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1
Kaushal, Parul, and Subhash Bhukya. "Fusion of C2 and C3: embryological and clinical perspective." Anatomy Journal of Africa 7, no. 2 (September 19, 2018): 1281–83. http://dx.doi.org/10.4314/aja.v7i2.177636.
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Skeletal abnormalities in the upper cervical region may result in severe neck ache, altered mobility, muscular weakness and sensory deficits. Fused cervical vertebrae (FCV) have been reported in literature, however cases with fused articular facets have scarcely been documented. During routine osteology demonstration, we came across fused axis and the 3rd cervical vertebra. There was complete fusion of the vertebral arch on the left side along with complete fusion between the inferior articular facet of C2 and superior articular facet of C3. There was partial fusion between the bodies of the vertebrae and the right half of the vertebral arch. Owing to the vital role of this region in various neck movements and spinal alignment, knowledge of such asymmetric variations in the upper cervical region, is of immense importance to orthopedicians, radiologists, neurosurgeons, anaesthetists, physiotherapists.Keywords: intubation, synostosis, axis, block vertebrae
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Gomes, Letícia Dias, Alexandre Marques Paes Da Silva, and Patricia Nivoloni Tannure. "Manifestações bucais da Síndrome de Apert: relato de caso clínico." Revista de Odontologia da Universidade Cidade de São Paulo 28, no. 3 (November 14, 2017): 277. http://dx.doi.org/10.26843/ro_unicid.v28i3.213.
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A Síndrome de Apert, também chamada de acrocefalossindactilia tipo 1, é caracterizada pelo encerramento prematuro das suturas cranianas (craniossinostose), sindactilia simétrica das mãos e dos pés e anomalias faciais. Outras anormalidades observadas são atraso mental, anquilose articular e anomalias da coluna vertebral. Destacam-se, ainda, a hipoplasia da face média com Classe III, lábios hipotônicos, úvula bífida, erupção ectópica, má oclusão e pseudofenda palatina. A cavidade bucal desses pacientes apresenta normalmente uma redução no tamanho da maxila, em particular na direção anteroposterior. Essa redução pode resultar em apinhamento dentário e uma mordida aberta anterior. A mandíbula está dentro do tamanho e da forma normal, e simula um pseudoprognatismo. Anomalias dentárias, tais como dentes inclusos, erupção retardada, agenesia dentária, hipoplasia do esmalte, dentes ectópicos ou supranumerários são comumente observadas. Diante da necessidade de um tratamento multidisciplinar e da relevância do cirurgião-dentista no acompanhamento desses pacientes, o objetivo deste relato é descrever as manifestações bucais da síndrome, enfatizando as características mais frequentes no período de transição da dentição decídua para a dentição permanente.
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Werner, Thorsten, W. Thomas McNicholas, Jongmin Kim, Debra K. Baird, and Gert J. Breur. "Aplastic Articular Facets in a Dog With Intervertebral Disk Rupture of the 12th to 13th Thoracic Vertebral Space." Journal of the American Animal Hospital Association 40, no. 6 (November 1, 2004): 490–94. http://dx.doi.org/10.5326/0400490.
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A 6-year-old, female spayed Pomeranian was presented with acute hind-limb paraplegia with the presence of deep pain perception and urinary incontinence. Myelography showed a Hansen type I herniation of the12th to 13th thoracic intervertebral space (T12–13). Articular facets of the T12–13 and T13 to first lumbar vertebra (L1) were absent. The spinal cord was decompressed using a bilateral T12–13 modified lateral hemilaminectomy (pediculectomy). The aplastic sites were associated with minimal instability of the vertebral column, and stabilization of the vertebral column was not required. Familiarity with this condition is important, because articular facet aplasia may cause vertebral instability and may require an adjusted surgical approach or vertebral reduction and fusion following decompression.
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Liu, Songlin, Dasheng Gai, Qun Lu, Hanyuan Zhang, Xu Kuang, Wei Gong, Xin Xiang, and Hai Li. "Application of CT Image Based on Three-Dimensional Image Segmentation Algorithm in Diagnosis of Osteoarthritis." Journal of Medical Imaging and Health Informatics 11, no. 1 (January 1, 2021): 230–34. http://dx.doi.org/10.1166/jmihi.2021.3432.
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Objective: To investigate the application of multi-slice spiral CT in degenerative changes of lumbar facet joints using the LOG algorithm. Methods: The CT findings of 100 cases of degenerative vertebral facet joint disease were reviewed and analyzed in this paper. Results: The main CT manifestations of facet disease are osteophyte formation, articular hyperplasia and hypertrophy, osteosclerosis, narrowing of joint space, articular surface destruction, joint capsule calcification, joint gas accumulation, joint subluxation, and lateral recesses and vertebrae. Signs such as narrow mesopores. Conclusion: The multi-slice spiral CT (MSCT) and multi-planar reconstruction (MPR) techniques are analyzed by the LOG operator algorithm. It is found that the two techniques can fully display the anatomical structure and pathological changes of the vertebral facet joints, and are useful for the diagnosis of facet joint disease. Provide enough imaging evidence.
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XU, XING, DE-YOU WANG, CORWIN SULLIVAN, DAVID W. E. HONE, FENG-LU HAN, RONG-HAO YAN, and FU-MING DU. "A basal parvicursorine (Theropoda: Alvarezsauridae) from the Upper Cretaceous of China." Zootaxa 2413, no. 1 (March 29, 2010): 1. http://dx.doi.org/10.11646/zootaxa.2413.1.1.
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A new alvarezsaurid theropod, Xixianykus zhangi gen. et sp. nov., is described based on a partial postcranial skeleton collected from the Upper Cretaceous Majiacun Formation of Xixia County, Henan Province. The new taxon can be diagnosed by the following autapomorphies: sacral rib-transverse process complexes and zygapophyses fused to form separate anterior and posterior laminae; distinct fossa dorsal to antitrochanter on lateral surface of ilium; short ridge along posterior surface of pubic shaft near proximal end; distinct depression on lateral surface of ischium near proximal end; sharp groove along posterior surface of ischium; distal end of femur with transversely narrow ectocondylar tuber that extends considerable distance proximally as sharp ridge; transversely narrow tibial cnemial crest with sharp, ridgelike distal half; lateral margin of tibiotarsus forms step near distal end; fibula with substantial extension of proximal articular surface onto posterior face of posteriorly curving shaft; distal tarsals and metatarsals co-ossified to form tarsometatarsus; and sharp flange along anteromedial margin of metatarsal IV near proximal end. Cladistic analysis places this taxon as a basal parvicursorine within the Alvarezsauridae, a position consistent with the presence of several incipiently developed parvicursorine features in this taxon and also with its relatively early geological age. A brief analysis of vertebral functional morphology, together with data from the hindlimb, suggests that parvicursorines represent extreme cursors among non-avian dinosaurs.
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Shin, Ja Young, Aspalilah Alias, Eric Chung, Wei Lin Ng, Yuan Seng Wu, Quan Fu Gan, and Ker Woon Choy. "Identification of Race: A Three-Dimensional Geometric Morphometric and Conventional Analysis of Human Fourth Cervical Vertebrae in Adult Malaysian Population." Journal of Clinical and Health Sciences 6, no. 1(Special) (June 30, 2021): 17. http://dx.doi.org/10.24191/jchs.v6i1(special).13167.
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Introduction: Estimation of race plays a significant role in establishing personal identity in forensic anthropology. A cervical vertebra is one of the bones that is least researched in forensic applications. Our study aims to investigate the morphologic variations of the fourth cervical vertebrae (C4) between the different major races in the adult Malaysian population using a three-dimensional (3D) geometric morphometrics method. Methods: Computer tomography images of C4 vertebra, which consist of 386 subjects (169 Malay, 82 Chinese, and 135 Indian) were collected retrospectively from University of Malaya. Twenty-eight landmarks were placed on the images. Procrustes MANOVA, canonical variates analysis(CVA), discriminant function analysis (DFA), and linear measurement were performed using Planmeca Romexis, Checkpoint Stratovan, Morpho J, and Graphpad Prism software respectively to analyze the morphological variations of C4. Results: Procrustes MANOVA showed significant differences in the shape (p <0.0001) and centroid size (p = 0.0003) of the C4 vertebra between races. Canonical variate analysis showed significant differences for Mahalanobis (p <0.0001) and Procrustes (p <0.0001) distances among races. Besides that, a cross-validation value of 66.5% was demonstrated by discriminant function analysis. The use of linear measurements reveals no significant differences between the races, thesemeasurements are the vertebral body height, anterior-posterior length of the vertebral body, length of superior articular facet, and spinous process length. Both intra- and inter-observational reliabilities showed that acceptable human errors for measurement accuracy. Conclusions: Morphologic variations in the shape of C4 can assist in race estimation of the adult Malaysian population using the 3D geometric morphometric approach.
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Chanapa, Patcharin, and Pasuk Mahakkanukrauh. "LOCATIONS AND LENGTHS OF OSTEOPHYTES IN THE CERVICAL VERTEBRAE. LOCALIZACIONES Y LONGITUD DE LOS OSTEOFITOS EN LAS VÉRTEBRAS CERVICALES." Revista Argentina de Anatomía Clínica 3, no. 1 (March 28, 2016): 15–21. http://dx.doi.org/10.31051/1852.8023.v3.n1.13908.
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Muchos pacientes sufren de disfagia, vértigo, dolor en el brazo, entumecimiento o debilidad. Estos problemas pueden ser debidos a la aparición de osteofitos en las vértebras cervicales. El propósito de esta investigación ha sido estudiar las localizaciones y tamaño de los osteofitos en las vértebras cervicales. Se han usado 200 columnas cervicales (139 varones y 61 mujeres) de vértebras secas C3-C7, de un promedio de edad de 71 años (36-98 años). Se han encontrado osteofitos en 184 columnas (92 %), la mayoría en C5, C6, C4, C7 y C3 (83, 77, 74, 65 y 64%, respectivamente). La media del tamaño de los osteofitos en C3 (4.44 ±1.31 mm) ha sido mayor que los de C4-C7. La mayor cantidad de osteofitos se encontraron en los cuerpos vertebrales, carilla articular y foramen transverso (49,35 y 16%) respectivamente. La mayor longitud de los osteofitos en el cuerpo de las vértebras se encontraron en la vértebra fue 4.28 ±1.65 mmen C6, en la cara articular fue 5.07 ±1.57 mmen C5 y en el transverso foramen fue 2.49 ±1.57 mmen C6. La longitud de los osteofitos del lado anterior superior y de la cara inferior del cuerpo ha sido más larga que la de los lados posterior y lateral. La longitud de los osteofitos muestra una correlación significativa y directa con la edad. Conclusión: Los osteofitos que han aparecido en el cuerpo de las vértebras, la cara y el foramen transverso pueden incidir en las estructuras cercanas. Este estudio puede ayudar a explicar algunos problemas clínicos como la disfagia, insuficiencia vertebrobasilar y braquialgia. Many patients suffer from dysphagia, vertigo, arm pain, numbness or weakness. These problems may arise from osteophytes in the cervical vertebrae. The purpose was to study the distribution and lengths of osteophyte in the cervical vertebrae. We used 200 cervical columns (139 male and 61 female) of dry C3-C7 vertebrae. Osteophytes were found in 184 columns (92%), mostly at C5, C6, C4, C7 and C3 (83, 77, 74, 65 and 64% respectively) . The average length of osteophytes of C3 (4.44 ± 1.31 mm) was longer than those of C4-C7. The quantity of osteophytes mostly was found at vertebral bodies, articular facets and transverse foramen (49, 35 and 16%) respectively. The greatest osteophyte length of vertebral bodies was at C6 (4.28 ± 1.65 mm.), that of articular facet was at C5 (5.07 ± 1.57 mm.) and that of foramen transversarium was at C6 (2.49 ± 1.57 mm.). The osteophyte length of anterior area of superior and inferior surface of body was longer than posterior and lateral area. The osteophyte length was significantly correlated with age. Conclusion: The osteophytes that occurred at vertebral bodies, facet and transverse foramen may impinge on nearby structures. This study may help in explaining some clinical problems such as dysphagia, vertebrobasilar insufficiency and brachialgia.
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Neary, Casey P., William W. Bush, Deena M. Tiches, Amy C. Durham, and Patrick R. Gavin. "Synovial Myxoma in the Vertebral Column of a Dog: MRI Description and Surgical Removal." Journal of the American Animal Hospital Association 50, no. 3 (May 1, 2014): 198–202. http://dx.doi.org/10.5326/jaaha-ms-5992.
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A 12 yr old castrated male mixed-breed dog presented with a 2 wk history of progressive tetraparesis. Neurologic deficits included a short-strided choppy gait in the thoracic limbs and a long-strided proprioceptive ataxia in the pelvic limbs. Withdrawal reflexes were decreased bilaterally in the thoracic limbs. Signs were consistent with a myelopathy of the caudal cervical/cranial thoracic spinal cord (i.e., the sixth cervical [C] vertebra to the second thoracic [T] vertebra). A mass associated with the C6–C7 articular facet on the left side was identified on MRI of the cervical spinal cord. The lesion was hyperintense to spinal cord parenchyma on T2-weighted images, hypointense on T1-weighted images, and there was strong homogenous contrast enhancement. Significant spinal cord compression was associated with the lesion. The mass was removed through a C6–C7 dorsal laminectomy and facetectomy. Histopathology of the mass was consistent with a synovial myxoma of the articular facet. A postoperative MRI showed complete surgical resection. Albeit rare, synovial myxomas should be included in the list of differential diagnoses for neoplasms affecting the vertebral columns in dogs.
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Lalit, Monika, Sanjay Piplani, J. S. Kullar, and Anupama Mahajan. "Morphometric Analysis of Lateral Masses of Axis Vertebrae in North Indians." Anatomy Research International 2014 (August 24, 2014): 1–9. http://dx.doi.org/10.1155/2014/425868.
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Background and Objective. The lateral masses of axis have good cancellous bone quality beneath the articular surface of facets that make this area a good site for the insertion of an internal fixation device. Methods. 60 dry axis vertebrae were obtained for anatomic evaluation focused on pedicle, superior and inferior articular facets, and foramen transversarium. Based upon linear and angular parameters the mean, range, and standard deviation were calculated. Results. The mean length, width, and height of the pedicle were 21.61 ± 2.37 mm, 8.82 ± 2.43 mm, and 5.63 ± 2.06 mm. The mean pedicle superior angle and median angle were 23.3 and 32.2 degrees. The mean superior articular facet length, width, and external and internal height were 16.34 ± 1.56 mm, 14.35 ± 1.75 mm, 8.98 ± 1.36 mm, and 4.23 ± 0.81 mm. Depth of vertebral artery was 4.72 ± 0.83 mm. Mean inferior articular facet length and width were 11.13 ± 1.43 mm and 7.89 ± 1.30 mm. The mean foramen transversarium length and width were 5.11 ± 0.91 mm and 5.06 ± 1.23 mm. Conclusions. The study may provide information for the surgeons to determine the safe site of entry and trajectory for the screw implantation and also to avoid injuries to vital structures while operating around axis.
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Patkar, Sushil. "Posterior atlantoaxial fixation with new subfacetal axis screw trajectory avoiding vertebral artery with customized variable screw placement plate and screws to enhance biomechanics of fixation." Neurosurgical Focus: Video 3, no. 1 (July 2020): V10. http://dx.doi.org/10.3171/2020.4.focusvid.20168.
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Fixation for atlantoaxial dislocation is a challenging issue, and posterior C1 lateral mass and C2 pars–pedicle screw plate–rod construct is the standard of care for atlantoaxial instability. However, vertebral artery injury remains a potential complication. Recent literature has focused on intraoperative navigation, the O-arm, 3D printing, and recently use of robots for perfecting the trajectory and screw position to avoid disastrous injury to the vertebral artery and enhance the rigidity of fixation. These technological advances increase the costs of the surgery and are available only in select centers in the developed world.Review of the axis bone anatomy and study of the stress lines caused by weight transmission reveal that the bone below the articular surface of the superior facet is consistently dense as it lies along the line of weight transmission A new trajectory for the axis screw 3–5 mm below the midpoint of the facet joint and directed downward and medially avoids the course of the vertebral artery and holds the axis rigidly. Divergent screw constructs are biomechanically stronger. Variable screw placement (VSP) plates with long shaft screws permit manipulation of the vertebrae and realignment of the facets to the correct reduced position with fixation in the compression mode.The video can be found here: https://youtu.be/E1msiKjM-aA
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Goel, Atul. "Mobilization of the high-riding vertebral artery for C2 screw insertion." Neurosurgical Focus: Video 3, no. 1 (July 2020): V4. http://dx.doi.org/10.3171/2020.4.focusvid.20172.
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The basic surgical steps in the Goel technique of atlantoaxial fixation involve exposure of the atlantoaxial articulation, denuding of the articular cartilage, stuffing of bone graft pieces within the articular cavity, and subsequent instrumentation.“High-riding” vertebral artery in relationship to the pedicle-facet of C2 has been widely recognized to be a factor that makes insertion of the C2 pedicle-facet screw difficult or impossible. In this video, a technique of exposure and mobilization of the high-riding vertebral artery to permit safe C2 screw insertion is shown. An alternative option in the presence of such a high-riding vertebral artery is to use either C2 laminar or inferior facetal screw insertion.The video can be found here: https://youtu.be/LjxxINmzph0
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Tauro, Anna, Jeremy Rose, Clare Rusbridge, and Colin J. Driver. "Surgical Management of Thoracolumbar Myelopathies in Pug Dogs with Concurrent Articular Facet Dysplasia." VCOT Open 02, no. 01 (January 2019): e60-e72. http://dx.doi.org/10.1055/s-0039-1692147.
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Objectives The aim of this article is to present the outcome of vertebral stabilization using pins and polymethylmethacrylate in isolation or with concurrent spinal cord decompression for thoracolumbar myelopathies in Pug dogs with associated caudal articular process dysplasia. Materials and Methods Retrospective case review of 14 Pug dogs with thoracolumbar myelopathy and concurrent caudal articular process dysplasia identified with magnetic resonance imaging and computed tomography. Pug dogs were graded based on the Texas Spinal Cord Injury Scale and clinical follow-up was performed immediately after surgery, at the discharge and at during the postoperative period (median 5 months). Postoperative computed tomography was performed immediately post-surgical intervention in all cases and a variable postoperative time (6 weeks or 6 months). Follow-up with telephone interview with owners was performed at a median time of 12 months postoperatively. Results Median age of presentation was 8.5 years. In 10/14 cases, neurological improvement was observed, while urinary/faecal incontinence resolved in only two of seven affected cases. Other congenital vertebral malformations were identified in 9/14 cases. Clinical Significance In our population of Pug dogs with thoracolumbar myelopathy and concurrent caudal articular process dysplasia, vertebral stabilization in isolation or with concurrent spinal cord decompression appeared to result in a favourable clinical outcome in the majority of patients. This technique may be favourable for myelopathies with a reportedly poor surgical outcome in this breed.
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McCormack, Robert G., and George Athwal. "Isolated Fracture of the Vertebral Articular Facet in a Gymnast." American Journal of Sports Medicine 27, no. 1 (January 1999): 104–6. http://dx.doi.org/10.1177/03635465990270010401.
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Russo, Gabrielle A. "Prezygapophyseal articular facet shape in the catarrhine thoracolumbar vertebral column." American Journal of Physical Anthropology 142, no. 4 (March 22, 2010): 600–612. http://dx.doi.org/10.1002/ajpa.21283.
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Mitchell, Jeanette. "The intervertebral joints II: The facet joints." South African Journal of Physiotherapy 50, no. 1 (July 25, 2019): 11–14. http://dx.doi.org/10.4102/sajp.v50i1.680.
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The anatomy of the facet joints, also known as the zygapophyseal, apophyseal or lateral intervertebral joints, is described in detail. Particular reference is made to the changing orientation of the articular facets in the cervical, thoracic and lumbar parts of the spine, allowing different ranges of movement in these regions. Possible causes for back pain are explained as a function of the biomechanics of the vertebral column.
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Karli, Philemon, Martin Bass, Roman Inauen, and Danielle Bass. "Traumatic Unilateral Sixth to Seventh Cervical Vertebral Facet Luxation in a Dog." VCOT Open 01, no. 01 (July 2018): e19-e24. http://dx.doi.org/10.1055/s-0038-1676323.
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AbstractWe describe the surgical reduction of a traumatic, unilateral cervical vertebral facet joint luxation in a large breed dog. Computed tomography (CT) including CT myelography revealed complete luxation of the left articular processes C6 to C7 without fracture of the main weight-bearing structures. There was marked spinal cord compression secondary to the malalignment. Due to the non-ambulatory tetraparetic status, open reduction was chosen as the treatment of choice. After making a dorsal surgical approach to the caudal cervical spine, the luxated articular processes were visible and repositioned. Owing to marked mobility of this joint, temporary stabilization with a nonabsorbable suture between the spinous processes of C6 and C7 was performed and good stability was obtained. The dog recovered uneventfully from the surgery and regained normal ambulation. Follow-up examination including a second CT 9 months after surgery showed no neurological abnormalities and unrestricted motion of the neck. Normal cervical vertebral alignment with moderate osteoarthritis of the right facet joint and mild spondylosis deformans C6 to C7 were present. The present case report shows successful management of a traumatic cervical facet joint luxation without persistent neurological deficits. Open reduction and temporary stabilization with suture material seem to be a valuable method of treatment. The dorsal approach allowed direct inspection of the facet joints with concurrent access to place suture material for temporary stabilization.
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Liu, David D., Joaquin Q. Camara-Quintana, Owen P. Leary, Sohail Syed, Adetokunbo A. Oyelese, Albert E. Telfeian, Ziya L. Gokaslan, Jared S. Fridley, and Tianyi Niu. "Traumatic unilateral jumped facet joint in the upper thoracic spine: Case presentation and literature review." Surgical Neurology International 11 (April 25, 2020): 77. http://dx.doi.org/10.25259/sni_119_2020.
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Background: A jumped facet joint is defined by when the inferior articular process of the superior vertebra becomes locked anterior to the superior articular process of the inferior vertebra. These typically traumatic lesions are exceedingly rare in the thoracic spine. Here, we present a patient with a unilateral jumped facet joint in the upper thoracic spine treated with open reduction and an instrumented fusion. Case Description: A 45-year-old male presented after a significant motor vehicle accident. In the emergency room, he had a Glasgow Coma Score of 13 without any neurologic deficit. The thoracic computed tomography (CT) showed a significant jumped left facet at the T2-T3 level. Two days later, utilizing intraoperative CT-guided navigation and neuromonitoring, he underwent open reduction of the T2-T3 jumped facet plus an instrumented T1-T5 fusion. X-rays taken 3-month postoperatively showed a stable construct. Six months postoperatively, he remained neurologically intact. Conclusion: A unilateral jumped thoracic facet may be present in patients with fractured ribs. The mechanism of injury is most likely axial rotation. Both CT and magnetic resonance imaging studies allow for early detection of these very rare lesions and warrant open reduction and instrumented fusion.
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Numoto, Robert Tomohiko, Miyuki Takeda, Satoshi Tani, and Toshiaki Abe. "Fractures of the Lumbar and Sacral Superior Articular Processes: Report of Two Cases." Neurosurgery 56, no. 1 (January 1, 2005): E214—E218. http://dx.doi.org/10.1227/01.neu.0000145867.25167.cf.
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AbstractOBJECTIVE AND IMPORTANCE:Injury to the posterior vertebral elements of the lumbar spine represents a common cause of lower back pain in athletes. However, associations between nontraumatic fracture, nonathletic populations, and treatment remain poorly described. Diagnosis and treatment of two extremely rare symptomatic fractures of the superior articular process are discussed.CLINICAL PRESENTATION:Two male nonathletes presented with sudden lower back and leg pain after usual daily activities. No obvious abnormalities were revealed by radiography, magnetic resonance imaging, or myelography.INTERVENTION:In both patients, small fractures of the superior articular facet compressing the root shoulder were recognized after further examination, including detailed neurological evaluation of symptoms and targeted thin-slice computed tomography. After failure of conservative treatment, surgical debridement and removal of nonunion fracture were accomplished.CONCLUSION:Symptoms were resolved surgically without further complications or rehabilitation. Fractures of the superior articular facet causing intolerable lower back and sciatic leg pain are rare. We present the first reported cases of these fractures.
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Singh, Rahul, J. Passey, and R. S. Mishra. "Morphometry of superior articular facet of atlas vertebra in north Indian population." Journal of the Anatomical Society of India 65 (September 2016): S50. http://dx.doi.org/10.1016/j.jasi.2016.08.163.
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König, Stefan A., Axel Goldammer, and Hans-Ekkehart Vitzthum. "Anatomical data on the craniocervical junction and their correlation with degenerative changes in 30 cadaveric specimens." Journal of Neurosurgery: Spine 3, no. 5 (November 2005): 379–85. http://dx.doi.org/10.3171/spi.2005.3.5.0379.
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>Object. The goal of this project was to measure vertebral dimensions at the craniocervical junction and to investigate degenerative changes in this region and their correlations with the anatomical data. These studies will assist in an understanding of biomechanical conditions in this region, which are clinically relevant in cases of cervicogenic headaches and vertigo. Methods. The authors examined 30 cadaveric specimens obtained from patients ranging in age from 24 to 88 years at death. Measurements of angles of the vertebrae were conducted using an imprint method. Microsections of osseous endplates and articular cartilage were graded according to their degrees of degeneration by using the Petersson classification (0, no sign of degeneration; I, superficial degeneration with several fragmentations; II, deeper degeneration with cartilaginous disintegration and penetrating ulceration; or III, complete cartilaginous degeneration with the appearance of subchondral bone in > 50% of the articular surface). The authors found Grade I changes in 100% of the occiput specimens. In the superior articular cartilage of C-1 no changes (Grade 0) were found in two specimens, whereas 6% of the specimens exhibited Grade II changes and 89% exhibited Grade I changes. In the inferior articular cartilage of C-1, 57% of the specimens displayed Grade I changes, 14% Grade II, and 20% Grade III changes. In the superior articular cartilage of C-2, 62.5% of the specimens displayed Grade I changes and 25% Grade II changes. At the occiput—C1 level the authors found a higher frequency of degeneration at the upper left articular surface of the atlas (Quadrants 1 and 3), and at the C1–2 level they found a higher frequency of degeneration at the upper left and upper right articular surfaces of the axis (Quadrants 2 and 3, respectively). Using the McNemar test, the authors investigated the frequency of affection of single quadrants in a left—right side comparison (lateral reversal). Significant differences were identified for Quadrant 2 of the upper left articular surface of C-2 and Quadrant 3 of the upper right articular surface of C-2. These results correlate with the analysis of single articular surfaces of the axis, but contradict the results for the atlas, in which no significant difference in the left—right side comparison was found. Conclusions. Severe degeneration in the atlantooccipital joints appears to be a rare condition, with no Grade II or III degeneration found in the occipital condyles and 6% Grade I, 89% Grade II, but no Grade III changes in the superior articular cartilage of the atlas. Degeneration of the inferior articular cartilage of C-1 and the superior articular cartilage of C-2 indicates that the atlantoaxial joint faces more intense mechanical exposure, which is increased at the upper joint surfaces.
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Pait, T. Glenn, Phillip V. McAllister, and Howard H. Kaufman. "Quadrant anatomy of the articular pillars (lateral cervical mass) of the cervical spine." Journal of Neurosurgery 82, no. 6 (June 1995): 1011–14. http://dx.doi.org/10.3171/jns.1995.82.6.1011.
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✓ Knowledge of the relevant anatomy is important when developing a strategy for introducing screws into the lateral masses to secure internal fixation devices. This paper defines key bony landmarks and their relationship to critical neurovascular structures and identifies a location for safe placement of cervical articular pillar (lateral mass) screws. Measurements of anatomical landmarks in 10 spines from human cadavers aged 61 to 85 years were made by caliper and a metric ruler. Landmarks were the lateral facet line, rostrocaudal line, medial facet line, intrafacet line, and medial facet line—vertebral artery line. The average distances and ranges were recorded. Such great variance existed in measurements from spine to spine and within the same spine as to render averages clinically unreliable. Dissection revealed that division of the articular pillar into four quadrants leaves one, the superior lateral quadrant, under which there are no neurovascular structures; this may be considered the “safe quadrant” for placement of posterior screws and plates.
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Fronimos, John A., Jeffrey A. Wilson, and Tomasz K. Baumiller. "Polarity of concavo-convex intervertebral joints in the necks and tails of sauropod dinosaurs." Paleobiology 42, no. 4 (June 27, 2016): 624–42. http://dx.doi.org/10.1017/pab.2016.16.
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AbstractThe highly elongated necks, and often tails, of sauropod dinosaurs were composed of concavo-convex vertebrae that provided stability without compromising mobility. Polarities of these concavo-convex joints in the neck and tail are anatomically opposite one another but mechanically equivalent. Opisthocoelous cervical vertebrae and procoelous caudal vertebrae have the convex articular face directed away from the body and the concave articular face directed toward the body. This “sauropod-type” polarity is hypothesized to be (1) more resistant to fracturing of the cotylar rim and (2) better stabilized against joint failure by rotation than the opposite polarity. We used physical models to test these two functional hypotheses. Photoelastic analysis of model centra loaded as cantilevers reveals that neither polarity better resists fracture of the cotylar rim; strain magnitude and localization are similar in both polarities. We assessed the rotational stability of concavo-convex joints using pairs of concavo-convex centra loaded near the joint. Sauropod-type joints withstood significantly greater weight before failure occurred, a pattern we interpret to be dependent on the position of the center of rotation, which is always within the convex part of the concavo-convex joint. In sauropod-type joints, the free centrum rotates about a center of rotation that lies within the more stable proximal centrum. In contrast, the opposite polarity results in a free centrum that rotates about an internal point; when the condyle rotates down and out of joint, the distal end rotates back toward the body, unopposed by ligamentous support. Sauropod-type joints remained stable with greater mobility, more mechanically advantageous tensile element insertions, and greater distal loads than the opposite polarity. The advantages conferred by this joint polarity would have facilitated the evolution of hyperelongated necks and tails by sauropods. Polarity of concavo-convex joints of the appendicular skeleton (e.g., hip, shoulder) is also consistent with the demands of rotational stability.
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Mudiraj, Nitin R., and Manisha R. Dhobale. "Diffuse idiopathic skeletal hyperostosis - a case report." National Journal of Clinical Anatomy 02, no. 02 (April 2013): 086–88. http://dx.doi.org/10.1055/s-0039-3401704.
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AbstractThe case reported here is an incidental finding of a specimen of lower three lumbar vertebrae with sacrum. It displayed ossification of anterolateral aspect of lower three lumbar vertebrae with sparing of intervertebral disc space. Para-articular osteophytosis was found at zygopophyseal (facet) joints, however ankylosis was absent at zygopophyseal joints as well as at interspinous sites. Based on its features we labelled it as a case of diffuse idiopathic skeletal hyperostosis (DISH). It is a common but often unrecognized disorder of unknown etiology in elderly individuals. The awareness of this entity may stimulate clinicians and researchers to focus on its pathogenesis, treatment and prevention.
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Hsu, Charlie Chia-Tsong, Louise Meehan, Igor Fomin, Trevor William Watkins, Graham Ashburner, Nikolas Stewart, Michael Kreltszheim, Mahendrah Jaya Kumar, and Timo Krings. "Developmental anomalies of the lateral portion of the cervical neural arch: Multimodal imaging and clinical implications." Neuroradiology Journal 33, no. 3 (May 13, 2020): 252–58. http://dx.doi.org/10.1177/1971400920923284.
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Objective This study aimed to describe the imaging spectrum of developmental anomalies of the lateral portion of the cervical neural arch. Method This was a five-year retrospective review of consecutive computed tomography (CT) scans of the cervical spine for structural anomalies of the cervical vertebral pedicle and facets. CT, radiographs and, when available, magnetic resonance imaging studies were independently reviewed. Anomalies were grouped into the following three categories: the absence of a pedicle, clefts in the vertebral arch or isolated dysmorphism of the facet. Clinical data on demographics and neurological outcomes were documented. Results Among 9134 consecutive patients undergoing a CT scan of the cervical spine, 18 (0.2%) patients were found to have developmental anomalies of the pedicle and facets. Findings included 7/18 (39%) with congenital absence of a pedicle, 8/18 (44%) with clefts in the vertebral arch and 3/18 (17%) with isolated dysmorphism of the articular facets. No acute neurological deficits or spinal cord injuries were reported. Associated chronic symptoms included neck pain 10/18 (56%), radiculopathy 7/18 (39%) and myelopathy 1/18 (6%). Conclusion Developmental anomalies of the pedicle and facet may mimic traumatic spinal pathologies. Recognising a diverse spectrum of imaging findings is vital to prevent misdiagnosis and unnecessary intervention.
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Van Vlasselaer, Nicolas, Peter Van Roy, and Erik Cattrysse. "Morphological Asymmetry of the Superior Cervical Facets from C3 through C7 due to Degeneration." BioMed Research International 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/5216087.
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Introduction. Knowledge about facet morphology has already been discussed extensively in literature but is limited regarding asymmetry and its relation to facet degeneration. Method. Facet dimensions, surface area, curvature, and degeneration of the superior facets were measured in 85 dried human vertebrae from the anatomical collection of the Vrije Universiteit Brussel. The vertebrae were analysed using the Microscribe G2X digitizer (Immersion Co., San Jose, CA) and a grading system for the evaluation of cervical facet degeneration. Coordinates were processed mathematically to evaluate articular tropism. The statistical analysis includes the paired t-test and the Pearson correlation. Results. On average, no systematic differences between the left and right facets were found concerning morphology and degeneration. However, there were significant differences regardless of the side-occurrence. There was a significant correlation between the dimensions of the total facet surface and the degree of degeneration but not for the recognizable joint surface. Conclusions. Facet tropism of the upper joint facets occurred often in the cervical spine but without side preference. A bigger difference in degeneration asymmetry was associated with a bigger difference in facet joint dimension asymmetry.
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Arthurs, G. "Spinal instability resulting from bilateral mini-hemilaminectomy and pediculectomy." Veterinary and Comparative Orthopaedics and Traumatology 22, no. 05 (2009): 422–26. http://dx.doi.org/10.3415/vcot-08-09-0092.
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SummaryA four-year-old male Dachshund was presented with pelvic limb paresis due to inter-vertebral disc extrusion. The spine was surgically explored and decompressed by a bilateral mini-hemilaminectomy and intervertebral disc fenestration at T12–13, and a bilateral pediculectomy of T13. Five days postoperatively, the dog deteriorated because of T13 dorsal laminar subluxation and secondary spinal cord compression. This was surgically investigated and stabilised using bilateral articular facet positional screws and a dorsal spinal plate; the dog subsequently recovered well. Clinically significant spinal instability associated with mini-hemilaminectomy and pediculectomy surgery has not been reported previously.
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de Vicente, F., F. Bernard, D. FitzPatrick, and P. Moissonnier. "In vitro radiographic characteristics and biomechanical properties of the canine lumbar vertebral motion unit after lateral corpectomy, mini-hemilaminectomy and hemilaminectomy." Veterinary and Comparative Orthopaedics and Traumatology 26, no. 01 (2013): 19–26. http://dx.doi.org/10.3415/vcot-12-02-0016.
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SummaryObjective: The purpose of this study was to assess the effect of three surgical procedures (left lateral corpectomy [LC], LC plus mini-hemilaminectomy [LC-MH], and LC plus hemilaminectomy [LC-H]) on the biomechanics and intervertebral collapse of a lumbar vertebral motor unit (VMU).Methods: Six canine cadaveric first and second lumbar vertebrae (L1-L2) VMU were retrieved. Range-of-motion (ROM) was measured while a custom-built mechanical simulator applied 3 Nm torque in lateral bending, flexion and extension to the intact VMU and following the three surgical procedures (LC, LC-MH, LC-H) performed sequentially. Radiographs were taken with and without 3 kg axial compression at each step.Results: Left lateral corpectomy and LC-MH significantly increased the ROM in left lateral bending and total lateral bending. A LC-H significantly increased the ventral, left, right, total lateral, and total dorsoventral ROM. Significant intervertebral collapse was observed after LC-H with and without axial compression, and after LC and LC-MH, but only with axial compression.Clinical significance: A LC induces significantly increased ROM in lateral bending to the side of the surgery and in total lateral ROM. Extending the LC to a LC-MH does not change the spinal column stability compared to LC alone, while it provides better access to the spinal canal. The LC-H further destabilizes the VMU. The finding of intervertebral collapse following these surgical procedures confirms the importance of the intervertebral disc and articular facet in the maintenance of spatial integrity.
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Kazhanov, I. V., S. I. Mikityuk, А. V. Dol’, D. V. Ivanov, А. V. Kharlamov, А. V. Petrov, L. Yu Kossovich, and V. A. Manukovskiy. "Biomechanical Modeling of Options for Internal Fixation of Unilateral Fractures of the Sacrum." Traumatology and Orthopedics of Russia 26, no. 2 (July 9, 2020): 79–90. http://dx.doi.org/10.21823/2311-2905-2020-26-2-79-90.
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Relevance. Currently, the stability of various options for the fixation of sacral fractures by the finite element method has not been sufficiently studied.Purpose — the biomechanical characteristics of two variants of internal fixation of unilateral sacral fractures by various implants and the localization of the line of its fracture with respect to the articular facet of the L5-S1 vertebrae were studied.Materials and Methods. Using the finite element method, we studied the biomechanical characteristics of two options for fixing a one-sided longitudinal fracture of the sacrum with different localization of the line of its fracture: outside, inside and directly on the joint facet L5-S1. Two fixation options are considered: cannulated sacroiliac screws and a similar option in combination with a bilateral lumbar-pelvic transpedicular system.Results. The stresses in implants and bone under compression load and torso forward or backward are almost the same in all models. In the model of fixation with a sacroiliac screw of a one-sided longitudinal sacral fracture, the line of which passes through the articular process S1 of the vertebra (Isler II type), the greatest stress in the screws under compression load and bending moment was 619.7 MPa, which exceeds the yield strength of the titanium alloy and can damage the implants. In all models where the transpedicular system additionally acted as fixing structures, a decrease of 42–77% of maximum displacements was noted, by 28–79% of equivalent stresses in implants under all types of loads, while the equivalent stresses in the bone structures did not differ significantly. In models where the transpedicular system was additionally applied, a decrease of 42–77% of maximum displacements was noted, by 28-79% of stresses in implants under all types of loads, while the stresses in the bones did not differ much.Conclusion. In all cases of localization of the line of unilateral fracture of the sacrum, the use of a transpedicular system in combination with sacroiliac screws is more stable from the point of view of biomechanics. The most unstable is a one-sided longitudinal fracture of the sacrum passing through the facet L5-S1.
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Kaur, Jasveen, Kamaljeet Kaur, Poonam Singh, and Ajay Kumar. "Morphometric Study of Axis Vertebra in Subjects of Indian Origin." International Journal of Medical and Dental Sciences 7, no. 1 (January 9, 2018): 1615. http://dx.doi.org/10.18311/ijmds/2018/18911.
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<p><strong>Background:</strong> The axis vertebra, exhibits complex and extensive variability in the morphology and there are vital neurovascular structures in its proximity. Knowledge of this variability is important for neurosurgeons, orthopaedicians, otorhynologists and other physicians who in everyday practice are in contact with disorders of the spine and their consequences.</p><p><strong>Objective:</strong> The aim was to evaluate various morphometric dimensions of axis vertebrae and to compare with the available data.</p><p><strong>Material and Methods:</strong> 50 dried human axis vertebrae of Indian origin, available in the Department of Anatomy, Dayanand Medical College and Hospital, Ludhiana were studied. Various dimensions were taken with vernier calipers, metric scale and graph paper. The dimensions were measured in millimetres and statistically analysed with paired t-test.</p><p><strong>Results:</strong> The mean of maximum anteroposterior diameter (max.APD) and maximum transverse diameter (max.TD) of Superior Articular Facet (SAF) was measured as 17.42mm±1.73 and 15.31mm±1.44 on the right side, 17.64mm±1.51 and 15.17mm±1.48 on left side. The mean Distance from Lateral most edge of SAF to Midline was measured as 22.56mm ± 2.37 and 22.40mm ± 2.16 on the right and left sides, respectively. The mean Distance from Tip of Transverse Process to Midline was 26.45mm ± 2.85 on the right and 26.03mm ± 2.64 on the left side. The mean Height of Dens was measured as 13.83mm ± 1.52, mean Width of Dens as 9.57mm ± 0.85. Width of Pedicle was measured as 10.52mm ± 1.99 and 10.61mm ± 1.67on right and left sides, respectively.</p><p><strong>Conclusion:</strong> The knowledge of these dimensions can provide useful information for safe planning of osseous fixation.</p>
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Snidvongs, Saowarat, Rod S. Taylor, Alia Ahmad, Simon Thomson, Manohar Sharma, Angela Farr, Deborah Fitzsimmons, Stephanie Poulton, Vivek Mehta, and Richard Langford. "Facet-joint injections for non-specific low back pain: a feasibility RCT." Health Technology Assessment 21, no. 74 (December 2017): 1–130. http://dx.doi.org/10.3310/hta21740.
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BackgroundPain of lumbar facet-joint origin is a common cause of low back pain in adults and may lead to chronic pain and disability, with associated health and socioeconomic implications. The socioeconomic burden includes an inability to return to work resulting in loss of productivity in addition to direct and indirect health-care utilisation costs. Lumbar facet-joints are paired synovial joints between the superior and inferior articular processes of consecutive lumbar vertebrae and between the fifth lumbar vertebra and the sacrum. Facet-joint pain is defined as pain that arises from any structure that is part of the facet-joints, including the fibrous capsule, synovial membrane, hyaline cartilage and bone. This pain may be treated by intra-articular injections with local anaesthetic and steroid, although this treatment is not standardised. At present, there is no definitive research to support the use of targeted lumbar facet-joint injections to manage this pain. Because of the lack of high-quality, robust clinical evidence, the National Institute for Health and Care Excellence (NICE) guidelines on the management of chronic low back pain [NICE.Low Back Pain in Adults: Early Management. Clinical guideline (CG88). London: NICE; 2009] did not recommend the use of spinal injections despite their perceived potential to reduce pain intensity and improve rehabilitation, with NICE calling for further research to be undertaken. The updated guidelines [NICE.Low Back Pain and Sciatica in Over 16s: Assessment and Management. NICE guideline (NG59). London: NICE; 2016] again do not recommend the use of spinal injections.ObjectivesTo assess the feasibility of carrying out a definitive study to evaluate the clinical effectiveness and cost-effectiveness of lumbar facet-joint injections compared with a sham procedure in patients with non-specific low back pain of > 3 months’ duration.DesignBlinded parallel two-arm pilot randomised controlled trial.SettingInitially planned as a multicentre study involving three NHS trusts in the UK, recruitment took place in the pain and spinal orthopaedic clinics at Barts Health NHS Trust only.ParticipantsAdult patients referred by their GP to the specialist clinics with non-specific low back pain of at least 3 months’ duration despite NICE-recommended best non-invasive care (education and one of a physical exercise programme, acupuncture or manual therapy). Patients who had already received lumbar facet-joint injections or who had had previous back surgery were excluded.InterventionsParticipants who had a positive result following a diagnostic test (single medial branch nerve blocks) were randomised and blinded to receive either intra-articular lumbar facet-joint injections with steroids (intervention group) or a sham procedure (control group). All participants were invited to attend a group-based combined physical and psychological (CPP) programme.Main outcome measuresIn addition to the primary outcome of feasibility, questionnaires were used to assess a range of pain-related (including the Brief Pain Inventory and Short-Form McGill Pain Questionnaire version 2) and disability-related (including the EuroQol-5 Dimensions five-level version and Oswestry Low Back Pain Questionnaire) issues. Health-care utilisation and cost data were also assessed. The questionnaire visits took place at baseline and at 6 weeks, 3 months and 6 months post randomisation. The outcome assessors were blinded to the allocation groups.ResultsOf 628 participants screened for eligibility, nine were randomised to receive the study intervention (intervention group,n = 5; sham group,n = 4), six completed the CPP programme and eight completed the study.LimitationsFailure to achieve our expected recruitment targets led to early closure of the study by the funder.ConclusionsBecause of the small number of participants recruited to the study, we were unable to draw any conclusions about the clinical effectiveness or cost-effectiveness of intra-articular lumbar facet-joint injections in the management of non-specific low back pain. Although we did not achieve the target recruitment rate from the pain clinics, we demonstrated our ability to develop a robust study protocol and deliver the intended interventions safely to all nine randomised participants, thus addressing many of the feasibility objectives.Future workStronger collaborations with primary care may improve the recruitment of patients earlier in their pain trajectory who are suitable for inclusion in a future trial.Trial registrationEudraCT 2014-003187-20 and Current Controlled Trials ISRCTN12191542.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 74. See the NIHR Journals Library website for further project information.
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Sim, Ernst. "Vertical facet splitting: a special variant of rotary dislocations of the cervical spine." Journal of Neurosurgery 82, no. 2 (February 1995): 239–43. http://dx.doi.org/10.3171/jns.1995.82.2.0239.
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✓ A special variant of rotary displacement of the cervical spine with vertical splitting of an inferior articular process by its articulating partner is reviewed. Eighteen patients with unilaterally locked facet joints confirmed by computerized tomography were seen between 1986 and 1991. Five patients presented with vertical split fractures of an inferior articular process by impaction of the superior process of the subjacent vertebra. This specific fracture pattern is not accounted for in current classifications. Four males and one female with a mean age of 31 years (range 16 to 49 years) were affected. Three of the patients showed no neurological deficits. One patient presented with cerebral contusion and paresis of the right upper extremity, and in one patient the posterior funiculus was involved. Three of the injuries had been sustained recently; the other two were of longer duration. Surgical treatment was chosen in the three cases of recent injury. In two cases surgery was prompted by neurological deficits; in the third case impaction was felt to be of inadequate depth. Surgery consisted in fracture reduction and interbody fusion using plates. The two cases of long-term fractures were treated conservatively, and ankylosis of the facet joints eventually provided adequate stability. If radicular or spinal symptoms are absent, this special variant of locked facet joints can successfully be treated conservatively leaving the rotary displacement uncorrected, provided impaction is adequately deep. The author's experience has shown that indications for surgical management are relative rather than absolute in this fracture variant and that use of computerized tomography is essential to establish the fracture pattern.
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Liu, Xiaoguang. "Quantitative 3D Trajectory Measurement for Percutaneous Endoscopic Lumbar Discectomy." January 2018 1, no. 21;1 (July 15, 2018): E355—E365. http://dx.doi.org/10.36076/ppj.2018.4.e355.
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Background: Percutaneous endoscopic lumbar discectomy (PELD) has become an increasingly popular minimally invasive spinal surgery. Due to the technical evolution of PELD, the focus of decompression has shifted from the central nucleus to the subannular-protruded disc herniation, which allows direct neural decompression. Surgical entry into the spinal canal leads to the greater possibility of bony structure obstruction, thus the location and direction of the working channel are crucial. The existing preoperative measuring methods mainly rely on 2-dimensional (2D) x-ray images or MRI cross-sections. Because the bony structure and the trajectory are 3-dimensional (3D), the relationship between the anatomical lumbar structure and the working channel cannot be precisely evaluated. Objectives: To investigate a 3D method and quantitatively evaluate the trajectory for percutaneous endoscopic lumbar discectomy (PELD). Study Design: Technical note. Setting: Pain medicine center of a university hospital. Methods: Twenty patients suffering from L4/5 disc herniation were enrolled in this study. After reconstructing the preoperative CT images, the virtual trajectory was placed into the intervertebral foramen through gradient-changing angulations in relation to the coronal and transverse planes. The overlapping portion of the virtual trajectory and the lumbar vertebrae was evaluated. In addition, the probability of atypical structure involvement was calculated. Results: As cephalad angulation (CA) increased, the intersection volume of the L4 inferior articular process increased, while the total intersection volume, the intersection volume of the L5 superior articular process, the intersection volume of the facet joint, and the volume proportion of L5 superior articular process intersection in the facet joint all decreased. As coronal plane angulation (CPA) increased, the total intersection volume, the intersection volume of the L4 inferior articular process, and the intersection volume of the facet joint all increased, while the volume proportion of the L5 superior articular process intersection in the facet joint decreased. When CA increased to 15°-20°, there was a high probability of atypical structure involvement, whereas such a probability in the groups of CA 0° (CPA 15°, 20°, and 25°), CA 5° and CA 10° was low. Limitations: Only patients with L4/5 herniation were evaluated in this study. Conclusions: In terms of the regularity, the ideal angulation for L4/L5 PELD is CPA 5°-10° and CA 5°-10°, which can lead to a relatively low level of total damage to the bony structure, minimal damage to the facet joint, and negligible involvement of atypical structures. Key words: Lumbar disc herniation, percutaneous endoscopic lumbar discectomy (PELD), transforaminal, trajectory, 3D method, quantitative measurement, angulation, bony structure obstruction
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Veerapaneni, Karthika, Poornachand Veerapaneni, Nidhi Kapoor, Rohan S. Samant, Sisira Yadala, Sen Sheng, and Krishna Nalleballe. "Intractable Scapular Pain Due to Undiagnosed Osteoid Osteoma: A Case Report." Journal of Neurosciences in Rural Practice 11, no. 03 (July 2020): 489–91. http://dx.doi.org/10.1055/s-0040-1713305.
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AbstractA 36-year-old female patient presented to our stroke neurology clinic for progressively worsening intractable, sharp, shooting interscapular pain radiating to the right shoulder and neck, which she had experienced for 4 years. She had previously seen an orthopedist and was referred to a neurosurgeon for surgical intervention after an MRI of the cervical spine showed the C3–C4 right vertebral artery loop protruding into the right C3–C4 neural foramen and compressing the exiting C4 nerve root. MR neurography showed a stable tortuous right vertebral artery loop, causing a mass effect on the dorsal root ganglion. A neuroforaminal decompression surgery was planned. However, the patient visited our stroke neurology clinic for a second opinion before surgery. An MRI of the thoracic spine showed an enhancing soft tissue mass at the right T4–T5 pedicles and adjacent body. A chest CT with contrast showed a 1 cm radiolucent lesion in the superior articular facet of T5, which represented a nidus. A technetium bone scan showed focal increased uptake within the right T5 pedicle, which is indicative of osteoid osteoma. The patient underwent laminectomy/resection and was pain-free at a 6-month follow-up; biopsy confirmed osteoid osteoma. This case illustrates the importance of neurolocalization during diagnostic testing.
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Srivastava, Arun, Jayesh Sardhara, Sanjay Behari, Sindgikar Pavaman, Jeena Joseph, Kuntal Das, Anant Mehrotra, Awadhesh K. Jaiswal, and Kamlesh Bhaishora. "Knock and Drill Technique: A Simple Tips for the Instrumentation in Complex Craniovertebral Junction Anomalies without using Fluoroscopy." Journal of Neurosciences in Rural Practice 08, no. 01 (January 2017): 014–19. http://dx.doi.org/10.4103/0976-3147.193555.
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ABSTRACT Context: Existence of complex variable bony and vertebral artery (VA) anomalies at craniovertebral junction (CVJ) in subset of complex CVJ anomalies demands individualized instrumentation policy and placing screws in each bone requires strategic preoperative planning and intraoperative skills. Aim: To evaluate the clinical accuracy of knock and drill (K and D) technique for the screw placement in complex CVJ anomalies. Settings and Design: Prospective study and operative technical note. Materials and Methods: Totally 36 consecutive patients (16 - pediatrics, 20 - adult patients) of complex CVJ: Complete/partial occipitalized C1 vertebra; at least one hypoplastic (C1/C2) articular mass, rotational component, and variations in the third part of VA were included in this study. Preoperative detail computed tomography (CT) CT CVJ with three-dimensional reconstruction was done for the assessment of CVJ anatomy and facet joint orientation. The accuracy of novel technique was assessed with postoperative CT to evaluate cortical breach in between 5th and 7th postoperative day in all the patients. All patients were underwent clinico-radiological evaluation at 6-month follow-up. Results: Totally 144 screws were placed using K and D technique (pediatric group - 64 screws, adult patients - 80 screws). Total of 12 screws were placed in C1 lateral mass in both age group without any bony cortical breach and complication. Sixteen C2 pedicle screws and 12 C2 pars screw in pediatrics and 18 C2 pedicle screws in adult patients were placed without any bony breach or VA injury. Out of thirty subaxial lateral mass screws in pediatric group, the bony breach was encountered with one screw (3.3%). Total of 38 C2 pars screws was placed in adult group in which bony breach along with VA injury was encounter with 1screw (2.6%). Conclusion: A simple technique of K and D for placing a screw increases the accuracy and spectrum of bony purchase and has the potential to reduce the complication in patients with complex CVJ anomalies.
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Sumida, Stuart S. "New information on the pectoral girdle and vertebral column in Lupeosaurus (Reptilia, Pelycosauria)." Canadian Journal of Earth Sciences 26, no. 7 (July 1, 1989): 1343–49. http://dx.doi.org/10.1139/e89-113.
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UCLA VP 1651, a new specimen from the Lower Permian Admiral Formation of Archer County, Texas, provides information on heretofore unknown portions of the postcranial skeleton of the large pelycosaur Lupeosaurus. Presacral neural spines are elongate and have a subcircular cross section. Laterally directed tubercles are not present on any of the neural spines. Cervical vertebrae appear to have elongate neural spines and sharply keeled centra. Transverse processes are positioned relatively high above the bases of the centra through the length of axial column. The pattern of tilting of the neural spines is similar to that in the primitive edaphosaur Ianthasaurus hardestii. The proximal end of the first sacral rib contributes significantly to the intervertebral articular facet usually formed by the centra. The sacral ribs do not appear to fuse with one another distally. The ventral clavicular plate is greatly expanded anteriorly. The posterior edge of the subcoracoscapular fossa is very well defined. The available morphological information does not warrant a separate familial designation for the genus Lupeosaurus. Despite the lack of laterally directed tubercles of the neural spines, Lupeosaurus appears to be referrable to the Edaphosauridae. However, in the absence of cranial materials, this association must remain tentative. Although this description adds new information for only a restricted portion of the skeleton, it does appear to confirm the existence of a distinct, albeit rare, pelycosaur from the extensively studied fauna of the Lower Permian.
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Whitfield, Andrea R., and Julie Kanter. "Evaluating Causes of Back Pain in Patients with Sickle Cell Disease." Blood 126, no. 23 (December 3, 2015): 4593. http://dx.doi.org/10.1182/blood.v126.23.4593.4593.
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Abstract Background: Low back pain is a very common and costly problem that results in significant morbidity. When patients with sickle cell disease (SCD) present with back pain, physicians often assume that their pain is related to an acute painful crisis or to chronic pain caused by bone infarcts in the spinal column resulting in "H" shaped vertebral bodies. The occurrence of vertebral osteonecrosis in SCD patients is a well-documented cause of back pain and is noted on radiographs and often confirmed on magnetic resonance imaging (MRI). However, as with all presentations of pain in persons with SCD, the etiology can also be non-SCD related and should be fully evaluated. This case series profiles six patients with SCD who presented with back pain and underwent further assessment. Methods: We conducted a retrospective chart review of six patients with SCD (mean age of 30.8 years) who presented with back pain during 2014. Institutional review board (IRB) approval was obtained from the Medical University of South Carolina for retrospective chart review. All of the patients were seen in the Comprehensive Lifespan Sickle Cell Clinic for regular evaluation. These patients underwent further evaluation due to presenting symptoms of increased pain, change in quality or character of pain, or associated neuropathic complaints. Results: Three of the patients who presented with neuropathic symptoms were noted to have other (non-SCD) etiologies of back pain (facet cyst, vertebral disc protrusion) as outlined in Table 2. The etiology of the other three patients who presented with increased frequency of baseline pain was secondary to complications of SCD (Table 1). Table 1. Patients with back pain secondary to SCD complications Patient #1 Patient #2 Patient #3 Age 15yo 25yo 31yo Sex Male Female Female Genotype Hgb SS Hgb SS Hgb SS Body Mass Index (BMI) 27 20 27 Presentation Chronic low back pain (increased symptom for patient on chronic transfusion therapy) Increased frequency of low back pain Increased frequency of back pain MRI findings Diffuse decreased signal intensity of the vertebral bodies, related to iron deposition. Osseous sequelae of SCD with Lincoln log morphology. No evidence of significant degenerative changes. Remodeling of the vertebral bodies consistent with patient's known history of sickle cell disease (hyperplastic marrow). Treatment Ferriprox (on study) Opiates, Cymbalta Opiates Table 2. Patients with back pain secondary to other etiologies Patient #4 Patient #5 Patient #6 Age 32yo 36yo 46yo Sex Female Female Female Genotype Hgb SS Hgb SC Hgb SB+ Body Mass Index (BMI) 30 40 Not recorded Presentation New, atypical low back pain, worse with ambulation and upright position Chronic back pain with numbness and tingling in left leg Chronic low back pain and lower extremity tingling MRI findings Mild facet arthropathy at L3-L4 and L4-S1 with small juxta-articular/facet cysts at L3-4 without neuroforaminal or canal narrowing. Right central disc protrusion at L5-S1 with moderate central canal stenosis contacting the right transiting S1 nerve root. Slight interval increase in posterior disc bulge with bilateral paracentral protrusions and mild bilateral facet hypertrophy at L5-S1 causing mild narrowing of left neural foramen. Treatment Facet block and steroid administration with relief Neuropathic pain medication, physical therapy Neuropathic pain medication, referral for steroid injections Discussion: This case series reveals the importance of full evaluation of pain in patients with SCD, especially in those individuals who present with neuropathic or neurologic causes. These cases demonstrate that other etiologies of back pain can be seen and should be treated in patients with SCD. In addition, there is substantial evidence linking obesity (increased BMI) and incidence of low back pain (as also seen in several of these patients). Thus, enhanced primary care, including attention to obesity and diet, is also imperative in this patient population. Disclosures No relevant conflicts of interest to declare.
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Potapov, Vitaliy E., Zinaida V. Koshkareva, Aleksandr P. Zhivotenko, Oksana V. Sklyarenko, Anatoly V. Gorbunov, Sergey D. Glotov, and Vladimir A. Sorokovikov. "A rare clinical case of surgical treatment of a periarticular cyst of the facet joint of the lumbar spine." Journal of Clinical Practice 10, no. 2 (August 17, 2019): 97–103. http://dx.doi.org/10.17816/clinpract10297-103.
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Background. Periarticular cysts of the facet joint, due to their rare occurrence, often slip away from the attention of clinicians. However their formation and progression may cause compression of vascular-neural structures with subsequent manifestations of severe neurological disorders.
Description of the clinical case. We present a rare clinical case of surgical treatment of a periarticular cyst of the facet joint. A comprehensive examination of the patient S. revealed: Dorsopathy with degenerative spinal canal stenosis at LV-SI level; spondyloarthrosis; periarticular facet cyst at LV-SI level on the left; radiculopathy LV on the left, in the acute stage; pronounced pain and musculo-tonic syndrome. Complaints of the patient: constant pain in the lumbar spine, extending to the left lower extremity and aggravating when walking at a distance of 50-100 meters; feeling numb when walking on the plantar surface of the left foot. When examining the local status, a forced posture with a bowed head and torso forward was noted; smooth lumbar lordosis and antalgic right-sided scoliosis; tension of paravertebral muscles. Neurological examination revealed LVradiculopathy on the left with moderate paresis of the extensor muscles of the left foot and ipsilateral Lasègue's positive test. MRI examination revealed spinal canal stenosis, facet joint cyst at the level of LV-SI with dimensions of 14×8×8.5 mm. An operative intervention was performed: reconstructive decompressive-stabilizing spinal surgery with a single block removing the articular facet with a periarticular cyst at the left LV-SI level with subsequent posterior transpedicular fixation of the vertebral motor segment. Two months after the operation, complete medical and social rehabilitation of the patient was achieved. No complaints.
Conclusion. In case of compression of a periarticular cyst of vascular-neural structures with severe neurological disorders, surgical treatment with the cyst removal is recommended.
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Norman, David B. "Scelidosaurus harrisonii from the Early Jurassic of Dorset, England: postcranial skeleton." Zoological Journal of the Linnean Society 189, no. 1 (December 17, 2019): 47–157. http://dx.doi.org/10.1093/zoolinnean/zlz078.
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Abstract Scelidosaurus fossils were first discovered during the commercial quarrying of the Liassic sea-cliffs between Charmouth and Lyme Regis in Dorset during the late 1850s. The original specimens included a well-preserved skull embedded in a block of argillaceous limestone (marlstone). Shortly after this skull was retrieved, a series of more-or-less contiguous marlstone slabs were recovered, containing most of the skeleton of the same animal (NHMUK R1111). After rudimentary (hammer and chisel) mechanical preparation, Owen published descriptions of this material (Owen, 1861, 1863). These two monographs have been the sole references pertaining to the anatomy of Scelidosaurus for >150 years. The skeleton of the lectotype of Scelidosaurus harrisonii (NHMUK R1111) has since been extracted from the surrounding matrix using an acid-immersion technique. Some additional specimens held in the collections of the Natural History Museum London, the Bristol City Museum and the Sedgwick Museum in Cambridge provide anatomical material that allows detailed description of this taxon, for which we have had, until now, a surprisingly poor understanding. Axial skeleton: The axial skeleton of Scelidosaurus comprises eight cervical, 16 dorsal, four sacral and > 40 caudal vertebrae. During ontogeny, the posterior centrum articular surface of the 16th dorsal vertebra develops a firm, ligament-bonded junction with the succeeding sacral centrum. Apart from the atlas rib, which is single headed, double-headed ribs are present throughout the presacral vertebral series, and none shows any indication of fusion to its associated vertebra. However, those ribs attached to cervical vertebrae 2–4 were evidently bound firmly by connective tissue to rugose diapophyses. The last two (presacral) dorsal ribs show merger of the capitulum and tuberculum, meaning that they are separated by only a step. The angulation and arching of the dorsal ribs suggest that these animals had a broad (barrel-like) torso. Intercostal uncinate plates were present, attached to the posterior margins of some of the largest dorsal ribs. Their attachment sites are clearly marked, and these plates might have been composed of calcified cartilage in larger individuals. The sacral vertebrae fuse progressively during ontogeny, in an anterior-to-posterior sequence. The sacral ribs are long and robust, and tilt the iliac blade outward dorsally. A sacricostal ‘yoke’ (created by the fusion of the distal ends of adjacent sacral ribs) never forms. The base of the tail has a unique ball-and-socket-style joint between the centra of caudal vertebrae 1 and 2 in only one skeleton. This might have permitted powerful, but controlled, movements of the tail as a defensive weapon (or increased flexibility at the base of the tail, which might have been necessary for reproduction). Caudal ribs are initially long, blade-shaped projections that gradually decrease in size and become stub-like remnants that persist as far back as the midtail (approximately caudal vertebra 25). Haemal arches (chevrons) disappear nearer to the distal end of the tail (approximately caudal vertebra 35). Ossified tendons are preserved as epaxial bundles that are clustered in the ‘axillary’ trough (between the neural spine and transverse processes on either side of the midline). Ossified tendons are restricted to the dorsal and sacral region. Flattened ossified tendons are fused to the sides of sacral neural spines. In life, the ossified tendons might have formed a low-angled trellis-like arrangement. Appendicular skeleton: The pectoral girdle comprises a long scapula, with a distally expanded blade. The proximal portion is expanded and supports an oblique promontory, forming an acromial process anteriorly and a thick, collar-like structure posteriorly above the glenoid. Between these two features is a shallow basin, bordered ventrally by a sutural edge for the coracoid. The scapula–coracoid suture remains unfused in large (5-m-long) individuals. The coracoid bears a discrete foramen and forms a subcircular dished plate, with the shallowest of embayments along its posterior edge. Clavicles are present as small fusiform bones attached to the acromial process of the scapulae and leading edge of each coracoid. A sternum was reported as ‘some partially ossified element of the endoskeleton’ Owen (1863: 13), but subsequent preparation of the skeleton has removed all trace of this material. The humerus is relatively long and has a prominent rectangular and proximally positioned deltopectoral crest. The ulna is robust and tapers distally, but there is no evidence of an olecranon process. The radius is more rod-like and terminates distally in an enlarged, subcircular and convex articular surface for the carpus. The carpus is represented by an array of five discoid carpals. The manus is pentadactyl and asymmetrical, with short, divergent metacarpals and digits that terminate in small, arched and pointed unguals on digits 1–3 (only). The phalangeal formula of the manus is 2-3-4-3-2. The pelvis is dominated by a long ilium; the preacetabular process is arched, transversely broad, and curves laterally. In juveniles, this process is short and horizontal, but during ontogeny it increases considerably in length and becomes arched. The iliac blade is tilted laterally, meaning that its dorsal blade partly overhangs the femur. The acetabulum forms a partial cupola, and there is a curtain-like medial wall that reduces the acetabular fenestra to a comparatively low, triangular opening between the pubis and ischium. The postacetabular portion of the ilium is long and supports a brevis shelf. The ischium has a long, laterally compressed shaft that hangs almost vertically beneath the ilium, and there is no obturator process. The pubis has a long, narrow shaft and a relatively short, deep, laterally compressed prepubic process that twists laterally (its distal end lies almost perpendicular to the long axis of the ilium). The articular pad on the pubis for the femoral head faces posteriorly. The obturator foramen is not fully enclosed within the pubis, but its foramen is closed off posteriorly by the pubic peduncle of the ischium. The femur is stout and has a slightly medially offset femoral head, and the greater trochanter forms a sloping shoulder continuous with, and lateral to, the femoral head. The anterior (lesser) trochanter is prominent and forms a thick, thumb-shaped projection on the anterolateral corner of the femoral shaft. The fourth trochanter is pendent and positioned at midshaft. In larger individuals, it appears to become thickened and reinforced by becoming coated with metaplastic bone derived from the tendons attached to its surface. The distal end of the femoral shaft is slightly curved and expands to form condyles. There is a deep and broad posterior intercondylar groove, but the anterior intercondylar groove is barely discernible in juveniles and not much better developed in subadults. The tibia and fibula are shorter than the femur. The tibia is structurally dominant, and the shorter fibula is comparatively slender and bowed. The proximal tarsals are firmly bound by connective tissue to the distal ends of the tibia and fibula. The distal end of the tibia is stepped, which aids the firm interlock between the crus and proximal tarsals. There appear to be two roughly discoid tarsals (distal tarsals 3 and 4), and a rudiment of distal tarsal 5 appears to be sutured to the lateral margin of distal tarsal 4. Five metatarsals are preserved, but the fifth is a splint of bone attached to the proximal end of metatarsal 4. Metatarsals 2–4 are dominant, long and are syndesmotically interlocked proximally, but their shafts splay apart distally. Metatarsal 1 is much shorter than the other three, but it retains two functional phalanges (including a short, pointed ungual). The foot is anatomically tetradactyl but functionally tridactyl. The pedal digit formula is 2-3-4-5-0. The digits diverge, but each appears to curve medially along its length, creating the impression of asymmetry. This asymmetry is emphasized, because the three principal unguals are also twisted medially. The ungual of digit 2 is the largest and most robust of the three, whereas that of digit 4 is the smallest and least robust. The general girth of the torso and the displacement of the abdomen posteriorly (a consequence of the opisthopubic pelvic construction in this dinosaur) constrained the excursion of the hindlimb during the protraction phase of the locomotor cycle. The anterolateral displacement of the hindlimb during protraction is in accord with the freedom of motion that is evident at the acetabulum, the susceptibility of the hindlimb to torsion between and within its component parts, and the asymmetry of the foot. It is probable that thyreophorans (notably, ankylosaurs) used a similar oblique-parasagittal hindlimb excursion to accommodate their equally large and wide abdomens. This surmise accords with the structure of the pelves and hindlimbs of ankylosaurs. Derived stegosaurs might have obviated this ‘problem’, in part, because their hindlimbs were longer and their torsos and abdomens narrower and capable of being ‘stretched’ vertically to a greater extent. Nevertheless, the structure of their acetabula and hindlimbs indicates that the oblique-parasagittal style of hindlimb excursion remained a possibility and might be an evolutionary remnant of the locomotor style of basal, shorter-limbed stegosaurs. A reconstruction of the endoskeleton of Scelidosaurus is presented on the basis of this updated description. Although quadrupedal, this animal was only facultatively so, judged by its forelimb-to-hindlimb proportions and structure; it therefore betrays bipedality in its ancestry.
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Matsushima, Ken, Michihiro Kohno, Hitoshi Izawa, and Yujiro Tanaka. "Partial Transcondylar Approach for Ventral Foramen Magnum Neurenteric Cyst: 2-Dimensional Operative Video." Operative Neurosurgery 16, no. 3 (November 8, 2018): E81. http://dx.doi.org/10.1093/ons/opy300.
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Abstract The anterior foramen magnum area, ventral to the brainstem is one of the most difficult regions to access surgically, and the extent of osseous drilling through the far-lateral or transcondylar approach should be planned in each case based on the tumor extension.1,2 This video, reproduced after informed consent of the patient, demonstrates a case of a ventral foramen magnum neurenteric cyst surgically treated using the partial transcondylar approach. A 27-yr-old woman presented with gait disturbance, oscillopsia, and transient arm numbness. Neuroimaging revealed a ventral foramen magnum cystic tumor involving the basilar and bilateral vertebral arteries. The tumor extended inferiorly from the middle clivus to the C1 level, and occupied the whole premedullary cistern compressing the bilateral lower cranial nerves. The left partial transcondylar approach was performed with drilling the condylar fossa, superior part of the occipital condyle, C1 posterior arch, and posterior part of the jugular process to achieve the sufficient surgical view from the inferolateral side. The drilling of the occipital condyle was minimized so that the articular facet of the occipital condyle was preserved. The tumor on the bilateral side was completely removed as enabled by the sufficient surgical field without new neurological deficits. Three-dimensional reconstructed images based on the postoperative computed tomography scans demonstrated the appropriate extent of the osseous drilling.
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Bauer, S., and D. Paulus. "Multisegmental fusion of the lumbar spine a curse or a blessing?" Current Directions in Biomedical Engineering 1, no. 1 (September 1, 2015): 376–80. http://dx.doi.org/10.1515/cdbme-2015-0092.
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AbstractExcessive mechanical load of the spinal structures during unfavorable movements in daily life can lead to degenerative damages especially of the lumbar spine. If the affected structures are damaged in such a way that conventional therapy does not improve the situation, often a surgery is unavoidable. One surgical method is the fusion of the affected spinal segments. In particularly difficult cases, the fusion may even extend over more than one functional spinal unit. An appropriate method for the estimation of the biomechanical effects of such interventions to adjacent vertebral segments is the computer simulation. This paper presents a 3D-MultiBodySimulation(MBS-) model of the lumbar spine with realistic surfaces and included intersegmental discs as well as ligamental structures. For these elements the physical behavior like force-deformation relations and characteristic curves for the torque-angle relations are formulated. The facet joints are modeled as cartilage, in order to simulate the contact between the corresponding articular surfaces. With this simulation, the effects of mono- and multisegmental fusions to the lumbar structures can be analyzed. The comparison of the simulations shows a redistribution of loads within the intervertebral discs. In the simulation case of monosegmental spinal fusion, the intervertebral disc below the fused segment are more loaded than in the simulated healthy state. The validation of the model was carried out by comparing the results with FE-simulations, various of vitro experiments and experimental data from biomedical literature.
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Migliore, A., E. Bizzi, O. De Lucia, A. Delle Sedie, S. Tropea, M. Bentivegna, A. Mahmoud, and C. Foti. "Differences regarding Branded HA in Italy, Part 2: Data from Clinical Studies on Knee, Hip, Shoulder, Ankle, Temporomandibular Joint, Vertebral Facets, and Carpometacarpal Joint." Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders 9 (January 2016): CMAMD.S39143. http://dx.doi.org/10.4137/cmamd.s39143.
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Objectives The aim of the current study is to collect scientific data on all branded hyaluronic acid (HA) products in Italy that are in use for intra-articular (IA) injection in osteoarthritis (OA) compared with that reported in the leaflet. Methods An extensive literature research was performed for all articles reporting data on the IA use of HA in OA. Selected studies were taken into consideration only if they are related to products based on H As that are currently marketed in Italy with the specific joint indication for IA use in patients affected by OA. Results Sixty-two HA products are marketed in Italy: 30 products are indicated for the knee but only 8 were proved with some efficacy; 9 products were effective for the hip but only 6 had hip indication; 7 products proved to be effective for the shoulder but only 3 had the indication; 5 products proved effective for the ankle but only one had the indication; 6 products were effective for the temporomandibular joint but only 2 had the indication; only 2 proved effective for vertebral facet joints but only 1 had the indication; and 5 products proved effective for the carpometacarpal joint but only 2 had the indication. Conclusions There are only a few products with some evidences, while the majority of products remain without proof Clinicians and regulators should request postmarketing studies from pharmaceuticals to corroborate with that reported in the leaflet and to gather more data, allowing the clinicians to choose the adequate product for the patient.
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Goel, Atul, and Abhidha Shah. "Facetal distraction as treatment for single- and multilevel cervical spondylotic radiculopathy and myelopathy: a preliminary report." Journal of Neurosurgery: Spine 14, no. 6 (June 2011): 689–96. http://dx.doi.org/10.3171/2011.2.spine10601.
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The authors discuss their successful preliminary experience with 36 cases of cervical spondylotic disease by performing facetal distraction using specially designed Goel cervical facet spacers. The clinical and radiological results of treatment are analyzed. The mechanism of action of the proposed spacers and the rationale for their use are evaluated. Between 2006 and February 2010, 36 patients were treated using the proposed technique. Of these patients, 18 had multilevel and 18 had single-level cervical spondylotic radiculopathy and/or myelopathy. The average follow-up period was 17 months with a minimum of 6 months. The Japanese Orthopaedic Association classification system, visual analog scale (neck pain and radiculopathy), and Odom criteria were used to monitor the clinical status of the patient. The patients were prospectively analyzed. The technique of surgery involved wide opening of the facet joints, denuding of articular cartilage, distraction of facets, and forced impaction of Goel cervical facet spacers into the articular cavity. Additionally, the interspinous process ligaments were resected, and corticocancellous bone graft from the iliac crest was placed and was stabilized over the adjoining laminae and facets after adequately preparing the host bone. Eighteen patients underwent single-level, 6 patients underwent 2-level, and 12 patients underwent 3-level treatment. The alterations in the physical architecture of spine and canal dimensions were evaluated before and after the placement of intrafacet joint spacers and after at least 6 months of follow-up. All patients had varying degrees of relief from symptoms of pain, radiculopathy, and myelopathy. Analysis of radiological features suggested that the distraction of facets with the spacers resulted in an increase in the intervertebral foraminal dimension (mean 2.2 mm), an increase in the height of the intervertebral disc space (range 0.4–1.2 mm), and an increase in the interspinous distance (mean 2.2 mm). The circumferential distraction resulted in reduction in the buckling of the posterior longitudinal ligament and ligamentum flavum. The procedure ultimately resulted in segmental bone fusion. No patient worsened after treatment. There was no noticeable implant malfunction. During the follow-up period, all patients had evidence of segmental bone fusion. No patient underwent reexploration or further surgery of the neck. Distraction of the facets of the cervical vertebra can lead to remarkable and immediate stabilization-fixation of the spinal segment and increase in space for the spinal cord and roots. The procedure results in reversal of several pathological events related to spondylotic disease. The safe, firm, and secure stabilization at the fulcrum of cervical spinal movements provided a ground for segmental spinal arthrodesis. The immediate postoperative improvement and lasting recovery from symptoms suggest the validity of the procedure.
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Mahato, Niladri Kumar. "Variable positions of the sacral auricular surface: classification and importance." Neurosurgical Focus 28, no. 3 (March 2010): E12. http://dx.doi.org/10.3171/2009.12.focus09265.
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Object Although the area at the auricular surface defines the magnitude of weight transmission to the hip bones, this study proposes that the position of the auricular surfaces may also significantly influence load bearing patterns at the sacrum. This study attempts to investigate and classify variable positions of the auricular surfaces that may cause vertical shifts in weight-bearing patterns between the L-5 and S-1 segments, altering weight distribution at the lumbosacral and sacroiliac regions. Methods Three hundred human sacra were studied to determine the position and extent of their auricular surfaces in relation to the sacral segments. Specimens were grouped as “normal,” “high-up,” and “low-down” auricular surface-bearing sacra. All bones were also scrutinized for the presence of accessory articulating facets on the ala of the sacrum and sacralization of the L-5 segment or lumbarization of the S-1 segment. Seven dimensions and 5 articular areas were measured in all sacra. Nine indices were calculated to show proportional representation of dimensions and areas in the bones. Obtained data were analyzed for differences in groups of sacra bearing different auricular surface positions. Results Thirty-nine of the sacra (13%) showed auricular surfaces that occupied a high-up position (from upper S-1 to low S-2 segments). Forty-four of the sacra (15%) exhibited a low-down auricular surface (from the low S-1 to low S-3 sacral segments). The remaining bones demonstrated a normal position of the surface (from the S-1 to the middle of the S-3 segments). Twenty of the high-up sacra demonstrated unilateral or bilateral accessory articulating facets on the alae that articulated with extended transverse processes of the L-5 vertebrae. The low-down sacra transmitted load predominantly via lower (S2–3) segments and exhibited stouter, broader, and efficient weight-bearing lower sacral elements, and a prominent gap between the S-1 segment and the rest of the sacrum. The high-up sacra: 1) were shorter and broader in comparison with the normal sacra; 2) at times presented accessory articular facets on their alae; 3) had a smaller body span and a wider ala; 4) were found to have the plane of the facet joints nearer to the posterior aspect of the S-1 body; and 5) had the smallest of the facet areas. The low-down sacra were longer than they were broad, had a substantially broad body span at S-1, possessed the smallest interauricular distance, and showed considerable depth of the plane of the facet joints. Conclusions The position of the auricular surface varies in human sacra. These variations are associated with differential load bearing at the sacral joints. Only the high-up sacra demonstrated the presence of accessory articulating facets between L-5 and S-1. The position of the auricular surface can explain or possibly predict low-back pain situations.
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Lin, James D., Chao Wei, Jamal N. Shillingford, Eduardo C. Beauchamp, Lee A. Tan, Yongjung J. Kim, Ronald A. Lehman, and Lawrence G. Lenke. "Evaluation of a more ventral starting point for thoracic pedicle screws: higher maximal insertional arc and more medial and safer screw angulation." Journal of Neurosurgery: Spine 30, no. 3 (March 2019): 337–43. http://dx.doi.org/10.3171/2018.8.spine18175.
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OBJECTIVETo demonstrate that a more ventral starting point for thoracic pedicle screw insertion, produced by aggressively removing the dorsal transverse process bone down to the superior articular facet (SAF), results in a larger margin for error and more medial screw angulation compared to the traditional dorsal starting point (DSP). The margin for error will be quantified by the maximal insertional arc (MIA).METHODSThe study population included 10 consecutive operative patients with adult idiopathic scoliosis who underwent primary surgery. All measurements were performed using 3D visualization software by an attending spine surgeon. The screw starting points were 2 mm lateral to the midline of the SAF in the mediolateral direction and in the center of the pedicle in the cephalocaudal direction. The DSP was on the dorsal cortex. The ventral starting point (VSP) was at the depth of the SAF. Measurements included distance to the pedicle isthmus, MIA, and screw trajectories.RESULTSTen patients and 110 vertebral levels (T1–11) were measured. The patients’ average age was 41.4 years (range 18–64 years). The pedicle isthmus was largest at T1 (4.04 ± 1.09 mm), and smallest at T5 (1.05 ± 0.93 mm). The distance to the pedicle isthmus was 7.47 mm for the VSP and 11.92 mm for the DSP (p < 0.001). The MIA was 15.3° for the VSP and 10.1° for the DSP (p < 0.001). Screw angulation was 21.7° for the VSP and 16.8° for the DSP (p < 0.001).CONCLUSIONSA more ventral starting point for thoracic pedicle screws results in increased MIA and more medial screw angulation. The increased MIA represents an increased tolerance for error that should improve the safety of pedicle screw placement. More medial screw angulation allows improved triangulation of pedicle screws.
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Fragoulis, G. E., M. Pappa, G. Evangelatos, A. Iliopoulos, P. Sfikakis, and M. Tektonidou. "POS1073 AXIAL PSORIATIC ARTHRITIS AND ANKYLOSING SPONDYLITIS. SAME OR DIFFERENT? A REAL-WORLD STUDY WITH EMPHASIS ON COMORBIDITIES." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 815.3–816. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2129.
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Background:Axial involvement affects 25-70% of psoriatic arthritis (PsA) patients, depending on the criteria used for its definition. Efforts are underway to clarify the similarities and differences between axial-PsA and ankylosing spondylitis (AS).Objectives:We aimed to compare, in a real-world setting, axial-PsA and AS, in terms of demographic, radiologic and clinical (musculoskeletal and extra-articular) characteristics, with a focus on comorbidities.Methods:All AS (New York criteria, n=128) and PsA patients (CASPAR criteria, n=78) with axial involvement who were regularly followed-up in the outpatients’ rheumatology clinics from two tertiary hospitals (December 2018-July 2020) were included. Axial-PsA was defined when both of the following were ever present: inflammatory axial symptoms and radiological findings in X-ray or MRI of the sacroiliac joints or the spine. The following findings were considered: sacroiliitis (unilateral ≥ grade 3 or bilateral ≥ grade 2), corner lesions or squaring in the vertebrae, syndesmophytes (marginal or para-marginal) and facet joints arthritis.Demographic, radiologic and clinical characteristics including comorbidities were compared between AS and axial-PsA. For comorbidities (Major Adverse Cardiovascular Events [MACE: combined coronary disease and cerebrovascular accidents], hypertension, diabetes mellitus, dyslipidemia, depression, osteoporosis, and malignancies), adjustments were made for relevant confounders as follows: MACE were adjusted for: age, gender, smoking, hypertension, dyslipidemia, disease duration, DM and non-steroidal anti-inflammatory drugs [NSAIDs] use; depression for: age, gender and disease duration; malignancy for: age, gender, disease duration; hypertension for: age, sex, BMI, NSAIDs use, smoking for; DM: age, sex, BMI, glucocorticoids treatment; osteoporosis for: age, sex, glucocorticoids treatment. Statistical significance is considered for p-values less than 0.05 and 0.1 in univariate and multivariate analyses, respectively.Results:AS patients were younger (p=0.05) and were diagnosed at a younger age (p=0.002), more frequently of male gender (p=0.04), had lower BMI (p=0.006) and they were more frequently HLA-B27-positive (p=0.006). In AS patients, peripheral arthritis, dactylitis and nail involvement were less common (p=0.001 for all), in contrast to eye (p=0.001) and bowel involvement (p=0.004). Frequency of radiologic abnormalities in the spine was similar between the two groups while sacroiliitis was more often bilateral in AS and unilateral in axial-PsA (p<0.001 for both) Comorbidities, including MACE, were comparable between AS and axial-PsA, apart from depression which was more frequent in axial-PsA (Table 1. next page).Table 1.Comorbidities. Comparison between axial-PsA and AS. OR: odds ratio, MACE: Major cardiovascular events. * adjustments are reported in the textComorbiditiesaxial-PsA (n=79)AS(n=129)Crude OR(95%CI)Adjusted OR (95%CI)p-valueMACE* n (%)4 (5.1)6 (4.6)0.91 (0.25-3.34)1.73 (0.32-9.34)0.526Dyslipidemia n (%)37 (46.8)45 (34.9)0.61 (0.34-1.07)NA0.108Hypertension* n (%)27 (34.2)24 (18.6)0.44 (0.23-0.83)1.11 (0.38-3.21)0.843Diabetes mellitus* n (%)12 (15.2)10 (7.7)0.47 (0.19-1.14)1.65 (0.43-6.29)0.463Depression* n (%)19 (24.1)16 (12.4)0.44 (0.21-0.93)0.48 (0.22-1.07)0.07Osteoporosis* n (%)3 (3.8)10 (7.7)2.13 (0.57-7.98)2.40 (0.56-10.18)0.235Malignancies* n (%)3 (3.8)3 (2.3)0.60 (0.12-3.06)0.87 (0.16-4.70)0.870Conclusion:AS and axial-PsA have certain clinical and radiologic differences. Comorbidities were comparable, while depression was more common in axial-PsA.Disclosure of Interests:George E. Fragoulis: None declared, Maria Pappa: None declared, Gerasimos Evangelatos: None declared, Alexios Iliopoulos: None declared, Petros Sfikakis Grant/research support from: AbbVie, Pfizer, MSD, Roche, UCB, GSK, Novartis, Maria Tektonidou Grant/research support from: AbbVie, GSK, Genesis, MSD, Novartis, Pfizer, UCB.
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Sathapathy, S., B. S. Dhote, D. Mahanta, S. Tamilselvan, I. Singh, M. Mrigesh, and S. K. Joshi. "Gross morphological and sex wise morphometrical studies on the tenth, eleventh, twelfth and thirteenth thoracic vertebrae of Blue bull (Boselaphus tragocamelus)." Indian Journal of Animal Research, of (February 28, 2019). http://dx.doi.org/10.18805/ijar.b-3742.
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The present study was carried out on the tenth, eleventh, twelfth and thirteenth thoracic vertebrae of six specimens of adult Blue bull (Boselaphus tragocamelus) of either sex. The tenth, eleventh, twelfth and thirteenth thoracic vertebrae were characterized by long supraspinous process, cylindrical, but short centrum. The centrum was distinctly constricted in the middle and presented a thin-edged ventral crest. The arch presented shallow notches and was perforated by intervertebral foramina at its caudal aspect. The mammillary processes were fused with the anterior articular processes in T12 and T13. The backward slope of the dorsal supraspinous process decreased from T10 to T12. The supraspinous process of T13 was vertical and wide as lumbar vertebra. The costal facets were placed on either side at the end of the articular extremities of the centrum. However, the posterior costal facets were absent in T13. Each articular facet was a demi-facet which articulated with the half of the part of the head of the rib. The cranial vertebral notches were shallow and small, but the caudal ones were deeper. The arch was caudally perforated by an additional intervertebral foramen on either side. The cranial articular processes were represented by oval facets on the anterior part of the arch and faced upwards except in T11, where they were triangular in shape, whereas the caudal ones sprang from the base of the dorsal supraspinous process. The left caudal articular facets of T13 was placed at a higher level than the right ones.
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Sathapathy, S., B. S. Dhote, D. Mahanta, S. Tamilselvan, I. Singh, M. Mrigesh, and S. K. Joshi. "Gross Morphological and Sex wise Morphometrical Studies on the seventh, eighth and ninth thoracic vertebrae of Blue bull (Boselaphus tragocamelus)." Indian Journal of Animal Research, of (June 27, 2019). http://dx.doi.org/10.18805/ijar.b-3746.
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The present study was carried out on the seventh, eighth and ninth thoracic vertebrae of six specimens of adult Blue bull (Boselaphus tragocamelus) of either sex. The first, second and third thoracic vertebrae were characterized by long supraspinous process, cylindrical, but shorter centrum. The arch presented shallow notches and was perforated by intervertebral foramina at its caudal aspect. They also presented cranial and caudal facets on their bodies. The length and breadth of supra spinous processes was observed to decrease from T7 to T9. The transverse process was reported to be thick, strong and presented a rounded non-articular mammillary process and a facet ventrally, which in turn articulated with the facet of the tubercle of the corresponding rib. The dorsal suprasinous process presented two surfaces, two borders and a summit. The costal facets were placed on either side at the end of the articular extremities of the centrum. The cranial articular processes were represented by oval facets on the anterior part of the arch and faced upwards, whereas the caudal ones sprang from the base of the dorsal supraspinous process. However, the cranial and caudal articular facets of T8 were human foot print like in Blue bull. The Biometrical observations on different parameters of seventh, eighth and ninth thoracic vertebrae reflected significant (P less than 0.05) differences between the sexes of this species.
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Tang, Chao, Yuan He Fan, Ye Hui Liao, Qiang Tang, Fei Ma, Qing Wang, and De Jun Zhong. "Classification of unilateral cervical locked facet with or without lateral mass-facet fractures and a retrospective observational study of 55 cases." Scientific Reports 11, no. 1 (August 16, 2021). http://dx.doi.org/10.1038/s41598-021-96090-4.
Full textAbstract:
AbstractThis study describes a morphology-based unilateral cervical facet interlocking classification in an attempt to clarify the injury mechanism, instability, neurological deficits, radiological features, and determine optimum management strategies for these injuries. A total of 55 patients with unilateral cervical locked facet (UCLF) involving C3 to C7 were identified between January 1, 2012 and December 1, 2019. The injuries were classified into three types, and they were further divided into six subtypes using three-dimensional computed tomography. The injury mechanism, clinical features, neurological deficits, and imaging characteristics were analyzed, and the appropriate treatment strategies for UCLF were discussed. UCLFs were divided into the following six subtypes: UCLF without lateral mass-facet fracture (type I) in nine cases, with superior articular process fracture (type II A) in 22, with inferior articular process fracture (type II B) in seven, both superior and inferior articular process fractures (type II C) in four, with lateral mass splitting fracture (type III A) in three, and with lateral mass comminution fractures (type III B) in ten. A total of 22 (40.0%) of the 55 patients presented with radiculopathy, and 23 patients (41.8%) had spinal cord injuries. The subtype analyses showed high rates of radiculopathy in types II A (68.2%) and II C (75.0%), as well as significant spinal cord injury in types I (77.8%) and III (61.5%). Destruction of the facet capsule was observed in all patients, but the injury of disc, ligamentous complex, and vertebra had a significant difference among the types or subtypes. The instability parameters of the axial rotation angle, segmental kyphosis, and sagittal displacement showed significant differences in various types of UCLF. Closed reduction by preoperative and intraoperative general anesthesia traction was achieved in 27 patients (49.1%), and successful rate of closed reduction in type I (22.2%) was significantly lower than that in type II (51.5%) and type III (61.5%). A total of 35 of 55 patients underwent a single anterior fixation and fusion, 10 patients were treated with posterior pedicle and (or) lateral mass fixation, and combined surgery was performed in ten patients. Ten patients (18.2%) with a poor outcome were observed after first surgery. Among them, 3 patients treated with a single anterior surgery had persistent or aggravated radiculopathy and posterior approach surgery with ipsilateral facet resection, foramen enlargement, and pedicle and (or) lateral mass screw fixation was performed immediately, 5 patients treated with a short-segment posterior surgery showed mild late kyphosis deformity, and 2 patients with vertebral malalignment were encountered after anterior single-level fusion during the follow-up. This retrospective study indicated that UCLF is a rotationally unstable cervical spine injury. The classification proposed in this study will contribute to understanding the injury mechanism, radiological characteristics, and neurological deficits in various types of UCLF, which will help the surgeons to evaluate the preoperative closed reduction and guide the selection of surgical approach and fusion segment.
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Cook, Daniel J., and Boyle C. Cheng. "Development of a Model Based Method for Investigating Facet Articulation." Journal of Biomechanical Engineering 132, no. 6 (April 28, 2010). http://dx.doi.org/10.1115/1.4001078.
Full textAbstract:
Reported investigations of facet articulation in the human spine have often been conducted through the insertion of pressure sensitive film into the joint space, which requires incision of the facet capsule and may alter the characteristics of interaction between the facet surfaces. Load transmission through the facet has also been measured using strain gauges bonded to the articular processes. While this method allows for preservation of the facet capsule, it requires extensive instrumentation of the spine, as well as strain-gauge calibration, and is highly sensitive to placement and location of the strain gauges. The inherently invasive nature of these techniques makes it difficult to translate them into medical practice. A method has been developed to investigate facet articulation through the application of test kinematics to a specimen-specific rigid-body model of each vertebra within a lumbar spine segment. Rigid-body models of each vertebral body were developed from CT scans of each specimen. The distances between nearest-neighboring points on each facet surface were calculated for specific time frames of each specimen’s flexion/extension test. A metric describing the proportion of each facet surface within a distance (2 mm) from the neighboring surface, the contact area ratio (CAR), was calculated at each of these time frames. A statistically significant difference (p<0.037) was found in the CAR between the time frames corresponding to full flexion and full extension in every level of the lumbar spine (L1–L5) using the data obtained from the seven specimens evaluated in this study. The finding that the contact area of the facet is greater in extension than flexion corresponds to other findings in the literature, as well as the generally accepted role of the facets in extension. Thus, a biomechanical method with a sufficiently sensitive metric is presented as a means to evaluate differences in facet articulation between intact and treated or between healthy and pathologic spines.
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Xu, Wei-Xing, Wei-Guo Ding, Bin Xu, Tian-Hong Hu, Hong-Feng Sheng, Jia-Fu Zhu, and Xiao-Long Zhu. "Appropriate insertion point for percutaneous pedicle screw placement in the lumbar spine using c-arm fluoroscopy: a cadaveric study." BMC Musculoskeletal Disorders 21, no. 1 (November 14, 2020). http://dx.doi.org/10.1186/s12891-020-03751-y.
Full textAbstract:
Abstract Background We studied the characteristics and regularity of appropriate insertion points for percutaneous pedicle screw placement in the lumbar spine using C-arm X-ray fluoroscopy. The purpose of this study was to improve the accuracy of percutaneous pedicle screw placement and reduce the incidence of superior-level facet joint violation. Methods Six normal spinal specimens were included. Three different methods for placing percutaneous pedicle screws in the lumbar spine were applied, including the Roy-Camille method, Magerl method and Weinstein method. The relationships among the insertion point, pedicle projection and proximal facet joint on C-arm X-ray films were studied. The projection morphology of the vertebral pedicle in different segments of the lumbar spine was observed. The relationship between the outer edge of the pedicle projection and the outer edge of the cranial articular process was also studied. The distance between the insertion point and the facet joint (M1), the distance between the insertion point and outer edge of the cranial articular process (M2), and the distance between the insertion point and the projection center of the pedicle (M) were measured. Results In this study, we found that the projection shape of the vertebral pedicle differed across segments of the lumbar spine: the shape for L1-L3 was oval, and that for L4-L5 was round. The radiographic study showed that the outer edge of the cranial articular process was located on the lateral side of the outer edge of the pedicle projection and did not overlap with the pedicle projection. M for the Weinstein group was larger than that for the Roy-Camille group (P < 0.05). M1 for the Weinstein group was larger than that for the Roy-Camille and Magerl groups (P < 0.05). M2 for the Roy-Camille group was negative, M2 for the Magerl group was 0, and M2 for the Weinstein group was positive. Conclusion Under C-arm X-ray fluoroscopy, we were able to accurately identify the characteristics and regularity of the appropriate insertion point for percutaneous pedicle screw placement in the lumbar spine, which was important for improving the accuracy of percutaneous pedicle screw placement and reducing the incidence of superior-level facet joint violation.