Biomechanical contribution of the alar ligaments to upper cervical stability

Tisherman, Robert; Hartman, Robert A.; Hariharan, Kharthik; Vaudreuil, Nicholas J.; Sowa, Gwendolyn; Schneider, Michael J.; Timko, Michael; Bell, Kevin

doi:10.1016/j.jbiomech.2019.109508

Cited by 5 publications

(15 citation statements)

References 30 publications

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“…34 After unilateral alar ligament transection (right side), the increased mobility observed herein (Table 2) is consistent with the hypermobility described in other studies. 4,6,27,28 Increased ranges of flexion-extension at C0-C2 after unilateral alar ligament transection have been previously reported. 6,29 Panjabi et al 28 reported an increased flexion at C0-C1 and C1-C2 but an increased extension only at C1-C2.…”

Section: Discussionmentioning

confidence: 82%

“…4,6,27,28 Increased ranges of flexion-extension at C0-C2 after unilateral alar ligament transection have been previously reported. 6,29 Panjabi et al 28 reported an increased flexion at C0-C1 and C1-C2 but an increased extension only at C1-C2. Our results differ from this observation.…”

Section: Discussionmentioning

confidence: 82%

“…In some alar ligament studies, C3 has also been included. 4,6,28 Notably, the stiffness of the alar ligaments varies with the extension rate. 23 Some studies have applied a continuous torque, while others applied a load in an incremental manner, which influences the mechanical behavior: Continuous loading leads to smaller ROM.…”

Section: Discussionmentioning

confidence: 99%

“…Sometimes, both sides are combined when reporting alar ligament transection, and this may complicate the kinematic analysis. 6 For this reason, our left and right side values were provided separately.…”

Section: Discussionmentioning

confidence: 99%

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Intersegmental Kinematics of the Upper Cervical Spine

Lorente

Hidalgo-García

Rodríguez-Sanz

et al. 2021

Spine

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Study Design. Biomechanical study using cadaveric cervical spines. Objective. To evaluate joint mobility and stiffness at the craniovertebral junction. Summary of Background Data. Data on the intersegmental kinematics of the craniovertebral joints are available in the literature with a widespread range of values. The effect that alar ligament injuries have on intersegmental kinematics remains unclear and requires further biomechanical investigation. Methods. Ten occipito-atlanto-axial (C0-C1-C2) human specimens were articulated to flexion, extension, bilateral lateral bending, and bilateral axial rotation. The moment-rotation response was continuously tracked through the entire range of motion before and after unilateral alar ligament transection of the right side.Results. The intersegmental (C0-C1/C1-C2) moment-rotation response was continuously quantified in full flexion (7.2 AE 6.68/ 12.1 AE 5.88), extension (11.1 AE 6.48/3.0 AE 2.88), lateral bending to the right (3.1 AE 2.28/1.6 AE 1.28) and left sides (3.3 AE 1.68/ 2.1 AE 1.58), and axial rotation to the right (1.2 AE 3.58/32.3 AE 9.38) and left sides (2.7 AE 2.68/25.3 AE 8.38). Unilateral alar ligament transection increased the range of motion of C0-C2 in the three planes of movement; however, intersegmental motion alterations were not always observed. Conclusion. Increases in the range of extension and lateral bending at C0-C1, which had not been reported previously, were observed. Further, the range of rotation on the right and left sides increased, in conjunction with the increased ranges at C0-C1 and C1-C2.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intersegmental Kinematics of the Upper Cervical Spine

Lorente

Hidalgo-García

Rodríguez-Sanz

et al. 2021

Spine

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“…The mechanism of the injury is much more complicated than the flexion -extension as the term "whiplash" would suggest. Many theories attempted to define the pathophysiology of the WAD, among them purely biomechanical (injury of the anterior ligament complex and facet joint compression), hydrodynamic (displacement of the cerebrospinal fluid) and neurophysiological (central sensitisation) ones, but none is regarded to adequately describe the pathophysiology of the WAD [5,6,7] .…”

Section: Introductionmentioning

confidence: 99%

New Concept of Whiplash Injuries Rehabilitation

Godek

Guzek

Przychodzeń

2021

j. of hum. physiol.

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Whiplash injuries are a global health problem and a significant financial burden for both health care systems, and for insurance providers. The diverse symptomatology after whiplash injury both in the somatic, emotional and behavioral sphere prompted separation of the Whiplash Associated Disorders (WAD) as a separate category of diseases. The exact mechanism of whiplash injury is still under debate and theories explaining pathogenesis of WAD are very diverse ranging from purely biomechanical to neurophysiological, emphasizing central sensitization but the core disability seems to be strictly connected to somatosensory dysfunction. As a result, the optimal algorithm of rehabilitation has not been established and data published in the current literature on effectiveness of such algorithms are inconsistent. Based on the prsesnted here of Head Neutral Reference Point (HNRP), the objective of central desensitization is to restore valid somatosensory output from Cranio - cervical Junction (CCJ). This new concept of rehabilitation after whiplash presented here is based on clinical observations and is supported by initial results.

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