Explore the vast range of titles available.

Background The sequence of segmental contributions (SSC) offers insight into cervical spine motion, yet accurately analyzing these movements remains challenging. This study compares two tracking methods, developed at two independent centers (AECC and MUMC), to establish their agreement and reliability in measuring SSCs across segments C4 to C7. Understanding spinal biomechanics is crucial for future research into cervical spine pathology and dysfunction. Methods Twelve asymptomatic participants (ages 18–35 for “young” and 55–70 for “elderly”) performed flexion-extension movements. MUMC + utilized self-directed motion, while AECC used a guided protocol. To ensure comparability, 26 frames from the second half of each extension movement were analyzed. Agreement was assessed using ICCs, Spearman’s Rho, and Bland-Altman analysis. Although the sample size is small, a post-hoc power analysis indicated sufficient power, supported by a high volume of analyzed data points. Findings High intraclass correlation coefficients (ICCs) for the cumulative vertebral rotation (0.97), cumulative intervertebral rotation (0.97) and relative intervertebral rotation (0.93) indicated strong agreement between the two methods. Bland-Altman analysis showed minimal median differences (< 0.2˚) but wider limits of agreement at C6-C7. Normative SSC patterns appeared in 77.8% of younger participants but were absent in elderly participants. Interpretation This study confirms the reliability of SSC measurement between the two methods, laying the foundation for broader applications. SSC patterns observed in young adults follow a normative pattern, in alignment with previous research. The absence of a fixed pattern in elderly participants could indicate age-related changes or sample variation, warranting cautious interpretation due to the small sample size. Future studies with larger, diverse samples and AI-driven approaches could enhance SSC analysis, enabling better clinical relevance.

Background The term ‘physiological motion of the spine’ is commonly used although no proper definition exists. Previous work has revealed a consistent sequence of cervical segmental contributions in 80–90% of young healthy individuals. Age has been shown to be associated with a decreased quantity of motion. Therefore, it is of interest to study whether this sequence persists throughout aging. The aim of this prospective cohort study is to investigate if the consistent sequence of cervical segmental contributions in young asymptomatic individuals remains present in elderly asymptomatic individuals. Methods In this prospective cohort study, dynamic flexion to extension cinematographic recordings of the cervical spine were made in asymptomatic individuals aged 55–70 years old. Individuals without neck pain and without severe degenerative changes were included. Two recordings were made in each individual with a 2-to-4-week interval (T1 and T2). Segmental rotation of each individual segment between C4 and C7 was calculated to determine the sequence of segmental contributions. Secondary outcomes were segmental range of motion (sRoM) and sagittal alignment. Results Ten individuals, with an average age of 61 years, were included. The predefined consistent sequence of segmental contributions was found in 10% of the individuals at T1 and 0% at T2. sRoM and total range of motion (tRoM) were low in all participants. There was no statistically significant correlation between sagittal alignment, degeneration and sRoM in the respective segments, nor between cervical lordosis and tRoM. Conclusions This study shows that aging is associated with loss of the consistent motion pattern that was observed in young asymptomatic individuals. The altered contribution of the cervical segments during extension did not appear to be correlated to the degree of degeneration or sagittal alignment. Trial registration clinicaltrials.gov NCT04222777, registered 10.01.2020.

Purpose Post-operative pain after video-assisted thoracoscopic surgery is often treated using thoracic epidural analgesics or thoracic paravertebral analgesics. This article describes a case where a thoracic disc herniation is treated with a thoracoscopic microdiscectomy with post-operative thoracic epidural analgesics. The patient developed a bupivacaine pleural effusion which mimicked a hemothorax on computed tomography (CT). Methods The presence of bupivacaine in the pleural effusion was confirmed using a high performance liquid chromatography method. Results The patient underwent a re-exploration to relieve the pleural effusion. The patient showed a long-term recovery similar to what can be expected from an uncomplicated thoracoscopic microdiscectomy. Conclusion A pleural effusion may occur when thoracic epidural analgesics are used in patents with a corridor between the pleural cavity and epidural space.

Background and Objectives: All intervertebral discs (IVDs) degenerate with the progression of age. Currently we are unable to differentiate physiological lumbar intervertebral disc degeneration (LIDD) from pathophysiological using imaging. The first step in differentiating physiological from pathophysiological degeneration is to determine physiological LIDD. Biochemical and histological analysis are not viable tools to look at the IVD in patients or healthy subjects due to their invasive character. For this reason, a non-invasive MRI could be the solution to study the lumbar IVD and LIDD. Therefore, the purpose of this systematic literature review is to identify the physiological aging process of the lumbar IVD based on MRI studies in patients of all ages without a history of spine pathology or surgery. Materials and Methods: After searching four databases (PubMed, Embase, Web of Science, and Cochrane), titles and abstracts of the identified studies were screened using inclusion and exclusion criteria. Eligible articles were subjected to a full-text review. Quality assessment was performed using ROBINS-I for risk of bias and Oxford level of evidence. Results: In total, 38 articles were included in this review. Most studies were non-consecutive studies (n = 36). Two studies were exploratory cohort studies. Twenty-two studies were prospective studies and sixteen were retrospective. Level of evidence ranged from 2b–3b. After analysis, we could construct a timeline of physiological degeneration from the age of 20 until 50. A shift in biochemical composition of the IVD and small structural changes can be detected in this timeline. The loss and breakdown of proteoglycan (PG) appears to have a primary role in this initial stadium of LIDD. After the age of 50, degeneration accelerates, resulting in more ultrastructural changes of the IVD as well as loss of height, volume, and disc convexity. No significant difference in degree of LIDD was found between men and women. Finally, the lower lumbar levels L4/5 and L5/S1 had a significantly higher degree of LIDD than upper lumbar levels (L1/2, L2/3, and L3/4). Conclusions: This systematic literature review conceptualizes the theory of physiological ageing in the lumbar IVD based on MRI. Initially, there is change in biochemical composition of the IVD, which eventually results in ultrastructural changes. Future research should aim to validate this theory, preferably in a prospective cohort study.

Background: Qualitative motion analysis revealed that the cervical spine moves according to a consistent pattern. Current data analysis methods are limited by the extensive time required to process the retrieved data. A previous study demonstrated the feasibility of using a deep-learning model to automate analysis methods. However, segmentation accuracy needed to be improved. This study aims to improve segmentation model performance to enable reliable motion analysis. Methods: Four nnU-Net configurations were tested: baseline (A), pre-trained (B), with histogram equalization (C), and pre-trained with histogram equalization (D). Segmentation performance was evaluated using Dice Similarity Coefficient (DSC), Intersection over Union (IoU) and 95th percentile Hausdorff Distance (HD95). Vertebral rotation was estimated using mean shapes. Reliability was assessed using the Intraclass Correlation Coefficient (ICC). Sensitivity analyses were conducted. Results: Across all models, mean DSC ranged from 0.67 to 0.92, mean IoU from 0.55 to 0.85, and mean HD95 from 2.35 to 19.67 mm. After sensitivity analysis for low segmental range of motion (sROM) and low-quality recordings, the mean ICC ranged from 0.617 to 0.837 for model A, from 0.609 to 0.780 for model B, from 0.409 to 0.689 for model C, and from 0.480 to 0.835 for model D. Conclusions: This study shows that Models A and B can accurately analyze cervical motion patterns. High image contrast and an adequate sROM are essential for robust model performance. It also marks an important step toward automated qualitative motion analysis, increasing the accessibility of motion pattern evaluation.

Introduction To date, there is no consensus on which anterior surgical technique is more cost-effective in treating cervical degenerative disc disease (CDDD). The most commonly used surgical treatment for patients with single- or multi-level symptomatic CDDD is anterior cervical discectomy with fusion (ACDF). However, new complaints of radiculopathy and/or myelopathy commonly develop at adjacent levels, also known as clinical adjacent segment pathology (CASP). The extent to which kinematics, surgery-induced fusion, natural history, and progression of disease play a role in the development of CASP remains unclear. Anterior cervical discectomy with arthroplasty (ACDA) is another treatment option that is thought to reduce the incidence of CASP by preserving motion in the operated segment. While ACDA is often discouraged, as the implant costs are higher while the clinical outcomes are similar to ACDF, preventing CASP might be a reason for ACDA to be a more cost-effective technique in the long term. Methods and analysis In this randomized controlled trial, patients will be randomized to receive ACDF or ACDA in a 1:1 ratio. Adult patients with single- or multi-level CDDD and symptoms of radiculopathy and/or myelopathy will be included. The primary outcome is cost-effectiveness and cost-utility of both techniques from a healthcare and societal perspective. Secondary objectives are the differences in clinical and radiological outcomes between the two techniques, as well as the qualitative process surrounding anterior decompression surgery. All outcomes will be measured at baseline and every 6 months until 4 years post-surgery. Discussion High-quality evidence regarding the cost-effectiveness of both ACDA and ACDF is lacking; to date, there are no prospective trials from a societal perspective. Considering the aging of the population and the rising healthcare costs, there is an urgent need for a solid clinical cost-effectiveness trial addressing this question. Trial registration ClinicalTrials.gov NCT04623593. Registered on 29 September 2020.

Superficial siderosis is a rare disorder characterised by the deposition of haemosiderin on the surface of the central nervous system. Cognitive dysfunction has sporadically been reported in relation with superficial siderosis. We present a 61-year-old man with cognitive dysfunction in the presence of the typical radiological image of temporal and cerebellar superficial siderosis, most likely due to pseudomeningocoele 14 years after resection of a meningioma at the cervicothoracic junction. Xantochromia was present on cerebrospinal fluid investigation and a source of bleeding was seen during surgical exploration. Despite surgical treatment of the suspected bleeding source, the patient deteriorated and neuropsychological examination 1 year after surgery showed progression of cognitive dysfunction to dementia. It is likely that in the absence of other typical symptoms such as cerebellar ataxia and hearing loss, the cognitive dysfunction was not related to the superficial siderosis.

Background When surgically treating cervical degenerative disc disease, the most commonly performed procedure is anterior cervical discectomy. This procedure is performed with, or without fusion promoting methods. For both options the rate of fusion is high and there is much debate whether fusion of the treated segment is a contributing factor to accelerated degeneration of adjacent motion segments. In an effort to prevent degeneration of adjacent segments (ASDeg) due to loss of mobility at the operated level, cervical disc arthroplasty (CDA) was introduced. To evaluate the effectiveness of CDA in preventing ASDeg long term studies are necessary. However, prevention of ASDeg is based on the premise that mobile disc prostheses preserve cervical spine motion in a physiological way. In this article the authors describe a short term protocol for a study that aims to investigate whether CDA reaches the intended goal: restoration or preservation of physiological cervical spine motion. To this end, a technique is used to establish the sequence of contributions of cervical motion segments to flexion/extension of the spine. Methods 24 subjects between 18 and 55 years old, with radicular symptoms due to a herniated disc between C5 and C7, refractory to conservative therapy are randomized to simple discectomy, or CDA. These groups are preceded by a pilot group of three subjects receiving CDA. Fluoroscopic flexion-extension recordings are acquired preoperatively, and at three and 12 months postoperative. At these same time points, patient reported outcomes are collected, and a neurological examination is performed by and independent physician. Discussion Studies investigating arthroplasty determine mobility by measuring segmental range of motion (sROM), which gives no information other than presence, and quantity, of mobility. SROM suffer from high variability. The authors therefore chose to use a method previously used in healthy controls, to describe the dynamic process of cervical spine motion in more detail. Determining cervical spine motion patterns has been reported to be more consistent than sROM. If a physiological motion pattern is absent after surgery in the CDA group, prevention of future ASDeg is less likely. Radiological outcomes will be correlated to clinical outcomes. Trial Registration NCT00868335

Background: Physiological motion of the lumbar spine is a subject of interest for musculoskeletal health care professionals, as abnormal motion is believed to be related to lumbar conditions and complaints. Many researchers have described ranges of motion for the lumbar spine, but only a few have mentioned specific motion patterns of each individual segment during flexion and extension. These motion patterns mostly comprise the sequence of segmental initiation in sagittal rotation. However, an adequate definition of physiological motion of the lumbar spine is still lacking. The reason for this is the reporting of different ranges of motion and sequences of segmental initiation in previous studies. Furthermore, due to insufficient fields of view, none of these papers have reported on maximum flexion and extension motion patterns of L1 to S1. In the lower cervical spine, a consistent pattern of segmental contributions was recently described. In order to understand physiological motion of the lumbar spine, it is necessary to systematically study motion patterns, including the sequence of segmental contribution, of vertebrae L1 to S1 in healthy individuals during maximum flexion and extension. Objective: This study aims to define the lumbar spines’ physiological motion pattern of vertebrae L1, L2, L3, L4, L5, and S1 by determining the sequence of segmental contribution and the sequence of segmental initiation of motion in sagittal rotation of each vertebra during maximum flexion and extension. The secondary endpoint will be exploring the possibility of analyzing the intervertebral horizontal and vertical translation of each vertebra during maximum flexion and extension. Methods: Cinematographic recordings will be performed on 11 healthy male participants, aged 18-25 years, without a history of spine problems. Cinematographic flexion and extension recordings will be made at two time points with a minimum 2-week interval in between. Results: The study has been approved by the local institutional medical ethical committee (Medical Research Ethics Committee of Zuyderland and Zuyd University of Applied Sciences) on September 24, 2018. Inclusion of participants will be completed in 2020. Conclusions: If successful, these physiological motion patterns can be compared with motion patterns of patients with lumbar conditions before or after surgery. Ultimately, researchers may be able to determine differences in biomechanics that can potentially be linked to physical complaints like low back pain. Trial Registration: ClinicalTrials.gov NCT03737227; https://clinicaltrials.gov/ct2/show/NCT03737227 International Registered Report Identifier (IRRID): DERR1-10.2196/14741