Subaxial Cervical Vertebrae: Morphometric Study Of The Pedicles, Laminae And Vertebral Foramina

Introduction: The cervical region of vertebral column being the most common site of expression of stress in theform of pain in neck, cervical disc prolapse and cervical neuropraxia. Cervical vertebral column is influenced bymechanical, environmental, genetic, metabolic and hormonal factor and has to react to the forces of every day.Accurate anatomical descriptions of the pedicle, lamina and vertebral foramen are necessary for developmentand use of implantable devices and for spinal instrumentation that ranges from ‘transpedicular screw fixation’to ‘vertebroplasty’.Aim: To study the morphometric database of pedicles, laminae and vertebral foramina of subaxial cervicalvertebrae.Materials and Methods: Fifty-seven dry macerated sets of adult human cervical vertebral columns of unknownsex and age in the Department of Anatomy in Bharati Vidyapeeth University Medical College Pune and Smt.Kashibai Navale Medical College and General Hospital, Pune in Maharashtra. The length, thickness and heightof pedicles and laminae and anteroposterior and transverse length of vertebral foramina were measured withdigital Vernier caliperObservation: The pedicle length and thickness was found to increase uniformly from C3 to C7. Thickness oflamina was found to be maximum at C7 vertebra. Maximum anteroposterior length of vertebral foramen wasobserved at C3 and the maximum transverse length at C6.Conclusion: The result of this study will help in designing implants and instruments related to the cervicalvertebral column. It can also help in the management of traumatic and pathological fractures of cervical vertebralcolumn.

An Osteological Study On Morphometry Of Foramen Transversarium Of Sub Axial Vertebrae And Its Variations

Introduction: Cervical vertebrae are having foramen transversarium in their transverse process. Foramentransversarium’s dimensions and its variations are important for clinicians while handling vertebro basilarinsufficiency cases and also useful for spinal surgeons in spinal decompression procedures like foraminectomy,foraminotomyMaterials & Methods: The present study was done in 90 sub axial vertebrae (C3 to C7) which was collected fromRajah Muthiah Medical College, Chidambaram. Among 90, 56 were typical type and 34 were seventh cervicalvertebrae. Damaged vertebrae were excluded. Antero posterior length, transverse length & depth of foramentransversarium were measured using double tipped compass and digital vernier caliper. Double foramens andabsent foramens were noted.Result: The average antero posterior length of foramen transversarium of typical cervical vertebrae and seventhcervical vertebrae were 5.45 mm ± 0.12 mm and 5.66 mm ± 0.88 mm respectively. The average transverse lengthof foramen transversarium of typical and seventh cervical vertebrae was 6.72 mm ± 0.22 mm and 6.76 mm ± 0.08mm respectively.Conclusion: Anatomical knowledge on the dimensions of foramen transversarium and its variations are importantfor clinicians and neurologists for the various clinical conditions and spinal decompression procedures.

Nursing care of lower cervical spine fracture treated with 3D print microporous titanium artificial vertebral body / 中国实用护理杂志

Objective To summarize the perioperative nursing measures and effects of 3D printed artificial cervical vertebrae for lower cervical spine fractures. Methods Treatment of 15 cases of lower cervical spine fracture with 3D printed artificial cervical vertebrae. Preoperative cervical spine fixation to prevent spinal cord injury, strict observation of clinical symptoms, assist the doctor to perform CT three-dimensional reconstruction of the cervical spine, and calculate the physiological height of the injured vertebrae; maintain the surgical position fixed during surgery, carefully prepare the supporting equipment, familiar with the surgical related steps, accurate delivery of all types of surgical instruments to assist with intraoperative fluoroscopy. Postoperative focus on the neck to see if there is swelling, effectively maintain the airway patency, observe changes in spinal nerve function, develop a personalized functional exercise program to promote rehabilitation, and actively prevent complications. Results The JOA score increased from (9.23 ± 1.62) points before surgery to (14.09 ± 1.35) points after surgery, and the improvement rate was 62.55%. There were no complications such as difficulty swallowing, hoarseness, and difficulty breathing. Conclusions Through targeted perioperative care, surgical complications can be reduced and the quality of life of patients improved.

Nursing care of lower cervical spine fracture treated with 3D print microporous titanium artificial vertebral body / 中国实用护理杂志

Objective@#To summarize the perioperative nursing measures and effects of 3D printed artificial cervical vertebrae for lower cervical spine fractures.@*Methods@#Treatment of 15 cases of lower cervical spine fracture with 3D printed artificial cervical vertebrae. Preoperative cervical spine fixation to prevent spinal cord injury, strict observation of clinical symptoms, assist the doctor to perform CT three-dimensional reconstruction of the cervical spine, and calculate the physiological height of the injured vertebrae; maintain the surgical position fixed during surgery, carefully prepare the supporting equipment, familiar with the surgical related steps, accurate delivery of all types of surgical instruments to assist with intraoperative fluoroscopy. Postoperative focus on the neck to see if there is swelling, effectively maintain the airway patency, observe changes in spinal nerve function, develop a personalized functional exercise program to promote rehabilitation, and actively prevent complications.@*Results@#The JOA score increased from (9.23±1.62) points before surgery to (14.09±1.35) points after surgery, and the improvement rate was 62.55%. There were no complications such as difficulty swallowing, hoarseness, and difficulty breathing.@*Conclusions@#Through targeted perioperative care, surgical complications can be reduced and the quality of life of patients improved.

Evaluation of the SLICS use in the treatment of subaxial cervical spine injuries / Avaliação do SLICS no tratamento das lesões da coluna cervical sub-axial

The SLICS (Sub-axial Cervical Spine Injury Classification System) was proposed to help in the decision-making of sub-axial cervical spine trauma (SCST), even though the literature assessing its safety and efficacy is scarce. Method We compared a cohort series of patients surgically treated based on surgeon’s preference with patients treated based on the SLICS. Results From 2009-10, 12 patients were included. The SLICS score ranged from 2 to 9 points (mean of 5.5). Two patients had the SLICS < 4 points. From 2011-13, 28 patients were included. The SLICS score ranged from 4 to 9 points (mean of 6). There was no neurological deterioration in any group. Conclusion After using the SLICS there was a decrease in the number of patients with less severe injuries that were treated surgically. This suggests that the SLICS can be helpful in differentiating mild from severe injuries, potentially improving the results of treatment. .

O SLICS (Sub-axial Cervical Spine Injury Classification System) foi proposto para auxílio na tomada de decisão no tratamento do traumatismo da coluna cervical sub-axial. Contudo, existem poucos trabalhos que avaliem sua segurança e eficácia. Método Realizamos estudo comparativo de série histórica de pacientes operados baseados na indicação pessoal do cirurgião com pacientes tratados baseados na aplicação do SLICS. Resultados Entre 2009-10, 12 pacientes foram incluídos. O SLICS escore variou de 2 a 9 pontos (média de 5,5) com dois pacientes com escore menor que 4. Entre 2011-13, 28 pacientes foram incluídos. O escore de SLICS variou de 4 a 9 pontos, com média de 6. Conclusão Observamos que após o uso do SLICS houve uma diminuição do número de pacientes operados com lesões mais estáveis. Isso sugere que o SLICS pode ser útil para auxiliar a diferenciação de lesões leves das graves, eventualmente melhorando os resultados do tratamento. .

Interobserver and Intraobserver Reliability of Sub-Axial Injury Classification and Severity Scale between Radiologist, Resident and Spine Surgeon

OBJECTIVE: The sub-axial injury classification (SLIC) and severity scale was developed to decide whether to operate the cervical injured patient or not, but the reliability of SLIC and severity scale among the different physicians was not well known. Therefore, we evaluated the reliability of SLIC among a spine surgeon, a resident of neurosurgery and a neuro-radiologist. METHODS: In retrograde review in single hospital from 2002 to 2009 years, 75 cases of sub-axial spine injured patients underwent operation. Each case was blindly reviewed for the SLIC and severity scale by 3 different observers by two times with 4 weeks interval with randomly allocated. The compared axis was the injury morphology score, the disco-ligamentous complex score, the neurological status score and total SLIC score; the neurological status score was derived from the review of medical record. The kappa value was used for the statistical analysis. RESULTS: Interobserver agreement of SLIC and severity scale was substantial agreement in the score of injury morphology [intraclass correlation (ICC)=0.603] and total SLIC and severity sacle (ICC value=0.775), but was fair agreement in the disco-ligamentous complex score (ICC value=0.304). Intraobserver agreements were almost perfect agreement in whole scales with ICC of 0.974 in a spine surgeon, 0.948 in a resident of neurosurgery, and 0.963 in a neuro-radiologist. CONCLUSION: The SLIC and severity scale is comprehensive and easily applicable tool in spine injured patient. Moreover, it is very useful tool to communicate among spine surgeons, residents of neurosurgery and neuro-radiologists with sufficient reproducibility.

Accuracy and Safety in Pedicle Screw Placement in the Thoracic and Lumbar Spines : Comparison Study between Conventional C-Arm Fluoroscopy and Navigation Coupled with O-Arm(R) Guided Methods

OBJECTIVE: The authors performed a retrospective study to assess the accuracy and clinical benefits of a navigation coupled with O-arm(R) system guided method in the thoracic and lumbar spines by comparing with a C-arm fluoroscopy-guided method. METHODS: Under the navigation guidance, 106 pedicle screws inserted from T7 to S1 in 24 patients, and using the fluoroscopy guidance, 204 pedicle screws from T5 to S1 in 45 patients. The position of screws within the pedicle was classified into four groups, from grade 0 (no violation cortex) to 3 (more than 4 mm violation). The location of violated pedicle cortex was also assessed. Intra-operative parameters including time required for preparation of screwing procedure, times for screwing and the number of X-ray shot were assessed in each group. RESULTS: Grade 0 was observed in 186 (91.2%) screws of the fluoroscopy-guided group, and 99 (93.4%) of the navigation-guided group. Mean time required for inserting a screw was 3.8 minutes in the fluoroscopy-guided group, and 4.5 minutes in the navigation-guided group. Mean time required for preparation of screw placement was 4 minutes in the fluoroscopy-guided group, and 19 minutes in the navigation-guided group. The fluoroscopy-guided group required mean 8.9 times of X-ray shot for each screw placement. CONCLUSION: The screw placement under the navigation-guidance coupled with O-arm(R) system appears to be more accurate and safer than that under the fluoroscopy guidance, although the preparation and screwing time for the navigation-guided surgery is longer than that for the fluoroscopy-guided surgery.