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.     

Biomechanical contributions of upper cervical ligamentous structures in Type II odontoid fractures

Fractures of the odontoid present frequently in spinal trauma, and Type II odontoid fractures, occurring at the junction of the odontoid process and C2 vertebrae, represent the bulk of all traumatic odontoid fractures. It is currently unclear what soft-tissue stabilizers contribute to upper cervical motion in the setting of a Type II odontoid fracture, and evaluation of how concomitant injury contributes to cervical stability may inform surgical decision-making as well as allow for the creation of future, accurate, biomechanical models of the upper cervical spine. The objective of the current study was to determine the contribution of soft-tissue stabilizers in the upper cervical spine following a Type II odontoid fracture. Eight cadaveric C0-C2 specimens were evaluated using a robotic testing system with motion tracking. The unilateral facet capsule (UFC) and anterior longitudinal ligament (ALL) were serially resected to determine their biomechanical role following odontoid fracture. Range of motion (ROM) and moment at the end of intact specimen replay were the primary outcomes. We determined that fracture of the odontoid significantly increases motion and decreases resistance to intact motion for flexion–extension (FE), axial rotation (AR), and lateral bending (LB). Injury to the UFC increased AR by 3.2° and FE by 3.2°. ALL resection did not significantly increase ROM or decrease end-point moment. The UFC was determined to contribute to 19% of intact flexion resistance and 24% of intact AR resistance. Overall, we determined that Type II fracture of the odontoid is a significant biomechanical destabilizer and that concurrent injury to the UFC further increases upper cervical ROM and decreases resistance to motion in a cadaveric model of traumatic Type II odontoid fractures.     

An X-ray diffraction and X-ray absorption spectroscopy joint study of neuroglobin

Neuroglobin (Ngb) is a member of the globin family expressed in the vertebrate brain, involved in neuroprotection. A combined approach of X-ray diffraction (XRD) on single crystal and X-ray absorption spectroscopy (XAS) in solution, allows to determine the oxidation state and the structure of the Fe-heme both in the bis-histidine and the CO-bound (NgbCO) states. The overall data demonstrate that under X-ray the iron is photoreduced fairly rapidly, and that the previously reported X-ray structure of ferric Ngb [B. Vallone, K. Nienhaus, M. Brunori, G.U. Nienhaus, Proteins 56 (2004) 85-92] very likely refers to a photoreduced species indistinguishable from the dithionite reduced protein. Results from the XAS analysis of NgbCO in solution are in good agreement with XRD data on the crystal. However prolonged X-ray exposure at 15 K determines CO release. This preliminary result paves the way to experiments aimed at the characterization of pentacoordinate ferrous Ngb, the only species competent in binding external ligands such as O₂, CO or NO.     

Reproducibility of kinematic motion coupling parameters during manual upper cervical axial rotation mobilization: A 3-dimensional in vitro study of the atlanto-axial joint

IntroductionThe reproducibility of the 3-dimensional (3D) kinematic aspects of motion coupling patterns of segmental manual mobilizing techniques is not yet known. This study analyzes the segmental 3D aspects of manual mobilization of the atlanto-axial joint in vitro.Methods and materialsTwenty fresh human cervical specimens were studied in a test–retest situation with two examiners. The specimens were manually mobilized using three different techniques: a regional mobilization technique, a segmental mobilization technique on the atlas with manual fixation of the axis and a segmental mobilization applying a locking technique. Segmental kinematics were registered with a Zebris CMS20 ultrasound-based tracking system. The 3D aspects of motion coupling between main axial rotation and coupled lateral bending were analyzed by six parameters: the range of motion the three motion components, the cross-correlation, the ratio and the shift.ResultsThe results indicate stronger intra- than inter-examiner reproducibility. The range of motion of the axial rotation component shows a substantial level of intra- and inter-examiner reproducibility (ICC’s 0.67–0.76). The parameters describing the coupling patterns show only moderate to substantial intra-examiner reproducibility for the more experienced of the two examiners (ICC’s 0.55–0.68). All other correlations were not significant and no differences could be observed between regional versus segmental techniques.ConclusionReproducibility of segmental 3D-aspects of manual mobilization of the atlanto-axial joint in an in vitro situation can differ between examiners. The results of the present study may indicate a possible tendency to higher reproducibility if mobilizations are performed by an examiner with high expertise and experience in applying the specific techniques. Continued investigation including more examiners with different levels of experience and different techniques is necessary to confirm these observations.     

"Nonclassic" cytologic signs of cervical condyloma. A case-control study

The association between "nonclassic" cytologic signs of condyloma and human papillomavirus (HPV) infection in women with negative Papanicolaou smears was analyzed via a case-control study. The cytologic signs considered were mild koilocytosis, mild dyskeratosis, binucleation or multinucleation, cleared cytoplasm and nuclear hyperchromatism. The Papanicolaou smears of 166 cases that showed colposcopic and histologic evidence of HPV infection (but whose smears lacked the classic cytologic signs of condyloma) and 166 controls that were negative colposcopically were randomly admixed and blindly reviewed by a panel of cytologists. A significant association to HPV infection was observed for all of the nonclassic signs studied, but multivariate analysis showed a weakly independent association only for mild koilocytosis. The sensitivity (0.46) and the specificity (0.87) of these nonclassic signs were not satisfactory. The utility of selecting women with negative Papanicolaou smears for colposcopy on the basis of these signs is discussed.     

Mechanics of coracoacromial ligament transfer augmentation for acromioclavicular joint injuries

The objective of this study was to determine how effectively the Weaver-Dunn repair (both unaugmented and augmented with a suture and suture anchor) restores joint translation in response to applied loads to normal. Translation of a reference point on the clavicle relative to a reference point on the acromion was assessed in five cadaver shoulders by applying anterior, posterior and superior loads of 50 N to the clavicle using a specially designed test rig while measuring movement of the acromion and clavicle with an optical measurement system. Translation was determined for the intact joint, after simulated injury and Weaver-Dunn repair, and after augmentation of the Weaver-Dunn repair with a suture fixed to a suture anchor in the coracoid process. Joints were significantly more mobile after Weaver-Dunn repair (16.1 mm anterior, 15.7 mm posterior, 11.1 mm superior) than when intact (4.1 mm anterior, 3.2 mm posterior, 4.0 mm superior) (p < 0.005). Augmentation with a suture and suture anchor reduced separation of the Weaver-Dunn reconstruction significantly (to 5.3 mm anterior, 4.1 mm posterior, 2.0 mm superior) (p < 0.005). Joints reconstructed using an augmented Weaver-Dunn repair were not significantly more (or less) mobile than normal joints (p > 0.005), although the power of the test to detect this difference was low (power = 0.107). We anticipate that, when surgery is indicated for treating acromioclavicular joint injury, an augmented Weaver-Dunn reconstruction will yield a joint that is less painful, more functional and less likely to require revision.     

Traumatic injuries of the spinal cord in the cervical segment

A group of 1000 patients treated for traumatic injuries to the spinal cord in cervical segment was analysed. These patients were hospitalized at the Department of Rehabilitation in Konstancin in 1967-1987. The most frequent causes of spine injuries, level and degree of lesions to the spinal cord, techniques of conservative treatment and surgeries and results of therapy are discussed. Significant neurological improvement was observed in 62% of the treated patients. An improvement depended on the degree of lesion to the spinal cord, time and method of therapy, mechanism of trauma, and to some extent patients' age. Finally, hospitalization duration was analysed which greatly depend on the degree of lesions to the spinal cord.     

X-ray diagnosis of ruptures of the distal radioulnar joint]

The paper describes 42 intact, 14 damaged and 52 ruptured radioulnar joints. The joints width was measured, the radioulnar index calculated, x-ray pictures filtered. Variants of isolated injuries of the joints in different bone dislocation, changes in combined ruptures and injuries are described. The radioulnar index proved the best in quantitation of the joint damage.