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Prepared by internationally recognized members of The Cervical Spine Research Society Editorial Committee, the Fourth Edition of this best-selling volume is the most comprehensive, current, and authoritative reference on the cervical spine. It provides state-of-the-art coverage of basic and clinical research, diagnostic methods, and medical and surgical treatments, bringing together the latest thinking of the foremost orthopaedic surgeons, neurosurgeons, neurologists, rheumatologists, radiologists, anatomists, and bioengineers. Chapters cover anatomy, physiology, biomechanics, neurologic and functional evaluation, and radiographic evaluation and address the full range of pediatric problems, fractures, spinal cord injuries, tumors, infections, inflammatory conditions, degenerative disorders, and complications. More than 1,100 illustrations are included.

Abstract BACKGROUND: Although adult cervical spine deformity (ACSD) is associated with pain and disability, its health impact has not been quantified in comparison to other chronic diseases. OBJECTIVE: To perform a comparative analysis of the health impact of symptomatic ACSD to US normative and chronic disease values using EQ-5D (EuroQuol-5 Dimensions questionnaire) scores. METHODS: ACSD patients presenting for surgical treatment were identified from a prospectively collected multicenter database. Baseline demographics and EQ-5D scores were collected and compared with US normative and disease state values. RESULTS: Of 121 ACSD patients, 115 (95%) completed the EQ-5D (60% women, mean age 61 years, previous spine surgery in 44%). Diagnoses included kyphosis with mid-cervical (63.4%), cervico-thoracic (23.5%), or thoracic (8.7%) apex and primary coronal deformity (4.3%). The mean ACSD EQ-5D index was 0.511 (standard definition = 0.224), which is 34% below the bottom 25th percentile (0.780) for similar age- and gender-matched US normative populations. Mean ACSD EQ-5D index values were worse than the bottom 25th percentile for several other disease states, including chronic ischemic heart disease (0.708), malignant breast cancer (0.708), and malignant prostate cancer (0.708). ACSD mean index values were comparable to the bottom 25th percentile values for blindness/low vision (0.543), emphysema (0.508), renal failure (0.506), and stroke (0.463). EQ-5D scores did not significantly differ based on cervical deformity type (P = .66). CONCLUSION: The health impact of symptomatic ACSD is substantial, with negative impact across all EQ-5D domains. The mean ACSD EQ-5D index was comparable to the bottom 25th percentile values for blindness/low vision, emphysema, renal failure, and stroke.

Despite recent reports, the fossil record of pathologies in vertebrates is still patchy in terms of phylogeny, geological age and paleogeography. Here, we report several cases of pathological vertebrae in several specimens of the Late Triassic temnospondyl Metoposaurus krasiejowensis from Krasiejów. The presence of cervical block vertebrae (atlas-axis complex) is the oldest such case reported for any fossil tetrapod and the first such case reported in temnospondyls. Spinal arthropathy (or spinal arthritis) is the first such case for a non-amniote. Based on different levels of fusion among the centra in the three specimens, this pathology revealed different stages of disease development. Finally, hemivertebra (congenital scoliosis) have been noted previously; however, this is the first example of scoliosis caused by hemivertebra in the genus Metoposaurus . These findings from the Upper Triassic site in Krasiejów allow for a better characterization of vertebral diseases in the fossil record. This was possible because of the very rich material of vertebrae from the Krasiejów Konzentrat Lagerstätte.

Objective To propose a novel classification system for stratifying coronal curve patterns in congenital cervicothoracic scoliosis with hemivertebrae (CTS-HV). Methods Type A: regional cervicothoracic deformity only disturbing the balance of head-neck-shoulder complex; Type B: cervicothoracic deformity with significant trunk tilt to the convex side; Type C: cervicothoracic deformity with a significant compensatory thoracic curve. The reliability and reproducibility were assessed via the Kappa test. The differences among different subtypes in deformity parameters and bony structures were compared to identify the causative factors predisposing to different subtypes. Results 98 patients were classified into Type A (47 cases), Type B (31 cases), and Type C (20 cases). The Kappa test showed excellent reliability (Kappa value = 0.847) and reproducibility (Kappa value = 0.881). The proportions of Klippel-Feil syndrome in Types B (71.0%) and C (85.0%) were significantly higher than in Type A (46.8%; all P  < 0.05). Type A (66.0%) and Type B (71.0%) predominantly had their hemivertebra (HV) at T3 or T4, while Type C (75%) mostly had HV at T1 or T2. Type B exhibited the most severe trunk tilt, head shift, neck tilt, head tilt, and coronal balance distance (all P  < 0.05). Type C had the lowest T1 tilt and first rib angle despite the greatest cervicothoracic Cobb angle (all P  < 0.05). Conclusions This novel reliable classification allows a better understanding of structural diversity and different coronal compensatory mechanisms for the natural progression of CTS-HV. It can contribute to determining the individualized treatment strategy and standardizing academic communication for this rare clinical entity.

The syndrome of anterior fibroneural stalk, vertebral anomaly, enteric duplication cyst, and diaphragmatic hernia is a manifestation of abnormal notochordal development due to persistence of the neurenteric canal beyond early fetal gestational age. Our description of the third such published case to date supports this novel tetralogy and further illustrates the role of both pre- and postnatal imaging in achieving the diagnosis.

The paracondylar process is a rare osseous process arising at the cervicooccipital region that belongs to a large and heterogenic group of developmental abnormalities of the craniovertebral junction. We present a rare case of a paracondylar process in an 11-year-old girl, in which the diagnosis was made with the use of MRI, thereby skipping X-ray and CT scan, thus avoiding exposure of the young patient to radiation. To our knowledge, the use of MRI has not previously been reported in the investigation and diagnosis of such an abnormality. We describe the details of this variation emphasizing on awareness of this process, its anatomic relationships and its problems to clinicians, radiologists, surgeons and chiropractors.

BackgroundWe observed a rare anatomical variation of a persistent first intersegmental vertebral artery in the C1–C2 region in an elderly Chinese male cadaver at Changzhi Medical College. In this case, the vertebral artery, rather than passing through the transverse foramen of the atlas, exits the transverse foramen of C2 and enters the spinal canal at the lower portion of the C1 posterior arch. The original transverse foramen of C1 was filled with connective tissue. This report details the anatomical characteristics of this abnormal vertebral artery and discusses its anatomical, surgical, and developmental implications.PurposeWe describe the detailed morphological features of a rare VA variant and discuss the anatomical, clinical, and developmental aspects of this case.MethodsA case of head dissection. The anatomical characteristics of the VA were studied and documented, and anatomical measurements were collected.ResultsIn this case, the vertebral artery, rather than passing through the transverse foramen of the atlas, exits the transverse foramen of C2 and enters the spinal canal at the lower portion of the C1 posterior arch. The original transverse foramen of C1 was filled with connective tissue.ConclusionThe anomalous development of segmental arteries in our case is linked to failures in the embryonic sclerotome reconstruction during development and failure.

Duplication, accessory slips, and division of the rectus capitis posterior muscles are rare anatomical variations. Here we report a case of unilateral doubling of rectus capitis posterior major, and doubling of rectus capitis posterior minor with an accessory slip originating from the spinous process of the second cervical vertebra. The gross anatomical characteristics, clinical significance, and relationship of suboccipital musculature to the cervical myodural bridge is discussed in this report. Knowledge of rectus capitis posterior muscle variations may be of interest to clinicians practicing surgical approaches to the posterior cervical region due to the close proximity of the variations to typical muscular and neurovascular structures of the suboccipital region and potential association with the cervical myodural bridge.

BackgroundAbnormalities of the ventral lamina of the sixth cervical vertebra (AVL-C6) are thought to exert abnormal stress on the articular process joints (APJs) of the cervicothoracic junction. The aim of the study was to investigate the association between AVL-C6 and radiographic findings in the caudal cervical area and between clinical signs of neck pain and ataxia and radiographic findings.MethodsMedical records of horses subjected to cervical radiography were reviewed. Horses were classified into those with neck pain (group C), those with ataxia (group A) and healthy horses (group H). Presence of AVL-C6 and increased size, dysplasia, remodelling, fragmentation and osteochondral fragment at the APJs (C5–T1) were recorded. Univariable logistic regression analysis was performed to identify the associations between explanatory and dependent variables. Variables with P<0.2 were included in the multivariable analysis.ResultsOne hundred and sixteen horses were included (44 in group C, 29 in group A, 66 in group H); 24 of 116 horses had radiographic AVL-C6. Age, AVL-C6 and overall/C6–C7 increase in size remained in the final models.ConclusionsThe presence of AVL-C6 and moderate/severe increase in size of the caudal cervical APJs increase the odds of showing neck pain and, if severe, ataxia.

ABSTRACT Study Design A retrospective and consecutive study. Objective To demonstrate the curve evolution of distal non‐structural compensatory curves in patients with congenital cervicothoracic hemivertebra (CTH) scoliosis undergoing posterior‐only hemivertebra resection and to propose the possible mechanisms of this specific phenomenon. Summary of Background Data Though the spinal alignment could be well corrected via posterior hemivertebra resection in CTH patients, the high prevalence of distal curve progression was remarkable. However, the curve behavior of distal non‐structural compensatory curves and its possible mechanisms were unclear. Methods This study retrospectively reviewed a consecutive series of CTH patients undergoing posterior‐only hemivertebra resection with a minimum 24 months follow‐up. The parameters measured in coronal plane included local scoliosis, clavicle angle, head shift, and the Cobb angle of distal unfused segments. The distal curve was considered as an emerging scoliosis (ES) if with more than 20° progression and the apex of distal curve no less than 2 levels away from the lower instrumented vertebra. Results A total of 51 CTH patients with a mean age of 8.5 ± 3.8 years at surgery and a mean 38.0 ± 5.3 months follow‐up were recruited. The correction of local scoliosis and clavicle angle was statistically significant (p < 0.05 for all). The distal compensatory curve was 11.8 ± 5.3° before surgery and 6.5° ± 4.1° after surgery (p < 0.001), which was slightly increased to 11.6° ± 10.9° (p = 0.002) at the latest follow‐up. During follow‐up, the increase of distal compensatory curve was significantly correlated with the change in clavicle angle (r = 0.49, p = 0.038). The ES was observed in 10 patients (19.6%) with an average value of 28.0 ± 2.1° at diagnosis, including 7 patients within 6 months and 3 patients after 5 years postoperatively. The mean value of ES was 31.9° ± 3.1° at the latest follow‐up, while no patients required revision surgery. The ES was classified into compensatory and idiopathic types according to the typical curve behaviors. The compensatory ES usually presented within 6 months after operation and was responsible for further reconstruction of head and shoulder balance. While the idiopathic ES occurred at adolescent which may be related to the rapid body growth. Conclusions Distal compensatory curve had a tendency toward slight progression during follow‐up in CTH patients with posterior hemivertebra resection surgery. The prevalence of emerging scoliosis was 19.6% and the typical compensatory and idiopathic curve behavior were firstly proposed. Close and longitudinal follow‐up was thus highly recommended for CTH patients with posterior HV resection surgery. Distal compensatory curve had a tendency toward slight progression during follow‐up in CTH patients with posterior hemivertebra resection surgery. The prevalence of emerging scoliosis was 19.6% and the typical compensatory and idiopathic curve behavior were firstly proposed.