DOCSLIB.ORG

Deep Neck Flexor Exercise to Improve Physical Performance for People with Cerebral Palsy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Deep Neck Flexor Exercise to Improve Physical Performance for People with Cerebral Palsy MOJ Orthopedics & Rheumatology Deep Neck Flexor Exercise to Improve Physical Performance for People with Cerebral Palsy Introduction Mini Review posture that develops from non-progressive lesions that can be Volume 7 Issue 4 - 2017 causedCerebral by injury palsy tois thedefined developing as a disorder fetus and of infant’s movement brain; and it is not a disease, so its clinical features are similar to a common Yong-Gu Han* and Chang-Kyo Yun syndrome [1]. The immature brain’s development triggers Department of Physical Therapy, Daegu University constraints on their activities, and permanent obstacles to Rehabilitation Clinic, Republic of Korea attitude development and movement. In addition, nerve palsy *Corresponding author: Chang Kyo Yun, Department of at the injured site can create problems with sensation, language, Physical Therapy, Daegu University Rehabilitation Clinic, cognition, behavior, musculoskeletal system disturbances in 70 Myeongdeok-ro 8-gil, Nam-gu, Daegu, Republic of Korea, the coordination between different muscles, and sensory organ Email: coordination [2]. Thus, sufferers often lack the ability to maintain Received: February 17, 2017 | Published: February 27, 2017 postureIn the through normal normal development movement process, [3,4]. the baby can pull their chin and head up, in a lying posture at six months of age. This control have developed [5]. However, children with cerebral palsy this induces excessive neck extension, which reduces its stability whosignified have that not anti-gravityexperienced flexornormal muscles development that regulateshow a headpoor [12]. Therefore, the longus colli and longus capitis muscles acting ability to control their head, and head control is essential during as antagonists of the neck extensor muscles are emphasized the young children’s development, in this way, it will not permit [8]. These muscles perform a similar dynamic function, provide effective posture adjustment, and children cannot perform normal vertical stability for the neck, and serve to support the anterior movements in all postures [6]. Moreover, excessive extension posture in the neck and stooped trunk posture shortens sufferers’ posterior neck muscles, sustained posture creates weakness in cooperateof the base effectively of the neck to andgenerate support strong and musclefix each contraction joint [13,14]. force In toparticular, support the weightdeep cervical of the headflexion while muscles maintaining are lower the thancorrect to space, the arms are too heavy for movement, and the hands and posture of the neck and moving the head. They play a role in eyesthe posterior move separately neck muscles, [6]. Therefore, it is difficult maintaining to keep the balance head inand a endurance and stability [15]. Recently, the activation of the supporting and fixing the neck by providing strong static muscle Head regulation intervention is indispensable for improving posture is very difficult for children with cerebral palsy [7]. on the improvement of the abdominal muscle thickness, dynamic posture control with cerebral palsy, and the role of the deep neck andcervical static flexor balance muscles ability, have and been Proprioceptive proven to have function a positive of children effect with cerebral palsy [16]. showsflexor musclesa relatively to largemaintain amount posture of muscle control spindle and neck distributions stability Balance comparedhave been withemphasized other muscles, recently and [8]. can The require deep high neck Proprioceptive flexor muscle function [9]. Proprioceptive sensation plays an important role in Posture control gains stabilization with the ability to adjust maintaining posture to teach information about position sense the position of the body in space, and balance adjustment means and relative body orientation with regard to the ground, and the ability to maintain the center of gravity of the body at the intervention for that is positive for the maintenance of posture in cerebral palsy children [10]. particular, in the course of normal development, the development ofminimum the ability posture to locate fluctuation the head ofon a the child support in space surface is very [17,18]. important In Deep Neck Flexor Muscle Exercise [19,20]. However, the head-regulating ability of children with cerebral palsy is lowered due to the congenital disease, and The deep muscles of the neck include the cervical muscles the stabilization movement of the neck is applied through longus colli, longus capitis, rectus capitis anterior, and rectus intervention against this. When stabilizing the neck, improving capitis lateralis, and other muscles in the anterior, and the spinalis the stability and control ability of the head through strengthening the posterior; these muscles are involved in stabilizing and to improve the stability of the neck in a static balance will have cervicis, multifidus, suboccipitalis, and others are involved in supporting the neck [11]. Most children with cerebral palsy show the deep cervical flexor muscles and continuing sensory feedback of Soh et al. [22], the stabilization movement of the neck showed the lack of trunk stability. In particular, it is observed from the improvemetsa positive influence in the [21].functional As well reaching as looking test(FRT), in another timed research up and posturea posture when side bendingflexion posture forward or from forward a body flexion sitting posture position due that to Submit Manuscript | http://medcraveonline.com MOJ Orthop Rheumatol 2017, 7(4): 00279 Deep Neck Flexor Exercise to Improve Physical Performance for People with Cerebral Copyright: 2/3 Palsy ©2017 Yong Gu et al. go(TUG) expressing dynamic balance ability and Berg balance 5. scale(BBS) [16,22]. Therefore, the exercise of neck stabilization is positive, and it can be applied to the intervention method for Bly L (1991) A Historical and Current View of the Basis of NDT. 6. Pediatric Hong JS (2009) physical The therapy normal 3(3): development 131-136. for cerebral palsy treatment. improving the dynamic balance ability. Gunja publisher, South Korea. Trunk Stability 7. control synergies during quiet standing in healthy children and Stability of the trunk is the ability of the musculoskeletal Ferdjallah M, Harris GF, Smith P, Wertsch JJ (2002) Analysis of postural system to maintain a balance that is displayed as a small exercise 8. children with cerebral palsy. Clinical Biomechanics 17(3): 203-10. have undergone an abdominal development process and the MusclesBoyd-Clark of the LC, Cervical Briggs Spine. CA, SpineGalea 27(7): MP 694-701.(2002) Muscle Spindle stabilityor a distraction of the trunkof movement will be [23].reduced Children [24], withincluding cerebral not palsyonly Distribution, Morphology, and Density in Longus Colli and Multifidus the balance while sitting, but also decreased walking ability and 9. Hunt CC (1990) Mammalian muscle spindle: peripheral mechanism. upper-limb function. Therefore, the medial muscle of the body 10. PhysiolMatthews Rev PB 70(3): (1998) 643-663. Proprioceptors and their contribution to cerebral palsy and also has a positive effect on the stability of the somatosensory mapping: complex messages require complex requires mediation of the neck flexion movement of a child with contraction for the stabilization of the ventral trunk muscles and 11. processing.Kim SY, Lee CanHJ (2006) J PhysioI Literature Pharmacol review 66(4): on the430-438. association between a contributestrunk. The neck to the flexion automatic exercise adjustment secondarily of the activates trunk [25]. the muscle cervical dysfunction and the change of neuromuscular control activity. Body Alignment 67. Korean Academy of Orthopedic Manual Physical Therapy 12(1): 57- Regarding the posture of those with cerebral palsy, the trunk 12. Kim JC, Jeon HS, Yi CH, Kwon HY, Oh DW (2007) Strength and is bent forward and the head is excessively stretched; thus, the forward movement posture of the head due to the changes in endurance of the deep neck flexors of industrial workers with and without neck pain. Ergonomics Society of Korea 26(4): 25-31. changes, such as the longus colli muscle [26]. In particular, if head position can result in deep cervical flexor muscles thickness 13. 2505-2512.Conley MS, Meyer RA, Bloomberg JJ, Feeback DL, Dudley GA (1995) are weakened and the ability to adjust the head decreases, Noninvasive analysis of human neck muscle function. Spine 20(23): the deep flexor muscles, the longus colli and longus capitis, 14. Mayoux Benhamou M, Revel M, Vallee C, Roudier R, Barbet J, et al. (1994) Longus colli has a postural function on cervical curvature. Surg anterior scalene, are activated early and excessive chin and head movementsthe superficial are displayed,muscles, causingthe sternocleidomastoid hyperextension in themuscle superior and cervical vertebrae [27]. If these incorrect posture behaviors 15. Radiol Anat 16(4): 367-71. muscle responses during postural perturbations in humans. Exp persist chronically, the disc of the cervical spine will be pushed Keshner EA, Woollacott MH, Debu B (1988) Neck, trunk and limb and muscle shortening between the atlas and axis will occur, resulting in permanent deformation of the posture. Therefore, it is 16. BrainYun CK Res (2016) 71(3): The455-466. effect of neck stabilization exercise in sitting important to maintain proper alignment, and stabilization of the neck may be an effective intervention for this. with cerebral palsy. Department of Rehabilitation Science Graduate School,posture Deagu on deep
Load more

Recommended publications
  • 3 Approach-Related Complications Following Anterior Cervical Spine Surgery: Dysphagia, Dysphonia, and Esophageal Perforations
    3 Approach-Related Complications Following Anterior Cervical Spine Surgery: Dysphagia, Dysphonia, and Esophageal Perforations Bharat R. Dave, D. Devanand, and Gautam Zaveri Introduction This chapter analyzes the problems of dysphagia, dysphonia, and esophageal tears during the Pathology involving the anterior subaxial anterior approach to the cervical spine and cervical spine is most commonly accessed suggests ways of prevention and management. through an anterior retropharyngeal approach (Fig. 3.1). While this approach uses tissue planes to access the anterior cervical spine, visceral Dysphagia structures such as the trachea and esophagus and nerves such as the recurrent laryngeal Dysphagia or difficulty in swallowing is a nerve (RLN), superior laryngeal nerve (SLN), and symptom indicative of impairment in the ability pharyngeal plexus are vulnerable to direct or to swallow because of neurologic or structural traction injury (Table 3.1). Complaints such as problems that alter the normal swallowing dysphagia and dysphonia are not rare following process. Postoperative dysphagia is labeled as anterior cervical spine surgery. The treating acute if the patient presents with difficulty in surgeon must be aware of these possible swallowing within 1 week following surgery, complications, must actively look for them in intermediate if the presentation is within 1 to the postoperative period, and deal with them 6 weeks, and chronic if the presentation is longer expeditiously to avoid secondary complications. than 6 weeks after surgery. Common carotid artery Platysma muscle Sternohyoid muscle Vagus nerve Recurrent laryngeal nerve Longus colli muscle Internal jugular artery Anterior scalene muscle Middle scalene muscle External jugular vein Posterior scalene muscle Fig. 3.1 Anterior retropharyngeal approach to the cervical spine.
    [Show full text]
  • Injection Into the Longus Colli Muscle Via the Thyroid Gland
    Freely available online Case Reports Injection into the Longus Colli Muscle via the Thyroid Gland Małgorzata Tyślerowicz1* & Wolfgang H. Jost2 1Department of Neurophysiology, Copernicus Memorial Hospital, Łódź, PL, 2Parkinson-Klinik Ortenau, Wolfach, DE Abstract Background: Anterior forms of cervical dystonia are considered to be the most difficult to treat because of the deep cervical muscles that can be involved. Case Report: We report the case of a woman with cervical dystonia who presented with anterior sagittal shift, which required injections through the longus colli muscle to obtain a satisfactory outcome. The approach via the thyroid gland was chosen. Discussion: The longus colli muscle can be injected under electromyography (EMG), computed tomography (CT), ultrasonography (US), or endoscopy guidance. We recommend using both ultrasonography and electromyography guidance as excellent complementary techniques for injection at the C5-C6 level. Keywords: Anterior sagittal shift, longus colli, thyroid gland, sonography, electromyography Citation: Tyślerowicz M, Jost WH. Injection into the longus colli muscle via the thyroid gland. Tremor Other Hyperkinet Mov. 2019; 9. doi: 10.7916/tohm.v0.718 *To whom correspondence should be addressed. E-mail: [email protected] Editor: Elan D. Louis, Yale University, USA Received: August 13, 2019; Accepted: October 24, 2019; Published: December 6, 2019 Copyright: © 2019 Tyślerowicz and Jost. This is an open-access article distributed under the terms of the Creative Commons Attribution–Noncommercial–No Derivatives License, which permits the user to copy, distribute, and transmit the work provided that the original authors and source are credited; that no commercial use is made of the work; and that the work is not altered or transformed.
    [Show full text]
  • Cervical Spine and Cervicothoracic Junction Alexander R
    46 Cervical Spine and Cervicothoracic Junction Alexander R. Riccio, Tyler J. Kenning, John W. German SUMMARY OF KEY POINTS the approximate cervical spinal levels for the purposes of the skin incision. These include the hyoid bone (C3), thyroid • Understanding the anatomy of the cervical spine and cartilage (C4-5), cricoid cartilage (C6), and carotid tubercle neck is of the utmost importance for the surgeon (C6). These landmarks, however, may not be universally reli- operating in this region. able because, depending on a patient’s body habitus, they may be difficult to palpate reliably; moreover, the relationships are • The anatomy of this region can be classified from only an estimate and variability exists. superficial to deep and further analyzed by system, The most prominent structure of the upper dorsal surface including muscle, bone, nerves, vasculature, and soft of the nuchal region is the inion, or occipital protuberance. tissue. This may be palpated in the midline and is a part of the • Regarding the nerves in the neck, more focused occipital bone. The spinous processes of the cervical vertebrae consideration is taken for surgical purposes when may then be followed caudally to the vertebral prominence, discussing the laryngeal nerve as a result of the variably corresponding to the spinous process of C6, C7 (most potential morbidity associated with iatrogenic injury common), or T1. to this nerve. The prominent surface structure of the ventral neck is the • The vertebral artery is discussed in specific detail as laryngeal prominence, which is produced by the underlying well due to its clinical importance and proximity to thyroid cartilage.
    [Show full text]
  • THE MAIN PERIPHERAL CONNECTIONS of the HUMAN SYMPATHETIC NERVOUS SYSTEM by T
    THE MAIN PERIPHERAL CONNECTIONS OF THE HUMAN SYMPATHETIC NERVOUS SYSTEM By T. K. POTTS, M.B., CH.M. (SYDNEY)1 BIIE recent investigation (5,7) of the functional significance of the sympathetic system by 1)r N. D). itoyle and Professor J. I. Hunter has revealed the necessity for a re-examination of the anatomy of the human sympathetic system. Ini particular the operations of ramisectioni (7, 8) devised by Dr Royle, in collabora- tion with Professor Hunter, call for a more exact determination of the precise position and topographical relations of the sympathetic cord and its ram? cotitnunicantes than at present is available. The dissection described ill this note was undertaken primarily to provide the surgeon with this guidance. In this matter, two regions stand out as having assumed an added interest ill the light of recent research. I refer to those regions associated with the operations known as cervical, and lumbar sympathetic ramisection, which are performed to remove the rigidity of the musculature of the extremities ill spastic paralysis (2,3,4,5, 7, 8, 9,10). As a description of the rari commnunicantes necessarily involves some mention of the arrangement of corresponding ganglia, this will be done in considering the various regions. To facilitate demonstration, the services of Miss D. Harrison were procured and, under my guidance, faithful repro- dluetions of the dissection were made by her. The dissection has been mounted, and placed in the Wilson. Museum of Anatomy, at the Medical School, Uni- versity of Sydney. The cervical portion of the sympathetic is characterized by the absence of segmental ganglia, and of white rami comnimunicantes.
    [Show full text]
  • The Role of Ultrasound for the Personalized Botulinum Toxin Treatment of Cervical Dystonia
    toxins Review The Role of Ultrasound for the Personalized Botulinum Toxin Treatment of Cervical Dystonia Urban M. Fietzek 1,2,* , Devavrat Nene 3 , Axel Schramm 4, Silke Appel-Cresswell 3, Zuzana Košutzká 5, Uwe Walter 6 , Jörg Wissel 7, Steffen Berweck 8,9, Sylvain Chouinard 10 and Tobias Bäumer 11,* 1 Department of Neurology, Ludwig-Maximilians-University, 81377 Munich, Germany 2 Department of Neurology and Clinical Neurophysiology, Schön Klinik München Schwabing, 80804 Munich, Germany 3 Djavad Mowafaghian Centre for Brain Health, Division of Neurology, University of British Columbia Vancouver, Vancouver, BC V6T 1Z3, Canada; [email protected] (D.N.); [email protected] (S.A.-C.) 4 NeuroPraxis Fürth, 90762 Fürth, Germany; [email protected] 5 2nd Department of Neurology, Comenius University, 83305 Bratislava, Slovakia; [email protected] 6 Department of Neurology, University of Rostock, 18147 Rostock, Germany; [email protected] 7 Neurorehabilitation, Vivantes Klinikum Spandau, 13585 Berlin, Germany; [email protected] 8 Department of Paediatric Neurology, Ludwig-Maximilians-University, 80337 Munich, Germany; [email protected] 9 Schön Klinik Vogtareuth, 83569 Vogtareuth, Germany 10 Centre hospitalier de l’Université de Montréal, Montréal, QC H2X 3E4, Canada; [email protected] 11 Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany * Correspondence: urban.fi[email protected] (U.M.F.); [email protected] (T.B.) Abstract: The visualization of the human body has frequently been groundbreaking in medicine. In the last few years, the use of ultrasound (US) imaging has become a well-established procedure Citation: Fietzek, U.M.; Nene, D.; for botulinum toxin therapy in people with cervical dystonia (CD).
    [Show full text]
  • Acute Calcific Retropharyngeal Tendinitis
    CASE REPORT Acute calcific retropharyngeal tendinitis: a three-case series and a literature review Tendinite retrofaríngea calcificada aguda: série de três casos e revisão de literatura Paulo Sérgio Faro Santos1 ABSTRACT 2 Ana Carolina Andrade Acute retropharyngeal tendinitis is a rare, self-limiting, benign condition that is poorly described in the literature. It is clinically characterized by neck pain and stiffness and either dysphagia or odynophagia. Diagnosis depends on clinical 1 Neurologist, Head of the Headache and suspicion and imaging examination (computed tomography of the cervical Orofacial Pain Sector, Department of spine is the gold standard), with calcification found in the anterior region of the Neurology, Institute of Neurology of Curitiba, first and second vertebrae. The disease usually presents good clinical course, PR, Brazil with satisfactory response to the use of either non-steroidal anti-inflammatory 2 Resident doctor, Department of Neurology, drugs or corticosteroids, with remission of symptoms in days to weeks and of Institute of Neurology of Curitiba, PR, Brazil the calcification process in weeks to months. Keywords: Headache; Deglutition disorder; Tendon injury. RESUMO Tendinite retrofaríngea aguda é uma condição rara, autolimitada, benigna e pouco descrita na literatura. Caracteriza-se clinicamente por cervicalgia, rigidez de pescoço e disfagia ou odinofagia. O diagnóstico depende da suspeição clínica e de exame de imagem, sendo a tomografia computadorizada de coluna cervical o padrão-ouro, com o achado de calcificação em região anterior da primeira e segunda vértebras. A doença costuma apresentar uma boa evolução clínica, com resposta satisfatória ao uso de anti-inflamatórios não esteroidais ou corticosteroides, com remissão dos sintomas em dias a semanas e do processo de calcificação em semanas a meses.
    [Show full text]
  • Anatomy Module 3. Muscles. Materials for Colloquium Preparation
    Section 3. Muscles 1 Trapezius muscle functions (m. trapezius): brings the scapula to the vertebral column when the scapulae are stable extends the neck, which is the motion of bending the neck straight back work as auxiliary respiratory muscles extends lumbar spine when unilateral contraction - slightly rotates face in the opposite direction 2 Functions of the latissimus dorsi muscle (m. latissimus dorsi): flexes the shoulder extends the shoulder rotates the shoulder inwards (internal rotation) adducts the arm to the body pulls up the body to the arms 3 Levator scapula functions (m. levator scapulae): takes part in breathing when the spine is fixed, levator scapulae elevates the scapula and rotates its inferior angle medially when the shoulder is fixed, levator scapula flexes to the same side the cervical spine rotates the arm inwards rotates the arm outward 4 Minor and major rhomboid muscles function: (mm. rhomboidei major et minor) take part in breathing retract the scapula, pulling it towards the vertebral column, while moving it upward bend the head to the same side as the acting muscle tilt the head in the opposite direction adducts the arm 5 Serratus posterior superior muscle function (m. serratus posterior superior): brings the ribs closer to the scapula lift the arm depresses the arm tilts the spine column to its' side elevates ribs 6 Serratus posterior inferior muscle function (m. serratus posterior inferior): elevates the ribs depresses the ribs lift the shoulder depresses the shoulder tilts the spine column to its' side 7 Latissimus dorsi muscle functions (m. latissimus dorsi): depresses lifted arm takes part in breathing (auxiliary respiratory muscle) flexes the shoulder rotates the arm outward rotates the arm inwards 8 Sources of muscle development are: sclerotome dermatome truncal myotomes gill arches mesenchyme cephalic myotomes 9 Muscle work can be: addacting overcoming ceding restraining deflecting 10 Intrinsic back muscles (autochthonous) are: minor and major rhomboid muscles (mm.
    [Show full text]
  • Acute Calcific Tendinitis of the Longus Colli Is an Unusual Cause of Acute Neck Pain and Stiffness
    Hong Kong J Radiol. 2013;16:131-6 | DOI: 10.12809/hkjr1311055 CASE REPORt Acute Calcifict endinitis of the longus Colli A Agrawal, A Kalyanpur Teleradiology Solutions, 12B Sriram Road, Civil Lines, Delhi 110054, India ABStRACt Acute calcific tendinitis of the longus colli is an unusual cause of acute neck pain and stiffness. Acute calcific tendinitis is a relatively benign inflammatory condition that can clinically mimic more serious entities such as retropharyngeal abscess, spondylodiscitis, or spine trauma. On computed tomography, acute calcific tendinitis shows characteristic signs of amorphous calcification in the longus colli tendon at the C1 to C2 level and prevertebral fluid, which can help to distinguish this from other more ominous conditions afflicting the neck. This report presents the computed tomography features of this rare entity in three patients presenting with acute neck pain and stiffness. Key Words: Acute disease; Calcinosis; Neck muscles; Neck pain; Tendinopathy 中文摘要 急性頸長肌鈣化性肌腱炎 A Agrawal, A Kalyanpur 急性頸長肌鈣化性肌腱炎是急性頸部疼痛和僵直的非常罕見病因。急性鈣化性肌腱炎是一個相對良 性的炎症性疾病，臨床上可以與更嚴重的疾病如咽後膿腫、椎間盤炎或脊椎創傷表現相似。電腦斷 層掃描顯示急性鈣化性肌腱炎的特徵是在C1至C2水平的頸長肌肌腱位置出現無定形鈣化及椎前積 液，這些徵象有助於該病與頸部其他更嚴重的病理狀態之間的鑑別。本文報告因急性頸部疼痛和僵 直就診的三名該病患者，描述這種罕見疾病的電腦斷層掃描特徵。 iNtRODUCtiON neck movement. The clinical presentation may mimic Acute calcific tendinitis of the longus colli is an traumatic injury, retropharyngeal abscess, or infectious inflammatory process caused by calcium hydroxyapatite spondylitis / discitis.1 The recognition of characteristic crystal deposition in the superior
    [Show full text]
  • FIPAT-TA2-Part-2.Pdf
    TERMINOLOGIA ANATOMICA Second Edition (2.06) International Anatomical Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TA2, PART II Contents: Systemata musculoskeletalia Musculoskeletal systems Caput II: Ossa Chapter 2: Bones Caput III: Juncturae Chapter 3: Joints Caput IV: Systema musculare Chapter 4: Muscular system Bibliographic Reference Citation: FIPAT. Terminologia Anatomica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, 2019 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Anatomica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput II: OSSA Chapter 2: BONES Latin term Latin synonym UK English US English English synonym Other 351 Systemata Musculoskeletal Musculoskeletal musculoskeletalia systems systems
    [Show full text]
  • Decompression Via Microsurgical Anterior Foraminotomy for Cervical Spondylotic Myelopathy Technical Note
    Decompression via microsurgical anterior foraminotomy for cervical spondylotic myelopathy Technical note Hae-Dong Jho, M.D., Ph.D. Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Over the past few years, a microsurgical anterior foraminotomy technique has been developed by the author and used to achieve spinal cord decompression for the treatment of cervical spondylotic myelopathy. A 5 X 8­mm unilateral anterior foraminotomy is accomplished by resecting the uncovertebral joint via an anterior approach. Through the foraminotomy hole, the posterior osteophytes at the spinal cord canal are removed diagonally up to the beginning of the contralateral nerve root. To treat multilevel disease, a tunnel is made among the foraminotomy holes. This technique accomplishes widening of the spinal cord canal in the transverse and longitudinal axes by direct resection of the compressive lesions through the holes of unilateral anterior foraminotomies; however, it does not require bone fusion or postoperative immobilization. Postoperatively patients remain in the hospital overnight, and do not need to wear cervical braces. This new surgical technique has shown excellent clinical outcomes with fast recovery and adequate anatomical decompression in patients with cervical spondylotic myelopathy. The surgical technique is reported and illustrated by two of the author's cases. Key Words * cervical vertebrae * discectomy * intervertebral disc displacement * myelopathy * radiculitis * spine Cervical spondylotic myelopathy has been surgically treated either by a posterior decompressive laminectomy or by an anterior discectomy or vertebrectomy approach.[1,2,5­9] Decompressive laminectomy is actually an indirect decompressive procedure because compressive lesions are most often located anteriorly.[2,6,9] An anterior vertebrectomy approach requires bone graft fusion and immobilization for a few months.
    [Show full text]
  • Acute Neck Infections Blair A
    Acute Neck Infections Blair A. Winegar1, Wayne S. Kubal2 We present an overview of the imaging of acute neck infections mucosal space and may spread to the deep spaces of the neck if with a focus on contrast-enhanced CT. The emphasis of this chap- not appropriately treated. Infections that involve the pharyngeal ter is to enable the emergency radiologist to accurately diagnose mucosal space include pharyngitis, tonsillitis, peritonsillar ab- neck infections, to effectively communicate imaging findings with scess, and epiglottis. emergency physicians, and to function as part of a team offering In patients with acute tonsillitis, the affected tonsillar tissue is the best care to patients. enlarged and enhances after contrast material administration. The tonsils may display a striated enhancement pattern (tiger-stripe Patients with many types of head and neck infections may pres- appearance), reflecting inflamed enhancing mucosa with underly- ent in the emergency department. The causes of these disorders ing edematous submucosa. Uvulitis, enlargement and inflamma- include dental infection, penetrating trauma, and upper respiratory tion involving the uvula may be an associated finding (Fig. 2A). infections. Neck infections continue to portend significant morbid- Uncomplicated tonsillitis will not have a localized region of in- ity and mortality despite widespread access to antibiotics. Poten- ternal hypoattenuation. As the infection progresses, an ill-defined tially life-threatening complications may occur in approximately region of hypoattenuation without a well-defined enhancing wall 10–20% of acute neck infections, including airway obstruction, representing cellulitis or phlegmon may develop within the tonsil. septic thrombophlebitis with septic emboli, arterial pseudoaneu- This process may continue to evolve to abscess formation, defined rysm, and mediastinitis [1].
    [Show full text]
  • THE STRUCTURAL BASIS of EQUINE NECK PAIN by Nicole
    THE STRUCTURAL BASIS OF EQUINE NECK PAIN By Nicole Rombach A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of Large Animal Clinical Sciences –Doctor of Philosophy 2013 ABSTRACT THE STRUCTURAL BASIS OF EQUINE NECK PAIN By Nicole Rombach To date there are large gaps in the knowledge about the phenomenon of neck pain in the horse. This dissertation, which consists of four studies, aims to elucidate neck pain in the horse based on the concepts of neuromotor control and dynamic stability associated with neck pain in people. The first study describes the anatomy and morphology of two perivertebral muscles, namely, m. multifidus cervicis and m. longus colli. Both muscles are closely associated with neuromotor control and dynamic stability in people with neck pain. Based on findings in dissection, their anatomy and morphology are similar to those in people. As such, both muscles may play a role in vertebral stability in the neck of the horse. The second study investigated the prevalence and severity of osseous degenerative lesions in the articular process articulations of the equine cervical and cranial thoracic spine. Based on grading of osseous lesions of the articular process articulationsin this anatomical region, osseous degeneration is most prevalent in the mid-cervical and cervicothoracic region, and more prevalent in older and larger horses. In the first part of the third study, a technique was developed for repeatability of measurement of the cross-sectional area of m. multifidus cervicis and m. longus colli in the equine cervical spine, using ultrasound imaging. In the second part of this study, intra- and inter-operator repeatability was determined for measurement of the cross-sectional area of m.
    [Show full text]