Analysis of the effect and influencing factors of different surgical methods in the treatment of multi-level cervical spondylotic myelopathy / 中国综合临床

Objective:To explore the use of anterior cervical corpectomy and fusion (ACCF) combined with anterior cervical discectomy and fusion (ACDF) in patients with multilevel cervical spondylopathy myelopathy (CSM).Methods:The clinical data of 83 patients with multi-segment CSM admitted to the Department of Spinal Surgery of Hubei Liuqi2 Orthopaedic Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to January 2021 were retrospectively analyzed. According to the different surgical methods used in their treatment, they were divided into group A and group B. In group A, 44 patients were treated with anterior cervical ACCF combined with ACDF, and 39 patients in group B were treated with posterior single-door laminoplasty. The general clinical indexes such as operation time, perioperative bleeding volume and hospitalization time were collected.The neurological function and cervical dysfunction improvement effect of the patients before and 6 months after operation were evaluated by using the Japanese Orthopaedic Association (JOA) score and neck disability index (NDI) scale. The cervical curvature of the patients before and 6 months after operation was compared, The complications of the two groups were observed 6 months after operation. The patients were divided into improved group (72 cases) and non improved group (11 cases). Comparison between count data groups χ 2 inspection. Independent sample t-test was used for comparison between measurement data groups conforming to normal distribution. According to the results of univariate analysis, the meaningful factors were included in the binary Logistic regression to analyze the influencing factors related to the surgical efficacy. Result:The perioperative blood loss ((153.36±10.68) mL) and hospital stay ((10.11±2.30) d) in group A were lower than those in group B ((171.47±11.32) mL, (15.58±3.76) d). There were significant differences between the two groups ( t values were 7.50 and 8.10; both P<0.001). Six months after operation, the JOA score (13.70±1.49, 12.94±1.63) and cervical curvature (22.10±3.23, 13.38±3.12) of patients in groups A and B were all higher than those before operation (9.40±1.32, 9.36±1.51; 11.16±2.60, 11.23±2.71), and group A was higher than group B, the difference was statistically significant (JOA scores before and after operation: t values were 14.33 and 10.07, respectively; cervical curvature: t values were 17.50 and 3.25, respectively; t values between groups were 2.22 and 12.47, respectively, and the P values were <0.001, <0.001, <0.001, 0.002, 0.029 and <0.001, respectively). Six months after the operation, the NDI indexes of groups A and B (11.38±4.76, 14.79±4.85) were lower than those before the operation (39.56±9.43, 39.74±9.51), and those in group A were lower than in group B, and the difference was statistically significant ( t values were 17.70, 14.60, and 3.23; all P<0.001). Binary Logistic regression showed that the duration of disease ≥6 months ( OR=59.045, 95% CI: 6.485-537.629), the presence of cervical spinal cord MRI signal changes ( OR=0.031, 95% CI: 0.002-0.587), the surgical approach (posterior approach single-door laminoplasty) ( OR=6.300, 95% CI: 1.269-31.273) was an independent risk factor affecting the surgical outcome ( P values were <0.001, 0.021, and 0.024, respectively). Conclusion:Anterior cervical ACCF combined with ACDF has an ideal surgical effect in the treatment of patients with multi-segment CSM, which can significantly improve the cervical spinal nerve function and cervical curvature, shorten the operation time and reduce the perioperative blood loss. It isstill necessary to pay attention to the patient's disease course, MRI signals changes of cervical spinal cord and the effect of surgical methods on their surgical outcomes.

Correlation of craniovertebral parameters with the retropharyngeal space in posterior C1-C2 arthrodesis / Correlação dos parâmetros craniovertebral com o espaço retrofaríngeo na artrodese posterior C1-C2 / Correlación de los parámetros craneovertebral con el espacio retrofaríngeo en la artrodesis posterior C1-C2

ABSTRACT Introduction/Objective: The craniovertebral junction (CVJ) requires a detailed evaluation, as the changes in alignment caused by surgery can affect adjacent structures in a secondary way. Examples of these effects are dyspnea or dysphagia after posterior occipitocervical arthrodesis, due to decreased caliber of the oropharynx. These changes can be identified perioperatively by several radiographic parameters that aim to predict possible postoperative respiratory complications. Such complications appear to be related to the narrowest oropharyngeal airway space (nPAS), and may also occur following atlantoaxial (C1-C2) arthrodesis. This work aims to correlate the variation in CVJ alignment parameters before and after C1-C2 arthrodesis with the variation in nPAS. Methods: Patients who underwent posterior C1-C2 arthrodesis between 2011 and 2019 at the National Institute of Traumatology and Orthopedics (INTO) were included in the study, totaling 26 patients. The parameters evaluated included cervical lordosis, C1-C2 angle, slope of C2, Occipito-C2 angle (O-C2), pharyngeal inlet angle (PIA), pharyngeal tilt angle (PTA), occiput and external acoustic meatus to axis angle (O-EAa), cranial transverse motion against C2 angle (C2TA), axial tilt (AT) and the percentage of change in nPAS (%∆nPAS). Results: A correlation was observed between the change in C1-C2 angle, O-C2, PTA, C2TA and the %∆nPAS. Conclusion: The change in cervical alignment and CVJ parameters is correlated with %∆nPAS and should, therefore, be evaluated before and after atlantoaxial fusion as a means of predicting a possible respiratory complication. Level of Evidence: III; Cross sectional study .

RESUMO Introdução/Objetivo: A junção craniovertebral (JCV) deve ter avaliação detalhada já que as alterações de alinhamento ocasionadas pela cirurgia podem acometer estruturas adjacentes de forma secundária. Exemplos desses efeitos são dispneia ou disfagia depois de artrodese occipitocervical posterior, por diminuição no calibre da orofaringe. Essas alterações podem ser identificadas no perioperatório por diversos parâmetros radiográficos que visam predizer possíveis complicações respiratórias pós-operatórias. Tais complicações parecem estar relacionadas com o menor espaço da via orofaríngea (nPAS, narrowest oropharyngeal airway space) e também podem ocorrer depois de artrodese atlantoaxial (C1-C2). Este trabalho tem como objetivo correlacionar a variação dos parâmetros de alinhamento da JCV no pré e pós-operatório de artrodese C1-C2 com a variação do nPAS. Métodos: Foram incluídos no estudo pacientes submetidos à artrodese posterior C1-C2 entre 2011 e 2019 no Instituto Nacional de Traumatologia e Ortopedia (INTO), totalizando 26 indivíduos. Os parâmetros avaliados incluíram lordose cervical, ângulo C1-C2, inclinação de C2, ângulo Occipito-C2 (O-C2), ângulo de entrada da faringe (PIA, pharyngeal inlet angle), ângulo de inclinação da faringe (PTA, pharyngeal tilt angle), ângulo do eixo occipital e meato acústico externo (O-EAa, occiput and external acoustic meatus to axis angle), movimento transversal craniano contra o ângulo C2 (C2TA, cranial transverse motion against C2 angle), inclinação axial (AT, axial tilt) e porcentagem de mudança no nPAS (%∆nPAS) resultado: Foi observada correlação entre a mudança dos ângulos C1-C2, OC2, PTA, C2TA e a %∆nPAS. Conclusão: A alteração do alinhamento cervical e dos parâmetros da JCV está correlacionada com a %∆nPAS e deve, portanto, ser avaliada antes e depois da artrodese atlantoaxial como forma de prever uma possível complicação respiratória. Nível de Evidência III; Estudo transversal .

RESUMEN Introducción/Objetivo: La unión craneocervical debe ser objeto de una evaluación detallada, ya que los cambios de alineación provocados por la cirugía pueden afectar de forma secundaria a las estructuras adyacentes. Ejemplos de estos efectos son la disnea o la disfagia después de la artrodesis occipitocervical posterior debido a la disminución del calibre de la orofaringe. Estos cambios pueden identificarse en el período perioperatorio por varios parámetros radiográficos que pretenden predecir posibles complicaciones respiratorias postoperatorias. Estas complicaciones parecen estar relacionadas con el espacio orofaríngeo más estrecho (nPAS, narrowest oropharyngeal airway space) y también pueden producirse tras la artrodesis atlantoaxial (C1-C2). Este trabajo tiene como objetivo correlacionar la variación de los parámetros de alineación de la unión craneocervical en el período pre y postoperatorio de la artrodesis C1-C2 con la variación del nPAS. Métodos: Se incluyeron en el estudio los pacientes sometidos a artrodesis posterior C1-C2 entre 2011 y 2019 en el Instituto Nacional de Traumatología y Ortopedia (INTO), totalizando 26 individuos. Los parámetros evaluados incluyeron lordosis cervical, ángulo C1-C2, inclinación de C2, ángulo Occipito-C2 (O-C2), ángulo de entrada de la faringe (PIA, pharyngeal inlet angle),, ángulo de inclinación de la faringe (PTA, pharyngeal tilt angle) ), ángulo del eje occipital y el meato acústico externo (O-EAa, occiput and external acoustic meatus to axis angle), movimiento transversal craneal contra el ángulo C2 (C2TA, cranial transverse motion against C2 angle), inclinación axial (AT, axial tilt)) y porcentaje de cambio en el nPAS (%∆nPAS). Resultado: Se observó una correlación entre el cambio de los ángulos C1-C2, O-C2, PTA, C2TA y %∆nPAS. Conclusión: El cambio en la alineación cervical y los parámetros de la unión craneovertebral se correlaciona con el %∆nPAS y por lo tanto, debe evaluarse antes y después de la artrodesis atlantoaxial como forma de predecir una posible complicación respiratoria. Nivel de Evidencia III; Estudio transversal .

Relationship between cervical vertebral maturation and dental development in a sample of yemeni children and adolescents / Relación entre la maduración vertebral cervical y el desarrollo dental en una muestra de niños y adolescentes yemeníes

Objective: This study was conducted to investigate the relationship between dental development and cervical vertebral maturation stages in a group of Yemeni children and adolescents. Materials an Methods: The study included digital panoramic radiographs and lateral skull cephalograms obtained from 207 Yemeni subjects­122 females and 85 males aged between 8 to 18 years. Dental maturity was evaluated according to the method of Demirijian et al., calcification stages of the left mandibular canines, first and second premolars and second molars were assessed. Skeletal maturity was assessed by the cervical vertebral maturation (CVM) stages according to the method of Baccetti et al. Correlation between CVM and dental maturation was evaluated by Spearman rank-order correlation coefficient (SROCC). Results: CVM and dental calcification stages were highly correlated (p<0.001) in both genders, ranging from 0.686 to 0.873 for females and 0.787 to 0.871 for males. Calcification stages of the second molars showed the strongest correlation with CVM. Conclusion: Calcification stages of the second molar may be used as a reliable maturation indicator. Dental maturation may be applied to determine the skeletal maturity status of Yemeni children and adolescents.

Objetivo: Este estudio se realizó para investigar la relación entre el desarrollo dental y las etapas de maduración vertebral cervical en un grupo de niños y adolescentes yemeníes. Material y Métodos: El estudio incluyó radiografías panorámicas digitales y cefalogramas laterales del cráneo obtenidos de 207 sujetos yemeníes: 122 mujeres y 85 hombres de entre 8 y 18 años. La madurez dental se evaluó de acuerdo con el método de Demirijian et al. Se evaluaron las etapas de calcificación de los caninos mandibulares izquierdos, primer y segundo premolares y segundos molares. La madurez esquelética se evaluó mediante las etapas de maduración vertebral cervical (CVM) de acuerdo con el método de Baccetti et al. La correlación entre la CVM y la maduración dental se evaluó mediante el coeficiente de correlación de orden de rango de Spearman (SROCC). Resultado: Las etapas de CVM y calcificación dental estuvieron altamente correlacionadas (p<0.001) en ambos sexos, con un rango de 0.686 a 0.873 para las mujeres y 0.787 a 0.871 para los hombres. Las etapas de calcificación de los segundos molares mostraron la correlación más fuerte con CVM. Conclusión: las etapas de calcificación del segundo molar pueden usarse como un indicador de maduración confiable. La maduración dental puede aplicarse para determinar el estado de madurez esquelética de los niños y adolescentes yemeníes.

Clinical Efficacy of Modified Guizhi Jia Gegen Tang on Qi Stagnation and Blood Stasis Syndrome of Cervical Spondylotic Radiculopathy and Function of Neck and Upper Limb / 中国实验方剂学杂志

<b>Objective::To investigate the clinical efficacy of modified Guizhi Jia Gegen Tang on cervical spondylotic radiculopathy (CSR) with Qi stagnation and blood stasis syndrome and its effect on cervical vertebral mobility, isometric muscle strength and pain-related factors. <b>Method::Totally 162 CSR patients with Qi stagnation and blood stasis syndrome were randomly divided into observation group (81 cases) and control group (81 cases). The observation group was given modified Guizhi Jia Gegen Tang orally, 150 mL/time, twice a day, while the control group was given Jingshu granule orally for 6 g/time, twice a day. Both groups were treated for 8 weeks. The changes of median nerve F wave conduction velocity, cervical vertebral mobility, isometric muscle strength, CSR 20 subscale score and visual analogue score (VAS) were recorded before and after treatment. The total effective rate and the cure rate were counted after treatment. The levels of serum pain-related factors (5-HT), nerve growth factor (NGF) and prostaglandin E₂ (PGE₂) were measured before and after treatment. <b>Result::The total effective rate of the observation group was 98.77%, and the cure rate was 40.74%, which were better than 83.95%and 7.41%of the control group (<italic>P</italic><0.01). Compared with before treatment, the conduction velocity of median nerve F wave, cervical vertebral mobility, isometric muscle strength and CSR 20 score increased, whereas VAS score, pain related factors 5-HT, NGF and PGE₂ content decreased in both groups (<italic>P</italic><0.01). Compared with control group, median nerve F wave conduction velocity, cervical vertebral mobility, isometric muscle strength and CSR 20 subscale scores increased, while VAS score decreased, pain related factors 5-HT, NGF and PGE₂ contents decreased in the observation group (<italic>P</italic><0.01). <b>Conclusion::Modified Guizhi Jia Gegen Tang is effective in treating CSR with Qi stagnation and blood stasis syndrome, and can significantly improve the neck and hand functions and relieve pain.

Imaging analysis of ossification of the nuchal ligament with cervical curvature and segmental stability / 中国组织工程研究

BACKGROUND: In degenerative cervical spondylosis associated with cervical curvature straightening or segmental instability, ossification of the nuchal ligament caused by chronic injury of the nuchal ligament is very common. OBJECTIVE: To investigate the correlation between ossification of the nuchal ligament and cervical curvature and segmental stability of the cervical spine. METHODS: Data of 109 patients with degenerative cervical spondylosis, who were treated in Department of Spinal Surgery of Affiliated Hospital of Xuzhou Medical University from October 1, 2017 to October 31, 2018, were retrospectively analyzed. There were 61 male patients and 48 female patients, who aged 30 to 81 years old at a mean age of (55. 8±11. 1) years. All patients signed the informed consent. This study was approved by the Ethics Committee of Affiliated Hospital of Xuzhou Medical University. The patients underwent the X-ray examinations of cervical spine. The imaging observation included the distribution and degree of ossification of the nuchal ligament and the change of cervical physiological curvature and segment stability. The patients were divided into ossification group and non-ossification group according to whether or not the patients had ossification of the nuchal ligament. Gender, age, cervical curvature and lower cervical stability were compared between the two groups. Pearson correlation analysis was used to compare the relationship between the degree of ossification of the nuchal ligament and cervical curvature and cervical stability. Binary Logistic regression analysis was applied to evaluate the significant risk factors for the development of ossification of the nuchal ligament. RESULTS AND CONCLUSION: (1) Of 109 patients with degenerative cervical spondylosis, 56 patients with ossification of the nuchal ligament and ossification involved 83 cervical segments in ossification of the nuchal ligament patients, most of which were C4-5 (39. 8%) and Cm (42. 2%). (2) There was significant difference in age, C2-C7 Cobb angle, Jackson physiological stress curve, parameter angular displacement and horizontal displacement between the ossification group and non-ossification group (P < 0. 05). The degree of ossification of the nuchal ligament was positively correlated with angular displacement (f=0. 486, P < 0. 05). (3) The incidence of ossification of the nuchal ligament was significantly higher in patients with lower cervical instability (P < 0. 05). Age and lower cervical instability parameter angular displacement were significant risk factors for the development of ossification of the nuchal ligament. (4) Patients with ossification of the nuchal ligament are more likely to have cervical curvature straightening and lower cervical instability, especially in the segment instability. In the diagnosis and treatment of degenerative cervical spondylosis, the existence of ossification of the nuchal ligament causes corresponding attention.

Association between cervical vertebral maturation stages and dental calcification stages in patients with unilateral complete cleft lip and palate / 华西口腔医学杂志

OBJECTIVE@#The purpose of the study is to investigate the relationship between dental calcification stages (DCS) and cervical vertebral maturation stages (CVMS) in patients with unilateral complete cleft lips and palates (UCLP) and to provide a theoretical basis for the treatment time selection of cleft lip and palate (CLP) patients.@*METHODS@#A total of 123 UCLP patients and 215 non-CLP subjects were selected. The DCS of the left mandibular canine, premolar, and second molar in non-CLP subjects and on both cleft sides of UCLP patients were assessed utilizing the Demirjian method. CVMS was observed utilizing the Baccetti method. The results were analyzed by Spearman rank correlation, and the correlation coefficients were compared.@*RESULTS@#There was a correlation between the CVMS and the DCS of the left mandibular canine, the first premolar, the second premolar, and the second molar in the non-CLP subjects and on both cleft sides of the UCLP patients (r=0.762-0.864, P0.05).@*CONCLUSIONS@#DCS can be utilized as a biological index to determine the growth development statuses. The correlation between the CVMS and the DCS of the mandibular first premolar was the highest.

Skeletal Maturity Evaluation using Maxillary Canine Development in Growing Children / 대한소아치과학회지

This study aimed to investigate the correlation between maxillary canine's dental maturity and skeletal maturity of growing children. Cephalometric radiographs, hand-wrist radiographs and panoramic radiographs of 299 children aged 6 – 17 years were analyzed to measure the cervical vertebral maturation stages (CVMS), skeletal maturity indicators (SMI) and Demirjian index (DI). Spearman correlation test was used to analyze the correlation between dental maturity and skeletal maturity.There was significant positive correlation between the DI and CVMS in both boys and girls (p = 0.000). Similarly positive correlation was found between the DI and SMI (p = 0.000).The results of this study suggest that the dental maturity of maxillary canine can be used as auxiliary maturity indicator in growing children.

Evaluation of Midpalatal Suture Maturation using Cone-Beam Computed Tomography in Children and Adolescents / 대한소아치과학회지

This study aimed to analyze the association of midpalatal suture (MPS) maturation stages with skeletal maturation and age and to obtain references for establishing a treatment plan for rapid maxillary expansion (RME).Cone-Beam Computed Tomography (CBCT) images from 480 children (240 boys, 240 girls) aged 7 – 15 years were obtained. MPS maturation stages and cervical vertebral maturation indicator (CVMI) were evaluated, and the correlations between MPS maturation stages, CVMI, and age were determined using the Spearman's correlation test. The positive likelihood ratio (LHR) of CVMI for MPS maturation stages was calculated.MPS maturation stages and CVMI showed a strong correlation. Especially, CVMI 1 – 3 showed positive LHR greater than 10 for the diagnosis of stages A – C. MPS maturation stages and age were correlated strongly in girls and moderately in boys.Conventional RME produces the most favorable skeletal effect at CVMI 1 – 3 or those up to 12 years of age and fewer skeletal effects at CVMI 4 or at 13 years of age in girls and 13 – 15 years in boys. It is recommended to evaluate MPS maturation stages using CBCT before RME application at CVMI 5, 6 or at 14, 15 years of age in girls.

Williams Syndrome with Multiple Cervical Vertebral Fusion Presenting Dysphagia: A Case Report / 대한연하장애학회지

Williams syndrome is a multiple-system disorder, caused by deletion of the locus 7q11-23 gene and characterized by an ‘elfin’ facial appearance, developmental delay, cardiovascular disorders, and transient hypercalcemia. Vertebral abnormalities in Williams syndrome have not been reported yet, except for one case report on cervical stenosis at the C1 level. In this case, the authors incidentally found Williams syndrome with the fusion of the fifth and sixth cervical vertebrae and an associated dysphagia showing delayed, forward-deviating esophageal passage during a videofluoroscopic swallowing study. The authors could not confirm whether the multiple cervical vertebrae fusion was related with the Williams syndrome or was just incidental. However, because physiatrists frequently encounter children with Williams syndrome and numerous kinds of developmental delay, if a patient with Williams syndrome suffers from swallowing difficulty, evaluation of dysphagia and cervical abnormalities should be considered. The present authors report the case of multiple cervical vertebral fusion in Williams syndrome.

Motion characteristics of cervical spine based on continuous images / 中国医学影像技术

Objective To explore the motion features of cervical spine based on continuous X-ray images.Methods The cervical spontaneous continuous multi-frame sagittal images from flexion to extention positions were selected from cervical spondylosis patients (patients group) and healthy adult (normal group).After preprocessing and registration,the trajectory of single vertebral body were recorded,and the feature points of each vertebral body were extracted.Meanwhile,the rel ative geometry parameters and movement rate were calculated.Results The motion trajectory of patients' cervical spine C4-6 were different from healthy people.The angles between the left edge curve of the vertebral body (C4 and C5 vertebra) and the baseline of patients group were smaller than those of normal group in flexion position (all P＜0.05).There were instability in the movement of C4 vertebral body in patient group,and the volatility of the angle change,the rate of change and the frequency were larger.The relative position change of the adjacent single vertebral body in the patient group are smaller.Conclusion Through the preprocessing,registration,parameter extraction and result analysis,the changes of functional features in cervical spondylosis patients are truly reflected.And it also provides a new idea for dynamic analysis of cervical vertebrae based on X-ray images.

Cephalometric evaluation of the effects of the Twin Block appliance in subjects with Class II, Division 1 malocclusion amongst different cervical vertebral maturation stages

ABSTRACT Objectives: To evaluate the cephalometric changes in skeletal, dentoalveolar and soft tissue variables induced by Clark's Twin Block (CTB) in Class II, Division 1 malocclusion patients and to compare these changes in different cervical vertebral maturation stages. Methods: Pre- and post-treatment/observation lateral cephalograms of 53 Class II, Division 1 malocclusion patients and 60 controls were compared to evaluate skeletal, dentoalveolar and soft tissue changes. Skeletal maturity was assessed according to cervical vertebral maturation stages. Pre- and post-treatment/observation mean changes and differences (T2-T1) were compared by means of Wilcoxon sign rank and Mann-Whitney U-tests, respectively. Intergroup comparisons between different cervical stages were performed by means of Kruskal-Wallis test and Mann-Whitney U-test (p ≤ 0.05) . Results: When compared with controls, there was a significant reduction in ANB angle (p < 0.001), which was due to a change in SNB angle in CS-2 and CS-3 (p < 0.001), and in SNA (p < 0.001) and SNB (p = 0.016) angles in the CS-4 group. There was significant increase in the GoGn-SN angle in CS-2 (p = 0.007) and CS-4 (p = 0.024), and increase in Co-Gn and Go-Gn amongst all cervical stages (p < 0.05). There was significant decrease in U1-SN and increase in IMPA amongst all cervical stages (p < 0.05). There was significant retraction of the upper lip in CS-3 (p = 0.001), protrusion of the lower lip in CS-2 (p = 0.005), increase in nasolabial angle in CS-4 (p = 0.006) and Z-angle in CS-3 (p = 0.016), reduction in H-angle in CS-2 (p = 0.013) and CS-3 (p = 0.002) groups. When pre- and post-treatment mean differences were compared between different cervical stages, significant differences were found for SNA, SNB and UI-SN angles and overjet. . Conclusions: The Twin-Block along with the normal craniofacial growth improves facial esthetics in Class II, Division 1 malocclusion by changes in underlying skeletal and dentoalveolar structures. The favorable mandibular growth occurs during any of the cervical vertebral maturation stages, with more pronounced effect during CS-3 stage.

RESUMO Objetivo: avaliar as alterações em variáveis cefalométricas esqueléticas, dentoalveolares e do perfil tegumentar, induzidas pelo aparelho Twin Block de Clark (TBC), em pacientes com má oclusão de Classe II, divisão 1, e comparar as alterações nos diferentes estágios de maturação das vértebras cervicais. Métodos: telerradiografias laterais pré- e pós-tratamento de 53 pacientes com má oclusão de Classe II, divisão 1, foram comparadas às telerradiografias de 60 pacientes controle, para avaliar as alterações esqueléticas, dentoalveolares e no perfil tegumentar. A maturação esquelética foi avaliada de acordo com os estágios de maturação das vértebras cervicais. As alterações médias e as diferenças entre o pré- e o pós-tratamento (T2 - T1) foram comparadas por meio do teste de postos sinalizados de Wilcoxon e do teste U de Mann-Whitney, respectivamente. Foram realizadas comparações intergrupos para os diferentes estágios de maturação das vértebras cervicais, por meio do teste de Kruskal-Wallis e teste U de Mann-Whitney (p ≤ 0,05). Resultados: em comparação aos pacientes do grupo controle, constatou-se que houve uma redução significativa do ângulo ANB (p < 0,001), em virtude de alterações no ângulo SNB nos estágios CS2 e CS3 (p < 0,001), e nos ângulos SNA (p < 0,001) e SNB (p = 0,016) no estágio CS4. Houve um aumento significativo do ângulo GoGn-SN nos estágios CS2 (p = 0,007) e CS4 (p = 0,024), e um aumento em Co-Gn e Go-Gn em todos os estágios de maturação das vértebras cervicais (p < 0,05). Houve redução significativa em U1-SN e um aumento do IMPA em todos os estágios de maturação das vértebras cervicais (p < 0,05). Houve retração significativa do lábio superior em CS3 (p = 0,001), protrusão do lábio inferior em CS2 (p = 0,005), aumento do ângulo nasolabial em CS4 (p = 0,006) e do ângulo Z em CS3 (p = 0,016), além de redução do ângulo H em CS2 (p = 0,013) e CS3 (p = 0,002). Quando as diferenças médias entre pré- e pós-tratamento foram comparadas entre os diferentes estágios de maturação das vértebras cervicais, foram identificadas diferenças significativas para os ângulos SNA, SNB e UI-SN, assim como para o overjet. Conclusões: o uso do aparelho Twin-Block, associado ao crescimento craniofacial normal, melhora a estética facial em pacientes com má oclusão de Classe II, divisão 1, por meio de alterações nas estruturas esqueléticas e dentoalveolares subjacentes. Esse crescimento mandibular mais favorável pode ocorrer durante qualquer um dos estágios de maturação das vértebras cervicais, com um efeito mais acentuado durante o estágio CS3.

Edad cronológica y maduración ósea cervical en niños y adolescentes / Chronological age and cervical vertebral maturation among children and adolescents

Introducción: en las prácticas médicas, ortopédicas y odontológicas se ha reconocido la importancia de diferenciar la edad cronológica de la edad esquelética o maduración ósea. La estimación del desarrollo óseo a partir de las vértebras cervicales es un método que se ha comprobado como confiable. Objetivo: relacionar los estadios de maduración ósea desde las vértebras cervicales según lo describe Baccetti y la edad cronológica en niños y adolescentes entre 8 y 14 años que asistieron a una clínica odontológica. Métodos: la muestra seleccionada fue probabilística y estuvo conformada por un total de 130 niños de la ciudad de Cali, Colombia. Se tomó una radiografía lateral de cráneo y se evaluaron los estadios de maduración ósea vertebral cervical bajo los estándares del método descrito por Baccetti. Resultados: el coeficiente de correlación entre la edad cronológica y estadios de maduración cervical fue r= 0,69, lo que muestra una moderada relación entre estas dos variables para los niños estudiados. Los estadios de maduración y el sexo explicaron el 50,4 % de la variabilidad de la edad cronológica. Para todos los estadios de maduración se encontraron diferencias significativas (p< 0,001). Los niños varones presentaron mayores estadios iniciales de maduración, aunque no se encontró diferencias significativas en función del sexo (p> 0,05). Conclusiones: Se logra determinar un modelo para explicar la variación de la edad cronológica del niño en función del estadio de maduración ósea cervical y el sexo del niño basado en la relacion positiva moderada entre la edad cronologica y la maduración osea evidenciada hasta el estadio C3(AU)

Introduction: the importance of distinguishing chronological from skeletal age or bone maturation has been recognized in medical, orthopedic and dental practice. Estimation of bone development on the basis of cervical vertebrae has proved to be a reliable method. Objective: relate the stages of bone maturation based on cervical vertebral development as described by Baccetti to the chronological age of children and adolescents aged 8-14 years attending a dental clinic. Methods: probabilistic sampling was used to select 130 children from the city of Cali, Colombia. Lateral skull radiography was performed to evaluate the stages of cervical vertebral bone maturation using the method described by Baccetti. Results: the correlation coefficient between chronological age and cervical maturation stage was r= 0.69, showing a moderate relationship between the two variables for the children studied. Maturation stages and gender accounted for 50.4 % of the variability in chronological age. Significant differences were found for all maturation stages (p< 0.001). Boys had higher initial maturation stages, though significant differences were not found between the genders (p> 0.05). Conclusions: It is possible to determine a model to explain the change in chronological age depending on the stage of cervical bone maturation and sex of the child, based on moderate positive relationship between chronological age and bone maturation evidenced through C3 stadium(AU)

Artificial disc and vertebra system: a novel motion preservation device for cervical spinal disease after vertebral corpectomy

OBJECTIVE: To determine the range of motion and stability of the human cadaveric cervical spine after the implantation of a novel artificial disc and vertebra system by comparing an intact group and a fusion group. METHODS: Biomechanical tests were conducted on 18 human cadaveric cervical specimens. The range of motion and the stability index range of motion were measured to study the function and stability of the artificial disc and vertebra system of the intact group compared with the fusion group. RESULTS: In all cases, the artificial disc and vertebra system maintained intervertebral motion and reestablished vertebral height at the operative level. After its implantation, there was no significant difference in the range of motion (ROM) of C3-7 in all directions in the non-fusion group compared with the intact group (p>0.05), but significant differences were detected in flexion, extension and axial rotation compared with the fusion group (p<0.05). The ROM of adjacent segments (C3-4, C6-7) of the non-fusion group decreased significantly in some directions compared with the fusion group (p<0.05). Significant differences in the C4-6 ROM in some directions were detected between the non-fusion group and the intact group. In the fusion group, the C4-6 ROM in all directions decreased significantly compared with the intact and non-fusion groups (p<0.01). The stability index ROM (SI-ROM) of some directions was negative in the non-fusion group, and a significant difference in SI-ROM was only found in the C4-6 segment of the non-fusion group compared with the fusion group. CONCLUSION: An artificial disc and vertebra system could restore vertebral height and preserve the dynamic function of the surgical area and could theoretically reduce the risk of adjacent segment degeneration compared with the anterior fusion procedure. However, our results should be considered with caution because of the low power of the study. The use of a larger ...

Cervical vertebral anomalies in skeletal malocclusions: A cross-sectional study on orthodontic patients at the Aga Khan University Hospital, Pakistan.

Introduction: Morphological deviations of the cervical vertebral column have been described in relation to craniofacial aberrations and syndromes. Furthermore, it has recently been shown that abnormal morphology of upper cervical vertebrae is associated with malformation of the jaws and occlusion. Accordingly, it is relevant to focus on similar associations in patients with skeletal malocclusions. Therefore, the objectives of this study are to: • Identify the anomalies of the cervical column in patients with skeletal malocclusions • Determine the association between cervical vertebral anomalies and skeletal malocclusions. Materials and Methods: This cross‑sectional study was conducted on a total of 90 subjects at the Aga Khan University Hospital, Pakistan. The inclusion criteria were: (1) Pakistani origin; (2) standardized pretreatment profile radiograph with first six cervical vertebrae visible; and (3) accessibility of the second‑profile radiograph (mid‑ or posttreatment). The exclusion criteria were: (1) A prior history of orthodontic treatment; (2) any craniofacial anomaly; and (3) systemic muscle or joint disorder. Lateral cephalograms of all subjects (n = 90) were traced by the principal investigator and sagittal jaw relationship was assessed. A total of 30 subjects each with skeletal Class I, Class II, and Class III malocclusions were selected and the cervical vertebral anomalies were observed on their cephalometric radiographs. The frequencies of cervical vertebral anomalies according to skeletal malocclusion categories and gender were analyzed with the Chi‑square test, whereas association of cervical vertebral anomalies with skeletal malocclusions was assessed with logistic regression analysis. The level of significance (P ≤ 0.05) was used for the statistical tests. Results: Most common anomaly observed in the three groups was fusion between C2 and C3 (P = 0.006). This anomaly was found in 20% of subjects with skeletal Class I, 50% of subjects with skeletal Class II and 53.3% with skeletal Class III malocclusions. The highest frequencies of partial cleft at the level of C1 and occipitalization were observed in subjects with skeletal Class II and III malocclusions, respectively. However, none of the subjects showed fusion between C1 and C2 or dehiscence. No statistically significant gender difference was found in the occurrence of morphological deviations of the cervical column. The association of cervical vertebral anomaly was found to be the highest with skeletal Class III and lowest with skeletal Class I malocclusions. Conclusion: Fusion between C2 and C3 seems to be the most commonly occurring anomaly. This anomaly seems to be more often associated with skeletal Class III than skeletal Class I or Class II malocclusions.

Clinical significance and change with age of cervical vertebral uncinate process and transverse process of teenagers / 局解手术学杂志

Objective To explore the uncinate-transverse hole spacing developmental patterns and aging characteristics by means of studying the teenagers aging from 6~20 years old,and provide the basis for image analysis of the treatment and prevention of cervical spondy-losis. Method the 66 adolescents without trauma nor problems of nervous system were selected to do thin spiral CT scan(0. 625 ~1. 25 mm) ,the range was C1 ~T1 . The original data in the form of DICOM are analyzed according to gender and age. Results There was no sig-nificant difference in gender and different sides. Overall,the physical development of human increases gradually with age and has some signifi-cant differences. Conclusion There exists a close relationship between cervical hook-transverse process and the incidence of vertebral artery type and nerve root type cervical spondylosis.

Late Results of Anterior Cervical Discectomy and Fusion with Interbody Cages

STUDY DESIGN: Retrospective analysis. PURPOSE: To evaluate the effectiveness of anterior cervical discectomy with fusion for degenerative cervical disc disease. OVERVIEW OF LITERATURE: Anterior spinal surgery originated in the mid-1950s and graft for fusion was also employed. Currently anterior cervical microdiscectomy and fusion with an intervertebral cage is a widely accepted procedure for treatment of cervical disc hernia. Artificial grafts and cages for fusion are preferred because of their lower morbidity, reduced operating time and acceptable fusion rate. METHODS: The study involved retrospective analysis and investigation of long-term results for 41 consecutive patients who had undergone anterior cervical discectomy and fusion with an intervertebral cage for cervical disc hernia. The angle of lordosis, segmental height and range of motion were evaluated preoperatively and postoperatively at 1 month and 2 years. The clinical outcome was assessed by the visual analog scale and Odom's criteria. RESULTS: The angle of lordosis increased by 2.62degrees and the range of motion angle increased by 5.14degrees after the operation. The segmental height did not change. The visual analog scale and Odom's criteria scores decreased significantly after the operation. CONCLUSIONS: Using a cage in anterior cervical discectomy prevents segmental collapse, so the segmental height and the angle of lordosis are preserved and newly-developed pain does not occur.

Accuracy and Repeatability of Computer Aided Cervical Vertebra Landmarking in Cephalogram / 华中科技大学学报（医学）（英德文版）

The accuracy and repeatability of computer aided cervical vertebra landmarking (CACVL) were investigated in cephalogram.120 adolescents (60 boys,60 girls) aged from 9.1 to 17.2 years old were randomly selected.Twenty-seven landmarks from the second to fifth cervical vertebrae on the lateral cephalogram.were identified.In this study,the system of CACVL was developed and used to identify and calculate the landmarks by fast marching method and parabolic curve fitting.The accuracy and repeatability in CACVL group were compared with those in two manual landmarking groups [orthodontic experts (OE) group and orthodontic novices (ON) group].The results showed that,as for the accu racy,there was no significant difference between CACVL group and OE group no matter in x-axis or y-axis (P＞0.05),but there was significant difference between CACVL group and ON group,as well as OE group and ON group in both axes (P＜0.05).As for the repeatability,CACVL group was more reliable than OE group and ON group in both axes.It is concluded that CACVL has the same or higher accuracy,better repeatability and less workload than manual landmarking methods.It's reliable for cervical parameters identification on the lateral cephalogram and cervical vertebral maturation prediction in orthodontic practice and research.

Clinical observations of stand-alone MC + polyetheretherketone cage without anterior cervical plating in traumatic cervical disc herniation / 中华全科医师杂志

Twenty patients of traumatic cervical disc herniation in mono-segment were reconstructed after discectomy with a cage filled with autogenous cancellous illict-bone graft.Neither fracture nor dislocation was found by radiograph or magnetic resonance imaging.The average follow-up period was 22 months (range:6 - 36 months) and the average duration of bone graft fusion 4.9 months.No complications of internal fixation occurred.With this new cage,traumatic cervical disc herniation might be safely treated.

The Longitudinal Sagittal Growth Changes of Maxilla and Mandible According to Quantitative Cervical Vertebral Maturation / 华中科技大学学报（医学）（英德文版）

To investigate the longitudinal sagittal growth changes of maxilla and mandible according to the quantitative cervical vertebral maturation (QCVM) for adolescents with normal occlusion,mixed longitudinal data were used.The samples included 87 adolescents aged from 8 to 18 y old with normal occlusion (32 males,55 females) selected from 901 candidates.Sequential lateral cephalograms and hand-wrist films were taken once a year,lasting for 6 y.The longitudinal sagittal growth changes of maxilla and mandible according to QCVM were measured.There were some significant differences between maxilla and mandible according to QCVM.The sagittal growth change of maxilla showed a trend towards high velocity→decelerating velocity→completing velocity from QCVM stage Ⅰ to stage Ⅳ.The sagittal growth change of mandible showed a trend towards accelerating velocity→high velocity→decelerating velocity→completing velocity from QCVM stage Ⅰ to stage IV.With sagittal relationship,growth magnitude was almost the same between maxilla and mandible at QCVM stage Ⅰ.At stage Ⅱ the growth of mandible exceeded that of maxilla and growth in mandible continued at stages Ⅲ and Ⅳ,while the maxilla ceased to grow.Growth magnitude was greater and the growth duration was longer with male mandible.It is concluded that the longitudinal sagittal growth changes of maxilla and mandible on the basis of QCVM is of value in the orthodontic practice.

Determinación de la maduración esqueletal según el método de evaluación cervicovertebral y su relación con la oportunidad de tratamiento con clase II dentoesqueletal / Skeletal maturation determination by cervical vertebral assessment method and its relationship with dentoskeletal class II treatment opportunity

La presente revisión tiene por objetivo presentar una alternativa a la determinación del estado de maduración esqueletal. Usualmente se ha utilizado el método que analiza la radiografía de mano, con los consecuentes inconvenientes que acarrea al paciente, tanto económicos como de bioseguridad. Por otra parte significa un registro más de archivo en la ficha clínica. El método de maduración Cervicovertebral (CVM) analiza el desarrollo de tres vertebras cervicales (C2-C3-C4) en radiografías laterales de Cráneo. Existen 6 etapas de maduración las cuales se asocian al incremento de desarrollo craneofacial y particularmente al peak de aceleración de crecimiento mandibular. Constituye por tanto este elemento diagnóstico una ayuda en la determinación del inicio de terapias ortodóncico-ortopedicas en anomalías dentoesqueletales de Clase II.

The aim of this study was to update concepts about craniofacial development and maturation indexes. Usually, the hand wrist radiograph has been used as diagnostic complement for skeletal maturation.This means in a regular basis more exposure to radiation, more documents in patients file and obviously higher costs in complementary diagnostic tools.The cervical vertebral maturation method emphasizes the diagnosis in three cervical vertebrae (C2-C3-C4) usually seen in regular Lateral radiographs used in Orthodontics.There are six stages of maturation wich are linked to craniofacial development and specifically to mandibular growths peak. This method is a useful diagnostic tool in the treatment timing for orthodontic – orthopedic therapies usually associated to Class II anomalies.