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Sternal Occipital Mandibular Immobilization Brace

August 15, 2010 By Dr Arun Pal Singh Leave a Comment

Image Credit: http://www.ketteringsurgical.co.uk/orthopaedics/orthotic-cervical-co/somi-brace-sternal-occipital-mandibular-immobilizer.71437.htm

The sterno-occipital-mandibular immobilizer (SOMI) cervical orthosis is a rigid cervico thoracic orthosis  used for supporting the ervical spine . SOMI does not provide complete immobilization though. It is somewhere between a Philadelphia collar and a halo brace.

Structurally, it has a chest plate that goes up to the notch where the collarbones meet in the front and metal, aluminum, or plastic bars that curve over the shoulder.

Straps from the bars go over the shoulder and cross to the opposite side of the anterior plate to hold it in place.

A removable chin piece attaches to the chest plate with an optional headpiece that can be used when the chin piece is removed for eating.

The SOMI works well to control flexion of the upper cervical spine (C1-3). It does not control extension that well.

The SOMI is used to immobilize an unstable neck due to fracture or ligamentous injury or disruption.

Popularity: 12% [?]

Filed Under: Cervical Spine, Definitions, S-Z, Traction-Aids-Appliances Tagged With: cervical spine mobilization, SOMI brace, Sterno occipital mandibular immobilizer

Minerva Brace

August 14, 2010 By Dr Arun Pal Singh Leave a Comment

Minerva Brace

Image Credit: mattle.ch/upload/Minerva.jpg

The Minerva brace is a cervical and upper thoracic orthosis. It provides good orthotic control of the neck. There are many instances where Minerva brce can be used. For example severe whiplash injury or fracture of the vertebra or lower cervical fusion.

The Minerva orthosis has a rigid plastic posterior section that goes from the base of the skull down to the midtrunk. There is a solid chest piece in the front that is attached to the back along the sides with Velcro straps that can be adjusted.

Popularity: 12% [?]

Filed Under: Cervical Spine, Definitions, I-M, Traction-Aids-Appliances Tagged With: cervicothoracic orthoses, Minerva brace, rigid cervical immobilisation

Fractures to the Axis Vertebra

August 3, 2010 By Dr Arun Pal Singh Leave a Comment

The axis vertebra has unique anatomy and despite  fractures to the odontoid or pars interarticularis, is subject to a variety of injuries similar to those found in the lower cervical spine. Several basic fracture types are recognized and can be divided  into distinct categories

Type I

The fractures resemble an extension-type teardrop fracture of the inferior anterior end plate. These fractures are usually stable.

Type II

Fractures are characterized by hear fracture line through the C-2 vertebral body that runs horizontally.

Type III

It is a burst fracture of  C-2 vertebral body.

Type IV

These fractures are sagittal cleavage fractures are usually be highly unstable.

Treatment

Stable fractures can be treated by conservative means but unstable fractures would require operative treatment.

Popularity: 9% [?]

Filed Under: Cervical Spine, Spine Injuries Tagged With: Axis body fractures, C2 fractures, fractures C2

Cervical Injuries of the Ankylosed and Spondylotic Spine

July 31, 2010 By Dr Arun Pal Singh Leave a Comment

Patients with ankylosed and spondylotic spine can suffer cervical injury even after minor trauma. Therefore, the patients who present with neck pain or neurologic deficit after major or minor trauma should be considered to have a cervical spine injury until proven otherwise.

Degenerative spondylotic changes, such as vertebral body osteophytes, fixed subluxations, and facet hypertrophy can make plain films difficult to interpret. Therefore unless the injury is severe, the plain x-rays may not be helpful in detecting a level of injury. [Read more...]

Popularity: 9% [?]

Filed Under: Cervical Spine, Spine Injuries Tagged With: ankylosing spondylitis and cervical injury, cervical injury, cervical stiffness

Complications of Cervical Spine Surgery

June 25, 2010 By Dr Arun Pal Singh Leave a Comment

Cervical spine surgery is a major surgical procedure and like every other surgical procedure has potential for complications. Te complications can be related to injury or type of surgery performed.

Postoperative Complications

Neurologic Deficit

Neurological deficit is most devastating complication of spine surgery.   The cause could be an intraoperative event such as a direct spinal cord injury, posterior strut or graft displacement. Otherwise failure of the construct could be responsible.

A detailed examination is the key  to identification of the problem and it should follow with plain radiographs. [Read more...]

Popularity: 8% [?]

Filed Under: Cervical Spine Tagged With: cervical injuries, cervical spine injury, neck injuries, neurological deficit after cervical surgery, postoperative complications in spine surgery

Dislocation of C6-C7 Vertebra – Xray

June 15, 2010 By Dr Arun Pal Singh Leave a Comment

38 years old man suffered trauma to neck when a pole fell on him while he was working on his tube well. He developed sudden onset weakness in all the four limbs.

He reported to casualty about 2 hours after the injury and found to have quadriparesis [weakness in all four limbs] with grade 2 power in all the limbs along with numbness below sternum.

Xray revealed unifacetal dislocation of sixth cervical vertebra over seventh cervical vertebra.

MRI revealed C6-c7 disc impinging upon the cord. The patient was given injection solumedrol for 24 hours and was taken for anterior decompression, cervical plating and bone grafting.

This xray is one month postoperative and the patient has shown good recovery. He has 3+ power in all the limbs and is free of catheter.

Popularity: 11% [?]

Filed Under: Cervical Spine, Musculoskeletal Radiology, Orthopaedic Images, Spine Injuries Tagged With: anterior cervical plating, cervical dislocation, cervical fusion, cervical injury

What Is Basilar Impression?

June 4, 2010 By Dr Arun Pal Singh Leave a Comment

Basilar impression is an abnormality where the skull floor is indented by the upper cervical spine. The tip of the dens is more cephalad [towards head] and sometimes protrudes into the opening of the foramen magnum. This may cause brainstem encroachment and then risk neurologic damage from direct injury, vascular compromise, or cerebrospinal fluid flow alteration.

There are two types of basilar impression

  • Primary
  • Secondary

Primary basilar impression is a congenital abnormality often associated with other vertebral defects  like Klippel-Feil syndrome, odontoid abnormalities, atlanto-occipital fusion, and atlas hypoplasia. Primary basilar impression is found in 1% of the general population. [Read more...]

Popularity: 8% [?]

Filed Under: Cervical Spine Tagged With: basilar impression, cervical pain, cervical spine abnormality, odontoid excision

What Is Os Odontoideum

June 3, 2010 By Dr Arun Pal Singh Leave a Comment

Os odontoideum is an anomaly where the tip of the odontoid process is divided by a wide transverse gap. This leaves the apical segment without its basilar support.

This anomaly is very rare and  the exact incidence is unknown. While the exact etiology is not understood, it most likely represents an unrecognized fracture at the base of the odontoid or damage to the epiphyseal plate during the first few years of life.

Either of these can compromise the blood supply to the developing odontoid, resulting in the os odontoideum.

However another school of thought considers it  a congenital anomaly.

Presentation

These children usually present with local neck pain, and occasionally transitory episodes of paresis [weakness of limbs], myelopathy, or cerebral-brainstem ischemia due to vertebral artery compression from the upper cervical instability.

Sudden death can occur, but  is rare.

The neurologic symptoms are due to cord compression from posterior translation of the os into the cord in extension, or the odontoid into the cord in flexion. Increased motion at the C-1 to C-2 level can lead to vertebral artery occlusion ischemia of the
brainstem and posterior fossa structures, resulting in seizures, syncope, vertigo, and visual disturbances.

The long-term natural history is unknown.

Radiology

On radiographs,  an os odontoideum is seen as an oval or round ossicle with a smooth sclerotic border located in the position of the normal odontoid tip. the size is variable.

There are three radiographic types of os odontoideum

  • round
  • Cone
  • Blunt tooth

The base of the dens is usually hypoplastic. It is often difficult to differentiate an os odontoideum from nonunion following a fracture.

CT scans are useful to further delineate the bony anatomy. Fllexion-extension lateral radiographs are useful to assess instability.

Popularity: 8% [?]

Filed Under: Cervical Spine Tagged With: odontoid anomaly. upper cervical spine anomalies, Os odontoideum

Transverse Foramen Fractures And Vertebral Artery Injury

May 11, 2010 By Dr Arun Pal Singh Leave a Comment

Transverse foramen fractures in cervical spine can cause injury to vertebral artery. It can occur as a result of  occlusion, laceration, or distractive avulsion of the artery.

The incidence of vertebral artery injury following lower cervical spine trauma has been reported to be as high as 46%.

Transverse  foramen fractures have been associated with facet dislocations, facet fractures with translation, and transverse foramen fractures .

Majority of injuries are unilateral.

Diagnosis

Detection of the injury can has  important influences on overall decision making.

An xray would raise the suspicion of transverse foramen fracture. MR arteriograms are an effective means of noninvasive diagnosis of vertebral artery occlusion or narrowing following cervical trauma.

Arteriography is another option.

Bilateral vertebral artery injuries can be devastating, leading to cerebellar infarction.

Treatment

The vast majority of injuries are unilateral, which have a very low rate of clinical sequelae. In most cases, no specific treatment is necessary.

However, the presence of arterial injury does affect the treatment decision of the fracture.

Popularity: 7% [?]

Filed Under: Cervical Spine, Spine Injuries Tagged With: transverse foramen, vertebral artery

C7 Spinous Process Avulsion Fracture Or Clay Shoveler’s Fractures

May 10, 2010 By Dr Arun Pal Singh Leave a Comment

Fractures of the  spinous process fractures are usually benign injuries. Clay shoveler’s fracture is thought to occur from powerful contraction of the muscles that insert onto the spinous process.

Otherwise also the  spinous process fractures can be present with lamina fractures, facet dislocations, and various other injuries to the cervical spine.

Clay shoveler’s fracture is  type of hyperflexion avulsion injury  that causes fractures of spinous process at base. Most commonly they occur at C7 level followed by C6 and T1.

[Read more...]

Popularity: 16% [?]

Filed Under: Cervical Spine, Spine Injuries Tagged With: avuslsion fracture of cervical spine vertebra, C7 spinous process, clay shoveler fracture
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