퓨터情報學會論文誌 Vol.24 No.10

헬스케어 시스템에서 인간 목(경추)은 가장 중요한 기관 중 하나이고, 사람의 머리를 지탱하는 부위가 바로 경추이다. 요즘에는 스마트 폰으로 전화를 걸거나 모니터를 보기 위해 종종 목이 과로로 피곤한 경우가 많다. 이 논문에서 우리는 경추의 가쪽 돌림과 및 회전의 이상을 조사한다. 가쪽 돌림의 정상 각도는 20 ° ~ 45 °이고 정상적인 회전 각도는 50 ° ~ 90 °이다. 이 각도가 정상보다 낮아 통증이 느껴지면 경추에 문제가 있는 것이다. 또한 목 또는 경추의 가쪽 돌림 및 회전을 측정하는 방법과 이상을 치료하는 방법에 대해 알아본다. 그리고 경추의 가쪽 돌림 및 회전이상을 예방하는 방법도 살펴보도록 한다. 목이 비정상적인지 알아보기 위해 50 대 남성과 여성으로 100 명을 대상으로 실험을 수행하였다. In the healthcare system, the human neck(cervical spine) is one of the most important organs. The area that supports the human head is the cervical spine. Nowadays, we are often overworked our neck to calls with the smart phone or see the monitors. In this paper, we investigate the abnormalities of lateral flexion and rotation of the cervical spine. The normal angle of lateral flexion is 20 ° to 45 ° and the normal angle of rotation is 50 ° to 90 °. If this angle is below normal and we feel pain, there is something wrong with the cervical spine. In addition, learn how to measure the lateral flexion and rotation of the neck or cervical spine, and also to find out how to treat an abnormality. We also look at how to prevent more than lateral flexion and rotation of the cervical spine. The experiment was carried out with 100 people in their 50s, men and women, to find out whether the neck is abnormal.

사각근 증후군 환자의 경추 부정렬에 관한 연구

강지훈 ( Ji Hun Kang ),이길준 ( Kil Joon Lee ),박영회 ( Young Hoi Park ),금동호 ( Dong Ho Keum ) 한방재활의학과학회 2006 한방재활의학과학회지 Vol.16 No.4

Objectives : We investigated the possibility of cervical spine misalignment caused by Scalenus anticus syndrome to find out the Scalenus anticus syndrome could effect misalignment of cervical spine. Methods : 18 patients with Scalenus anticus syndrome who attended Dept. of Oriental Rehabilitation Medicine, College of Oriental Medicine, Dong-guk University from 20th June to 10th September 2006, were involved in the investigation. After researching misalignment through neutrality lateral, flexion lateral, extension lateral x-ray examination views, we measured difference of length of cervical spine misalignment. We analyzed the difference of length of cervical spine misalignment, and the relationship among the neutrality lateral, flexion lateral and extension lateral position. Results : Lateral flexion and lateral extension position were shown higher frequency than neutrality position in cervical spine misalignment. We got the statistical significance in the difference of length of cervical spine misalignment by position changes, it showed that C3, C4 vertebra bodies in lateral neutrality position, C2, C3, C4, C5 vertebra bodies in flexion lateral position, C3-5 vertebra bodies in extension lateral position. Conclusions : It was considered that scalenus anticus syndrome could increase cervical spine misalignment which could be a factor of making in cervical spine disease.

경추의 신연-굴곡 손상에서 케이지와 금속판을 이용한 전방 추체간 유합술의 유용성 - 케이지와 자가 장골 삼중 피질골의 비교 -

박희전,김완기,유호영 대한척추외과학회 2009 대한척추외과학회지 Vol.16 No.2

연구계획: 후향적 연구 연구목적: 경추의 신연-굴곡 손상에서 자가 장골 삼중 피질골 이식 또는 케이지 삽입 후 금속판 고정을 병행한 전방 추체간 유합술 시행한 환자에서 방사선학적 변화와 임상적 결과를 비교, 분석하여 그 유용성과 안전성에 대해 알아 보고자 한다. 대상 및 방법: 경추부 신연-굴곡 손상 환자 중 전방감압과 유합술로 치료하고 1년 이상 추시 가능하였던 환자 47례 (남자 32명, 여자 15명)를 대상으로 하였다. 47례 중 32례는 자가 장골 삼중 피질골 이식(1군)을, 나머지 15례에서는 자가 장골능에서 채취한 해면골을 충전한 PEEK 케이지를 삽입(2군)하였으며 전례에서 전방 금속판 고정을 병행하 였다. 방사선학적 평가는 추체간 골유합의 여부 및 시기, 수술 전, 후와 최종추시에서 유합분절의 전만각과 유합분절 전후방 높이 변화와 임상적 결과를 비교 분석하였다. 결과: 골유합은 술 후 평균 12.6±2.5주에 전례에서 얻을 수 있었다. 유합분절 전만각은 술 후에 비해 1군에서 0.4± 4.8도, 2군에서 0.5±3.8도 감소하여 양군 간에 차이를 보이지 않았다(p=0.69). 유합분절의 전후방 높이는 1군에서 9.2 ±7.7%, 5.3±6.2%, 2군에서는 각 각 3.4±3.8%, 3.4±2.7% 감소하여 통계학적으로 유의하게 Ⅰ군에서 많은 감소를 보 였다(p=0.03, 0.04). 초기 ASIA 점수는 1군에서 63.3±35.4, 2군에서 75.8±26.0, 마지막 추시에서는 각각 14.1±16.7, 8.5±9.8의 호전을 보여 양군 간에 차이를 보이지 않았다(p=0.11). 결론: 경추의 신연-굴곡 손상 치료 시 자가 장골을 충전한 PEEK 케이지와 금속판 고정술을 병행한 전방 유합술식은 골 공여부의 합병증을 최소화하면서 자가 장골 삼중 피질골을 이용한 유합술과 비교하여 동일하게 방사선학적으로 나 임상적으로 만족할 만한 결과를 얻을 수 있는 유용한 치료 방법으로 사료된다. Study Design: This is a retrospective study Objectives: We wanted to evaluate the effectiveness and safety of anterior interbody fusion (AIF) using cage and plate fixation for treating distractive flexion injury of the cervical spine according to the radiological and clinical outcomes. Summary of the Literature Review: AIF of the cervical spine using autoiliac bone and plate fixation is known as an effective method for treating not only degenerative disease, but also trauma as well. However, the problem lies in the complications that occur at the donor site. To avoid these complications, the fusion method using a cage is becoming more frequently used, but there are not many reports on using a cage and plate for treating trauma in the cervical spine. Materials and Methods: We retrospectively analyzed 47 patients with distractive flexion injury of the cervical spine and who underwent anterior decompression and interbody fusion with a autoiliac bone graft and plate fixation (Group I, 32 patients) or who underwent anterior decompression and interbody fusion with cage and plate fixation (Group II, 15 patients). We statistically analyzed the changes of the segmental lordosis, the fused segmental body height, the fusion rate on plain radiography and the neurologic recovery with using an ASIA scoring system. Results: All the cases were fused by 12.6±2.5weeks after operation. The changes of segmental lordosis shows no statistical difference between the two groups (p=0.69). The anterior and posterior vertebral heights of the fused segments of Group I were more decreased than those of Group Ⅱ, and there was a statistical difference between the two groups (p=0.03, 0.04). The initial and last follow up neurologic statuses were not statistically difference between the two groups (p=0.11) Conclusions: For the treatment of fracture-dislocation injury in the cervical spine, AIF using a PEEK cage filled with autoiliac bone and plate fixation is an effective method with the least possibility of complications at the donor site, and at the same time, this surgical method shows equally satisfactory results, both radiologically and clinically, as fusion with using a tricortical autoiliac bone graft.

The Sagittal Balance of the Cervical Spine: Radiographic Analysis of Interdependence between the Occipitocervical and Spinopelvic Alignment

Alijani Babak,Rasoulian Javid 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.3

Study Design: This was a prospective clinical study.Purpose: Previous studies have indicated that cervical lordosis is a parameter influenced by segmental and global spinal sagittal balance parameters. However, this correlation still remains unclear. Therefore, a better understanding of the normal values and interdependencies between inter-segmental alignment parameters is needed. This is a preliminary analysis that helps to understand these factors.Overview of Literature: Change in global sagittal alignment is associated with poor health-related quality of life. Questions regarding which parameters play the primary roles in the progression of spinal sagittal imbalance and which might be compensatory factors remain unanswered.Methods: Prospectively, 420 adults (105 asymptomatic, 105 cervical symptomatic, 105 lumbar symptomatic, and 105 post-surgical) were selected. Whole-spine standing lateral radiographs were taken, and spinopelvic, thoracic, and cervical parameters were measured. Then, the data were analyzed using correlation coefficient test and multiple regression analysis.Results: All the parameters showed a normal distribution. The mean values of the cervical parameters are as follows: C₁C₂ Cobb angle, −27.07°±4.3°; C₂C₇ Cobb angle, −16.4°±5.6°; O_CC₂ Cobb angle, −14.5°±3.8°; O_CC₇ Cobb angle, −29.8°±5.6°; C₂C₇ Harrison angle, 20.4°±4.3°; and C₇ slope, −25.4°±5.6°. The analysis of these parameters revealed no statistically significant difference between asymptomatic, symptomatic, and post-surgical patients. C₇ sagittal vertical axis (SVA) correlated with the C₂C₇ Cobb angle (<i>r</i> =0.7) in all groups. No significant correlation was noted between cervical and spinopelvic parameters in asymptomatic patients. However, C₁C₂ Cobb angle correlated significantly with pelvic incidence (PI, <i>r</i> =−0.2), lumbar lordosis (LL, <i>r</i> =0.2), and pelvic tilt (PT, <i>r</i> =−0.2) in cervical symptomatic patients. Irrespective of the patient symptom sub-group (n=420), C₁C₂ Cobb angle correlated with LL (<i>r</i> =0.1) and C₂C₇ Harrison angle correlated with PI and PT (<i>r</i> =0.1).Conclusions: Our results indicate significant interdependence between the spinopelvic and cervical alignment, especially in cervical symptomatic patients. In addition, strong correlation was found between the C₇ SVA and C₂C₇ Cobb angle. Overall, the results of this study could help to better understand the cervical sagittal alignment and serve as preliminary data for planning surgical reconstruction procedures.

Recent advances in finite element modeling of the human cervical spine

김윤혁,Batbayar Khuyagbaatar,김경수 대한기계학회 2018 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.32 No.1

The human cervical spine is a complex structure that is the most frequently injured site among all spinal injuries. Therefore, understanding of the cervical spine injury and dysfunction, and also biomechanical response to external stimuli is important. Finite element (FE) modeling can help researchers to access the internal stresses and strains in the bones, ligaments and soft tissues more realistically, and it has been widely adopted for spine biomechanics research. Although in recent years numerous techniques have been developed, there are no recent literature reviews on FE models of the cervical spine. Our objective was to present recent advances in FE modeling of the human cervical spine in terms of component modeling, material properties, and validation procedures. Model applications and further development are also discussed. The integration of new technologies will allow us to generate more accurate and comprehensive model of the cervical spine, which can increase efficiency and model applicability. Finally, the FE modeling can help to facilitate diagnosis, treatment, and prevention technologies for cervical spine injuries.