European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Retrospective analysis of kinetic magnetic resonance images (kMRI). ⋯ This study demonstrates the normal cervical segmental mobility for the entire cervical spine using kMRI. These results will be helpful to understand the normal mobility of the cervical spine and for understanding the relationship between kinematics of the cervical spine and disc degeneration for future comparisons.
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Influence of cervical spine position on the radiographic parameters of the thoracic inlet alignment.
Cervical sagittal balance is a complex phenomenon, influenced by many factors, which cannot be described by cervical lordosis alone. Attention has been focused on the relationship between T1 slope, thoracic inlet angle, and cervical sagittal balance. However, the effect of cervical position on these parameters has not been evaluated yet. The aim of this study was to assess the influence of cervical flexion and extension on radiographic thoracic inlet parameters. ⋯ Neck tilt measurements were not influenced by position of the cervical spine. T1 slope was significantly influenced by flexion and extension of the neck. This puts the concept that TIA is a morphologic parameter into question. This information should be taken into consideration when analyzing lateral radiographs of the cervical spine for clinical decision-making.
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No standard strategy exists for the management of cervical kyphotic deformity in patients with severe osteoporosis. In fact, in such subpopulation, standard algorithms commonly used in patients with normal bone mineral density may not be applicable. In this Grand Rounds, the authors present a challenging case of a patient with Hajdu-Cheney syndrome, a rare disorder of bone metabolism induced by a Notch-2 mutation, who presented with cervical kyphotic deformity and severe osteoporosis. ⋯ This case illustrates some intra-operative nuances as well as specific surgical recommendations for cervical deformity surgery in patients with severe osteoporosis, such as avoidance of Caspar pins for interbody distraction, use of intra-operative fluoroscopy for achievement of bicortical purchase of anterior cervical screws and placement of pedicle screws during posterior instrumentation. Moreover, such illustrative case demonstrates that, in the subpopulation of patients with severe osteoporosis, it may be possible to successfully apply cervical distraction after an isolated anterior approach with a satisfactory improvement in the cervical alignment, possibly avoiding more laborious 540-degree approaches such as the previously described back-front-back or front-back-front surgical algorithms.
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Limited data is available in the literature on the radiographic results of multilevel posterior lumbar interbody fusion (MPLIF) in the treatment of degenerative scoliosis. The objective of our study was to evaluate the segmental and global correction achieved with MPLIF in the treatment of degenerative scoliosis. ⋯ Our results demonstrate that a satisfactory correction can be achieved in degenerative scoliosis with MPLIF. In addition, our results show that it is significantly more likely to achieve a satisfactory radiological outcome in younger, female patients with low pre-operative PT.