Intervertebral range of motion characteristics of normal cervical spinal segments (C0-T1) during in vivo neck motions.

The in vivo intervertebral range of motion (ROM) is an important predictor for spinal disorders. While the subaxial cervical spine has been extensively studied, the motion characteristics of the occipito-atlantal (C0-1) and atlanto-axial (C1-2) cervical segments were less reported due to technical difficulties in accurate imaging of these two segments. In this study, we investigated the intervertebral ROMs of the entire cervical spine (C0-T1) during in vivo functional neck motions of asymptomatic human subjects, including maximal flexion-extension, left-right lateral bending, and left-right axial torsion, using previously validated dual fluoroscopic imaging and model registration techniques. During all neck motions, C0-1, similar to C7-T1, was substantially less mobile than other segments and always contributed less than 10% of the cervical rotations. During the axial rotation of the neck, C1-2 contributed 73.2 ±â€¯17.3% of the cervical rotation, but each of other segments contributed less than 10% of the cervical rotation. During both lateral bending and axial torsion neck motions, regardless of primary or coupled motions, the axial torsion ROM of C1-2 was significantly greater than its lateral bending ROM (p < 0.001), whereas the opposite differences were consistently observed at subaxial segments. This study reveals that there are distinct motion patterns at upper and lower cervical segments during in vivo neck motions. The reported data could be useful for the development of new diagnosis methods of cervical pathologies and new surgical techniques that aim to restore normal cervical segmental motion.

A morphometric and stereological study on cervical spinal cord segment of goose.

In this study, volume density of white matter and grey matter areas of cervical segment of spinal cord in adult geese weighing 3-4 kg was examined using stereological methods. 10 geese were used as material without sex discrimination. All animals underwent perfusion with 10% buffered formaldehyde. Following the perfusion, animals were kept in 10% formaldehyde for 1 week. Geese were then dissected. Cervical area of spinal cord was revealed removing cervical spine. Tissue samples were obtained from each segment of cervical area. 5 µm thick cross-sections were taken from these tissue samples via microtome. Series of cross-sections were obtained by sampling in the ratio of 1/250 including 12 cross-sections from each cervical segment of every animal. Cross-sections were stained by haematoxylin eosin. They were photographed under microscope. Volume density (volume fractions) of both whole tissue and white matter and grey matter parts in each cervical segment of spinal cord were calculated using Cavalieri's Principle. In the study, total volume of cervical segment, volume of white matter and grey matter, and ratios of these volumes one another were assessed in goose.

A Morphological and Stereological Study on Cervical Segment of Spinal Cord of Quails.

In this study, volume densities of white and grey matters of cervical segments of spinal cords of quail were investigated stereologically. In both sexes, mature, six quails were used as material of this study. All animals were fixed by perfusing in 10% buffered formalin. Tissue specimens were obtained from cervical spinal cords. These tissue specimens were cut every fiftieth section at 5 µm thickness by a microtome. And mean six or seven sections were examined from every block by this method at microscope. After that, these sections were stained by haematoxylin eosin and photographed. Densities of volumes of all tissues of cervical segments of whole spinal cords and white and grey matters were calculated with principle of Cavalieri. As a result, total volume of spinal cord, volumes of white and grey matters of cervical segment and volume rates of white and grey matters were calculated.

Operative stabilization of the remaining mobile segment in ankylosed cervical spine in systemic onset - juvenile idiopathic arthritis: A case report.

We describe a case of a 19-year-old young man with oligoarthritis type of juvenile idiopathic arthritis, who presented with several month duration of lower neck pain and progressive muscular weakness of all four limbs. X-rays of the cervical spine demonstrated spontaneous apophyseal joint fusion from the occipital condyle to C6 and from C7 to Th2 with marked instability between C6 and C7. Surgical intervention began with anterolateral approach to the cervical spine performing decompression, insertion of cage and anterior vertebral plate and screws, followed by posterior approach and fixation. Care was taken to restore sagittal balance. The condition was successfully operatively managed with multisegmental, both column fixation and fusion, resulting in pain cessation and resolution of myelopathy. Postoperatively, minor swallowing difficulties were noted, which ceased after three days. Patient was able to move around in a wheelchair on the sixth postoperative day. Stiff neck collar was advised for three months postoperatively with neck pain slowly decreasing in the course of first postoperative month. On the follow-up visit six months after the surgery patient exhibited no signs of spastic tetraparesis, X-rays of the cervical spine revealed solid bony fusion at single mobile segment C6-C7. He was able to gaze horizontally while sitting in a wheelchair. Signs of myelopathy with stiff neck and single movable segment raised concerns about intubation, but were successfully managed using awake fiber-optic intubation. Avoidance of tracheostomy enabled us to perform an anterolateral approach without increasing the risk of wound infection. Regarding surgical procedure, the same principles are obeyed as in management of fracture in ankylosing spondylitis or Mb. Forestrier.

A Case of Vernet Syndrome due to Varicella Zoster Virus Infection with Skin Lesion Induced by Cervical Segment Involvement / 대한피부과학회지

Vernet syndrome associated with varicella zoster virus (VZV) has been rarely reported. The diagnosis is established based on typical symptoms such as dysphagia, hoarseness, and unilateral difficulty in neck movement. Lack of skin lesions is common and makes it harder to consider VZV infection. A 53-year-old woman presented with left neck pain, dysphagia, hoarseness, and headache, with an erythematous vesicle on her neck. Laryngoscopy revealed paralysis of her left-soft palate and left-vocal cord. Upon cerebrospinal fluid (CSF) examination, her white blood cell (WBC) count, protein levels, glucose levels, and VZV antibody titer were elevated; moreover, VZV-DNA was detected. Magnetic resonance imaging (MRI) showed no sign of brain tumor, aneurysm or fracture. The patient was diagnosed with Vernet syndrome associated with VZV infection, having presented with a skin lesion involving the cervical segment.

Fracture through fused cervical segments following trauma in a patient with Klippel-Feil syndrome.

Klippel-Feil syndrome (KPS) is a congenital spinal deformity characterised by the presence of at least one fused cervical segment. We report an unusual case of a fracture through fused cervical segment in a patient with KPS, who presented with quadriparesis and progressed on to develop respiratory failure and quadriplegia and who had a successful outcome following surgery. To the best of our knowledge, fracture through fused cervical segments in a Klippel-Feil patient has not been reported previously and this case report extends the spectrum of injuries seen in patients with KPS.

O papel da ultrassonografia modo B na avaliação anatômica musculoesquelética do segmento cervical da coluna vertebral de cães / The role of B-mode ultrasonography in the musculoskeletal anatomical evaluation of the cervical region of the dog spine

This study characterized the normal musculoskeletal anatomy of the cervical segment of the spine of dogs by means of B-mode ultrasonography. The objective was to establish the role of B-mode ultrasonography for the anatomical evaluation of the cervical spine segment in dogs, by comparing the ultrasonographic findings with images by computed tomography and magnetic resonance imaging. The ultrasound examination, in transverse and median sagittal sections, allowed to identify a part of the epaxial cervical musculature, the bone surface of the cervical vertebrae and parts of the spinal cord through restricted areas with natural acoustic windows, such as between the atlanto-occipital joint, axis and atlas, and axis and the third cervical vertebra. The images, on transverse and sagittal planes, by low-field magnetic resonance imaging, were superior for the anatomical identification of the structures, due to higher contrast between the different tissues in this modality. Computed tomography showed superiority for bone detailing when compared with ultrasonography. As for magnetic resonance imaging, in addition to the muscles and cervical vertebrae, it is possible to identify the cerebrospinal fluid and differentiate between the nucleus pulposus and annulus fibrosus of the intervertebral discs. Although not the scope of this study, with knowledge of the ultrasonographic anatomy of this region, it is believed that some lesions can be identified, yet in a limited manner, when compared with the information obtained mainly with magnetic resonance imaging. The ultrasound examination presented lower morphology diagnostic value compared with the other modalities.

Este estudo caracterizou a anatomia musculoesquelética normal do segmento cervical da coluna vertebral de cães por meio da ultrassonografia modo B. O objetivo do trabalho foi estabelecer o papel da ultrassonografia modo B na avaliação anatômica do segmento cervical de cães, comparando os achados ultrassonográficos com imagens por tomografia computadorizada e ressonância magnética. O exame ultrassonográfico, em cortes transversais e sagitais mediano, permitiu a identificação de parte da musculatura epaxial do pescoço, superfície óssea das vértebras cervicais e medula espinhal em áreas restritas com janelas acústicas naturais, como entre a articulação atlantoccipital, áxis e atlas, e áxis e terceira vértebra cervical. As imagens, em planos transversais e sagitais, por ressonância magnética de baixo campo foram superiores na identificação anatômica das estruturas, devido ao maior contraste entre os diferentes tecidos nessa modalidade. A tomografia computadorizada se mostrou superior no detalhamento ósseo da região quando comparada ao exame ultrassonográfico. Já a ressonância magnética, além dos músculos e vértebras cervicais, permitiu a identificação do líquido cefalorraquidiano, e diferenciar núcleo pulposo e anel fibroso dos discos intervertebrais. Embora não seja objetivo direto deste estudo, com o conhecimento da anatomia ultrassonográfica dessa região, acredita-se que algumas lesões possam ser identificadas, contudo de maneira restrita, quando comparadas as informações obtidas, principalmente na imagem por ressonância magnética. O exame ultrassonográfico apresentou valor morfológico inferior.

Microvascular Anatomy of Extreacranial and Cavernous Internal Carotid Artery(ICA) / 대한뇌혈관학회지

Although lacking of unanimously accepted nomenclature and numbering system of the internal carotid artery (ICA) segments, recently adopted system may be applicable in terms of its simplicity and practical purposes. According to this seven-tier system, we briefly summarized the normal microvascualr anatomy of the ICA from the extracranial cervical (C1) segment to the clinoid (C5) segment of the ICA and surrounding structures with relevant schematic drawings. Also we presented a spectrum of normal variants and congenital anomalies with respect to the normal anatomy.

Microvascular Anatomy of Extreacranial and Cavernous Internal Carotid Artery(ICA) / 대한뇌혈관학회지

Although lacking of unanimously accepted nomenclature and numbering system of the internal carotid artery (ICA) segments, recently adopted system may be applicable in terms of its simplicity and practical purposes. According to this seven-tier system, we briefly summarized the normal microvascualr anatomy of the ICA from the extracranial cervical (C1) segment to the clinoid (C5) segment of the ICA and surrounding structures with relevant schematic drawings. Also we presented a spectrum of normal variants and congenital anomalies with respect to the normal anatomy.