Evaluation of the efficiency of cervical orthoses on cervical fracture: A review of literature

Spine Bracing: When to Utilize-A Narrative Review

Spinal bracing is a common non-surgical technique that allows clinicians to prevent and correct malformations or injuries of a patient's spinal column. This review will explore the current standards of practice on spinal brace utilization. Specifically, it will highlight bracing usage in traumatic injuries, pregnancy, pediatrics, osteoporosis, and hyperkyphosis; address radiological findings concurrent with brace usage; and provide an overview of the braces currently available and advancements in the field. In doing so, we aim to improve clinicians' understanding and knowledge of bracing in common spinal pathologies to promote their appropriate use and improve patient outcomes.

Wearable neck assistive device strain evaluation study on surface neck muscles for head/neck movements

BACKGROUND

This article examines a dynamic wearable assistive device for individuals suffering from pain in the neck. As a part of the clinical treatment, static braces/cervical collars are suggested, however, these collars aid the person in maintaining the upright position of the head but restrict the head motion to a single configuration. To address this problem, a dynamic wearable assistive cervical collar is fabricated based on human anatomical head/neck data.

OBJECTIVE

The objective of this study is to observe the strain acting on the neck surface muscles for bending and compression neck movements with and without the neck brace using a strain sensor.

METHODS

To evaluate the perform of this device, experimental trials were conducted on test subjects to find out the angular tilt of the head with the device worn using the cervical range of motion (CROM) device. In addition, a neck surface muscle strain study is also conducted using strain sensors to investigate the strain produced while using the wearable assistive device. The strain on the neck surface muscle is measured using NI-9236 strain DAQ (data acquisition system). In this experimental study, a group of aged individuals with minor neck pain were recruited to study the head/neck movements.

RESULTS

It was found that by using the proposed assistive device, test subjects were able to mimic 65% of human head/neck movements like flexion, extension, lateral bending, and rotation, and the strain generated from the neck surface muscle was minimal.

CONCLUSION

The results show that using the designed assistive device reduced the strain on neck surface muscle, and strain obtained is within the range of 40 × 10-6 to 80 × 10-6, and may aid in recovery of the individuals suffering with neck pain.

[Guideline-conform treatment of injuries to the subaxial cervical spine]

Injuries to the subaxial cervical spine are increasing and have an increased neurological risk compared to the thoracic and lumbar spines. The current treatment recommendations according to the therapeutic recommendations of the Spine Section of the German Society for Orthopedics and Trauma Surgery (DGOU) as well as the S1 guidelines of the German Trauma Society (DGU) are presented. This second part of the article describes the correct indications and treatment planning for injuries to the cervical spine. Based on the AOSpine classification for subaxial cervical spine injuries, decisions can be made about conservative or surgical treatment as well as individual details of the treatment. The underlying principles of treatment are relief of neurological structures, restoration of stability and reconstruction/preservation of the physiological alignment.

Cervical spine TB - Current concepts in management

OBJECTIVE

Cervical tubercular disease (CTB) is a rare pathology and constitutes 3-5% of all spinal TB. It includes atlantoaxial TB and sub-axial TB. As the literature evidence on this subject is scarce, majority of issues concerning CTB are still controversial. The current narrative review comprehensively discusses the various aspects related to CTB. Literature search: An elaborate search was made using keywords cervical tuberculosis, atlantoaxial tuberculosis, sub-axial tuberculosis, and cervico-thoracic tuberculosis, on pubmed and google (scholar.google.com) databases on 2 December 2020. We identified crucial questions regarding CTB and included relevant articles pertaining to them.

RESULTS

The initial search using keywords cervical tuberculosis, atlantoaxial tuberculosis, sub-axial tuberculosis, and cervico-thoracic tuberculosis yielded 4128, 76, 3 and 9 articles on 'pubmed' database, respectively. A similar search using the aforementioned keywords yielded 1,96,000, 2130, 117 and 728 articles on 'google scholar' database. The initial screening resulted in the identification of 178 articles. Full manuscripts were obtained for these articles and thoroughly scrutinised at the second stage. Review articles, randomised controlled trials and level 1 studies were given preference. Overall, 41 articles were included.

CONCLUSION

AATB and SACTB constitute 0.3 to 1% and 3% of spinal TB, respectively. The incidence of neuro-deficit in CTB is significantly more than other spinal TB. The general principles of management of CTB are similar to spinal TB elsewhere and medical therapy remains the cornerstone. Surgery is advocated in specific scenarios involving gross neuro-deficit, later stages of disease with significant bony/ligamentous disruptions, altered sagittal balance, drug resistance, and poor response to medications. The surgical approaches for AATB include anterior-alone, posterior-alone and combined approaches, although posterior access is the most preferred. Most of the studies on SACTB have supported the role of anterior approach. Additionally, posterior stabilisation may be necessary in specific scenarios. The overall long-term outcome in CTB is favourable.

Occipital condyle syndrome in a case of rotatory atlantoaxial subluxation (type II) with craniovertebral junction tuberculosis: Should we operate on "active tuberculosis?"

Tuberculosis of the craniovertebral junction is rare as well as intriguing. We present a unique amalgamation of three rare entities: craniovertebral tuberculosis, occipital condyle syndrome, and nontraumatic type II rotatory atlantoaxial dislocation in one patient. We reviewed the limited literature available and the underlying pathophysiology to highlight the pattern of the disease presentation, progression, and response to management options. A 13-year-old girl presented with neck pain, torticollis, and right hypoglossal weakness following a fall from stairs 10 months back. Radiological investigation suggested right occipital condylar destruction with right-sided neck tilt and rotatory atlantoaxial dislocation. The contrast magnetic resonance imaging was suggestive of craniovertebral tuberculosis with primary foci in the right lung (apical cavitary lesion). In view of an intact neurological condition, she was started on antitubercular treatment and she continues to do well during the follow-up. It remains debatable if an anticipation of this problem calls for a surgical addressal at the acute stage of the disease as a delayed correction is likely to be more complex. While a halo device is preferable in these cases, it remains cumbersome and less preferred in comparison to the Philadelphia collar.

Role of O-C2 angle in the development of dysphagia in patients with halo-vest fixation

Background

Dysphagia is one of the most serious complications in patients treated with a halo-vest brace. However, the cause of dysphagia development by halo-vest fixation is not yet clear. We therefore investigated the incidence of dysphagia and cervical alignment as well as clinical data from medical charts in patients treated with a halo-vest brace.

Methods

We retrospectively reviewed clinical data from the medical charts of 49 patients who had undergone halo-vest fixation. Occipito (O)-C2 angle, C2-C6 angle, and pharyngeal inlet angle were assessed by lateral plain X-rays of the cervical spine. The impacts of these parameters on incidence and severity of dysphagia were analyzed.

Results

Thirteen patients (32%) suffered from dysphagia during halo-vest fixation, and age and length of intensive care unit (ICU) stay were greater in the dysphagia group (p = 0.044 and 0.013, respectively) than in those who did not develop dysphagia. O-C2 angle was smaller in the dysphagia group (p = 0.016). After multivariate logistic analysis, body mass index, ICU stay, and O-C2 angle remained as independent risk factors related to incidence of dysphagia. Spearman rank correlation showed a negative correlation between ICU stay and Food Intake Level Scale (FILS) (p = 0.026), and a positive correlation between O-C2 angle and FILS (p = 0.008).

Conclusion

This study suggested that O-C2 angle is related to both incidence and severity of dysphagia due to halo-vest fixation.

Managing the cervical spine in multiple myeloma patients

Discuss the relevant literature on surgical and nonsurgical treatments for multiple myeloma (MM) and their complementary effects on overall treatment. Existing surgical algorithms designed for neoplasia of the spine may not suit the management of spinal myeloma. Less than a fifth of metastatic, including myelomatous lesions, occur in the cervical spine but have a poorer prognosis and surgery in this area carries a higher morbidity. With the advances of chemotherapy, early access to radiotherapy, early orthosis management, and high definition imaging, including CT and MRI, surgical indications in MM have changed. Medical decompression (or oncolysis), including in the presence of neurological deficit and orthotic stabilization, are proving viable nonsurgical options to manage MM. A key to decision making is the assessment and monitoring of biomechanical spinal stability as part of a multidisciplinary approach.