Browsing by Subject "Cervical spine"
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Item Open Access Adult cervical spine deformity: a state-of-the-art review.(Spine Deform, 2023-09-30) Jackson-Fowl, Brendan; Hockley, Aaron; Naessig, Sara; Ahmad, Waleed; Pierce, Katherine; Smith, Justin S; Ames, Christopher; Shaffrey, Christopher; Bennett-Caso, Claudia; Williamson, Tyler K; McFarland, Kimberly; Passias, Peter GAdult cervical deformity is a structural malalignment of the cervical spine that may present with variety of significant symptomatology for patients. There are clear and substantial negative impacts of cervical spine deformity, including the increased burden of pain, limited mobility and functionality, and interference with patients' ability to work and perform everyday tasks. Primary cervical deformities develop as the result of a multitude of different etiologies, changing the normal mechanics and structure of the cervical region. In particular, degeneration of the cervical spine, inflammatory arthritides and neuromuscular changes are significant players in the development of disease. Additionally, cervical deformities, sometimes iatrogenically, may present secondary to malalignment or correction of the thoracic, lumbar or sacropelvic spine. Previously, classification systems were developed to help quantify disease burden and influence management of thoracic and lumbar spine deformities. Following up on these works and based on the relationship between the cervical and distal spine, Ames-ISSG developed a framework for a standardized tool for characterizing and quantifying cervical spine deformities. When surgical intervention is required to correct a cervical deformity, there are advantages and disadvantages to both anterior and posterior approaches. A stepwise approach may minimize the drawbacks of either an anterior or posterior approach alone, and patients should have a surgical plan tailored specifically to their cervical deformity based upon symptomatic and radiographic indications. This state-of-the-art review is based upon a comprehensive overview of literature seeking to highlight the normal cervical spine, etiologies of cervical deformity, current classification systems, and key surgical techniques.Item Open Access Global spinal deformity from the upper cervical perspective. What is "Abnormal" in the upper cervical spine?(Journal of craniovertebral junction & spine, 2019-07) Passias, Peter G; Alas, Haddy; Lafage, Renaud; Diebo, Bassel G; Chern, Irene; Ames, Christopher P; Park, Paul; Than, Khoi D; Daniels, Alan H; Hamilton, D Kojo; Burton, Douglas C; Hart, Robert A; Bess, Shay; Line, Breton G; Klineberg, Eric O; Shaffrey, Christopher I; Smith, Justin S; Schwab, Frank J; Lafage, VirginieHypothesis
Reciprocal changes in the upper cervical spine correlate with adult TL deformity modifiers.Design
This was a retrospective review.Introduction
The upper cervical spine has remarkable adaptability to wide ranges of thoracolumbar (TL) deformity.Methods
Patients >18 years with adult spinal deformity (ASD) and complete radiographic data at baseline (BL) and 1 year were identified. Patients were grouped into component types of the Roussouly classification system (Type 1: Pelvic incidence [PI] <45° and lumbar lordosis [LL] apex below L4; Type 2: PI <45° and LL apex above L4; Type 3:45°65°). Patients were categorized by increasing severity of Schwab modifiers at BL (0, +, and ++) and further grouped by regional malalignment moving cranially (P: pelvic only; LP: lumbopelvic; TL: thoracic and LP; C: subaxial and TL). Analysis of variance and Pearson's r assessed changes in BL upper cervical parameters (C0-2, C0 slope, McGregor's Slope [MGS], and CBVA) across groups.Results
A total of 343 ASD patients were analyzed. When grouped by BL Schwab and Roussouly, Group P had the lowest BL disability compared to other Groups, while Roussouley Type 1 correlated with higher BL disability compared to Type 2. Moving cranially up the spine, Group P, Group LP, and Group TL did not differ in C0-2 angle, C0 slope, MGS, or CBVA. Group C had a significantly smaller C0-C2, and more negative MGS, C0 slope, and CBVA than noncervical groups. Type 1 trended slightly higher CBVA and MGS than types 2-4, but no differences in cervical lordosis, C0-C2, or C0S were found. MGS (r = -0.131, P = 0.015), CBVA (r = -0.473, P < 0.001), and C0S (r = -0.099, P = 0.042) correlated most strongly with sagittal vertical axis (SVA) compared to other Schwab modifiers. We found SVA > 34 mm predicted a 1 unit (°°) decrease in MGS (odds ratio [OR]: 0.970 [0.948-0.993], P = 0.010), while cervical SVA >51 mm predicted a 1 unit increase in MGS (OR: 1.25 [1.12-1.38], P < 0.001).Conclusions
Our study suggests that upper cervical alignment remains relatively stable through most broad variations of adult TL deformity. Changes in SVA correlated most with upper cervical changes.Item Open Access How to diagnose cervicogenic dizziness.(Archives of physiotherapy, 2017-01) Reiley, Alexander S; Vickory, Frank M; Funderburg, Sarah E; Cesario, Rachel A; Clendaniel, Richard ACervicogenic dizziness (CGD) is a clinical syndrome characterized by the presence of dizziness and associated neck pain. There are no definitive clinical or laboratory tests for CGD and therefore CGD is a diagnosis of exclusion. It can be difficult for healthcare professionals to differentiate CGD from other vestibular, medical and vascular disorders that cause dizziness, requiring a high level of skill and a thorough understanding of the proper tests and measures to accurately rule in or rule out competing diagnoses. Consequently, the purpose of this paper is to provide a systematic diagnostic approach to enable healthcare providers to accurately diagnose CGD. This narrative will outline a stepwise process for evaluating patients who may have CGD and provide steps to exclude diagnoses that can present with symptoms similar to those seen in CGD, including central and peripheral vestibular disorders, vestibular migraine, labyrinthine concussion, cervical arterial dysfunction, and whiplash associated disorder.