Spine
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Knowledge of the normal movements of the occipito-atlanto-axial joint complex is important for evaluating clinical cases that may be potentially unstable. The purpose of this in vitro study was to quantitatively determine three dimensional movements of the occiput-C1 and C1-C2 joints. Ten fresh cadaveric whole cervical spine specimens (occiput to C7) were studied, using well-established techniques to document the movements in flexion, extension, left and right lateral bending, and left and right axial rotation. ⋯ Neutral zones for flexion/extension, right/left lateral bending, and right/left axial rotation were, respectively: 1.1, 1.5, and 1.6 (occiput-C1); and 3.2, 1.2, and 29.6 degrees (C1-C2). Ranges of motion for flexion, extension, lateral bending (one side), and axial rotation (one side) were, respectively: 3.5, 21.0, 5.5, and 7.2 degrees (occiput-C1 joint) and 11.5, 10.9, 6.7, and 38.9 degrees (C1-C2 joint). The greatest intervertebral motion in the spine was axial rotation at the C1-C2 joint, with the neutral zone constituting 75% of this motion.
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Comparative Study
A comparison of anterior cervical fusion, cervical laminectomy, and cervical laminoplasty for the surgical management of multiple level spondylotic radiculopathy.
The risks and success of surgery for multiple level cervical spondylotic radiculopathy differs from that of single level disease. The problems associated with multiple level anterior fusion over single level fusion include higher pseudoarthrosis rates than that associated with single level disease. Bilateral and multiple level laminectomy carries the risk of potential instability. ⋯ Roentgenograms indicated spinal stenosis (sagittal diameter less than 12 mm) at 28 levels (15 patients) for the anterior fusion group, 14 levels (9 patients) in the laminectomy group, and 24 levels (13 patients) in the laminoplasty group. Subluxation (2 mm or less) was present at 14 levels (13 patients) in the anterior fusion group, nine levels (9 patients) in the laminectomy group, and 15 levels (8 patients) in the laminoplasty group. Loss of lordosis was present in eight patients undergoing anterior fusion, six patients undergoing laminectomy, and six patients who had a laminoplasty.(ABSTRACT TRUNCATED AT 250 WORDS)
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Abnormalities in the upper cervical spine resulting in cervical myelopathy in patients with Down's syndrome have been well-documented. However, two adult Down's syndrome patients recently presented with cervical myelopathy secondary to abnormalities of the lower cervical spine. ⋯ They were found to have an increased prevalence of lower cervical spondylosis that significantly correlated with physical findings consistent with cervical myelopathy. Therefore, physicians dealing with Down's patients should closely monitor neurological function and obtain flexion/extension laterals of the cervical spine to evaluate C1-C2 instability and degenerative changes in the lower cervical spine if a change in neurologic status is noted.
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Diagnostic cervical medial branch blocks and zygapophysial joint blocks were used to test the hypothesis that the cervical zygapophyseal joints can be the source of pain in patients with idiopathic neck pain. Complete temporary relief of all symptoms was obtained in 17 out of 24 consecutive patients. ⋯ Internal-control observations in nine of the 17 patients established the diagnostic validity of the blocks used. The high yield of positive responders in this study probably reflects the propensity of patients with zygapophysial joint syndromes to gravitate to a pain clinic when this condition is not recognised in conventional clinical practice.
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The pain drawings of 54 low-back-pain patients were examined to find out if it is possible to use them as a brief screening test in order to assess the psychological impairment of the patients. We were using the scoring system of Ransford et al, which we slightly changed, and chose as a criterion variable the ERMSS (Erweiterte Revidierte Mehrdimensionale Schmerzskala) of Cziske. ⋯ A correlation was found between pain drawing score and the sensory-discriminative dimension of pain perception, whereas there was no such correlation between drawing score and the affective dimension. These results indicate that the pain drawing score might not be a sufficiently valid instrument for assessing psychological disturbances in pain patients to allow it to be used for individual diagnosis without hesitation.