The Role of Torsion in Cervical Spine Trauma

Myers, Barry S.; McElhaney, James H.; Doherty, Brian J.; Paver, Jacqueline G.; Gray, Linda

doi:10.1097/00007632-199108000-00002

Cited by 33 publications

(13 citation statements)

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“…Myers et al reported also the successful application of MRI in a cervical spine cadaver model [3]. Although pooled data differences were low, during 10°rotation MRI and CT measurements revealed a distinctive difference in rotation values, especially for specimen 1 (7°vs.…”

Section: Discussionmentioning

confidence: 98%

“…Atlanto-axial rotatory fixation has been described in detail by several authors as a cause of acute torticollis in pediatric patients or as a posttraumatic complication [1][2][3]. Considerable literature is available that focuses on rotatory displacement of C1 on C2 with the dens or the lateral articular process acting as a pivot [1,[4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Quantification of C2 cervical spine rotatory fixation by X-ray, MRI and CT

et al. 2004

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Atlanto-axial rotatory displacement is known to be a cause of childhood torticollis and may as well be responsible for chronic neck pain after rear-end automobile collisions. The objective was to determine whether quantification of C2 malrotation is possible by plain radiographs in comparison to CT as the golden standard. MR imaging was evaluated as to whether it was of equal value in the detection of bony landmarks. C2 vertebra of five human cadaveric cervical spine specimens, ligamentously intact, were rotated using a Steinmann pin in steps of 5 degrees up to 15 degrees right and 15 degrees left. Plain radiographs, CT and MRI images were taken in each rotational step. Data were analyzed for quantification of C2 rotation by three independent examiners. A rotation of 5 degrees led to a spinous process deviation (SPD) from the midline of 3 mm as measured on an a.p. plain radiograph. A coefficient of rotation was calculated (1.62 degrees mm(-1)). Data analyzed by three examiners revealed a small coefficient of variation (0.03). MRI and CT measurements showed comparable results for the quantification of rotation; however, in both techniques the 15 degrees rotation was underestimated. Quantification of upper cervical spine malrotation was possible on plain radiographs using the SPD and a rotation coefficient. MRI and CT were equally successful in the assessment of C2 malrotation.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Quantification of C2 cervical spine rotatory fixation by X-ray, MRI and CT

et al. 2004

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“…Their apparatus applied no torque to the specimen, and yet lower cervical rotation was observed prior to unilateral dislocation. Myers et al demonstrated that while unilateral facet dislocation could be produced by direct torsional loading of the lower cervical spine, the lesion could not be the result of torsional loading of the head because of the comparative weakness of the atlantoaxial joint [ 100 ]. The authors currently believe that the lesion is produced by a mechanism similar to the bilateral facet dislocation, with the difference being due to bending out of the plane of symmetry, or the presence of pre-existing facet tropism of other structural asymmetry.…”

Section: Discussionmentioning

confidence: 99%

Neck Injury Biomechanics

2014

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This chapter summarizes the research on the biomechanical responses of the neck in a form that will be useful in design of protective systems and in the development of societal strategies to reduce the number of cervical spine injuries. Neck injuries are described in detail and injury mechanisms are explained. Accidents that involve neck injuries are analyzed. Real-life neck injuries are presented and laboratory results are synthesized to provide a rational basis for understanding neck injury. In order to maintain a reasonable scope, we restrict our discussion to severe fractures -those with a high probability of spinal cord injury. Low AIS injuries, such as whiplash, sprains and strains are left to other sources.Most of what we know about catastrophic neck injury comes from two sources: clinical studies including accident reconstruction, and cadaver studies. In the last 30 years, the fi eld of biomechanics has made signifi cant gains in understanding the complex dynamics that accompany both head-impact neck injury and inertial neck injury. Cervical injury mechanisms involve a wide range of loading modes with various combinations of force and concurrent bending moment. Using the historical concepts of excessive head motion as a cause of neck injury frequently leads to paradoxical and incorrect conclusions regarding neck injury mechanism. In contrast, when the neck is viewed as a mechanical structure, whose injury is a consequence of the deformations of a segmented beam column

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“…The estimated lower bounds of axial torsional tolerance are between 13.6 ± 4.5 Nm and 17.2 ± 5.1 Nm [13]. This amount of torque produces upper cervical spinal injuries.…”

Section: Torsionmentioning

confidence: 95%