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Luo Y, Huang X, Yue Y, Lin X, Chen G, Wang K, Luo Y. In vivo cervical vertebrae kinematic studies based on dual fluoroscopic imaging system measurement: A narrative review. Heliyon 2024; 10:e30904. [PMID: 38765031 PMCID: PMC11097065 DOI: 10.1016/j.heliyon.2024.e30904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/21/2024] [Accepted: 05/07/2024] [Indexed: 05/21/2024] Open
Abstract
Understanding the motion characteristics of cervical spine through biomechanical analysis aids in the identification of abnormal joint movements. This knowledge is essential for the prevention, diagnosis, and treatment of related disorders. However, the anatomical structure of the cervical spine is complex, and traditional medical imaging techniques have certain limitations. Capturing the movement characteristics of various parts of the cervical spine in vivo during motion is challenging. The dual fluoroscopic imaging system (DFIS) is able to quantify the motion and motion patterns of individual segments. In recent years, DFIS has achieved accurate non-invasive measurements of dynamic joint movements in humans. This review assesses the research findings of DFIS about the cervical spine in healthy and pathological individuals. Relevant study search was conducted up to October 2023 in Web of Science, PubMed, and EBSCO databases. After the search, a total of 30 studies were ultimately included. Among them, 13 studies focused on healthy cervical spines, while 17 studies focused on pathological cervical spines. These studies mainly centered on exploring the vertebral bodies and associated structures of the cervical spine, including intervertebral discs, intervertebral foramina, and zygapophyseal joints. Further research could utilize DFIS to investigate cervical spine motion in different populations and under pathological conditions.
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Affiliation(s)
- Yuanbiao Luo
- Department of Orthopedics, The First Hospital of Putian City, Putian, Fujian, China
| | - Xinwei Huang
- Department of Rehabilitation Therapy, Yangzhi Affiliated Rehabilitation Hospital of Tongji University, Shanghai, China
| | - Yongda Yue
- Department of Orthopedics, The First Hospital of Putian City, Putian, Fujian, China
| | - Xiande Lin
- Department of Orthopedics, The First Hospital of Putian City, Putian, Fujian, China
| | - Guoxian Chen
- Department of Orthopedics, The First Hospital of Putian City, Putian, Fujian, China
| | - Kun Wang
- Department of Rehabilitation Therapy, Kunshan Rehabilitation Hospital, Suzhou, Jiangsu, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation Therapy, Yangzhi Affiliated Rehabilitation Hospital of Tongji University, Shanghai, China
| | - Ye Luo
- Department of Orthopedics, The First Hospital of Putian City, Putian, Fujian, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
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Oyekan AA, LeVasseur CM, Shaw JD, Donaldson WF, Lee JY, Anderst WJ. Changes in intervertebral sagittal alignment of the cervical spine from supine to upright. J Orthop Res 2023; 41:1538-1545. [PMID: 36484123 PMCID: PMC10250559 DOI: 10.1002/jor.25500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Cervical sagittal alignment is a critical component of successful surgical outcomes. Unrecognized differences in intervertebral alignment between supine and upright positions may affect clinical outcomes; however, these differences have not been quantified. Sixty-four patients scheduled to undergo one or two-level cervical arthrodesis for symptomatic pathology from C4-C5 to C6-C7, and forty-seven controls were recruited. Upright sagittal alignment was obtained through biplane radiographic imaging and measured using a validated process with accuracy better than 1° in rotation. Supine alignment was obtained from computed tomography scans. Coordinate systems used to measure supine and upright alignment were identical. Distances between adjacent bony endplates were measured to calculate disc height in each position. For both patients and controls, the C1-C2, C2-C3, and C3-C4 motion segments were in more lordosis when upright as compared with supine (all p < 0.001). However, the C4-C5, C5-C6, and C6-C7 motion segments were in less lordosis when upright as compared with supine (all p ≤ 0.004). There was an interaction between group and position at the C1-C2 (p = 0.002) and C2-C3 (p = 0.001) motion segments, with the controls demonstrating a greater increase in lordosis at both motion segments when moving from supine to upright. The results indicate that cervical motion segment alignment changes between supine and upright positioning, those changes differ among motion segments, and cervical pathology affects the magnitude of these changes. Clinical Significance: Surgeons should be mindful of the differences in alignment between supine and upright imaging and the implications they may have on clinical outcomes.
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Affiliation(s)
- Anthony A Oyekan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA
- Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - Clarissa M LeVasseur
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA
- Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeremy D Shaw
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA
- Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - William F Donaldson
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA
- Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joon Y Lee
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA
- Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
| | - William J Anderst
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Pittsburgh Ortho Spine Research (POSR) Group, University of Pittsburgh, Pittsburgh, PA, USA
- Biodynamics Laboratory, Orthopaedic Research Laboratories, University of Pittsburgh, Pittsburgh, PA, USA
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The Impact of Single-Level ACDF on Neural Foramen and Disc Height of Surgical and Adjacent Cervical Segments: A Case-Series Radiological Analysis. Brain Sci 2023; 13:brainsci13010101. [PMID: 36672082 PMCID: PMC9857145 DOI: 10.3390/brainsci13010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/01/2023] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Background: ACDF has become one of the established procedures for the surgical treatment of symptomatic cervical spondylosis, showing excellent clinical results and effective improvements in neural functions and neck pain relief. The main purpose of ACDF is neural decompression, and it is considered by some authors as an indirect result of the intervertebral distraction and cage insertion and the consequent restoration of the disc space and foramen height. Methods: Radiological data from 28 patients who underwent single-level ACDF were retrospectively collected and evaluated. For neural foramen evaluation, antero-posterior (A-P) and cranio-caudal (C-C) diameters were manually calculated; for intervertebral disc height the anterior, centrum and posterior measurement were calculated. All measurements were performed at surgical and adjacent (above and below) segments. NRS, NDI and also the mJOA and Nurick scale were collected for clinical examination and complete evaluation of patients’ postoperative outcome. Results: The intervertebral disc height in all its measurements, in addition to the height (C-C diameter) of the foramen (both right and left) increase at the surgical segment when comparing pre and postop results (p < 0.001, and p = 0.033 and p = 0.001). NRS and NDI radiculopathy scores showed improved results from pre- to post-op evaluation (p < 0.001), and a negative statistical correlation with the improved disc height at the surgical level. Conclusions: The restoration of posterior disc height through cage insertion appears to be effective in increasing foraminal height in patients with symptomatic preoperative cervical foraminal stenosis.
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Yeni YN, Azad S, Oravec D, Schildcrout A, Basheer A, Bey MJ, Bartol SW, Chang V. Intervertebral kinematics during neck motion 6.5 years after fusion and artificial disc replacement. Clin Biomech (Bristol, Avon) 2022; 99:105756. [PMID: 36063742 DOI: 10.1016/j.clinbiomech.2022.105756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Arthroplasty with artificial disc replacement for surgical treatment of cervical spine degeneration was introduced with the notion that motion-preserving approaches would prevent development of adjacent segment disease. Though clinical outcomes favor arthroplasty over the commonly used anterior cervical discectomy with fusion approach, clinical studies confirming the biomechanical basis of these results are lacking. The aim of this study was to compare intervertebral kinematics between arthroplasty and fusion patients 6.5 years post-surgery during physiological motion of the neck. METHODS Using a biplane dynamic X-ray system, computed tomography imaging and model based tracking algorithms, three dimensional intervertebral kinematics were measured during neck axial rotation and extension in 14 patients treated for cervical radiculopathy with fusion (n = 8) or arthroplasty (n = 6). The measurements were performed at 2-year (baseline) and 6.5 year post-surgical time points, with the main interest being in the interaction between surgery types and time points. 3 translations and 3 rotations were investigated for the index (C5C6), and upper- (C4C5) and lower adjacent levels (C6C7). FINDINGS Surgery-time interaction was significant for axial rotation (P < 0.04) and flexion-extension rotation (P < 0.005) in C4C5 during neck axial rotation, left-right translation (P < 0.04) in C5C6 and anterior-posterior translation in C6C7 (P < 0.04) during neck extension. In contrast with the expectations, axial rotation and flexion-extension decreased in C4C5 during neck rotation and anterior-posterior translation decreased in C6C7 during neck extension for fusion. INTERPRETATION The findings do not support the notion that adjacent segment motion increases after fusion.
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Affiliation(s)
- Yener N Yeni
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA.
| | - Sherwin Azad
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA; School of Medicine, Wayne State University, Detroit, MI, USA
| | - Daniel Oravec
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA
| | - Andrew Schildcrout
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA
| | - Azam Basheer
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
| | - Michael J Bey
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA
| | - Stephen W Bartol
- Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
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Evaluation of Dynamic Foraminal Stenosis with Positional MRI in Patients with C6 Radiculopathy-Mimicking Pain: A Prospective Radiologic Cohort Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1385387. [PMID: 35722464 PMCID: PMC9203214 DOI: 10.1155/2022/1385387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022]
Abstract
Objective Patients with a C6 radiculopathy-mimicking complaint are always in the gray zone if the diagnosis is not clear. The aim of the study is to make the diagnosis clear if the neck and shoulder pain is caused by a dynamic stenosis of the neural foramen at the C5-C6 level. Methods Patients with a C6 radiculopathy-mimicking complaint were included in the study. Patients had a cervical spine magnetic resonance imaging (MRI) at the normal limits, or a minimal protrusion at the C5-C6 level underwent a dynamic MRI procedure. We measured the foraminal area and spinal cord diameter (SCD) at the C5-C6 level by using the PACS system ROI irregular are determination integral embedded to PACS. Inter- and intraobserver reliability of measurements was evaluated. Results were analyzed statistically, and a p value< 0.05 was accepted as statistically meaningful. Results A total of 23 patients between January 2019 and June 2019 were included in the study. There were 10 men and 13 women, and the mean age was 41.3 (range 33-53). Foraminal area decrease at C5-C6 in extension and increase in flexion when compared with the neutral position was statistically significant (p < 0.001). Foraminal area changes between the complaint side and the opposite side was not statistically different (p > 0.05). Interobserver and intraobserver reliability of measurements were classified as in almost perfect agreement. Conclusions Our present work presented dynamic and positional foraminal changes in MRI with radiculopathy-mimicking patients. Soever, we did not find a difference between the clinical complaint side and the opposite side in radiculopathy-mimicking patients. Cervical radiculopathy pain should not be attributed only to foraminal sizes. PACS embedded irregular area measurement integral allows the easy measure of a big number of patients without additional set-up and digital work requirements.
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