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Biomechanical testing of cadaveric spinal segments forms the basis for our current understanding of healthy, pathological, and surgically treated spinal function. Over the past 40 years there has been a substantial amount of data published based on a spinal biomechanical testing regimen known as the flexibility method. This data has provided valuable clinical insights that have shaped our understanding of low back pain and its treatments. Virtually all previous lumbar spinal flexibility testing has been performed at room temperature, under very low motion rates, without the presence of a compressive follower-load to simulate upper body weight and the action of the musculature. These limitations of previous work hamper the applicability of published spinal biomechanics data, especially as researchers investigate novel ways of treating low back pain that are intended to restore the spine to a healthy biomechanical state. Thus, the purpose of this thesis work was to accurately characterize the rate-dependent flexibility of the lumbar spine at body temperature while in the presence of a compressive follower-load. A custom spine simulator with an integrated environmental chamber was developed and built as part of this thesis work. Cadaveric spinal motion segments were tested at 12 different rates of loading spanning the range of voluntary motion rates. The testing methodology allowed for comparison of spinal flexibility at room and body temperatures in the three primary modes of spinal motion, both with and without a compressive follower-load. Additionally, the work developed a stochastic model for rate-dependent spinal flexibility that allows for accurate prediction of spinal flexibility at any rate within the range of voluntary motion, based on a single flexibility test. In conclusion, the biomechanical response was significantly altered due to testing temperature, loading-rate, and application of a compressive follower-load. The author emphasizes the necessity to simulate the physiological environment during ex vivo biomechanical analysis of the lumbar spine in order to obtain a physiological response. Simplified testing procedures may be implemented only after the particular effect is known.

While lumbar kinematics can be measured in vivo, most measurements are invasive (such as percutaneous bone pins), provide high doses of radiation (such as biplane fluoroscopy), or are taken with the patient in a static position (such as MRIs). Recent work suggests that lumbar kinematics can be determined by dynamic measurements of epidermal strain in the lower back. This work aims to develop and examine a method of examining lumbar kinematics via optoelectronic motion capture utilizing skin-mounted markers in the lumbar region. Two studies were performed. One study examined lumbar epidermal strain in 28 asymptomatic subjects during diagnostic movements, while the second study used fresh/frozen cadavers to compare segmental lumbar kinematics as measured by both an optoelectronic motion capture system utilizing skin-mounted markers and an electromagnetic motion capture system utilizing sensors mounted to percutaneous bone pins inserted into the spinous processes. In the first study, participants had a grid-like marker set adhered to their lower back. They were instructed to perform 17 diagnostic movements, with data from three trials of each exercise being captured. Data was analyzed in MATLAB to examine segmental lumbar kinematics. Analysis shows trends consistent with expected movement patterns for asymptomatic individuals with measurement values consistent with those found in previous studies. Trends of symmetry in motion for left versus right motions were observed, as well as a trend for the return motion in a movement to be faster than the outgoing motion. In the second study, three fresh/frozen cadavers were outfitted with electromagnetic motion tracking sensors mounted to bone pins which were placed in the spinous processes of L1-S2. Each cadaver also had a similar grid-like marker set of optical motion tracking markers adhered in the lumbar region. The cadavers were moved through 10 of the same diagnostic exercises with data from seven trials from each exercise being captured. Data was analyzed in MATLAB to compare the end range of motion as measured by the optical system to the same measurements by the electromagnetic system. End ROM values showed statistically different measurements for five of the twelve segment measurements compared. Data collected in this work contributes to the establishment of normative dynamic kinematics of the lumbar spine in the asymptomatic population. It also outlines the strengths and weaknesses of the methodology utilized.

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Yes / In the last 10 years the University of Bradford Library Acquisitions Department has shrunk from 13 members of staff to 5. This has led to us embracing new technology to help streamline workflows within the department. As well as utilising EDI functionality, changing processing workflows and using shelf-ready books, we have devised innovative ways of dealing with everyday tasks. Topics included cover: PDA deduplication; spine labelling on a large scale; the weeding of discarded books; using saved global updates on incoming MARC records and using load profiles innovatively.

Σκοπός: Η προσέγγιση και η αντιμετώπιση των κακώσεων της Αυχενικής Μοίρας της Σπονδυλικής Στήλης (ΑΜΣΣ) εξακολουθεί και σήμερα να παρουσιάζει διαφορές μεταξύ των διαφόρων κέντρων. Κατά καιρούς μάλιστα έχουν προταθεί πλείστοι τρόποι αντιμετώπισης: από συντηρητική με κρανιακή έλξη μέχρι πολύ επιθετική χειρουργική αντιμετώπιση με συνδυασμένες πρόσθιες και οπίσθιες προσπελάσεις. Στόχος της διατριβής ήταν η παρουσίαση της χειρουργικής εμπειρίας της Ορθοπαιδικής Κλινικής του Πανεπιστημίου Πατρών στην αντιμετώπιση των ασθενών αυτών και η ανάλυση των επιπλοκών των διαφόρων μεθόδων σταθεροποίησης. Έγινε προσπάθεια να απαντηθούν τα ακόλουθα ερωτήματα: 1) Ποια πρέπει να είναι σήμερα η διαγνωστική προσέγγιση των ασθενών με κάκωση στην ΑΜΣΣ; 2) Ποιοι ασθενείς χρειάζονται σταθεροποίηση; 3) Τι είδους σταθεροποίηση και ποιες είναι οι επιπλοκές αυτής; Ακολούθως, ποιος πρέπει να είναι ο σύγχρονος αλγόριθμος προσέγγισης των ασθενών με κακώσεις στην ΑΜΣΣ; 4) Ποιες είναι οι μακροχρόνιες επιπτώσεις της σταθεροποίησης; Μεθοδολογία: Εκατόν-δώδεκα ασθενείς με ασταθείς κακώσεις στην ΑΜΣΣ υποβλήθηκαν στην Κλινική μας σε πρόσθια, οπίσθια σταθεροποίηση ή και στις δύο. Ένας ασθενής θεωρούνταν ότι είχε ασταθή κάκωση της ΑΜΣΣ εάν είχε 5 ή παραπάνω βαθμούς με βάση τα κριτήρια αστάθειας των White & Panjabi. Τουλάχιστον ένας χρόνος παρακολούθησης (follow-up) ήταν αναγκαίος για να ενταχθεί ένας ασθενής στη μελέτη, με αποτέλεσμα να επιλεγούν τελικά 97 ασθενείς. Εβδομηντατέσσερις ασθενείς υποβλήθηκαν σε αριστερή προσθιοπλάγια προσπέλαση [Ομάδα Α]. Σε 65 ασθενείς έγινε πρόσθια αποσυμπίεση και τοποθέτηση φλοιοσπογγώδους λαγονίου αυτομοσχεύματος και σταθεροποίηση με πλάκα και βίδες, είτε με πλάκα της AO/ASIF ή με πλάκα CSLP. Στους υπόλοιπους 9 ασθενείς, η αποκατάσταση της σπονδυλικής στήλης περιελάμβανε τη χρήση κλωβού πλέγματος τιτανίου στο οποίο τοποθετούνταν σπογγώδη αυτομοσχεύματα από την περιοχή της σωματεκτομής. Εικοσιτρείς ασθενείς υποβλήθηκαν σε οπίσθια σταθεροποίηση είτε με πλάκες πλαγίων ογκωμάτων (πλάκες Roy-Camille) (19 ασθενείς), ή με πολυαξονικές βίδες (4 ασθενείς) [Ομάδα Β]. Αποτελέσματα – Συμπεράσματα: 1) Εφόσον η κλινική εικόνα ενός ασθενούς με κάκωση στην ΑΜΣΣ επιβάλλει τη διενέργεια αξονικής τομογραφίας, η διερεύνηση μπορεί να γίνει με ασφάλεια με τη χρήση ενός σύγχρονου πολυτομικού αξονικού τομογράφου (MDCT) και μόνο, παραλείποντας τις απλές ακτινογραφίες. 2) Τα κριτήρια αστάθειας των White και Panjabi υπαγορεύουν μια ασταθή κάκωση στην ΑΜΣΣ, η οποία θα πρέπει να αντιμετωπίζεται κατά προτίμηση με χειρουργικό τρόπο. 3) Η στατιστική ανάλυση των αποτελεσμάτων δεν ανέδειξε στατιστικά σημαντικές διαφορές μεταξύ των 2 ομάδων σταθεροποίησης όσον αφορά τις κλινικά σημαντικές επιπλοκές (p=0.26). Ομοίως, οι κλινικά μη σημαντικές επιπλοκές, καθώς και το ποσοστό επανεγχειρήσεων δε διέφεραν στατιστικά μεταξύ των δύο ομάδων (p=0.245 και p=0.475 αντίστοιχα). Ωστόσο, η πρόσθια σταθεροποίηση παρουσιάζει σημαντικά πλεονεκτήματα, μπορεί να αντιμετωπίσει το σύνολο σχεδόν των κακώσεων της ΑΜΣΣ συμπεριλαμβανομένου των εξαρθρημάτων, και μόνο κατ’ εξαίρεση απαιτείται συμπληρωματική σταθεροποίηση. Επιπλέον, η εξέλιξη της μεθόδου βοήθησε στην εξάλειψη επιπλοκών που παρατηρούνταν με τα παλαιότερης τεχνολογίας υλικά. Ως εκ τούτου, οι τρέχουσες ενδείξεις για οπίσθια σταθεροποίηση είναι τα μη ανατασσόμενα εξαρθρήματα, οι κακώσεις πολλαπλών επιπέδων και οι ασθενείς με τραχειοστομία. 4) Η οστεοποίηση των παρακειμένων διαστημάτων στις κακώσεις της ΑΜΣΣ φαίνεται ότι έχει διαφορετική αιτιολογία από αυτή της αυχενικής σπονδύλωσης, μπορεί να εμφανιστεί πολύ πρώιμα στην μετεγχειρητική περίοδο και, ακόμα και όταν είναι εμφανής ακτινολογικά, σπανίως προκαλεί συμπτώματα. / Aim: The diagnostic approach and management of patients with cervical spine injuries differs among various centers. Conservative management with skeletal traction to aggressive surgical treatment with combined anterior and prosterior stabilization are within the possible alternatives. We aimed at presenting the experience from the surgical treatment of these patients gathered in the Department of Orthopaedic Surgery in the University Hospital of Patras. We further analyzed the complications associated with each approach and we tried to answer the following questions: 1) Which is the current diagnostic approach of patients with cervical spine injuries? 2) Which patients should be stabilized? 3) What type the stabilization should be and which are its complications? Moreover, which is the appropriate algorithm in the treatment of these patients? 4) Which are the long-term consequences of the stabilization? Materials & Methods: One hundred and twelve patients with unstable cervical spine injuries underwent anterior, posterior stabilization or both. A patient was considered to have an unstable injury if he had ≥ 5 points in the White and Panjabi checklist. At least one year of follow-up was necessary for a patient to be included in the study, which yielded a total of 97 patients. Seventy-four patients underwent a left-sided anterolateral approach [Group A]. Sixty-five of them had anterior decompression and iliac bone grafting. The remaining 9 patients underwent corpectomy and cervical spine reconstruction with titanium mesh cage, filled with morselized autograft from the corpectomy site. All these patients were instrumented using an anterior cervical plate. Twenty-three patients underwent posterior stabilization, either with lateral mass plates of Roy-Camille (19 patients), or polyaxial screws and rods (4 patients) [Group B], along with concomitant iliac bone autografting. Results – Conclusions: 1) If there is a need for computed tomography (CT) in a patient with cervical spine injury, the diagnostic work-up can be done with safety using only a modern multi-detector CT, obviating the need for plain radiographs. 2) The White and Panjabi criteria imply an unstable injury which should be preferentially stabilized by surgical means. 3) Statistical analysis of the clinically significant complications did not reveal significant difference between the posterior procedures and the anterior ones (p=0.26). Likewise, insignificant complications, as well as reoperation rates did not differ significantly among the two groups (p=0.245 and p=0.475 respectively). However, anterior stabilization for cervical spine injuries presents several advantages, can deal with almost all types of injuries and it only exceptionally requires supplemental stabilization. It should be also stressed that the advances in technology and metallurgy have eliminated the complications observed with older implants. Current indications for posterior stabilization are the irreducible dislocations, multilevel injuries and patients with tracheostomy. 4) Adjacent-level ossification in cervical spine injuries appears to be of different etiology than in cervical spondylosis, it may appear very early in the postoperative period and, even when it is evident radiographically, it very rarely (if ever) produces any symptoms.

Cette étude a été subventionnée par le Fonds de recherche du Québec - Santé (FRQ-S, grant # 21230 – 2) / Les infiltrations foraminales cervicales sont associées à un risque de complications neurologiques majeures. Cette étude compare l’efficacité des infiltrations facettaires, plus sécuritaires, à celle des infiltrations foraminales dans le traitement de la cervico-brachialgie secondaire à une spondylose et/ou à une hernie discale, à 4 semaines post traitement. Cinquante-six sujets ont été randomisés pour recevoir une infiltration foraminale (15 hommes, 13 femmes ; âge moyen 52 ans) ou facettaire (8 hommes, 20 femmes ; âge moyen 44 ans). L’issue principale était l’intensité de la douleur mesurée sur une échelle visuelle analogique (0 – 100). Les issues secondaires étaient le Neck Disability Index et le Medication Quantitative Scale. Suivant les analyses en intention-de-traiter et en intention-du-protocole, pour un score de douleur initial moyen, une réduction significative de l’intensité de la douleur a été observée avec les infiltrations facettaires [45.3% (95%CI: 21.4; 69.2) et 37.0% (95%CI: 9.2; 64.7)] contrairement aux infiltrations foraminales [9.8% (95%CI: +11.5; 31.2) et 17.8% (95%CI: +6.6; 42.2)]. Les infiltrations facettaires ont procuré une amélioration cliniquement (mais non statistiquement) significative du Neck Disability Index [24.3% (95%CI: +2.9; 51.5) et 20.7% (95%CI: +6.2; 47.6),], contrairement aux infiltrations foraminales [9.6% (95%CI: +15.2; 34.4) et 12.8% (95%CI: +11.2; 36.7)]. Les infiltrations facettaires étaient au moins aussi efficaces que les infiltrations foraminales pour un score initial de douleur ≤ 60, alors que l’analyse de non infériorité n’était pas concluante pour un score initial ≥ 80, de même que pour le Neck Disability Index. Les infiltrations n’ont pas été associées à une réduction du score de Medication Quantitative Scale. Les infiltrations facettaires sont efficaces dans le traitement de la névralgie cervico-brachiale et représentent une alternative valable et plus sécuritaire aux infiltrations foraminales. / Transforaminal corticosteroid injections can be performed in the management of cervical radiculopathy but carry the risk of catastrophic complications. This study compares the efficacy of transforaminal and facet corticosteroid injections at 4 weeks post treatment. We randomly assigned 56 subjects to receive CT-guided transforaminal (15 men, 13 women; mean age 52 years; range 28 – 72 years) or facet (8 men, 20 women; mean 44 years; range 26 – 60 years) injections. The primary outcome was pain severity rated on a visual analog scale (0-100). Secondary outcome measures were the Neck Disability Index and the Medication Quantitative Scale. In the intention-to-treat and as-treated analyses, for a mean baseline score, facet injections demonstrated a significant pain score reduction of 45.3% (95%CI: 21.4; 69.2) and 37.0% (95%CI: 9.2; 64.7), while transforaminal injections showed nonsignificant pain score reduction of 9.8% (95%CI: +11.5; 31.2) and 17.8% (95%CI: +6.6; 42.2). While facet injections demonstrated an improvement in Neck Disability Index score of [24.3% (95%CI: +2.9; 51.5); 20.7% (95%CI: +6.2; 47.6),] as opposed to transforaminal injections [9.6% (95%CI: +15.2; 34.4); 12.8% (95%CI: +11.2; 36.7)], the results did not reach statistical significance. Noninferiority of facet to transforaminal injections was demonstrated for baseline pain score ≤ 60, while noninferiority analysis was inconclusive for baseline pain score ≥ 80 and for the Neck Disability Index score. Neither intervention showed a significant medication intake score reduction over time. Facet injections are effective for the treatment of cervical radiculopathy and represent a valid and safer alternative to transforaminal injections.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xii, 72, Annexures 1-10, [19] leaves / The purpose of this research was to conduct a descriptive study of cervical cases recorded at the Durban University of Technology Chiropractic Day Clinic from 1995 to 2005 as there is a paucity of information on the recorded cases of neck pain in South Africa.

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / The relationship between TMD and dysfunction in the cervical spine has been reported in the literature and there are many case studies which have shown favourable results when treatment was aimed at the TMJ, cervical spine relationship. However, the numerous TMD treatment protocols described in the literature concerning this relationship, and the effectiveness of these treatments have not been well established. In spite of this many chiropractors treat TMD. TMD is a multifactoral condition and conservative treatment options need to be further investigated in order to determine if manual interventions directed at the cercival spine in the treatment of TMD are beneficial. Objectives: The purpose of this study was to compare myofascial trigger point therapy and manipulative therapy of either the TMJ, cervical spine or a combination of the two in order to determine their effectiveness for the TMD. Method: Thirty participants with TMD were randomly assigned to one of three treatment groups. Participants in each group received two treatments per week for two weeks with a follow up consultation in the third week. Data were collected before the commencement of the first, second, and fourth treatments and at the follow up consultation. Outcome measures included algometer readings, CROM, Mouth opening readings, NRS and a disability questionnaire. SPSS version 15.0 was used for analysis of the data. A p value <0.05 was considered as statistically significant. Multivariate testing was used for intra- and inter-group comparisons. Profile plots were generated to assess the direction and trend of the effect and to visually compare the trends in the different treatment groups. Results: Inter-group comparisons did not reveal any statistically significant different improvements between the three treatment groups. Conclusion: All groups responded favourably to treatment and showed trends towards improvement. However, statistically analysis revealed that no one treatment protocol was superior to the other. Although no definitive inferences may be drawn regarding the effectiveness of each treatment approach, within group trends indicated that the combination of the two treatment approaches may be preferred.