Search Results (122)

The internal branch of the superior laryngeal nerve (IbSLN) plays a critical role in the sensory innervation of the supraglottic larynx. It is essential for protective reflexes such as coughing and swallowing. This nerve is frequently at risk during surgeries involving the cervical region, including thyroidectomy, carotid endarterectomy, and anterior cervical spine procedures. Injury to the IbSLN may lead to postoperative complications. A comprehensive review of the morphological and topographic characteristics of the IbSLN is presented, focusing on its anatomical course, relationships with key vascular structures, branching patterns, and clinically significant variations. Full article

Background/Objectives: Equestrian activities can result in spine injuries. Most studies are from single centers, and none use a national database. It was the purpose of this study to describe the demographics, injury mechanisms, and types of equestrian-associated spinal injuries using a US national ED database. Methods: The National Electronic Injury Surveillance System database was queried for equestrian-related spine injuries from 2000–2023. ED disposition was categorized as discharged or not discharged. Statistical analyses accounted for the weighted, stratified nature of the data to obtain national estimates. Results: There were an estimated 54,830 patients, having an average age of 42 years. Most were female (73.6%) and White (93.7%); one-half (51.1%) were not discharged from the ED. The spine level was the lumbar (49.1%), thoracic (24.4%), sacrococcygeal (15.5%), and cervical (11.0%) spine. Multiple spine fractures occurred in 4.0%. A simple fall off a horse occurred in 53.6% of the injuries, and the patient was bucked/thrown/kicked off the horse in 39.7%. Neurologic injury was rare (1.8%). Hospital admission was highest in the cervical group (74.3%) and lowest in the sacrococcygeal group (33.5%). The cervical group had the highest percentage of males (43.7%) compared to the thoracic, lumbar, and sacrococcygeal groups (22.8%, 27.3%, 16.8%, respectively). There were proportionally fewer females in those over 50 years of age, where the male percentage was 11.7%, 25.6%, and 31.6% for those <18 years, 18–50 years, and >50 years old, respectively. Conclusions: This large study can be used as baseline data to evaluate further changes in equestrian injuries, especially the impact of further prevention strategies, education protocols, and legislative/governmental regulations of public equestrian localities. Full article

This study investigates occupant kinematic and injury responses in zero-gravity seats under rear impacts at 16 km/h, 40 km/h, and 56 km/h and evaluates the protective performance of a conventional three-point seat belt system and a four-point seat belt system. First, a THUMS (Total Human Model for Safety)-based finite element assembly consisting of a regular seat model and a conventional three-point seat belt system was verified by comparing the kinematic responses and time-history curves of head acceleration, head rotation, and the T1 acceleration of PMHS (Postmortem Human Subject) tests. Then, a THUMS-based finite element assembly in a zero-gravity seat with a three-point seat belt system was created, and computational biomechanical analyses revealed that at low-to-medium impact speeds (16 and 40 km/h), the occupant exhibited backward sliding in the zero-gravity seat along the seatback with lower limb rotation and did not experience head and neck injury. However, a 56 km/h impact induced an excessive seatback rotation and caused the head to become out of position. The neck collided with the upper part of the headrest and caused a surge in the contact force between the neck and the headrest. The head injury and neck injury were comprehensively analyzed via the head injury metrics and neck injury metrics, including cervical spine injury metrics and cervical ligament injury metrics. Further, a four-point seat belt system was adopted and demonstrated better and more balanced restraining effects by reducing the relative displacement between the occupant’s head and chest in the x- and y-directions by 26% and 84%, respectively. Therefore, the occupant’s head remains in position and the collision between the neck and the headrest can be avoided. Maximum reductions in the head and neck injury metrics reached 70% and 57%, respectively. The current study illustrates the disadvantages of the traditional three-point seat belt system in restraining the occupant in a zero-gravity seat under rear impact and shows the four-point seat belt to be a better alternative. This study sheds light on seat belt system design and optimization towards future zero-gravity seats under rear impact. Full article

The human neck is highly vulnerable in motor vehicle crashes, and cervical spine response data are essential to improve injury prediction tools (e.g., crash test dummies, human body models). This feasibility study aimed to implement the use of pressure sensors in whole-body post-mortem human subject (PMHS) cervical spine intervertebral discs (IVDs) to confirm the feasibility and repeatability of cervical IVD pressure response to biomechanic research. Two fresh frozen whole-body PMHSs were instrumented with miniature pressure sensors (Model 060S, Precision Measurement Company, Ann Arbor, MI, USA) at three cervical IVD levels (C3/C4, C5/C6, and C7/T1) using minimally invasive surgical insertion techniques. Each PMHS underwent three quasistatic motion test trials, and each trial included multiple head/neck motions (i.e., gentle traction, flexion/extension, lateral bending, axial rotation, and forced tension/compression). Results showed marked pressure differences between both the cervical level assessed and the motion undertaken as well as successful intra-subject repeatability between the three motion trials. This study demonstrates that changes in cervical IVD pressure are associated with motion events of the cervical spine. Cervical IVD response data could be utilized to assess and supplement the characterization of the head/neck complex motion, and data could facilitate the continued improvement of injury prediction tools. Full article

Background: Recreational participation in Mixed Martial Arts (MMA) has rapidly increased. Despite consistent evidence of a high injury prevalence in MMA athletes, the neuromuscular implications of regular MMA training remain underexplored. The cervical spine is particularly vulnerable to trauma due to repetitive impacts and high mechanical demands in combat sports. Methods: This case-control study compared cervical spine function and self-reported symptoms between 25 recreational MMA athletes and 25 matched individuals who engaged in general fitness training. Outcome measures included Neck Disability Index (NDI), Post-Concussion Symptom Scale (PCSS), pain and headache reports, cervical range of motion (ROM), proprioception, isometric strength, and endurance. Multivariate logistic regression analysis was used to identify the predictors of group classification. Results: The MMA group exhibited significantly higher values for post-concussion symptoms (p = 0.012), cervical flexor endurance (p = 0.031), and the number of concussions (p = 0.001) but lower flexion ROM (p = 0.031). No significant differences were observed in strength, proprioception, or NDI scores. Logistic regression identified the number of concussions, age, total cervical ROM, and average rotation strength as significant predictors of group membership (model AUC = 0.96; Nagelkerke R² = 0.797). Conclusions: Recreational MMA athletes demonstrated higher rates of concussion-related symptoms and reduced cervical flexion ROM than noncontact exercisers despite no statistically significant differences in strength and proprioception. These findings suggest that cumulative exposure to amateur MMA is associated with alterations in cervical neuromuscular characteristics. These results support the implementation of targeted mobility, endurance, and injury prevention programs in recreational MMA training. Full article

Diffuse alveolar hemorrhage (DAH), a catastrophic complication of connective tissue disorders (CTDs), manifests as rapid-onset hypoxemia, alveolar infiltrates, and progressive bleeding into the airways. While immune-mediated alveolar–endothelial injury primarily drives its pathophysiology, diagnosis is based on bronchoscopy and chest imaging. The clinical urgency lies in securing the compromised airway and stabilizing respiratory failure, a challenge increased by CTD-specific anatomical alterations such as cervical spine instability, cricoarytenoid arthritis, and subglottic stenosis. High-dose corticosteroids and immunosuppression are essential, while severe cases require extracorporeal membrane oxygenation or plasmapheresis. This comprehensive review introduces two novel approaches to address fundamental gaps in the management of CTD-induced DAH: a structured algorithm for a CTD-specific airway risk stratification tool, integrating anatomical screening and the application of lung ultrasounds (LUSs) for post-intubation CTD-induced DAH ventilation management. The need for a multidisciplinary team approach is also discussed. Despite aggressive care, mortality remains high (25–50%), underscoring the necessity for improved early recognition and intervention strategies for these high-risk patients. Full article

Postoperative infection following anterior cervical spine surgery, particularly when complicated by esophageal injury, is a rare but serious condition associated with significant morbidity and mortality. This review elucidates the complex interplay between postoperative infection and esophageal injury. We systematically analyzed studies from 2000 to 2025 using PubMed, Scopus, and Web of Science, focusing on infection, esophageal injury, surgical outcomes, and management strategies, with emphasis on recent advances in diagnostics, surgical techniques, and postoperative care. Our findings highlight the multifactorial nature of these complications and the critical role of early recognition, accurate diagnosis, and timely management. Imaging modalities such as CT, MRI, and contrast esophagography, along with flexible esophagoscopy, are indispensable in assessing injury and infection extent. Effective management requires a multidisciplinary approach integrating broad-spectrum antibiotics, surgical debridement, vascularized flap reinforcement, negative pressure wound therapy, and antibiotic-loaded cement beads. Meticulous postoperative care with prolonged antibiotics, nutritional support, and imaging follow-up is vital for optimizing outcomes. Innovative approaches, including vascularized muscle flaps and hyperbaric oxygen therapy, show promise in enhancing healing and reducing infections. Our review underscores the need for future meta-analyses to strengthen evidence and refine protocols. As surgical techniques evolve, so too must our diagnostic, surgical, and postoperative strategies to minimize complications and improve patient outcomes. Full article

Background/Objectives: Soccer players, particularly females, exhibit an increased risk of both concussions and Anterior Cruciate Ligament (ACL) injuries. Emerging evidence suggests that neurcognitive deficits following concussions may impair neuromuscular control, increasing ACL injury susceptibility. This study aims to explore the interplay between concussions, neuromuscular deficits, and ACL injury risk, while proposing targeted prevention strategies. Methods: A comprehensive review of current literature was conducted to analyze the biomechanical and neurophysiological impact of concussions on ACL injury risk. Key areas investigated include the effect of sub-concussive impacts on proprioception, reaction time, and postural stability, as well as sex-based differences in injury susceptibility. Results: Findings indicate that post-concussion neuromuscular impairments—such as altered proprioception, delayed reaction times, and compromised joint stability—heighten ACL injury risk. Female athletes, due to biomechanical and hormonal factors, are particularly vulnerable. Preventive measures, including neuromuscular training, cervical spine strengthening, and optimized return-to-play protocols, are essential to mitigate these risks. Conclusions: Longitudinal research is needed to further elucidate the connection between head trauma and ACL injuries. Implementing evidence-based interventions and policy changes, such as modifying heading exposure in youth athletes, may enhance player safety and reduce long-term injury burden in female soccer players. Full article

Vertebral artery injury (VAI) is a known complication of blunt cervical spine trauma with a potential risk of stroke. Factors including cervical bony injury, spinal cord injury, and overall trauma severity have been linked to an increased risk of VAI. Despite its prevalence, there is little consensus on various aspects of this pathology, including its initial screening, diagnostic approaches, and therapeutic strategies. A recent systematic review and meta-analysis from our group highlighted the dynamic nature of vertebral artery occlusion, revealing the underrecognized recanalization rates and potential stroke risks associated with delayed recanalization. While anticoagulant and/or antiplatelet therapy (ACAP) remains the cornerstone of VAI management, treatment is often complicated by co-existing injuries, such as intracranial hemorrhage or cervical trauma, which may preclude or delay ACAP usage or necessitate surgical intervention. This comprehensive narrative review synthesizes the latest evidence on VAI and associated ischemic sequelae, with the goal of elucidating its pathophysiology and natural history, summarizing current data on screening and diagnosis, and exploring key considerations for medical and endovascular management. Full article

Minimal facet and lateral mass fractures of the subaxial cervical spine (C3–C7) are a distinct subset of spinal injuries that present diagnostic and therapeutic challenges. These fractures often result from low-energy trauma or hyperextension mechanisms. They are frequently stable. However, subtle fracture instability and associated soft tissue injuries may lead to delayed instability, neurological compromise, and/or chronic severe pain if not properly identified. Accurate diagnosis relies on a combination of plain radiography, high-resolution computed tomography (CT), and magnetic resonance imaging (MRI) to assess bony and ligamentous integrity. Treatment strategy is determined based on fracture stability, neurological status, and radiographic findings. Most stable fractures can be effectively treated with conservative treatment, allowing for natural healing while minimizing complications. However, when instability is suspected—such as those with significant disc and ligamentous injuries, progressive deformity, or neurological deficits—surgical stabilization may be considered. The presence of vertebral artery injury (VAI) can further complicate management. To mitigate the risk of stroke, a multidisciplinary approach that includes neurosurgery, vascular surgery, and interventional radiology is needed. Surgical treatment aims to restore spinal alignment, maintain stability, and prevent further neurological deterioration with approaches tailored to individual fracture patterns and patient-specific factors. Advances in surgical techniques, perioperative management, and endovascular interventions for VAI continue refining treatment options to improve clinical outcomes while minimizing complications. Despite increasing knowledge of these fractures and associated vascular injuries, optimal treatment strategies remain unclear due to limited high-quality evidence. This review provides a comprehensive analysis of the anatomy, biomechanics, classification, imaging modalities, and treatment strategies for minimal facet and lateral mass fractures in the subaxial cervical spine, highlighting recent advancements in diagnostic tools, therapeutic approaches, and managing vertebral artery injuries. A more precise understanding of the natural history and optimal management of these injuries will help spine specialists refine clinical decision-making and improve patient outcomes. Full article

Whiplash injuries (WLs) are the most frequent cause of emergency room visits after motor vehicle collisions. In clinical practice, massage, electrotherapy, mobilization, or therapeutic exercise are used. As part of manual therapy, high-velocity, low-amplitude manipulative techniques can also be used. Objectives: To evaluate the effect of the cervical Specific Adjustment Technique (SAT) in adults affected by whiplash on pain, functionality, cervical mobility, and radiological changes in cervical curvature through a prospective, single-blind, randomized clinical trial. Methods: One hundred and nineteen patients with grade II acute WL were randomly assigned to either the manipulation group (MAN group = 59) or the rehabilitation group (RHB group = 60) to receive 3 or 20 sessions of treatment, respectively. Both groups were measured at baseline and 15, 30, and 120 days after starting treatment. Results: Statistically significant differences were found in the MAN group in flexion (p = 0.041) and left-side bending (p = 0.022); similar statistical values were found in the other measures. According to the interaction treatment-time effect, statistical significance for the Cobb angle was obtained in the MAN group (p = 0.047). Conclusions: the effects of SAT were comparable in terms of pain, functionality, and mobility of the cervical spine. Although further research is needed on its effects in the acute phase, due to its effectiveness and lower associated cost, SAT could be considered a useful technique, at least during the first 3 months after a traffic collision. Full article

Vertebral fracture (VF) may induce spinal cord injury that can lead to serious consequences which eventually may paralyze the entire or some parts of the body depending on the location and severity of the injury. Diagnosis of VFs is crucial at the initial stage, which may be challenging because of the subtle features, noise, and homogeneity present in the computed tomography (CT) images. In this study, Wide ResNet-40, DenseNet-121, and EfficientNet-B7 are chosen, fine-tuned, and used as base models, and a Bayesian-based probabilistic ensemble learning method is proposed for fracture detection in cervical spine CT images. The proposed method considers the prediction’s uncertainty of the base models and combines the predictions obtained from them, to improve the overall performance significantly. This method assigns weights to the base learners, based on their performance and confidence about the prediction. To increase the robustness of the proposed model, custom data augmentation techniques are performed in the preprocessing step. This work utilizes 15,123 CT images from the RSNA-2022 C-spine fracture detection challenge and demonstrates superior performance compared to the individual base learners, and the other existing conventional ensemble methods. The proposed model also outperforms the best state-of-the-art (SOTA) model by 1.62%, 0.51%, and 1.29% in terms of accuracy, specificity, and sensitivity, respectively; furthermore, the AUC score of the best SOTA model is lagging by 5%. The overall accuracy, specificity, sensitivity, and F1-score of the proposed model are 94.62%, 93.51%, 95.29%, and 93.16%, respectively. Full article

Background: The dorsal scapular nerve (DSN) and the long thoracic nerve (LTN) exhibit variable anatomical pathways, which may contribute to upper back pain and impaired scapular movement in affected patients. This study investigates these variations to enhance clinicians’ diagnostic and surgical approaches. Methods: The bilateral cervical regions of 32 formalin-embalmed donors (64 sides) were dissected to document the origin of the DSN, the relationship with the scalene muscles of the DSN, and anatomical connections between the DSN and LTN. Measurements of the distance between the mastoid process and the piercing point of the DSN to the scalene muscle were obtained with digital calipers. Additional measurements were obtained from the medial border of the scapula at two specific locations: the scapular spine (zone 1) and the midpoint between the scapular spine and the inferior angle of the scapula (zone 2). Results: The DSN demonstrated four distinct cervical spinal nerve root origins and five unique scalene muscle piercing patterns. The average distance between the DSNs’ scalene muscle piercing point and the mastoid process was 94.87 ± 10.09 mm, with significantly greater distances observed in male donors compared to female donors (p < 0.001). Connections between the DSN and LTN were identified in 65.2% of the examined cervical regions. The mean distance of the DSN from the medial border of the scapula at zone 2 was significantly greater than at zone 1 (p < 0.001). Conclusions: The anatomical variation findings and classification of the DSN provide valuable insights, offering guidance for conducting clinical procedures of the scalene and rhomboid musculature in a way that minimizes the risk of iatrogenic injury. The documented variations may also assist in the diagnosis and management of DSN-related pathologies such as DSN neuropathy. Full article

Corpectomy is the surgical procedure of resecting a vertebral body or a part of it in order to decompress neural structures. Corpectomy is performed in patients with degenerative disease or cancer and following injury to the spine. We present a case of multilevel corpectomy in a female patient with massive degenerative disease associated with rheumatoid arthritis, combined with cervical myelopathy and osteoporosis. We present the case of a female patient who underwent C4-C5-C6 corpectomy and spinal stabilisation with a Cervical 3D Expandable cage and a cervical plate attached to the C3-C7 bodies. The rheumatoid arthritis caused degenerative changes, which, combined with the impact of environmental conditions and the patient’s postural defects, led to a pathological profile of the spine along the vertical and transverse axis, manifesting clinically as a cervical myelopathy with its characteristic neurological symptoms. Pre-operative imaging studies revealed a critical stenosis of the spinal canal. This report showcases an effective surgical technique for severe degenerative disease bearing an increased risk of tetraplegia that could be brought on by even a minor injury to the cervical spine in the presence of this kind of pathology. Multilevel cervical corpectomy can be an effective method for treating spinal canal stenosis to prevent the onset of neurological deficits. This procedure requires careful diagnostic work-up, surgical planning and an interdisciplinary approach, especially in patients with co-morbidities. Full article

Background/Objectives: Many patients evaluated by shoulder specialists suffer from intractable pain, neuropathy, and weakness. The pectoralis minor (PM) remains the only scapula muscle to receive lower trunk (C8-T1) input. We propose a novel syndrome: the Human Disharmony Loop. This model portrays how this unique PM innervation causes scapular dyskinesia, which deranges the anatomy of the upper limb girdle and produces a refractory symptom complex of pain, neuropathy, and weakness. We hypothesize that certain patients with historically intractable symptoms of the upper limb girdle may benefit from PM tenotomy. Methods: Ten patients of diverse etiologies presented with a similar constellation of complaints. The patients included a female athlete, a female with macromastia, a male bodybuilder, and patients with post-radiation breast cancer, post-operative shoulder arthroplasty, interscalene block injury, cervical spine disease, persistent impingement after rotator cuff repair, direct traction injury, and occupational disorder. All patients exhibited coracoid tenderness, scapula protraction with internal rotation and anterior tilt, and pain involving the neck, shoulder, and upper back. The patients demonstrated varying degrees of arm neuropathy, subacromial impingement, and occipital headaches. The patients failed all prior treatments by multiple subspecialists, including surgery. Each patient underwent isolated open PM tenotomy. Results: In all ten patients, PM tenotomy substantially reduced shoulder, upper back, and neck pain, cleared concomitant neuropathy, restored full motion, and eradicated occipital headaches. The response to surgery was rapid, dramatic, and durable. Conclusions: The unique asymmetric neurologic innervation to the sole ventral stabilizer of the scapula, the pectoralis minor, predisposes the human shoulder to neurologic and musculoskeletal imbalance. This produces the Human Disharmony Loop: a clinical syndrome spanning from the neck to the fingertips, with chronic pain, neuropathy, and weakness. These challenging patients may benefit dramatically from isolated PM tenotomy. Full article