Symptoms of the cervical spine in temporomandibular and cervical spine disorders

This study was performed to assess the prevalence of signs and symptoms related to cervical spine disorders (CSD) in subgroups of patients with temporomandibular disorders (TMD) and to compare TMD patients and CSD patients with regard to the results of orthopaedic cervical spine tests. One hundred and eleven consecutive patients with TMD and 103 consecutive patients with signs and symptoms of CSD were examined. The results indicated that there is a considerable overlap in the signs and symptoms of patients with TMD and patients with CSD. Signs and symptoms on neck extension occurred more often in CSD patients than in subgroups of TMD patients. No significant differences in upper cervical extension, neck flexion, and shoulder girdle function were found between CSD patients and subgroups of patients with TMD. Patients with CSD reported neck pain during active and passive movements of the neck more often than the subgroups of patients with TMD. TMD patients and CSD patients did not differ with regard to pain on shoulder girdle function and palpation of the shoulder girdle. Logistic regression analyses showed that orthopaedic tests of the cervical spine are of minor importance in discriminating between patients with TMD and patients with CSD. It is concluded that TMD with a myogenous involvement in contrast to TMD with only an arthrogenous involvement should no longer be viewed as a local disorder of the stomatognathic system. The upper quarter, including the stomatognathic system, cervical spine, and shoulder girdle, should be evaluated in patients with more complex or persistent symptoms in the head and neck region.     

Inflammatory disorders of the cervical spine

The most common inflammatory disorders affecting the cervical spine include adult and juvenile rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and psoriatic arthritis. These disorders are characterized by typical deformities and instabilities of the cervical spine that result from the destruction caused by synovitis in bony and ligamentous structures in the neck. The treatment of these inflammatory lesions differs from the treatment of similar lesions found in the posttraumatic or degenerative spine. This article attempts to outline the epidemiology, clinical manifestations, and natural history of these conditions. Various radiographic parameters for evaluating disease progression have been used over the years, and their usefulness is reviewed in the context of recent studies better defining the radiographic natural history of these lesions. An algorithm for the use of the various imaging methods including magnetic resonance scanning is provided, and recent progress in delineating the proper timing of surgical intervention and the predictors of neurologic recovery is presented. The current surgical procedures available to treat these conditions are discussed with emphasis on distinguishing those cases in which stabilization alone is required from those in which a decompression procedure is also necessary.     

Constructing personality scales under the assumptions of an ideal point response process: Toward increasing the flexibility of personality measures.

The main aim of this article is to explicate why a transition to ideal point methods of scale construction is needed to advance the field of personality assessment. The study empirically demonstrated the substantive benefits of ideal point methodology as compared with the dominance framework underlying traditional methods of scale construction. Specifically, using a large, heterogeneous pool of order items, the authors constructed scales using traditional classical test theory, dominance item response theory (IRT), and ideal point IRT methods. The merits of each method were examined in terms of item pool utilization, model-data fit, measurement precision, and construct and criterion-related validity. Results show that adoption of the ideal point approach provided a more flexible platform for creating future personality measures, and this transition did not adversely affect the validity of personality test scores. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Evaluation of PAPNET--a semiautomated system used in the screening against cervical cancer

The PAPNET-system is a current example of automated technological progress in the pathological laboratory field. As the first Department of Pathology in Denmark, we have tested the applicability of this semi-automatical screening system in screening against cervical cancer. 3000 prospectively selected cervical smears were entered into the project. 1500 of these were first prescreened by the use of PAPNET and the negative slides were then manually rescreened. The remaining 1500 slides consisted of manually screened smears diagnosed as negative or inadequate. They were subsequently rescreened by the use of PAPNET. We only found one false negative smear in each group. Compared with histological follow-up the diagnoses CIN 1-3 were histologically confirmed in both groups. The PAPNET-assisted screening of cervical smears is faster, more valid and less fatiguing than the conventional screening method. Nevertheless, our results show no diagnostic quality improvement by the use of PAPNET. This is probably due to a strict screening procedure and a limited work load of a maximum of about 40-50 slides per cytotechnologist a day in our laboratory.     

Oropharyngeal morbidity following transoral approaches to the upper cervical spine

OBJECTIVE: A clinical definition of a hypertensive emergency is excessively high blood pressure in the presence of symptoms indicating end organ damage. Equally high blood pressure without symptoms is called a hypertensive crisis. Patients with hypertensive crisis or emergency need prompt, effective, and specific therapy and a controlled reduction of blood pressure. METHODS: We performed a randomized, double-blind multi-centre study, to compare the safety, efficacy and tolerability of an intravenous (i.v.) infusion of two dihydropyridine calcium channel blockers (either nifedipine or felodipine) in 122 patients, of whom 63 were diagnosed as hypertensive emergencies and 59 as hypertensive crisis, who had not reacted adequately (diastolic blood pressure <115 mmHg) to 5 mg of nifedipine PO. RESULTS: Both drugs lowered blood pressure adequately in more than 90% of the patients and were well tolerated. Only one patient had to be withdrawn, because of an excessive decrease in blood pressure. CONCLUSION: Patients with excessively high blood pressure who do not react to oral nifedipine can be treated equally effectively with felodipine and nifedipine IV. Felodipine is easier to handle because of its lack of light sensitivity.     

Surgery in the degenerative cervical spine

Degenerative changes of the cervical spine include changes of the bony and discoligamentous structures that can create mechanical alterations of the anatomy. Compressive syndromes and deformation or instability represent basic indications for surgery. In the upper cervical spine, osteoarthritis of the C1-C2 facet manifests with suboccipital pain syndrome caused by generally unilateral degenerative changes of the atlantoaxial facet. Fixation and atlantoaxial fusion represent the treatment of choice. In rare instances the presence of os odontoideum is responsible for atlantoaxial instability. Narrowing of the lateral recess in the subaxial spine produces radicular symptoms. The clinical symptoms should be supported with imaging methods such as computed tomography or magnetic resonance imaging. Selective decompression produces satisfactory results. Spondylotic cervical myelopathy requires the addition of neurophysiologic investigations. Posterior decompression with laminoplasty or anterior decompression procedures with corpectomy of the involved segments represent therapeutic options with comparable results. In the presence of axial neck pain, the exact location of the painful segment challenges clinicians and radiologists. Only in cases in which the clinical findings correlate with the radiologic changes should surgical fusion be considered as a last therapeutic means to resolve the painful condition.     

Biomechanics of injury of the cervical spine

Whiplash injuries of the cervical spine are of special medical and socio-economic importance. Biomechanical studies of the injury have proven, that a hypertranslation of the capito-cervical region takes place first, leading to ligamentous hyperdistension and ruptures, when exceeding elastic deformation, thus possibly resulting in mechanical disturbance and rotatory malpositioning. Diagnosis of so called "functional disorders" bears difficulties concerning objective tests for structural lesions. This demands the definition of diagnostic parameters and clinical signs, which also consider vegetative phenomena. This paper aims at a systematic clinical and radiological check. Adequate therapeutic means have to be concordant to prognosis. Therefore functional parameters should already determine differential diagnosis. This is based on technical feasibilities and needs future scientific efforts.     

Langerhans cell histiocytosis of the cervical spine: case report of an unusual location

An unusual location for Langerhans cell histiocytosis of the cervical spine is presented. The osteolytic lesion, instead of being located in the vertebral body, was visualised in the left lateral mass of the fifth cervical vertebra, extending into the vertebral body and through the interapophyseal joint into the lateral mass of the fourth cervical vertebra.     

Dysphagia due to cervical spine involvement in ankylosing spondylitis

Here we present a case of a patient with a massive ossification of annulus fibrosus and longitudinal ligament at the level C3-C4, C4-C5 and C5-C6, also called the Van Swaay bridge. One can observe a propulsion of the pharingeal tissue at the level of the massive Van Swaay bridge between C5 and C6 which caused pressure and dysphagia.     

Late instability in cervical spine fractures secondary to laminectomy

Of 256 patients with a major spinal cord injury as a result of fracture of the cervical spine, 38 per cent had a laminectomy. Three months after injury, 33 per cent of the patients with laminectomy required fusion for instability compared to 22 per cent of the nonlaminectomy group. There were no cases of late instability in pure flexion or extension fracture groups. Ninety per cent of the late instability cases were in the groups with hyperflexion and flexion compression fractures. Laminectomy should be avoided for these fractures, but early fusion may be necessary to prevent progressive deformity.     

Idiopathic tumoral calcinosis involving the cervical spine

An increase in parasitaemia is not uncommon after initiation of treatment for Plasmodium falciparum malaria, but its exact significance is unknown. The time-course of parasitaemia was assessed retrospectively in 33 patients with severe imported malaria. In 19 patients (group 1) mean parasitaemia (+/- SEM) fell promptly after starting quinine treatment, from 24.9 +/- 4.1% on day 0 to 9.7 +/- 2.3% on day 1 and 1.8 +/- 0.7% on day 2. In 14 other patients (group 2), parasitaemia did not change significantly or increased, with mean parasitaemia (+/- SEM) of 9.5 +/- 2.1% on day 0, 17.2 +/- 2.6% on day 1, and 3.7 +/- 1.8% on day 2. Simplified acute physiology scores on admission (mean +/- SEM) were 17.4 +/- 1.4 in group 1 and 11.7 +/- 1.0 in group 2 (P = 0.006). The mean number of complications of malaria per patient (+/- SEM) was 2.9 +/- 0.5 in group 1 and 1.6 +/- 0.3 in group 2 (P = 0.046). Two group 1 patients died. Initially, more than 95% of peripheral blood parasites were tiny and small rings in both groups, and this distribution was unchanged on day 1, suggesting that the parasitaemia increase in group 2 was not due to release of sequestered mature parasites. In severe falciparum malaria, a rise in parasitaemia after treatment initiation may be of favourable prognostic significance and should not lead to aggressive therapeutic approaches such as exchange transfusion.     

Intradiscal pressure recordings in the cervical spine

OBJECTIVE: Experimental investigations analyzing the biomechanics of the cervical spine are less common than similar studies of other regions of the spine. There are no reports on cervical intradiscal pressure (PID) measurements in vitro. We therefore wanted to establish normal values for PID under physiological conditions by simultaneous muscle force simulation. Moreover, the impact of ventral cervical fusion should be elucidated, because in clinical studies, it is a well-known phenomenon that the adjacent segments often show increased degenerative changes. We present a pilot study. METHODS: Seven human cervical spine specimens were tested biomechanically in a specially developed spine tester. Only pure moments were used for flexion/extension, axial rotation, and lateral bending (maximal moment +/- 0.5 Nm). PID was measured simultaneously in C3-C4 and C5-C6. The specimens were tested as intact specimens and after discectomy and fusion in C4-C5. Both test situations were repeated with simulation of muscle forces. RESULTS: We found characteristic load-pressure curves for each of the three motion axes. In neutral position, PID correlated well with former published data from in vivo measurements. After fusion of C4-C5, there was a marked increase of PID in both adjacent segments (e.g., < or = 180% for axial rotation). With muscle force simulation, the increase was even higher (e.g., < or = 400% for axial rotation). CONCLUSION: For the first time, PID could be measured in the cervical spine in an experimental setting. The results obtained using normal specimens under physiological conditions confirmed those reported in two clinical studies. After cervical fusion, a marked increase in PID could be found in both adjacent segments. Presuming that an increase in PID had a negative effect on metabolism of the intervertebral disc, our results may help to explain why progressive degeneration occurs in these segments.     

Sclerotic lesions of the cervical spine in sarcoidosis

Sarcoidosis is a common multisystem disorder characterized by noncaseating epithelial granulomata, with osseous involvement typically seen in 5% of patients. While the lace-like or cystic pattern frequently seen in radiographs of the phalanges is well appreciated, sclerotic lesions of the spine are uncommon. We review a case of sarcoidosis of the cervical spine with sclerotic changes that mimicked blastic metastatic disease.     

Clinical and technical assessment of the cervical spine

In analysis of the cervical and cervicobrachial syndrome with or without signs of compression of the nerve root or spinal cord, functional assessment of the cervical spine is of great importance. Comparisons between actively performed and passively induced motion can be verified by using standardized computer-assisted assessment allowing precise documentation of the range of motion and coupled motion. The age-related normal values should be considered. The neurological assessment includes not only the cranial nerves and upper extremities but also lower extremities to avoid overlooking the signs of cervical myelopathy. In patients with compression of nerve roots or the spinal cord neurophysiology might be helpful in identifying or verifying compression. In patients with suspected myelopathy sensory evoked potentials will allow assessment of the function of the ascending spinal pathways and motor evoked potentials, assessment of the function of the descending cortical spinal pathways.