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Liengswangwong W, Lertviboonluk N, Yuksen C, Jamkrajang P, Limroongreungrat W, Mongkolpichayaruk A, Jenpanitpong C, Watcharakitpaisan S, Palee C, Reechaipichitkool P, Thaipasong S. Validity of Inertial Measurement Unit (IMU Sensor) for Measurement of Cervical Spine Motion, Compared with Eight Optoelectronic 3D Cameras Under Spinal Immobilization Devices. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2024; 17:261-269. [PMID: 39050910 PMCID: PMC11268762 DOI: 10.2147/mder.s475166] [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: 05/23/2024] [Accepted: 07/04/2024] [Indexed: 07/27/2024] Open
Abstract
Background The assessment of cervical spine motion is critical for out-of-hospital patients who suffer traumatic spinal cord injuries, given the profound implications such injuries have on individual well-being and broader public health concerns. 3D Optoelectronic systems (BTS SmartDX) are standard devices for motion measurement, but their price, complexity, and size prevent them from being used outside of designated laboratories. This study was designed to evaluate the accuracy and reliability of an inertial measurement unit (IMU) in gauging cervical spine motion among healthy volunteers, using a 3D optoelectronic motion capture system as a reference. Methods Twelve healthy volunteers participated in the study. They underwent lifting, transferring, and tilting simulations using a long spinal board, a Sked stretcher, and a vacuum mattress. During these simulations, cervical spine angular movements-including flexion-extension, axial rotation, and lateral flexion-were concurrently measured using the IMU and an optoelectronic device. We employed the Wilcoxon signed-rank test and the Bland-Altman plot to assess reliability and validity. Results A single statistically significant difference was observed between the two devices in the flexion-extension plane. The mean differences across all angular planes ranged from -1.129° to 1.053°, with the most pronounced difference noted in the lateral flexion plane. Ninety-five percent of the angular motion disparities ascertained by the SmartDX and IMU were less than 7.873° for the lateral flexion plane, 11.143° for the flexion-extension plane, and 25.382° for the axial rotation plane. Conclusion The IMU device exhibited robust validity when assessing the angular motion of the cervical spine in the axial rotation plane and demonstrated commendable validity in both the lateral flexion and flexion-extension planes.
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Affiliation(s)
- Wijittra Liengswangwong
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Natcha Lertviboonluk
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaiyaporn Yuksen
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Parunchaya Jamkrajang
- College of Sports Science and Technology, Mahidol University, Nakhon Pathom, Thailand
| | | | | | - Chetsadakon Jenpanitpong
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sorawich Watcharakitpaisan
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chantarat Palee
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Picharee Reechaipichitkool
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suchada Thaipasong
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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2
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Li AY, McCarthy L, Hrabarchuk E, Spiera Z, Marayati NF, Schupper AJ, Hannah TC, Genadry L, Ali M, Quinones A, Kalagara R, Baron R, Sideras P, Naidich TP, Choudhri TF. Novel Grading Scales for Static and Flexion-Extension Magnetic Resonance Imaging in Patients with Cervical Spondylotic Myelopathy. World Neurosurg 2023; 173:e218-e227. [PMID: 36787858 DOI: 10.1016/j.wneu.2023.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Flexion-extension magnetic resonance imaging (MRI) has potential to identify cervical pathology not detectable on conventional static MRI. Our study evaluated standard quantitative and novel subjective grading scales for assessing the severity of cervical spondylotic myelopathy in dynamic sagittal MRI as well as in static axial and sagittal images. METHODS Forty-five patients underwent both conventional and flexion-extension MRI prior to anterior cervical discectomy and fusion from C4 through C7. In addition to measuring Cobb angles and cervical canal diameter, grading scales were developed for assessment of vertebral body translation, loss of disc height, change in disc contour, deformation of cord contour, and cord edema. Data were collected at all levels from C2-C3 through C7-T1. Variations in measurements between cervical levels and from flexion through neutral to extension were assessed using Mann-Whitney, Kruskal-Wallis, and two-way ANOVA tests. RESULTS Cervical canal diameter, vertebral translation, and posterior disc opening changed significantly from flexion to neutral to extension positions (P < 0.01). When comparing operative versus nonoperative cervical levels, significant differences were found when measuring sagittal cervical canal dimensions, vertebral translation, and posterior disc opening (P < 0.01). Degenerative loss of disc height, disc dehydration, deformation of ventral cord contour, and cord edema were all significantly increased at operative levels versus nonoperative levels (P < 0.01). CONCLUSIONS Flexion-extension MRI demonstrated significant changes not available from conventional MRI. Subjective scales for assessing degenerative changes were significantly more severe at levels with operative cervical spondylotic myelopathy. The utility of these scales for planning surgical intervention at specific and adjacent levels is currently under investigation.
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Affiliation(s)
- Adam Y Li
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Lily McCarthy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eugene Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zachary Spiera
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Naoum Fares Marayati
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Theodore C Hannah
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lisa Genadry
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Addison Quinones
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rebecca Baron
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Panagiotis Sideras
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas P Naidich
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Zhang JF, Umenta J, Ali A, Reynolds R, Ham PB, Thomas RD, Piryani R, Izhar M, Wrotniak B, Swayampakula AK. Cervical spine flexion-extension radiography versus magnetic resonance imaging in pediatric patients following blunt traumatic injury. Trauma Surg Acute Care Open 2023; 8:e001016. [PMID: 36761391 PMCID: PMC9906377 DOI: 10.1136/tsaco-2022-001016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/22/2023] [Indexed: 02/09/2023] Open
Abstract
Background In pediatric trauma patients, 60-80% of spinal cord injuries involve the cervical vertebrae. While the American College of Radiology offers guidelines for best imaging practices in the setting of acute pediatric trauma, there is a lack of uniformity in imaging-decision protocols across institutions. MRI has been shown to demonstrate high sensitivity for both bony and ligamentous injuries while also avoiding unnecessary radiation exposure in the pediatric patient population. However, the efficacy of flexion-extension (FE) radiography following initial MRI has not been evaluated in children. Our hypothesis is that FE radiography conducted following an initial MRI does not contribute significant diagnostic information or reduce time to cervical collar removal and thus can be removed from institutional protocols in order to avoid unnecessary testing and reduce pediatric radiation exposure. Methods Trauma data were collected for pediatric patients presenting with suspected acute cervical spine injury from 2014 to 2021. A total of 108 patients were subdivided into 41 patients who received "MRI Only" and 67 patients who received both "MRI and FE" diagnostic cervical spine imaging. Chi-square testing and t-tests were performed to determine differences between MRI and FE radiographic detection rates of bony and ligamentous injuries in the subgroups. Results In patients for whom FE did not find any injury, MRI detected bony and ligamentous injuries in 9/63 and 12/65 cases, respectively. In 3/21 (14.3%) cases in which MRI detected a bony and/or ligamentous injury and FE did not, patients eventually required surgical intervention for c-spine stabilization. No patients required surgical fixation when FE radiography showed an abnormality and MRI was normal. Addition of follow-up FE radiography after initial MRI did not have a significant effect on overall hospital length of stay (MRI Only vs MRI+FE: 9.2±12.0 days vs 8.6±13.5 days, p=0.816) or on rates of collar removal at discharge or greater than 48 hours after imaging (MRI Only vs MRI+FE: 41.5% vs 56.7%, p=0.124). Conclusions FE radiography following initial MRI did not have a significant effect on reducing time to cervical collar removal or overall hospital length of stay. In addition, in 3 of 6 cases (50.0%) in which surgical fixation was required, MRI detected ligamentous and/or bony injury while FE radiography was normal. Level of Evidence This study contributes Level 2b scientific evidence consistent with a well-designed cohort or case-control analytic study.
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Affiliation(s)
- Jeff F Zhang
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Janet Umenta
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Adil Ali
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Renee Reynolds
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York, USA
| | - Phillip Benson Ham
- Department of Surgery, Division of Pediatric Surgery, John R Oishei Children’s Hospital, Buffalo, New York, USA
| | - Richard D Thomas
- Department of Radiology, John R Oishei Children's Hospital, Buffalo, New York, USA
| | - Ravi Piryani
- Department of Pediatrics, Division of Critical Care Medicine, John R Oishei Children’s Hospital, Buffalo, New York, USA
| | - Muhammad Izhar
- Department of Radiology, John R Oishei Children's Hospital, Buffalo, New York, USA
| | - Brian Wrotniak
- Department of Pediatrics, Division of Critical Care Medicine, John R Oishei Children’s Hospital, Buffalo, New York, USA
| | - Anil K Swayampakula
- Department of Pediatrics, Pediatric Critical Care, Cook Children’s Medical Center, Fort Worth, Texas, USA
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Abstract
No definite consensus exists for the clearance of the cervical spine (C-spine)
after blunt trauma, despite many validated algorithms, recommendations and
guidelines. We intend to answer the most relevant questions with which physicians
are confronted when clearing C-spines after blunt trauma in emergency departments
(EDs). To exclude significant C-spine injuries we designed an algorithm to be
compatible with clinical practice, to simplify patient management and avoid
unrewarding evaluation. We conducted an exploratory PubMed search including articles published from January
2000 to October 2018. Keywords used were “cervical spine”,
“injury”, “clearance”, “Canadian C-spine
Rule”, “CCR” and “national emergency x-radiography
utilization study”. Clinical and experimental studies were included in a
detailed review. We based our literature review on 33 articles. While answering fundamental triage
questions from daily clinical practice, the current literature is discussed in
detail. We designed an algorithm for the C-spine clearance suitable for any trauma
centre with a high-quality multiplanar reconstruction computerized tomography (CT)
scan continuously available. The high sensitivity of the Canadian C-spine Rule (CCR) prevents missing C-spine
injuries while limiting the amount of unnecessary radiologic examinations. Plain
radiographs were fully abandoned for C-spine clearance. A negative CT scan is
sufficient to clear the majority of C-spine injuries and allows for collar removal.
In case of motor symptoms or radio-clinical discrepancy, the advice of a specialized
spine surgeon must be requested. Magnetic resonance imaging must not be routinely
used. Neck pain despite negative imaging is not a reason to delay removal of stiff
cervical collars.
Cite this article: EFORT Open Rev 2020;5:253-259. DOI:
10.1302/2058-5241.5.190047
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Affiliation(s)
- Michaël Moeri
- Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Switzerland
| | - Dominique A Rothenfluh
- Oxford University Hospitals NHS Foundation Trust, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
| | - Christoph J Laux
- Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Switzerland
| | - Dennis E Dominguez
- Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Switzerland.,Oxford University Hospitals NHS Foundation Trust, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
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Qu N, Lindstrøm R, Graven-Nielsen T, Hirata RP. Experimental cervical interspinous ligament pain altered cervical joint motion during dynamic extension movement. Clin Biomech (Bristol, Avon) 2019; 65:65-72. [PMID: 30991232 DOI: 10.1016/j.clinbiomech.2019.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although the cervical interspinous ligament is a potential source of neck pain, the effects on cervical joint motion and pressure pain sensitivity has never been investigated. The understanding of the relationship will broaden our understanding of cervical biomechanics and improve diagnosis and treatment of neck pain. METHODS Fluoroscopy videos of cervical flexion and extension movements and pressure pain thresholds over bilateral C2/C3 and C5/C6 facet joints were collected in fifteen healthy subjects before and after injections of hypertonic and isotonic saline in C4/C5 ISL. The videos were divided into 10 even epochs and the motion of individual joints during each epoch was extracted. Joint motion parameters including anti-directional motion, pro-directional motion, total joint motion and joint motion variability were extracted across epochs. Joint motion parameters and PPTs were compared before and after injection of hypertonic and isotonic saline separately. FINDINGS Compared with baselines: hypertonic saline injection 1) decreased anti-directional motion and joint motion variability at C4/C5 (P < 0.05) and increased at C2/C3 (P < 0.05) during extension; 2) increased total joint motion of C0/C1 during first half range (P < 0.05) and decreased during second half range of extension, and total joint motion of C2/C3 increased during second half range of extension (P < 0.05) and; 3) increased pressure pain thresholds over left C2/C3 facet joint (P < 0.01). INTERPRETATION The cervical interspinous ligament pain redistributed anti-directional motion between C4/C5 and C2/C3 during dynamic extension and decreased pressure pain sensitivity over the left C2/C3 facet joint.
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Affiliation(s)
- Ning Qu
- SMI, Department of Health and Science Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Rene Lindstrøm
- SMI, Department of Health and Science Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health and Science Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Rogerio Pessoto Hirata
- SMI, Department of Health and Science Technology, Faculty of Medicine, Aalborg University, Denmark.
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Dadabo J, Jayabalan P. Acute management of cervical spine trauma. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:353-362. [PMID: 30482363 DOI: 10.1016/b978-0-444-63954-7.00033-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Traumatic cervical spine injuries represent a significant cause of morbidity and mortality in sports. Appropriate management of such injuries is critical to minimizing harm and facilitating optimal long-term recovery and outcome. Management strategies begin with emergency preparedness amongst sideline providers and extends to paramedic services and medical teams in the acute care setting. This chapter outlines the principles of treatment across the care continuum, with a primary focus on hospital-based care. Diagnostic imaging and equipment considerations are reviewed, with discussion of corticosteroid administration, therapeutic hypothermia, and traction of the cervical spine. Approaches to cervical spine stabilization and return to play are also detailed, with an emphasis on patient-centered care and individualized treatment approaches to the athlete.
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7
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Oh JJ, Asha SE, Curtis K. Diagnostic accuracy of flexion-extension radiography for the detection of ligamentous cervical spine injury following a normal cervical spine computed tomography. Emerg Med Australas 2016; 28:450-5. [DOI: 10.1111/1742-6723.12612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/17/2016] [Accepted: 03/14/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Jason Jaeseong Oh
- St George Clinical School, Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
| | - Stephen Edward Asha
- St George Clinical School, Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
- Emergency Department; St George Hospital; Sydney New South Wales Australia
| | - Kate Curtis
- St George Clinical School, Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
- Trauma Service; St George Hospital; Sydney New South Wales Australia
- Sydney Nursing School; The University of Sydney; Sydney New South Wales Australia
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