Head-Cervical Spine Motion Measurement in Healthy Population: Comparison of CROM Apparatus and "G-Plus" APP on iPhone.

BACKGROUND: Assessment of head-cervical spine motion (HCSM) is a vital index of functional evaluation for cervical surgery, but there is a lack of HCSM datasets in the healthy population and no suitable tools to measure HCSM in clinical practice. The objectives of this study were to obtain the normal values of HCSM in a healthy population, test the reliability and validity of an APP "G-Plus," and analyze related influencing factors of HCSM. METHODS: We measured HCSM in 6 directions of 500 healthy people with a CROM apparatus and "G-Plus." The intraclass correlation coefficient (ICC) was used to test the reliability of "G-Plus." The validity of "G-Plus" measurements as compared with the CROM apparatus was tested by Bland-Altman statistics. We used multiple linear regression analysis to test the correlation among age, gender, body mass index (BMI), neck configuration (ratio of cervical circumference to cervical length), and HCSM. RESULTS: Excellent interrater and intrarater reliability were demonstrated for CROM (ICC:0.929-0.993) and "G-Plus" (ICC: 0.898-0.991). Bland-Altman plots demonstrated an acceptable agreement between CROM and "G-Plus." Age was negatively correlated with HCSM. HCSM in females was superior to males except for flexion. Neck configuration affected HCSM in the direction of extension, right lateral flexion, and left and right rotation. BMI was correlated with flexion and extension. CONCLUSIONS: "G-Plus" is a reliable and convenient tool for HCSM measurement in clinical practice. The presentation of datasets of HCSM in healthy population provides a basic reference for cervical function assessment. Age, gender, BMI, and neck configuration are significantly correlated to HCSM.

Outcomes in Thoracolumbar and Lumbar Traumatic Fractures: Does Restoration of Unfused Segmental Mobility Correlated to Implant Removal Time?

BACKGROUND: Posterior fixation without fusion can treat thoracolumbar and lumbar traumatic fractures effectively in certain cases. However, whether patients benefit from implant removal and the correlation between the range of motion (ROM) of the involved segments and the removal time have not been determined. METHODS: From 2018 to 2020, we retrospectively reviewed data of patients with AO spine type A or B thoracolumbar or lumbar traumatic fractures who underwent implant removal. A total of 17 patients (group A), 21 patients (group B), and 12 patients (group C) underwent implant removal after the index surgery within 12 months, between 12 and 24 months, and over 24 months, respectively. Clinical and radiological outcomes, including visual analog scale for back pain, patient satisfaction, Oswestry disability index, and EuroQol 5 dimensions questionnaire, for quality of life and segmental ROM were analyzed. RESULTS: The average follow-up time was 9.1 ± 5.7 months after implant removal. There were no significant differences in visual analog scale and patient satisfaction among the 3 groups at the same observation time point. Among the 3 groups, patients in group A gained the lowest Oswestry disability index and highest EuroQol 5 dimensions questionnaire scores after removal and at the final follow-up. The best ROM was obtained in group A followed by groups B and C (11.5° ± 6.2°, 5.5° ± 1.6°, and 2.4° ± 0.6°, respectively). CONCLUSIONS: Immobilization of the involved segments over 24 months may lead to loss of ROM. Regained segmental ROM is correlated negatively with implant removal time, and removal within 12 months promises a better ROM and quality of life.