Tratamiento de las fracturas cervicales aisladas de tipo "masa lateral flotante": serie de casos / Treatment of isolated "floating lateral mass" fractures of the cervical spine: A case series

Objetivo: Presentar una serie de casos de pacientes con fracturas cervicales de tipo "masa lateral flotante" con énfasis en describir el rol de la lesión discal en la potencial inestabilidad segmentaria. Materiales y métodos: Se realizó un estudio descriptivo y retrospectivo de una serie de pacientes con fracturas facetarias de tipo "masa lateral flotante", aisladas, diagnosticadas entre el 1 de enero de 2016 y el 1 de enero de 2022. Se incluyeron pacientes con lesiones de tipo "masa lateral flotante" según la clasificación AO, diagnosticadas por tomografía computarizada y, al menos, 6 meses de seguimiento. Se excluyó a aquellos con fracturas patológicas, lesiones por fragilidad ósea y registros incompletos. Resultados: Se analizó a 16 pacientes (media de la edad 42.86; DE 12,396), con predominio del sexo masculino (81,25%). El 68,75% tenía una lesión del disco intervertebral en el segmento fracturado y el 18,75%, anterolistesis. A 11 pacientes se les propuso un tratamiento conservador durante 12 semanas. La fractura consolidó en el 45,4% y 6 (54,6%) evolucionaron con traslación. El fracaso del tratamiento conservador se asoció con lesión del disco intervertebral. Once pacientes fueron operados, en su mayoría, con artrodesis cervical anterior monosegmentaria. Conclusiones: En esta serie de casos, la presencia de una lesión asociada del disco intervertebral fue más frecuente cuando el tratamiento conservador fracasó y cuando se decidió una artrodesis como tratamiento inicial. La mayoría de las cirugías se realizaron por vía anterior con discectomía y artrodesis cervical anterior en un único nivel, y se lograron buenos resultados. Nivel de Evidencia: IV

Introduction: We report a series of patients with "floating lateral mass" cervical fractures, focusing on the role of disc injury in potential segmental instability. materials and methods: We conducted a descriptive and retrospective study on a case series of isolated floating lateral mass facet fractures diagnosed between January 1, 2016 and January 1, 2022. Patients with floating lateral mass lesions according to the AO classification, diagnosed by computed tomography, and at least 6 months of follow-up were included. Patients with pathological fractures, bone fragility injuries and incomplete records were excluded. Results: We included 16 cases, the average age was 42.86 (SD 12.396), and the majority were male (n=13; 81.25%). 68.75% (n=11) had intervertebral disc injury in the fractured segment, while 18.75% (n=3) had anterolisthesis. Conservative treatment was proposed for 12 weeks in 11 patients (68.75%), of whom 5 (45.4%) achieved fracture healing and 6 (54.6%) progressed to translation. Cases where conservative treatment failed were associated with intervertebral disc injury. Eleven patients were treated surgically, mostly with monosegmental anterior cervical arthrodesis. Conclusions: We report a series of cases in which the existence of an associated intervertebral disc injury was more frequent in patients with failed conservative treatment and in those initially treated with arthrodesis. Most of the surgical cases were treated using an anterior approach with discectomy and anterior cervical arthrodesis at a single level, with favorable outcomes. Level of Evidence: IV

Estenosis espinal de triple región sintomática: reporte de un caso y revisión narrativa de la bibliografía / Symptomatic triple-region spinal stenosis: Case report and narrative literature review

La estenosis espinal de las tres regiones de la columna en simultáneo es un cuadro infrecuente que requiere una adecuada valoración clínica y de las imágenes. En la actualidad, no existen guías establecidas para su abordaje diagnóstico y terapéutico. El objetivo de este artículo es describir la presentación clínica, el tratamiento y la evolución en un paciente con triple estenosis y contrastarlos con la evidencia disponible a través de una revisión narrativa de la bibliografía. Se presenta a una mujer de 69 años de edad que consultó con un cuadro de paraparesia progresiva asociado a ciatalgia derecha y signos de motoneurona superior positivos. En los estudios por imágenes, se constató una triple estenosis: cervical, torácica y lumbar. Se procedió a la descompresión y la resección tumoral torácica asociadas al tratamiento conservador de las estenosis cervical y lumbar. La evolución era favorable al año de la cirugía. La estenosis espinal de triple región sintomática es una condición rara, las valoraciones clínicas y radiológicas adecuadas permitirán un diagnóstico correcto con un abordaje adecuado y oportuno. Nivel de Evidencia: IV

Simultaneous spinal stenosis across all three regions of the spine is an uncommon condition that requires proper clinical and imaging assessment. There are currently no established guidelines for its diagnosis and treatment. The objective of this paper is to describe, based on a case report, the clinical presentation, treatment, and progression of triple stenosis in a patient and compare it with available evidence through a narrative literature review. A 69-year-old woman presented with progressive paraparesis associated with right sciatica and positive signs of upper motor neuron involvement. Imaging confirmed triple stenosis: cervical, thoracic, and lumbar. She underwent thoracic decompression and tumor resection, as well as conservative treatment for cervical and lumbar stenoses, and showed favorable progress one year after surgery. Symptomatic triple-region spinal stenosis is an uncommon condition. Proper clinical and radiological assessments will enable an accurate diagnosis with appropriate and timely intervention. Level of Evidence: IV

Timing of Surgery and Pre-operative Physiological Parameters as Clinical Predictors of Surgical Outcomes in Traumatic Subaxial Cervical Spine Fractures and Dislocations / Momento da cirurgia e parâmetros fisiológicos pré-operatórios como fatores preditivos clínicos de desfechos cirúrgicos em fraturas e luxações traumáticas subaxiais da coluna cervical

Abstract Objective To evaluate the risk factors and outcomes in patients surgically treated for subaxial cervical spine injuries with respect of the timing of surgery and preoperative physiological parameters of the patient. Methods 26 patients with sub-axial cervical spine fractures and dislocations were enrolled. Demographic data of patients, appropriate radiological investigation, and physiological parameters like respiratory rate, blood pressure, heart rate, PaO2 and ASIA impairment scale were documented. They were divided pre-operatively into 2 groups. Group U with patients having abnormal physiological parameters and Group S including patients having physiological parameters within normal range. They were further subdivided into early and late groups according to the timing of surgery as Uearly, Ulate, Searly and Slate. All the patients were called for follow-up at 1, 6 and 12 months. Results 56 percent of patients in Group S had neurological improvement by one ASIA grade and a good outcome irrespective of the timing of surgery. Patients in Group U having unstable physiological parameters and undergoing early surgical intervention had poor outcomes. Conclusion This study concludes that early surgical intervention in physiologically unstable patients had a strong association as a risk factor in the final outcome of the patients in terms of mortality and morbidity. Also, no positive association of improvement in physiologically stable patients with respect to the timing of surgery could be established.

Resumo Objetivo Avaliar os fatores de risco e os desfechos em indivíduos submetidos ao tratamento cirúrgico de lesões subaxiais da coluna cervical em relação ao momento da cirurgia e aos parâmetros fisiológicos pré-operatórios dos pacientes. Métodos O estudo incluiu 26 pacientes com fraturas e luxações subaxiais da coluna cervical. Dados demográficos, investigação radiológica apropriada e parâmetros fisiológicos, como frequência respiratória, pressão arterial, frequência cardíaca, pressão parcial de oxigênio (PaO2) e escalas de disfunção da American Spine Injury Association (ASIA), foram documentados. No período pré-operatório, os pacientes foram divididos em dois grupos. O grupo instável (I) continha pacientes com parâmetros fisiológicos anormais e o grupo estável (E) era composto por pacientes com parâmetros fisiológicos dentro da faixa de normalidade. Os pacientes foram ainda subdivididos em grupos de tratamento precoce e tardio de acordo com o momento da cirurgia como Iprecoce, Itardio, Eprecoce e Etardio. Todos os pacientes foram chamados para consultas de acompanhamento em 1, 6 e 12 meses. Resultados Cinquenta e seis por cento dos pacientes do grupo E apresentaram melhora neurológica em um grau ASIA e desfecho bom independentemente do momento da cirurgia. Os desfechos em pacientes do grupo I com parâmetros fisiológicos instáveis e submetidos à intervenção cirúrgica precoce foram maus. Conclusão Este estudo conclui que a intervenção cirúrgica precoce em pacientes com instabilidade fisiológica teve forte associação como fator de risco no desfecho final em termos de mortalidade e morbidade. Além disso, não foi possível estabelecer nenhuma associação positiva de melhora em pacientes com estabilidade fisiológica em relação ao momento da cirurgia.

Evaluation of Head and Cervical Spine Posture after Therapy with Maxillary Protraction Appliances / Evaluación de la Postura de la Cabeza y la Columna Cervical Después de la Terapia con Aparatos de Protracción Maxilar

SUMMARY: The objective of this study was to evaluate the changes of head and cervical spine posture of skeletal class malocclusion in adolescent with maxillary protraction. Thirty cases of skeletal class malocclusion were randomly selected from the Stomatological Hospital of Shanxi Medical University. High-quality lateral cephalograms were collected including pre- and posttreatment to compare the changes of head and cervical spine posture. Data were processed using SPSS 26.0 statistical software. The paired-t test was used to compare pre- and posttreatment mean angular measurements.A significant difference in the SNA(p<0.001), SNB(p<0.01), and ANB(p<0.001) between T1 and T2 showed an improvement in the sagittal relationships. A significant change was observed in middle cervical spine posture, while upper cervical spine posture variables showed no significant difference after treatment. Skeletal class with maxillary protraction appliance not only led to the improvement of sagittal relationship, but also changed the middle cervical spine posture.

El objetivo de este estudio fue evaluar los cambios en la postura de la cabeza y la columna cervical debido a la maloclusión clase esquelética en adolescentes con protracción maxilar. Treinta casos de maloclusión de clase esquelética fueron seleccionados al azar del Hospital Estomatológico de la Universidad Médica de Shanxi. Se recogieron cefalogramas laterales de alta calidad, incluidos el tratamiento previo y posterior, para comparar los cambios en la postura de la cabeza y la columna cervical. Los datos se procesaron con el software estadístico SPSS 26.0. Se utilizó la prueba t pareada para comparar las medidas angulares medias antes y después del tratamiento. Una diferencia significativa en SNA (p <0,001), SNB (p <0,01) y ANB (p <0,001) entre T1 y T2 mostró una mejora en las relaciones sagitales. Se observó un cambio significativo en la postura de la columna cervical media, mientras que las variables de postura de la columna cervical superior no mostraron diferencias significativas después del tratamiento. La clase esquelética con aparato de protracción maxilar no solo condujo a la mejora de la relación sagital, sino que también cambió la postura de la columna cervical media.

Morphometric study and anatomical variation with its incidence of foramina transversaria on the lower cervical vertebrae / Estudio morfométrico y variación anatómica con la incidencia de forámenes transversos en las vértebras cervicales inferiores

SUMMARY: Anatomical variation of the foramina transversaria (FT) is associated with vertebral neurovascular symptoms and can cause complications after lower spine surgery, especially cervical pedicle screw (CPS) insertion. FT variation has been documented and classified in various populations, as this information can help increase cervical stability in subaxial vertebral surgery. Although the morphometry of the upper cervical spine in Thai populations has been reported, there have yet been no studies examining the features of FT. The FT of dried cervical spines (C3-C7; left and right side; n = 107, male = 53 and female = 54) were examined for morphological variation, and their anteroposterior (AP) and transverse (T) diameters were measured using a digital vernier caliper. Morphometric data and variations were compared by sex and lateral side. It was that the C3-C6 FT in both sexes were round, and the C7 FT was elliptical with an oblique right side. FT diameters did not differ significantly by sex except for the AP diameters of C6-C7 and for T diameters of C4 and C7. The left AP diameters of C3-C6 were significantly longer than the right, as were the T diameters of C4 and C7 FT. Additionally, T diameter was significantly longer than that of the AP, except that of the left C6 in male spines, which did not differ from the AP. Most FT examined were round. These findings should be considered in the provisional diagnosis of vertebral neurovascular symptoms caused by FT variation as well as that of neurovascular damage after cervical pedicle screw placement.

La variación anatómica del foramen transverso (FT) se asocia con síntomas neurovasculares vertebrales y puede causar complicaciones después de la cirugía de columna cervical inferior, especialmente la inserción de tornillos pediculares cervicales (TPC). La variación del FT se ha documentado y clasificado en varias poblaciones, ya que esta información puede ayudar a aumentar la estabilidad cervical en la cirugía vertebral subaxial. Aunque se ha informado sobre la morfometría de la columna cervical superior en poblaciones tailandesas, aún no se han realizado estudios que examinen las características de FT. Se examinó la variación morfológica del FT de vértebras cervicales secas (C3-C7; lado izquierdo y derecho; n = 107, hombres = 53 y mujeres = 54), y se midieron sus diámetros anteroposterior (AP) y transverso (T) usando un pie de metro digital. Se compararon datos morfométricos y variaciones por sexo y lado. Los FT de C3-a C6 en ambos sexos eran redondos, y el FT C7 era elíptico con el lado derecho oblicuo. Los diámetros del FT no difirieron significativamente por sexo excepto para los diámetros AP de C6- C7 y para los diámetros transversos de C4 y C7. Los diámetros AP izquierdos de C3-C6 eran significativamente más largos que los del lado derecho, al igual que los diámetros transversos de C4 y C7. Además, el diámetro transverso fue significativamente mayor que el AP, excepto el C6 izquierdo en las vértebras de hombres, que no difirió del AP. La mayoría de los FT examinados eran redondos. Estos hallazgos deben ser considerados en el diagnóstico provisional de síntomas neurovasculares vertebrales causados por la variación del FT, así como en el de daño neurovascular tras la colocación de tornillos pediculares cervicales.

Evaluation of the normal craniocervical junction craniometry in 137 asymptomatic patients / Evaluación de la craneometría de la unión craneocervical normal en 137 pacientes asintomáticos

SUMMARY: To our best knowledge, most of the craniometric studies on the normal craniocervical junction (CCJ), are still poorly studied and based on measurements taken from plain radiographs. In this study, the authors conducted a craniometric evaluation of the CCJ in a population without known CCJ abnormalities. The purpose of the study was to assess the normal CCJ craniometry based on measures obtained from CT scans. The authors examined 137 consecutive CCJ CT scans obtained in patients evaluated at their hospital for treatment of non-CCJ conditions between 2018 and 2019. Twelve craniometrical dimensions were conducted, including the relation of the odontoid with the cranial base, the atlantodental interval (ADI), the clivus length, and the clivus-canal angle (CCA).

Hasta donde sabemos, aun son escasos y pocos los estudios craneométricos respecto a la unión craneocervical normal (UCCN) y estos se basan en mediciones tomadas de radiografías simples. En este estudio, realizamos una evaluación craneométrica de la UCCN en una población sin anomalías conocidas. El propósito del estudio fue evaluar la craneometría UCCN normal en función de las medidas obtenidas de las tomografías computarizadas. Los autores examinaron 137 tomografías computarizadas UCCN consecutivas obtenidas en pacientes evaluados en su hospital para el tratamiento de condiciones no UCCN entre los años 2018 y 2019. Se realizaron doce dimensiones craneométricas, incluida la relación del proceso odontoides con la base del cráneo, el intervalo atlantodental (ADI), la longitud del clivus y el ángulo clivus-canal (CCA).

Angle class II/2nd division: is there an alignment? / Classe II/2ª divisão de Angle: existe alinhamento?

Introduction: Interdisciplinary investigative study of the stomatognathic-cervical complex, necessary to understand the structure and biomechanics of this system in Angle Class I and II / 2nd Division participants. Objective: To evaluate alignment and position of cranial cervical structures on radiographs and their functional relationship with the stomatognathic system. Material and method: Trans Oral and Profile radiographs were submitted to biomechanical analysis, considered the linear and angular measurement of Atlas and Axis through the application included in the radiogram software. Result: We observed a significant difference in the angular measurements of vertical alignment between the Skull, Axis, and the Mandible (p = <0.001), and in the left joint between the Atlas and the Axis (AE: p = 0.011; SEA: p = 0.042). Among the linear measures of the distances between the Atlas and the Axis, the AOD distance presented statistics quite close to the level of significance (p = 0.0502), but above. There was no statistically significant difference in the other measures. Conclusion: In this study, the alignment between the Atlas and Axis cervical vertebrae and the mandible and angles of the atlanto-occipital joints are altered in Class II / 2nd Division participants. There is no difference in the size and distance of the Atlas and the Axis between the Classes.

Introdução: Estudo interdisciplinar investigativo do complexo cérvico-estomatognático, necessário para compreender a estrutura e a biomecânica desse sistema em participantes Classe I e II/2ª Divisão de Angle. Objetivo: Avaliar o alinhamento e a posição das estruturas crânio cervicais nas radiografias de participantes Classe I e II/2ª Divisão de Angle e sua relação funcional com o sistema estomatognático. Material e método: As imagens digitais Trans Oral e Perfil de participantes com maloclusão Classe I e II/2ª Divisão de Angle foram submetidas à medição linear e angular do crânio, mandíbula, Atlas e do Áxis através do software Advantage Workstation 4.6 (AW4.6 ext. 04). Resultado: Houve diferença significativa nas medidas angulares de alinhamento vertical entre o Crânio, Áxis e a Mandíbula (p = <0,001), e da articulação esquerda entre o Atlas e o Áxis (AE: p = 0,011; AAE: p = 0,042). Das medidas lineares das distâncias entre o Atlas e o Áxis, a distância AOD apresentou estatística bastante próxima do nível de significância (p=0,0502), porém acima. Não houve diferença significativamente estatística nas demais medidas avaliadas. Conclusão: Neste estudo, o alinhamento entre as vértebras cervicais Atlas e Áxis e a mandíbula e os ângulos das articulações atlanto occipitais se mostraram alterados nos participantes Classe II/2ª Divisão de Angle. Não há diferença significativa no tamanho e distância do Atlas e do Áxis entre as Classes.

Experiência de pacientes com lesão medular em reabilitação: um estudo misto acerca dos cuidados de enfermagem / Experience of patients with spindle injury in rehabilitation: a mixed study about nursing care

: A obtenção da satisfação do paciente é uma das ferramentas de investigação de indicadores de qualidade, sendo fonte de informação relevantes para o desenvolvimento de melhorias na qualidade da assistência. Objetivo: O estudo teve por intuito compreender a visão e a satisfação de pacientes com lesão medular internados em um centro de referência em reabilitação, quanto aos cuidados de enfermagem, de forma a evidenciar o papel do profissional enfermeiro na adesão durante o processo de reabilitação e readaptação. Metodologia: Trata-se de uma pesquisa de campo de caráter misto com abordagem exploratória observacional, realizada em um centro de reabilitação, com 22 participantes, sendo que 21 destes corresponderam à pesquisa qualitativa. Para a coleta de dados, foram aplicados o Instrumento de Satisfação do Paciente (ISP) e um questionário com 4 questões norteadoras. Resultados: A satisfação dos participantes em relação aos cuidados de enfermagem foi positiva nos três domínios, sendo o domínio educacional o mais bem avaliado (4,39), seguido da área técnica profissional (4,06) e por último confiança (4,04). Os resultados qualitativos foram divididos em duas categorias "Relação enfermeiro-paciente" e "A percepção do cuidado". Conclusão:Tornou-se claro o papel do enfermeiro na adesão à reabilitação, sendo possível constatar a relação da satisfação com os aspectos de humanização em saúde

Obtaining patient satisfaction is one of the research tools for quality indicators, being a source of relevant information for the development of improvements in the quality of care. Objective: The study aimed to understand the vision and satisfaction of patients with spinal cord injury hospitalized in a Rehabilitation Reference Center, regarding nursing care, in order to highlight the role of nurses in adherence during the rehabilitation and readaptation process. Methodology: This is a mixed field research with an exploratory observational approach, carried out in a Rehabilitation Center, with 22 participants, 21 of which corresponded to qualitative research. For data collection, the Patient Satisfaction Instrument (PSI) and a questionnaire with 4 guiding questions were applied. Results: The classification of participants in relation to nursing care was positive in the three domains, with the educational domain being the best evaluated (4.39), followed by the technical-professional area (4.06) and finally trust (4.04). Qualitative results were divided into two categories "Nurse-patient relationship" and "Perception of care". Conclusion: In addition, the role of nurses in adherence to rehabilitation became clear, and it was possible to verify the relationship between satisfaction and aspects of humanization in health

3D-printed vertebral body in anterior spinal reconstruction after total spondylectomy for patients with cervical chordoma / 北京大学学报(医学版)

OBJECTIVE@#To investigate whether 3D-printed artificial vertebral body can reduce prosthesis subsidence rate for patients with cervical chordomas, through comparing the rates of prosthesis subsidence between 3D printing artificial vertebral body and titanium mesh for anterior spinal reconstruction after total spondylectomy.@*METHODS@#This was a retrospective analysis of patients who underwent surgical treatment for cervical chordoma at our hospital from March 2005 to September 2019. There were nine patients in the group of 3D artificial vertebral body (3D group), and 15 patients in the group of titanium mesh cage (Mesh group). The patients' characteristics and treatment data were extracted from the medical records, including age, gender, CT hounsfield unit of cervical vertebra and surgical information, such as the surgical segments, time and blood loss of surgery, frequency and degree of prosthesis subsidence after surgery. Radiographic observations of prosthesis subsidence during the follow-up, including X-rays, CT, and magnetic resonance imaging were also collected. SPSS 22.0 was used to analysis the data.@*RESULTS@#There was no significant difference between the two groups in gender, age, CT hounsfield unit, surgical segments, time of surgery, blood loss of posterior surgery and total blood loss. Blood loss of anterior surgery was 700 (300, 825) mL in 3D group and 1 500 (750, 2 800) mL in Mesh group (P < 0.05). The prosthesis subsidence during the follow-up, 3 months after surgery, there was significant difference between the two groups in mild prosthesis subsidence (P < 0.05). The vertebral height of the 3D group decreased less than 1 mm in eight cases (no prosthesis subsidence) and more than 1 mm in one case (mild prosthesis subsidence). The vertebral height of the Mesh group decreased less than 1 mm in five cases (no prosthesis subsidence), and more than 1 mm in eight cases (mild prosthesis subsidence). Two patients did not have X-rays in 3 months after surgery. There was a statistically significant difference between the two groups in the prosthesis subsidence rate at the end of 12 months (P < 0.01). The vertebral height of eight cases in the 3D group decreased less than 1 mm (no prosthesis subsidence) and one case more than 3 mm (severe prosthesis subsidence). Four of the 15 cases in the Mesh group decreased less than 1 mm (no prosthesis subsidence), two cases more than 1 mm (mild prosthesis subsidence), and nine cases more than 3 mm (severe prosthesis subsidence). There was a statistically significant difference between the two groups in the prosthesis subsidence rate at the end of 24 months (P < 0.01). The vertebral height of seven cases in the 3D group decreased less than 1 mm (no prosthesis subsidence), one case more than 3 mm (severe prosthesis subsidence), and one case died with tumor. One case in the Mesh group decreased less than 1 mm (no prosthesis subsidence), one case more than 1 mm (mild prosthesis subsidence), 11 case more than 3 mm (severe prosthesis subsidence), one case died with tumor and one lost the follow-up. Moreover, at the end of 12 months and 24 months, there was significant difference between the two groups in severe prosthesis subsidence rate (P < 0.01).@*CONCLUSION@#3D-printed artificial vertebral body for anterior spinal reconstruction after total spondylectomy for patients with cervical chordoma can provide reliable spinal stability, and reduce the incidence of prosthesis subsidence after 2-year follow-up.

Comparative analysis of clinical efficacy between posterior percutaneous endoscopic discectomy and anterior cervical discectomy and fusion in the treatment of cervical spondylotic radiculopathy / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy of posterior percutaneous endoscopic discectomy(PPECD) in the treatment of cervical spondylotic radiculopathy.@*METHODS@#A total of 56 patiens with single segment cervical spondylotic radiculopathy from December 2017 to October 2020, were randomly divided into observation group and control group. In observation group, there were 16 males and 11 females, including 8 cases of C4,5, 13 cases of C5,6 and 6 cases of C6,7 performed posterior percutaneous endoscopic discectomy, aged from 34 to 61 years old with an average of (51.15±6.29) years old. In control group, there were 19 males and 10 females with single segment cervical spondylotic radiculopathy including 10 cases of C4,5, 14 cases of C5,6 and 5 cases of C6,7 performed anterior cervical discectomy and fusion, aged from 40 to 65 years old with an average of (53.24±5.31) years old. The operative time, intraoperative blood loss, postoperative time of lying in bed and length of postoperative hospital stay were recorded. Visual analogue scale(VAS) and neck disability index(NDI) were used to evaluate the clinical efficacy. Cervical plain films or MRIs, CTs were taken for re-visiting patients.@*RESULTS@#All patients were followed up more than 2 years. The observation group patients were followed up, the duration ranged from 24 to 42 months with an average of (30.48±4.91) months. The control group patients were followed up, the duration ranged from 25 to 47 months, with an average of (32.76±4.53) months. Compared with control group, operative time, intraoperative blood loss, postoperative time of lying in bed and length of postoperative hospital stay were decreased(P<0.05). Compared with pre-operation, VAS of neck and upper limb and NDI at the latest follow-up between two groups were significantly improved(P<0.05). Compared with control group, VAS of neck and upper limb at 1 day after operation in observation group were significantly reduced(P<0.05). There was no significant difference in VAS of neck and upper limb and NID at 1, 3 months and the latest follow-up after operation between two groups(P>0.05). In the observation group, one patient's deltoid muscle strength was weakened to grade 4 after operation, and returned to normal after 12 weeks of conservative treatment. In control group, there was 1 case of postoperative adjacent spondylosis with symptoms of spinal compression after 2 years operation, then underwent cervical artificial intervertebral disc replacement. And there was 1 case of dysphagia after operation in control group and improved after 1 year. There was no significant difference in incidence of complications between two groups.@*CONCLUSION@#PPECD has advantages of shortening operative time, decreasing intraoperative blood loss, reducing postoperative time of lying in bed and length of postoperative hospital stay. However, applicable age range of patients and long-term clinical efficacy needs further study.

Multivariate correlation analysis of T1S and C7S / 中国骨伤

OBJECTIVE@#To determine whether C7 angles (C7 slope, C7S) could replace T1 angles (T1 slope, T1S) by correlation analysis of T1S and C7S.@*METHODS@#A total of 442 patients from July 2015 to July 2020 in outpatient and inpatient department were enrolled retrospectively, and 259 patients who could identify the upper endplate of T1 were screened out . Of them, there were 145 males and 114 females, aged from 20 to 83 years old with an average of (58.6±11.2) years, including 163 patients with cervical spine surgery and 96 non-surgical patients. Patients were stratified by sex, age, cervical kyphosis, cervical alignment imbalance, and cervical spine surgery. These 259 patients included 145 cases in the male group, 114 cases in the female group;76 cases in the youth group (<40 years old), 109 cases in the middle-aged group (40 to 60 years old), and 74 cases in the elderly group(>60 years old); 92 cases in the cervical kyphosis group, 167 cases in the non-kyphosis group;51 cases in the cervical sequence imbalance group, 208 cases in the non-imbalance group;163 cases in the cervical surgery group, 96 cases in the non-operation group. The correlations of C7S and T1S in various modalities groups were analyzed.@*RESULTS@#Of 442 patients, the recognition rate of upper endplate of T1 was 58.6%(259/442), and that of C7 was 90.7%. The mean T1S and C7S of the 259 patients were (24.5±8.0)° [(25.9±7.7)° in the male group and (23.7±6.9)° in the female group] and (20.8±7.3)° [(22.5±7.5)° in the male group and(19.7±5.8)° in the female group], respectively. The total correlation coefficient between C7S and T1S was r=0.89, R2=0.79, and the linear regression equation was T1S=0.91×C7S+4.35. In the above general information and the grouping of deformity factors, T1S was highly correlated with C7S(r value 0.85 to 0.92, P<0.05).@*CONCLUSION@#There is a high correlation between T1S and C7S in different factor groups. For cases where T1S cannot be measured, C7S can be used to provide guidance and reference for evaluating the sagittal balance of the spine, analyzing the condition, and formulating surgical plans.

Advances in surgical strategies for ossification of posterior longitudinal ligament involving the C 2 segment / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the application of surgical strategies for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) involving the C 2 segment.@*METHODS@#The literature about the surgery for cervical OPLL involving C 2 segment was reviewed, and the indications, advantages, and disadvantages of surgery were summarized.@*RESULTS@#For cervical OPLL involving the C 2 segments, laminectomy is suitable for patients with OPLL involving multiple segments, often combined with screw fixation, and has the advantages of adequate decompression and restoration of cervical curvature, with the disadvantages of loss of cervical fixed segmental mobility. Canal-expansive laminoplasty is suitable for patients with positive K-line and has the advantages of simple operation and preservation of cervical segmental mobility, and the disadvantages include progression of ossification, axial symptoms, and fracture of the portal axis. Dome-like laminoplasty is suitable for patients without kyphosis/cervical instability and with negative R-line, and can reduce the occurrence of axial symptoms, with the disadvantage of limited decompression. The Shelter technique is suitable for patients with single/double segments and canal encroachment >50% and allows for direct decompression, but is technically demanding and involves risk of dural tear and nerve injury. Double-dome laminoplasty is suitable for patients without kyphosis/cervical instability. Its advantages are the reduction of damage to the cervical semispinal muscles and attachment points and maintenance of cervical curvature, but there is progress in postoperative ossification.@*CONCLUSION@#OPLL involving the C 2 segment is a complex subtype of cervical OPLL, which is mainly treated through posterior surgery. However, the degree of spinal cord floatation is limited, and with the progress of ossification, the long-term effectiveness is poor. More research is needed to address the etiology of OPLL and to establish a systematic treatment strategy for cervical OPLL involving the C 2 segment.

Mode establishment and preliminary clinical application of anterior cervical surgery in outpatient setting / 中国修复重建外科杂志

OBJECTIVE@#To establish the mode of anterior cervical surgery in outpatient setting, and evaluate its preliminary effectiveness.@*METHODS@#A clinical data of patients who underwent anterior cervical surgery between January 2022 and September 2022 and met the selection criteria was retrospectively analyzed. The surgeries were performed in outpatient setting ( n=35, outpatient setting group) or in inpatient setting ( n=35, inpatient setting group). There was no significant difference between the two groups ( P>0.05) in age, gender, body mass index, smoking, history of alcohol drinking, disease type, the number of surgical levels, operation mode, as well as preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale score of neck pain (VAS-neck), and visual analogue scale score of upper limb pain (VAS-arm). The operation time, intraoperative blood loss, total hospital stay, postoperative hospital stay, and hospital expenses of the two groups were recorded; JOA score, VAS-neck score, and VAS-arm score were recorded before and immediately after operation, and the differences of the above indexes between pre- and post-operation were calculated. Before discharge, the patient was asked to score satisfaction with a score of 1-10.@*RESULTS@#The total hospital stay, postoperative hospital stay, and hospital expenses were significantly lower in the outpatient setting group than in the inpatient setting group ( P<0.05). The satisfaction of patients was significantly higher in the outpatient setting group than in the inpatient setting group ( P<0.05). There was no significant difference between the two groups in operation time and intraoperative blood loss ( P>0.05). The JOA score, VAS-neck score, and VAS-arm score of the two groups significantly improved at immediate after operation when compared with those before operation ( P<0.05). There was no significant difference in the improvement of the above scores between the two groups ( P>0.05). The patients were followed up (6.67±1.04) months in the outpatient setting group and (5.95±1.90) months in the inpatient setting group, with no significant difference ( t=0.089, P=0.929). No surgical complications, such as delayed hematoma, delayed infection, delayed neurological damage, and esophageal fistula, occurred in the two groups.@*CONCLUSION@#The safety and efficiency of anterior cervical surgery performed in outpatient setting were comparable to that performed in inpatient setting. Outpatient surgery mode can significantly shorten the postoperative hospital stay, reduce hospital expenses, and improve the patients' medical experience. The key points of the outpatient mode of anterior cervical surgery are minimizing damage, complete hemostasis, no drainage placement, and fine perioperative management.

Correlação entre os estágios de maturação da sutura palatina mediana e das vértebras cervicais / Correlation between the maturation stages of the median palatal suture and cervical vertebrae

Introdução: Atualmente, a avaliação da maturação da sutura palatina mediana (MSPM) em pacientes que precisam ser submetidos à expansão rápida da maxila é realizada por meio de tomografias computadorizadas de feixe cônico (TCFC). No entanto, doses adicionais de radiação são induzidas ao paciente para a aquisição desse exame. Objetivo: Correlacionar os estágios de MSPM com os estágios de maturação das vértebras cervicais (MVC). Material e métodos: Um total de 268 TCFC da região da cabeça e do pescoço de indivíduos de ambos os sexos e com idades variando entre 5 e 76 anos foram analisadas de forma cega por uma única examinadora. O estágio de MSPM foi avaliado por meio da observação da maxila no corte axial e foi classificado como A, B, C, D ou E. Por outro lado, o estágio de MVC foi avaliado por meio do corte sagital das vértebras cervicais e foi classificado como CS1, CS2, CS3, CS4, CS5 ou CS6. A concordância intraexaminador foi avaliada por meio do Coeficiente Kappa. O teste de Correlação de Spearman foi utilizado para avaliar a correlação entre os estágios de MSPM e os estágios de MVC. Resultados: Uma correlação positiva forte foi encontrada entre os estágios de MSPM e MVC. Os estágios A e B mostraram correlação com os estágios CS1, CS2 e CS3. Diferentemente, o estágio C se correlacionou com maior frequência com os estágios CS4 e CS5. Por fim, os estágios D e E, se mostraram mais frequentes em indivíduos nos estágios CS5 e CS6 de forma similar. Conclusão: A predição da MSPM por meio da MVC em telerradiografias laterais pode ser uma alternativa viável à avaliação sutural na TCFC em pacientes nos estágios CS1, CS2 e CS3. A partir do estágio CS4, uma TCFC é recomendável para avaliar com maior segurança o estágio de MSPM e definir a melhor modalidade de expansão (AU).

Introduction: Currently, the assessment of maturation of the midpalatal suture (MPSM) in patients who need to undergo rapid maxillary expansion is performed using cone-beam computed tomography (CBCT). However, additional doses of radiation are induced to the patient for the acquisition of this exam. Objective: To correlate the stages of MPSM with the stages of maturation of the cervical vertebrae (CVM). Material and methods: A total of 268 CBCT of the head and neck of individuals of both sexes and aged between 5 and 76 years were analyzed blindly by a single examiner. The MPSM stage was assessed by observing the maxilla in the axial view and was classified as A, B, C, D or E. On the other hand, the CVM stage was assessed in the sagittal view of the cervical vertebrae and was classified as CS1, CS2, CS3, CS4, CS5 or CS6. Intraexaminer agreement was analyzed using the Kappa coefficient. Spearman's Correlation test was used to assess the correlation between MPSM and CVM stages Results: A strong positive correlation was found between MPSM and CVM stages. Stages A and B showed correlation with stages CS1, CS2 and CS3. Differently, stage C correlated more frequently with stages CS4 and CS5. Finally, stages D and E were more frequent in individuals in stages CS5 and CS6, similarly. Conclusion: The prediction of MPSM by assessing CVM in lateral cephalograms seems to be a viable alternative to the sutural evaluation in CBCT in patients in stages CS1, CS2 and CS3. From the CS4 stage onwards, a CBCT is recommended to assess the MPSM stage and define the most adequate expansion modality for patients (AU).

Artritis reumatoide de la columna cervical: aspectos clave para el cirujano ortopédico / Rheumatoid arthritis of the cervical spine: key aspects for the orthopedic surgeon

La artritis reumatoide es una enfermedad inflamatoria autoinmune crónica que afecta con frecuencia a la columna cervical. El diagnóstico clínico de la afección cervical puede ser difícil; por lo tanto, se recomienda la evaluación radiográfica sistemática de todos los pacientes. El tratamiento oportuno de estas lesiones es importante para preservar la independencia, la función neurológica, e, incluso, la vida de los pacientes. Este artículo es una revisión actualizada de todos los aspectos de la artritis reumatoide de la columna cervical relevantes para el cirujano ortopédico.

Rheumatoid arthritis is a chronic inflammatory autoimmune disease that frequently affects the cervical spine. The clinical diagnosis can be difficult; therefore, a systematic radiographic evaluation of all patients is recommended. The timely treatment of these lesions is important to preserve the self-reliance, the neurological function, and even the lives of the patients. The present article is an update of all the aspects pertaining to cervical spine rheumatoid arthritis that are relevant to the orthopedic surgeon.

Comparison of the reproducibility of two cervical vertebrae maturation methods

Aim: Facial orthopaedic treatments based on the stimulation or restrictions of craniofacial bone growth are more effective when carried out during the pubertal growth spurt. The aim of this cross-sectional study was to evaluate the reproducibility of two cervical vertebrae methods (CVM) with manual tracing and direct visual inspection. Methods: A sample of 60 lateral cephalometric radiographs (10 of each of the 6 CVM stages) was randomly selected from 171 records. 5 orthodontists classified these radiographs according to the skeletal maturation stage in 2002 and 2005, and the application of both methods was conducted by direct visual inspection and evaluation through manual tracing. Results: The average reliability of the two methods determination and the two forms of evaluation was substantial. The direct visual inspection evaluation showed the highest reliability and agreement interexaminer values for both methods, as well as the intraexaminers evaluation. Conclusion: The reproducibility of CVM method was substantial, indicating its clinical use to determine the skeletal maturity and the ideal moment for treatment execution

Síndrome de Klippel-Feil en un lactante / Klippel-Feil syndrome in an infant

Se presenta el caso clínico de un lactante de 11 meses de edad, quien fue remitido a la consulta de Genética Clínica del Centro Provincial de Genética Médica de la provincia de Holguín, por presentar dismorfias faciales asociadas a retardo motor, cuello corto y disminución de movimientos. Se realizó interrogatorio, examen físico exhaustivo y estudios radiológicos de columna cervical, que mostraron la fusión de vértebras cervicales, lo cual permitió diagnosticar el síndrome de Klippel-Feil. Se proyectó habilitación con ejercicios para fortalecer los músculos paravertebrales y se brindó asesoramiento genético a la familia.

The case report of an 11 months infant is presented, who was referred to the Clinical Genetics Service of the Medical Genetics Provincial Center in Holguín province, due to facial dysmorphias associated with motor retardation, short neck and decreasing movements. Interrogation, exhaustive physical exam and radiological studies of cervical column were carried out that showed the fusion of cervical vertebras, which allowed to diagnose the Klippel-Feil syndrome. A qualification with exercises was projected to strengthen the paravertebral muscles and genetic advice to the family was provided.

Importância da ginástica laboral na flexibilidade de coluna em servidores do Hospital Universitário / Importance of occupational gymnastics in spine flexibility in workers at the university hospital

Introdução: os cuidados com os trabalhadores é uma importante questão de saúde pública. Objetivo: avaliar os efeitos da ginástica laboral (GL) na flexibilidade da coluna cervical e lombar de servidores do hospital universitário. Materiais e Métodos: trata-se de um estudo experimental. Participaram do estudo, 50 colaboradores distribuídos em dois grupos: Controle (CTL, n=25) e Experimental (EXP, n=25). O grupo CLT não participou das aulas de GL e o grupo EXP realizou 16 sessões de GL, quatro vezes por semana, por quatro semanas. A flexibilidade da coluna cervical e lombar dos participantes foi realizada em dois momentos, antes de iniciarem o programa de GL e após 16 sessões. Resultados: foi verificado que a prática de GL resultou em um aumento da flexibilidade cervical. Em relação à coluna lombar, o período de intervenção não impediu a redução da flexibilidade, no entanto, essa redução foi 50% menor no grupo EXP quando comparado ao grupo CTL. Conclusão: o programa de GL é uma estratégia de intervenção fundamental para a saúde do trabalhador, visto que a flexibilidade é um importante componente da atividade física relacionada à saúde.

Introduction: care of workers is an important public health issue. Objective: to evaluate the effects of occupational gymnastics (OG) on the flexibility of the cervical and lumbar spine of employees at the university hospital. Materials and Methods: this is an experimental study. A total of 50 employees participated in the study, divided into two groups: Control (CTL, n = 25) and Experimental (EXP, n = 25). The CLT group did not participate in the OG classes and the EXP group had 16 OG sessions, which took place four times a week, for four weeks. The flexibility of the cervical and lumbar spine of the participants was assessed in two moments, before starting the OG program and after 16 sessions. Results: it was observed that the practice of OG resulted in an increase in cervical flexibility. Regarding the lumbar spine, the intervention period did not prevent the reduction in flexibility; however, this reduction was 50% lower in the EXP group when compared to the CTL group. Conclusion: the OG program is a fundamental intervention strategy for workers' health, since flexibility is an important component of physical activity related to health.