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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Comparative Study
Can intermuscular cleavage planes provide proper transverse screw angle? Comparison of two paraspinal approaches.
The goal of this study was to determine which paraspinal approach provided a better transverse screw angle (TSA) for each vertebral level in lower lumbar surgery. ⋯ In the lower lumbar vertebrae (L3-L5) and S1, pedicle screw placement through the Weaver's approach may more easily yield the preferred TSA consistent with TPA than that through the Wiltse's approach. The reference values obtained in this paper may be applied regardless of sex, age or BMI and the descriptive statistical results may be used as references for applying the two paraspinal approaches.
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Case Reports
Postoperative pharyngocutaneous fistula: treated by sternocleidomastoid flap repair and cricopharyngeus myotomy.
Pharyngoesophagocutaneous fistula (PEF) is one of the rare but serious complications of antero-lateral approach to cervical spine surgery. Because of its rarity, the true incidence of PEF is not clear. But, retrospective analysis of large series of cervical spine surgery reports 0-1.62 % incidence (Cloward in Surg 69:175-182, 1971; Elerkay et al. in J Neurosurg Spine 90(Suppl 1):35-41, 1999). Proximity to the vertebral column and thin walls makes the upper digestive tract vulnerable to injury in cervical trauma, surgical or nonsurgical. Presentation in early postoperative period is not rare and carries high morbidity and mortality (Jones and Ginsberg in Ann Thorac Surg 53(3):534-543, 1992). Various procedures for these fistulae such as simple closure, muscle flap interposition, esophageal diversion and jejunal interposition are reported. Some authors also advise removal of prosthetic plates and posterior stabilization, besides the repair of fistulae in a staged manner (Orlando et al. in Spine 28(15):E290-E295, 2003). ⋯ This case series highlights the importance of cricopharyngeus myotomy for treating PEF and the improved results with the prosthesis kept undisturbed.
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Comparative Study
A comparative investigation of flexion relaxation phenomenon in healthy and chronic neck pain subjects.
The cervical flexion relaxation phenomenon (FRP) is a neck extensor myoelectric "silence" that occurs during complete cervical and lumbar flexion. In contrast to low back pain, the changes that occur during FRP in chronic neck pain (CNP) patients are still not clear. The aim of this study was to assess the characteristics of this phenomenon in the cervical region in CNP patients and controls. ⋯ The results of the present study indicate that FRP in CNP patients was seen less than the healthy subjects, and moreover the FRP period was reduced in CNP patients. Our results also suggest that the changes in FRP of CNP patients may be due to the increased CES activity in these patients.
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The morphology of the alar ligaments has been inconsistently described, particularly with regard to the existence of an atlantal portion. Despite these inconsistencies, these descriptions have been used to develop physical tests for the integrity of these ligaments in patients with cervical spine problems. The purpose of this study was to describe the detailed macrostructure of the alar ligaments. ⋯ The absence of findings with respect to the atlantal portion of the alar ligament suggests that it may be considered an anatomical variant, not an essential component for stability of the craniocervical complex. These findings may inform the use and interpretation of clinical tests for alar ligament integrity.
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Our objectives were to develop a skull-neck-thorax model capable of quantifying spinal motions in an intact human cadaver neck with and without cervical orthoses, determine the effect of orthoses on three-dimensional load-displacement properties of all cervical spinal levels, and compare and contrast our results with previously reported in vivo data. ⋯ Our results indicate that cervical orthoses effectively immobilized the entire cervical spine in flexion/extension and the lower cervical spine in lateral bending. The CTOs improved immobilization of the lower cervical spine in flexion/extension as compared to the collars. The orthoses were least effective at restricting lateral bending of the upper spinal levels and axial rotation of all spinal levels, except C1/2. Understanding immobilization provided by orthoses will assist clinicians in selecting the most appropriate brace based upon patient-specific immobilization requirements.