Comparative strengths and structural properties of the upper and lower cervical spine in flexion and extension

The purpose of this study is to test the hypothesis that the upper cervical spine is weaker than the lower cervical spine in pure flexion and extension bending, which may explain the propensity for upper cervical spine injuries in airbag deployments. An additional objective is to evaluate the relative strength and flexibility of the upper and lower cervical spine in an effort to better understand injury mechanisms, and to provide quantitative data on bending responses and failure modes. Pure moment flexibility and failure testing was conducted on 52 female spinal segments in a pure-moment test frame. The average moment at failure for the O-C2 segments was 23.7+/-3.4Nm for flexion and 43.3+/-9.3Nm for extension. The ligamentous upper cervical spine was significantly stronger in extension than in flexion (p=0.001). The upper cervical spine was significantly stronger than the lower cervical spine in extension. The relatively high strength of the upper cervical spine in tension and in extension is paradoxical given the large number of upper cervical spine injuries in out-of-position airbag deployments. This discrepancy is most likely due to load sharing by the active musculature.     

Biomechanical analysis of the anterior cervical fusion

This paper presents a biomechanical analysis of the cervical C5–C6 functional spine unit before and after the anterior cervical discectomy and fusion. The aim of this work is to study the influence of the medical procedure and its instrumentation on range of motion and stress distribution. First, a three-dimensional finite element model of the lower cervical spine is obtained from computed tomography images using a pipeline of image processing, geometric modelling and mesh generation software. Then, a finite element study of parameters' influence on motion and a stress analysis at physiological and different post-operative scenarios were made for the basic movements of the cervical spine. It was confirmed that the results were very sensitive to intervertebral disc properties. The insertion of an anterior cervical plate influenced the stress distribution at the vertebral level as well as in the bone graft. Additionally, stress values in the graft decreased when it is used together with a cage.     

Biomechanical analysis of the anterior cervical fusion

This paper presents a biomechanical analysis of the cervical C5-C6 functional spine unit before and after the anterior cervical discectomy and fusion. The aim of this work is to study the influence of the medical procedure and its instrumentation on range of motion and stress distribution. First, a three-dimensional finite element model of the lower cervical spine is obtained from computed tomography images using a pipeline of image processing, geometric modelling and mesh generation software. Then, a finite element study of parameters' influence on motion and a stress analysis at physiological and different post-operative scenarios were made for the basic movements of the cervical spine. It was confirmed that the results were very sensitive to intervertebral disc properties. The insertion of an anterior cervical plate influenced the stress distribution at the vertebral level as well as in the bone graft. Additionally, stress values in the graft decreased when it is used together with a cage.     

青年颈椎生理曲度变直全节段有限元建模与分析

目的建立青年颈椎生理曲度变直和正常的全节段有限元模型,进行对比与分析。方法采集青年颈椎曲度变直志愿者CT数据,利用生物力学有限元软件构建高质量颈椎全节段模型,然后采用基于离散微分属性的体网格变形技术,将变直模型映射生成曲度正常模型,在相同边界条件进行下进行对比分析。结果在前屈、后伸、侧弯、和旋转工况下,生理曲度变直模型的活动度范围比正常值要小,并且出现再分配。在应力分布方面,C3-C4,C4-C5之间的小关节、钩突关节,和C3-C4之间的椎间盘出现应力集中。结论通过使用新型建模软件和体网格变形技术,能方便构建颈椎生理曲度变直和正常模型,分析结果对青年颈椎病的临床诊治有指导意义。     

Functional computed tomography in the diagnosis of injuries to the ligamentous apparatus of the upper cervical spine in children and adolescents]

Altogether 40 children and adolescents were investigated after injuries of the upper cervical spine using radiograms through the open mouth, functional radiograms of the cervical spine, and functional CT. Various injuries of the ligamentous apparatus of the upper cervical spine were revealed in 31 patients.     

Influence of age,gender and weight on spinal osteoarthritis in the elderly: An analysis of morphometric changes using X-ray images

Various factors in addition to normal aging are reported to be associated with spinal osteoarthritis. The links between the risk factors and osteoarthritis are unclear. This study proposes an analysis of factors associated with spinal osteoarthritis using a collection of cervical and lumbar X-ray images, maintained by the US National Library of Medicine. Five hundred and forty-eight images of adults (60–74 years old, 242 males, 306 females) are analyzed. Six to nine anatomical points are selected by an experienced radiologist on each vertebra. Four dimensionless indexes are calculated: the anterior-to-posterior height ratio (APR), the disc space relative to posterior height of vertebra (DS) and the number of osteophytes. Correlations of these parameters are estimated with three anthropometric indexes: age, gender and body mass index. The univariate relationships are evaluated using one-way analysis of variance and Kruskal-Wallis test. Osteophytes are more frequent for men than for women. Men have lower APR from the levels L1 to L4 and lower DS at the levels C4 and C5. The lumbar levels L2 and L4 are more affected with age by changes in APR. Obese group has a higher DS at the level C3-C4 and a higher APR at the level L1. The analysis of images shows the predominant effect of osteoarthritis at the lower levels of the cervical and lumbar spine.     

MRI and X-ray in axial spondyloarthritis: the relationship between inflammatory and structural changes

Demonstration of an association between inflammation and spinal ankylosis has been challenging. Until the advent of MRI, prospective study was not possible due to inaccessibility of tissue. Recent studies using MRI have described an association between the presence of bone edema at vertebral corners on MRI and the subsequent development of syndesmophytes at the corresponding vertebral corners on radiography. Although reports have also highlighted the development of new syndesmophytes where the baseline MRI shows no inflammation, MRI has limited sensitivity for detection of spinal inflammation that is clearly evident on histopathology. There are also crucial methodological challenges because radiographic assessment is limited to the anterior corners of the cervical and lumbar spine while MRI lesions in the cervical spine are often small while spurious inflammatory signal is common in the lumbar spine. Follow-up MRI evaluation in two independent studies has also shown that inflammatory lesions that resolve after anti-TNF therapy are more prone to develop into syndesmophytes. It may be possible that very early inflammatory lesions resolve completely without sequelae if anti-TNF therapy is introduced before new bone formation becomes largely autonomous. For an individual patient the overall development of new bone during anti-TNF therapy may therefore depend on the balance between the number of early and more mature inflammatory lesions. Clinical trials of anti-TNF agents in early spondyloarthritis together with prospective MRI studies will allow more detailed testing of this hypothesis as a major priority for the research agenda in spondyloarthritis.     

X-ray signs of ligamentous cervical injuries from joint manual therapy

X-ray study was conducted in 40 patients undergoing joint manual therapy (MT) to study its impact on the ligamentous apparatus of the cervical spine. The patients who had received rotational manual therapeutic techniques were found to have statodynamic dysfunction (100%), x-ray signs of ligamentous cervical injury (62%), or intervertebral disk protrusions (67%). An algorithm for cervical spine x-ray study in the frontal and lateral projections was compiled to perform after MT in the early and late periods.     

Magnetic resonance imaging, computed tomography, and conventional X-ray in 3 cases of symmelia

BACKGROUND: Symmelia is a rare birth defect, often combined with severe malformations of the urogenital system and the lower gastrointestinal tract. Additionally, a deformed pelvis and various degrees of separation of the lower limbs are present. CASES: We report the examination findings of 3 autopsy specimens of symmelia using magnetic resonance imaging (MRI) and computed tomography (CT) with 3-dimensional (3D) reconstructions, and conventional X-ray. CONCLUSIONS: MRI and CT with the addition of 3D visualization can be used additionally with autopsy and conventional X-ray images in the investigation of such complex anatomical abnormalities.     

CT影像和X线平片在脊柱爆裂型骨折诊断中的对比分析

目的分析X线平片与CT影像在脊柱爆裂骨折诊断中的应用价值。方法选取2015年7月~2016年7月我院收治的脊柱爆裂骨折患者70例为研究对象,按随机数字表法分为对照组和观察组,对照组患者予以X线平片进行诊断,观察组患者予以CT影像进行诊断,对比分析两组患者的检出率、检出时间以及检查费用情况。结果对照组患者的检出率为65.71%,检出时间(9.21±0.13)min,检查费用(115±25.20)元;观察组患者的检出率为88.57%,检出时间(2.32±0.30)min,检查费用(628±52.6)元。两组比较差异均有统计学意义(均P0.05)。结论脊柱爆裂型骨折患者行CT影像学诊断的临床价值明显优于X线平片,值得作为脊柱爆裂型骨折的首选检查方法。     

Ossification of the posterior longitudinal ligament]

The authors described 21 patients aged 37 to 83 with ossification of the posterior longitudinal ligament (10 with ischemic myelopathy, 6 with aftermaths of a trauma of the cervical spine, and 5 with the radicular syndrome on the basis of vertebral osteochondrosis. X-ray signs of three types of ossification of the posterior longitudinal ligament were defined and specified: linear, curved and mixed. The linear type was more frequently observed in the cervical spine whereas the curved type was more frequent in the lumbar spine.     

A role for magnetic susceptibility in synthetic computed tomography

PurposeRadiotherapy treatment planning based on magnetic resonance imaging (MRI) benefits from increased soft-tissue contrast and functional imaging. MRI-only planning is attractive but limited by the lack of electron density information required for dose calculation, and the difficulty to differentiate air and bone. MRI can map magnetic susceptibility to separate bone from air. A method is introduced to produce synthetic CT (sCT) through automatic voxel-wise assignment of CT numbers from an MRI dataset processed that includes magnetic susceptibility mapping.MethodsVolumetric multi-echo gradient echo datasets were acquired in the heads of five healthy volunteers and fourteen patients with cancer using a 3 T MRI system. An algorithm for CT synthesis was designed using the volunteer data, based on fuzzy c-means clustering and adaptive thresholding of the MR data (magnitude, fat, water, and magnetic susceptibility). Susceptibility mapping was performed using a modified version of the iterative phase replacement algorithm. On patient data, the algorithm was assessed by direct comparison to X-ray computed tomography (CT) scans.ResultsThe skull, spine, teeth, and major sinuses were clearly distinguished in all sCT, from healthy volunteers and patients. The mean absolute CT number error between X-ray CT and sCT in patients ranged from 78 and 134 HU.ConclusionSusceptibility mapping using MRI can differentiate air and bone for CT synthesis. The proposed method is automated, fast, and based on a commercially available MRI pulse sequence. The method avoids registration errors and does not rely on a priori information, making it suitable for nonstandard anatomy.     

Multisegmental image fusion of the spine]

Fusion of medical images is a technique that permits the correlation of homologous anatomical structures in different imaging modalities on the basis of a spatial transformation of the data sets. CT and MRI of the spine provide complementary information of possible relevance for diagnostic and therapeutic decisions. Methods enabling a multisegmental CT-MRI fusion of the spine were developed. These solve the problem of altered spatial relationships of the individual anatomical structures due to differing patient positioning in successive data acquisitions. Routine clinical CT and MRI data of a thoracic section of the spine were obtained and transferred to a PC-workstation. Following segmentation of the CT-data, landmarks for each individual vertebra were defined in the CT and MRI data. For each individual vertebra the algorithm we developed then carried out a rigid registration of the CT information to the MR data. The fused data sets were presented as colour-coded images or on the basis of dynamic variation of transparency. To assess registration precision, fiducial registration errors (FRE) and target registration errors (TRE) were calculated. The algorithm permitted multi-segmental image fusion of the spine. The average time required for defining the landmarks was 22 seconds per landmark for CT, and 34 seconds per landmark for MR. The average FRE was 1.53 mm. The TRE for the vertebrae was less than 2 mm. The colour-coded images were particularly suitable for assessing the contours of the anatomical structures, whereas dynamic variation of the transparency of overlapping CT images enabled a better overall assessment of the spatial relationship of the anatomical structures. The algorithm permits precise multi-segmental fusion of CT and MR of the spine, which was not possible using current fusion-algorithms due to variations in the spatial orientation of the anatomical structures caused by different positioning of the axial skeleton in successive examinations.     

Epidural pharmacotherapy in patients with dystrophic diseases of the lumbosacral spine

The results of treatment were analyzed in 70 patients with dystrophic diseases of the lumbosacral spine complicated by the displacement of intervertebral disks. All the examinees had a long history and a protracted exacerbation resistant to conservative therapy. Long-term local epidural pharmacotherapy (LTLEP) was used for their treatment. The essence of the method was to employ selective catheterization under X-ray guidance of the epidural space, to bring a catheter directly to a pathological area. Further it was irrigated with drugs many times. The results of treatment were analyzed from changes in the pain syndrome in the early and periods and from the data of repeated studies (magnetic resonance imaging (MRI) and computed tomography (CT)). LTLEP was highly effective, i.e. 84.3% of positive results. Follow-up MRI or CT findings show that the pathological substrate disappears or significantly decreases in sizes in 83.4% of cases. LTLEP is safe: in the study group, there were no complications due to the manipulation itself and after treatment the patients' health status did not deteriorate owing to a therapeutic process. If conservative therapy is inefficient, it may be used as an alternative to conventional and low-invasive neurosurgical operations.     

应用反向滤过及迭代重建方法评估标准放射剂量与低剂量颈椎 CT图像质量的对比研究

目的：利用反向滤过重建（filtered back-projection,FBP）及迭代重建（iterative reconstruction,IR）方法评估标准剂量及低剂量 对颈椎CT 图像质量的影响。方法：40 例受检对象行颈椎CT 检查,将其随机分为两组：标准剂量组（SD,120 kVp, 275 mAs）及低 剂量组（LD,120 kVp,150 mAs）,随机选择管电流值,所有数据均行FBP 及IR 重建。测量C3 C4 及C6 C7 椎间盘水平椎间盘、脊 神经、脊髓、韧带以及周围软组织的图像噪声值（Image noise,IN）,信噪比（signal-to-noise,SNR）及对比信噪比（contrast-to-noise, CNR）。结果：在测量的各椎间盘水平,迭代重建的信噪比及对比噪声比要明显高于反向滤过重建方法,并有效的降低了图像噪 声。低剂量迭代重建图像与标准剂量反向滤过图像相比无明显统计学意义。排除剂量及扫描层面的影响,椎间盘、脊神经及韧带 的图像质量,迭代重建评分要明显高于反向滤过重建,结果具有统计学差异;而低剂量迭代重建图像质量评分与标准剂量反向滤 过重建相比无明显差异。软组织及椎体的图像质量,迭代重建图像质量评分要低于反向滤过重建方法,结果具有统计学差异;而 低剂量迭代重建图像质量评分与标准剂量反向滤过重建相比无明显差异。整体病例图像质量评分,迭代重建方法要高于反向滤 过重建方法,低剂量迭代重建方法要高于标准剂量反向滤过重建方法。结论：应用低剂量扫描方式以及迭代重建方法进行颈椎 CT 检查可以为临床提供较好的图像质量,对于椎间盘、脊神经、脊髓显示较好,对于周围软组织以及椎体来说,图像质量相对较 差,同时可以降低大约40%的放射剂量。     

Synovial cytokine expression in psoriatic arthritis and associations with lymphoid neogenesis and clinical features

Demonstration of an association between inflammation and spinal ankylosis has been challenging. Until the advent of MRI, prospective study was not possible due to inaccessibility of tissue. Recent studies using MRI have described an association between the presence of bone edema at vertebral corners on MRI and the subsequent development of syndesmophytes at the corresponding vertebral corners on radiography. Although reports have also highlighted the development of new syndesmophytes where the baseline MRI shows no inflammation, MRI has limited sensitivity for detection of spinal inflammation that is clearly evident on histopathology. There are also crucial methodological challenges because radiographic assessment is limited to the anterior corners of the cervical and lumbar spine while MRI lesions in the cervical spine are often small while spurious inflammatory signal is common in the lumbar spine. Follow-up MRI evaluation in two independent studies has also shown that inflammatory lesions that resolve after anti-TNF therapy are more prone to develop into syndesmophytes. It may be possible that very early inflammatory lesions resolve completely without sequelae if anti-TNF therapy is introduced before new bone formation becomes largely autonomous. For an individual patient the overall development of new bone during anti-TNF therapy may therefore depend on the balance between the number of early and more mature inflammatory lesions. Clinical trials of anti-TNF agents in early spondyloarthritis together with prospective MRI studies will allow more detailed testing of this hypothesis as a major priority for the research agenda in spondyloarthritis.     

Flexion and extension structural properties and strengths for male cervical spine segments

New vehicle safety standards are designed to limit the amount of neck tension and extension seen by out-of-position motor vehicle occupants during airbag deployments. The criteria used to assess airbag injury risk are currently based on volunteer data and animal studies due to a lack of bending tolerance data for the adult cervical spine. This study provides quantitative data on the flexion-extension bending properties and strength on the male cervical spine, and tests the hypothesis that the male is stronger than the female in pure bending. An additional objective is to determine if there are significant differences in stiffness and strength between the male upper and lower cervical spine. Pure-moment flexibility and failure testing was conducted on 41 male spinal segments (O-C2, C4-C5, C6-C7) in a pure-moment test frame and the results were compared with a previous study of females. Failures were conducted at approximately 90 N-m/s. In extension, the male upper cervical spine (O-C2) fails at a moment of 49.5 (s.d. 17.6)N-m and at an angle of 42.4 degrees (s.d. 8.0 degrees). In flexion, the mean moment at failure is 39.0 (s.d. 6.3 degrees) N-m and an angle of 58.7 degrees (s.d. 5.1 degrees). The difference in strength between flexion and extension is not statistically significant. The difference in the angles is statistically significant. The upper cervical spine was significantly stronger than the lower cervical spine in both flexion and extension. The male upper cervical spine was significantly stiffer than the female and significantly stronger than the female in flexion. Odontoid fractures were the most common injury produced in extension, suggesting a tensile mechanism due to tensile loads in the odontoid ligamentous complex.     

CT 与X线诊断肠梗阻的临床价值探讨

目的：探讨腹部X 线与CT 扫描鉴别急性肠梗阻的准确性,为临床诊断提供参考。方法：选取2011年8 月-2013 年8 月我院 收治的66 例急性肠梗阻患者的临床资料进行回顾分析。所有患者均经手术活检或病理诊断证实为急性肠梗阻。术后患者均行腹 部X 线及CT扫描检查,对两种方法判断肠梗阻的发生、梗阻部位、类型及病因与手术病理结果进行比较,评价并分析两种检查 方法的准确率。结果：66 例肠梗阻患者中,X线检出率为89.39%,CT 检出率为95.45%。X 线诊断小肠梗阻准确率为72.10%,CT 为86.05%;X线诊断结肠梗阻准确率为69.57%,CT 为86.96%。X线诊断肿瘤准确率为69.57%,CT 为86.96%;X线诊断肠粘连 准确率为67.86%,CT 为82.14%;X 线诊断肠套叠准确率为60.00%,CT 为80.00%;X线诊断单纯性机械性肠梗阻准确率为78.72%,CT为82.98%;X线诊断绞窄性肠梗准确率为73.68%,CT 为78.95 %。CT 对肠梗阻部位、病因及类型的诊断准确率高于腹部X 线片,差异具有统计学意义(P<0.05)。结论：腹部X 线与CT 用于诊断急性肠梗阻具有较高的准确率,但CT 对于肠梗阻部位、梗阻类型及梗阻病因的诊断优于X线片。     

CT and MRI Determination of Intermuscular Space within Lumbar Paraspinal Muscles at Different Intervertebral Disc Levels

BackgroundRecognition of the intermuscular spaces within lumbar paraspinal muscles is critically important for using the paramedian muscle-splitting approach to the lumbar spine. As such, it is important to determine the intermuscular spaces within the lumbar paraspinal muscles by utilizing modern medical imaging such as computed tomography (CT) and magnetic resonance imaging (MRI).MethodsA total of 30 adult cadavers were studied by sectional anatomic dissection, and 60 patients were examined using CT (16 slices, 3-mm thickness, 3-mm intersection gap, n = 30) and MRI (3.0T, T2-WI, 5-mm thickness, 1-mm intersection gap, n = 30). The distances between the midline and the superficial points of the intermuscular spaces at different intervertebral disc levels were measured.ResultsBased on study of our cadavers, the mean distances from the midline to the intermuscular space between multifidus and longissimus, from intervertebral disc levels L1–L2 to L5–S1, were 0.9, 1.1, 1.7, 3.0, and 3.5 cm, respectively. Compared with the upper levels (L1–L3), the superficial location at the lower level (L4–S1) is more laterally to the midline (P<0.05). The intermuscular space between sacrospinalis and quadratus lumborum, and that between longissimus and iliocostalis did not exist at L4–S1. The intermuscular spaces in patients also varied at different levels of the lumbar spine showing a low discontinuous density in CT and a high signal in MRI. There were no significant differences between the observations in cadavers and those made using CT and MRI.ConclusionThe intermuscular spaces within the paraspinal muscles vary at different intervertebral disc levels. Preoperative CT and MRI can facilitate selection of the muscle-splitting approach to the lumbar spine. This paper demonstrates the efficacy of medical imaging techniques in surgical planning.     

Evaluation of cross-sectional geometry and mass density distributions of humans and laboratory animals using computerized tomography

The purpose of this study was to determine the cross-sectional geometry and mass density distribution of a young porcine subject using the X-ray computerized tomographic (CT) method and to perform a comparative study of anatomical features of this subject and a 3 yr old female child specimen. The cross-sectional CT scans of the porcine subject were obtained at 1 cm intervals. The outlines of each cross section and of selected anatomical components within each section were obtained by standard picture processing techniques. The mass and inertia tensor for each cross section and for each anatomical structure in a section were computed based on the CT numbers. The porcine subject was then sacrificed, frozen, sectioned and photographed. These sectional photographs were then compared with those obtained from the CT method. Tabulated cross-sectional mass and inertia tensor obtained from CT scans of the porcine subject were also used to compare with similar results derived from previously completed CT scans of the 3 yr old female child specimen. In particular, the comparisons were made on the location of the center of gravity and the inertia tensor in the head, neck, head and neck and cervical spine regions. Some immediate applications of this data are inputs to finite element models, lumped parameter biodynamic models, computer simulation of vehicle crash victims, and dummy design.