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Unlabelled: Osteoarthritis of the spine is a major global health problem, it is an epidemic of our times. It affects all parts of the spine, but the hardest to treat is its cervical region. The cervical spine is most mobile, delicate and sensitive to any load. It requires special care in conservative treatment. To date the selection of effective therapeutic approaches has been controversial., Aim: The aim of the study was to assess the progress of rehabilitation in patients with cervical radicular pain syndrome after using two different methods of treatment: HILT and spinal axial traction with the use of Saunders device., Materials and Methods: The randomized study included 150 patients (81 women and 69 men, aged 24-67 years, mean age 45.5) divided into two groups of 75 patients each with characteristic symptoms of radicular pain. The measurement of the range of cervical spine movement of the cervical spine, visual analog scale for pain - VAS and a NDI questionnaire (Neck Disability Index - Polish version) - an indicator of functional disorders - were used to evaluate the effectiveness of the two different therapies., Results: The results obtained by Saunders method remained significantly higher than those obtained when HILT laser therapy was used for most of the examined parameters. A thorough analysis of the results showed greater analgesic efficacy, improved global mobility and reduced functional impairment in patients treated with Saunders method., Conclusions: Both therapeutic methods manifest analgesic effect and a positive impact on the improvement of range of cervical spine movement in patients with radicular pain in this spine region. HILT laser therapy and Saunders traction device reduce neck disability index in the treated patients., (© 2015 MEDPRESS.)

Background: Assessment of the stability of the cervical spine following an injury is an important part of the diagnostic work-up. It is not always easy as the mechanism of injury does not always determine the degree of spinal stability. An actual instability is often confused with increased compensatory instability that is still within physiological limits, i. e. excessive mobility of the segment positioned above the part that has been immobilised as a result of trauma or vertebral block. Spinal injuries with instability are usually an indication for surgery. On the basis of 30 years' experience, the author presents indications for anterior approach surgery, based on the mechanism of injury and the patient's neurological status following an injury to the cervical spine., Material and Methods: A total of 1,225 patients have been operated on. Indications are defined for surgery using rod or plate implants and compression plates. Radiographic and neurological outcome data are presented for 1138 who had been followed up for at least 6 months., Results: A good radiographic outcome was obtained in a total of 78% patients, including 84% of the recipients of rod implants and 65% of the recipients of plate implants. Neurological improvement was seen in 68% of patients with neurological symptoms, including substantial improvements in 26% of the patients., Conclusions: 1. Assessment of spinal stability is an important element of diagnostic work-up. 2. It is essential to distinguish actual instability requiring surgery from a compensatory increase in mobility of the segment lying above the immobilised segment of the spine. 3. An anterior approach procedure, apart from stabilising the spine, serves to decompress the spinal cord and offers a chance of neurological and functional improvement.

The term tennis elbow applies to the state in which the patient feels pain in the area of lateral epicondyle and concomitantly suffers from strength disorders together with diminished capability of the upper limb. Even a very brief look at the specialist literature reveals that there is a number of terms for this particular pain unit. Throughout many years this pain was linked with the inflammation of the common extensors tendon. Presently there is a widespread agreement that this painful condition is connected with the degeneration in the area of common extensors tendon, in particular the extensor carpi radialis brevis. A closer consideration of the pathomechanism of the tennis elbow points to the fact that this seemingly simple pain unity is a complex problem. Moreover, it shows how important the nuances in patients opinion are and how such details can influence not only the diagnose but also the treatment.

Background: The spinal overload syndrome develops as a result of the gradual wearing away of the structural elements of the spine due to loads exceeding their endurance strength in the setting of reduced adaptability. The aim of the investigation was to study the limitation of mobility in the cervical spine and determine the effect of the spinal overload syndrome on postural equilibrium., Material and Methods: The study enrolled 27 patients with signs of overload of the cervical spine. Postural equilibrium was measured by stabilography. Range of motion in the cervical spine was also evaluated., Conclusions: The investigations of spinal mobility indicate a disturbance of muscular equilibrium. Most of the patients suffered from Lewit's upper crossed syndrome. The disturbance of postural equilibrium is of functional origin.

Background and Purpose: There is no standard timing of the spinal cord decompression. Experimental animal models and clinical investigations on Methylprednisolone (NASCIS-2 and -3) indicate that the time up to 8 hours is the optimal therapeutic window for the early spinal cord decompression. We accepted this time window in our practice. A retrospective clinical evaluation of the early (up to 8 hours) operative decompression of the injured cervical spinal cord was undertaken., Material and Methods: The early operative decompression (range of 2-8 hours) of the cervical spinal cord was done in 32 patients (82% of operated cervical spinal cord injured patients). The neurologic clinical status of patients was assessed according to the ASIA impairment scale. In neurological terms 7 patients were completely and 25 incompletely impaired. Cervical spine injuries included 26 fractures and fracture-dislocations and the rest (6 cases) involved dislocations and disc ruptures. The mean patient age was 31.2 years (range of 16-69) and the average follow-up time was 13 months (range of 6-24). Methylprednisolone standard treatment was applied in all patients on admission to hospital. After diagnostic examinations patients were qualified and immediately operated. We performed 25 corpectomies, 6 discectomies and 1 decompressive laminectomy with stabilization in all cases., Results: The final assessment covers 29 patients because 3 (9.4%) of them died during 4-6 weeks after operation. One patient has not improved and still had A degree but 28 remaining patients (94.5%) have improved neurologically at follow-up. 69% of them recovered by one degree and 27.6% by two degrees on the ASIA scale. In the early postoperative stage during their hospital stay 47% of patients had one degree improvement., Conclusions: The early cervical spinal cord decompression creates optimal conditions for the neurological recovery. Encouraging results presented in the paper indicate the purposefulness of the decompression performed as fast as possible and indicate the necessity to make emergency services more efficient in order to shorten delivery time to specialized spine centers.

Unlabelled: Active Range of motion (AROM) is one of the crucial parameters assessed in the cervical spine evaluation. Repeated standardized AROM evaluation enables objectified monitoring of disease progress or therapy related improvement. Active spine therapy according to DBC (Documentation Based Care) requirement is a contemporary therapeutic system with proven efficacy in spinal disorders. The therapeutic concept f DBC is mechanotherapy based and introduces special devices designed for active exercises in strictly defined range, rate and load. DBC-3CR device is constructed for active motion (composed of rotation, anteflexion and lateral flexion) exercise of the cervical spine with repeated dynamic load. Technical properties allow to avail the machine for diagnostic purposes as far complex range of motion is concerned., Purpose: Comparison of AROM between healthy volunteers and patients with cervical disorders. Evaluation of DBC-3CR validity in complex AROM measurement Patients: A--99 healthy volunteers; B--106 patients with chronic neck pain resulting from cervical spondylosis; C--36 patients with acute neck pain related to cervical disc disease or whiplash injury., Methods: Complex AROM detection with DBC-3CR was compared with reference measurements (goniometric and inclinometric simple AROM detection). Age and sex dependence of AROM among healthy subjects was observed. AROM was compared between B, C and reference groups., Discussion: AROM was significantly decreased in patients with chronic and acute neck pain. Motion limitation pattern was symmetric in both groups. The presence of linear dependency between complex AROM acquired with DBC-3CE and rotation acquired with goniometer was observed (Pearson coefficient 0.81 at p < 0.0001)., Conclusions: I. DBC-3CR device is useful in AROM evaluation. 2. AROM in healthy subjects decreases with age, but is sex--independent parameter. 3. In cervical spondylosis AROM is symmetrically reduced as far as rotation and lateral flexion are concerned. 4. Acute cervical pain results in symmetric AROM limitation.

The aim of the study was to estimate the effect of the neck proprioception on the postural reflexes in the cases of the cervical pathology in the whiplash injury and degenerative disease of the cervical vertebral column. The investigation using ENG and stabilometry was performed in 81 patients. Experimental observations were done among 10 pigeons with limitation of the neck proprioceptors action by special neck tutor. Their postural reflexes were analysed during balance test on the seesaw. Our conclusion is, that disorders of the proprioceptors impulastion can damage the postural reflexes even in patients with normal labyrinth function.

Vertebrobasilar insufficiency is described as one of the reasons for tinnitus, especially of patients with degenerative cervical spine lesions showed in radiographic imaging. In this study we present the electronystagmographic results of 76 tinnitus patients in two groups: 56 persons with and 18 persons without degenerative cervical findings. All patients underwent clinical otoneurological, audiological and additionally Doppler sonography of vertebral artery examination. We found incorrect cervical radiography in 76.3% tinnitus patients and pathological vertebral artery blood flow in 20.7%, most frequently in patients with cervical degenerative lesions. Electronystagmographic outcome of vestibular system in tinnitus patients in both groups showed abnormal recordings in positional nystagmus in 51.7% and 27.8% persons, saccadic test in 43.1% and 44.4% persons and in smooth pursuit test in 41.3% and 33.3% persons respectively. There were no significant differences between groups in ENG results. It can suggest central vestibular impairment in these patients. ENG examination, seem to be a useful method in vestibular system evaluation in tinnitus patients. Radiographic imaging of cervical spine is less valuable in these patients.

Study Design: Subsidence is a common phenomenon in the process of interbody fusion. The paper presents a retrospective clinical and radiological evaluation of subsidence in a group of 23 patients after cervical corpectomy with mesh cage and plate stabilization. Subsidence magnitude and its impact on the stabilizing system and on the clinical and radiological outcome were estimated., Material and Method: The mesh cage and cervical plate stabilization was preformed after one- (20 cases) or two-level (3 cases) corpectomy. The patients' mean age was 35 years (age range 18-72); 9 patients were aged over 50. Indications to corpectomy were: neurological impairment due to burst body fractures in 14 cases, multilevel spondylosis in 5, and OPLL in 2 patients. One patient had a kidney cancer metastasis. The mean follow-up period was 17 months (range 12-28 mo.). The patients' clinical status was evaluated using the ASIA scale in the post-traumatic group, and the Odom criteria in spondylotic cases. In all the cases pain severity was estimated by the VAS scale. Magnitude of subsidence was measured on consecutive lateral x-rays during the follow-up. Bone fusion was confirmed after 3 months in lateral flexion-extension x-rays. Changes in the local and general cervical lordosis were evaluated during the follow-up., Results: A 72-year-old patient died after 6 weeks due to causes unrelated to the surgery. In all the remaining patients bone fusion was attained. There were no cases of the clinical status deterioration during the follow-up. Subsidence of over 1 mm was found in 19 patients (86.4%). The mean value of subsidence was 2.2 mm, but in a group of older patients (aged over 50) it amounted to 2.8 mm. In 4 cases (18.1%) with hardware complications, i.e. a screw breakage or slipping, the mean subsidence magnitude was 4.3 mm. Local and general cervical lordosis were maintained during the follow-up period, even in the group with excessive subsidence. The screw breakage site was invariably the round hole of the plate., Conclusions: The subsidence phenomenon is seen in a majority of fused patients. Nevertheless, clinical and radiological results of the surgery are good. An excessive subsidence may result from hardware complications. In newly designed plates subsidence should be taken into account.

Fractures of the base of odontoid process are serious spinal injuries. Their treatment still remains controversial. External rigid immobilisation is the way of conservative healing. Operations by posterior approach: posterior atlantoaxial fixation, atlantoaxial transarticular screw fixation or even occipitocervical fixation limit range of head motion. Direct odontoid screw fixation preserves normal motion of C1-C2 junction. Success of this method depends on proper patients selection. The authors present description of surgical technique based on literature review and their own experience. The authors perform odontoid fixation by means of single cannulated cancellous screw guided by K-wire. This wire provides stability of broken odontoid process during procedure of screw insertion. Old fracture--1 case in author's experience--has been curetted before fixation. The authors reviewed clinical efficacity and results of direct odontoid screw fixation published in current literature.

The goal of this work is to attempt to evaluate the motor efficiency of the cervical spine by taking into account the range of active movements and the strength of muscle groups in pain syndrome associated with instability of the cervical segment of the spine (CSPS), to point out possible dependencies between the tested parameters of motor efficiency, and to indicate the suitability of motor efficiency examination in assessing the effectiveness of rehabilitation. The results from tests performed on 71 patients indicate that persons suffering from CSPS, in comparison to healthy subjects, ae characterized by very low motor efficiency of the cervical spine. The greatest limitation on the range of active movements occurred in vertical inclination and rotation, while the greatest deficit of strength appeared in the muscle groups of lateral flexors. Moreover, these parameters of motor efficiency showed a high degree of dependency in the examinations. The results from the preliminary examination and the high dynamics of change in the control examinations suggest that motor efficiency examinations are useful in assessing the effectiveness of rehabilitation procedures in patients with CSPS.

Degenerative changes of the cervical spine often cause the pains and vertigo as well as pathological results of otoneurological tests. The aim of the study was to estimate the frequency of the symptoms occurrence in the group of 146 patients, 63 male and 83 female, with degenerative changes of the cervical spine. Permanent or periodical headaches of various intensity occurred in 60% of the patients. Balance disturbances was observed in 74% of the patients, specially in women. In the cervical spine X-ray there were observed most frequently marginal degenerations with osteophytosis (16%), intervertebral disk narrowing (10%), and shallowing of the physiological lordosis (11%). In ENG examination, positional nystagmus (42-38%), gaze nystagmus (14-23%) were mainly recorded, with the eyes opened and closed. The eye-tracking pattern test was pathological in 57%. Optokinetic test results showed pathological records in 32% of the patients, unilateral weakness was observed in 22% and bilateral weakness in 17% of the patients. Observations mentioned above confirm frequent pathology and the necessity of early diagnosis and treatment of patients with degenerative changes of the cervical spine.

The purpose of the study was to establish the effect of degenerative lesions of cervical vertebrae on blood flow velocity in the vertebrobasilar system measured by means of Doppler phenomenon using Transpect--TCD device according to generally accepted principles. The study was carried out in 20 healthy controls and 40 individuals with these lesions (aged 16-60 years). It was found that blood flow velocity in this arterial system is highly variable individually. In patients with degenerative changes pathological reduction of this velocity was found in this system which is an unquestionable evidence of the influence of these lesions on blood flow in vertebral arteries.

In 41 cases of vertigo without abnormalities in neurological examinations BAEP examination, specialistic otological examination, X-ray of the cervical spine were done. In most cases Doppler USG examination of the carotid and vertebral arteries and EEG and CT of the head were obtained. The most frequent abnormality in these examinations were changes in cervical spine found in 30 cases (90%) and in BAEP--36.5%. BAEP changes were most frequently found in patients with known factors for dizziness--41.2%, followed by those with CT changes--33.3%, cervical spine changes--28.6% and changes in USG of the arteries supplying the brain from the neck.

A rare case of intradural subarachnoid cyst in the vertebral canal was observed in a female aged 52 years. Operation was followed by marked improvement of the neurological condition. The large defect of the dura required grafting of lyophilized dura. The role of MRI in the diagnosis of this case is stressed.

Elongated styloid process syndrome courses in the form of the chronic, noncharacteristic ailment of the pain, within facial skeleton and the lasting, noneffective treatment. This study shows (for example three own cases of elongated styloid process syndrome) the difficulty of diagnose in this group, which can course under the form of dysphagia. This study point at the necessity excludes elongated styloid process syndrome in every unexplained pains of craniofacial and cervical, especially that, easy digital palpation near tonsils and spot film (X-ray) of elongated styloid process syndrome allow to put the right diagnose.

The estimation of the topodiagnostic value of cervical nystagmus and its changes in vertebrobasilar insufficiency was the aim of this work. The analysis was performed on 79 patients with the positive cervical nystagmus test. There was not any correlation between the side of neurologic signs, the level of CNS damage and the direction of cervical nystagmus. The changes of nystagmus direction are usefulness topodiagnostically too.

Using the neck rotation test during examination of Doppler's blood flows in vertebral arteries and basilar artery, the authors examined 60 subjects aged 16-60 years, including 20 healthy ones and 40 with cervical spondylarthrosis. The Transpect-TCD was used. Half the patients with cervical spine changes had also receptive hearing damage of low degree. The study demonstrated that neck rotation affected of patological Doppler's blood flows in one or in both vertebral arteries at 50% patients with cervical spondylarthrosis, but without clinical symptoms, and at 70% patients with cervical spondylarthrosis and clinical symptoms. The neck rotation test can have diagnostic significance by examination of sufficiency in vertebrobasilar system, or qualitative significance to microsurgical treatment.

Using the neck rotation test during recording of auditory brainstem evoked potentials the authors examined 60 subjects aged 16-60 years, including 20 healthy ones and 40 with cervical spondylarthrosis. The Neuromatic 2000 C Dantec device was used. Half the patients with cervical spine changes had also receptive hearing damage of low degree. The study demonstrated that neck rotation affected the latency time of the analysed waves I and II. The time was significantly prolonged in the patients with spondylarthrosis. The authors believe that simultaneous prolongation of the mean latency between waves I-III suggests worse compensation of circulation in patients, especially in the initial part of the auditory pathway. The authors think that the neck rotation test could be used in the study of brainstem auditory evoked potentials as a challenge test.

The aim of this work was comparative evaluation of the cervical nystagmus in cervical torsion test with the Nylen's positional nystagmus and their diagnostic value in correlation from anatomical state of cervical column. The authors examined 40 patients with degeneration of cervical spinal column and with normal radiograph of cervical spinal column. The obtained results showed that the cervical nystagmus in cervical torsion test was more frequent (47.5%) than the Nylen's positional nystagmus (37.5%). The cervical nystagmus in cervical torsion test was observed also in health subjects. The authors think that the above mentioned deviations can be caused by the discreet degeneration of cervical spinal column, unseizable in radiograph. The examinations showed that the cervical nystagmus in cervical torsion test could be used simultaneously with the Nylen's positional nystagmus in diagnostic of vertigo, first at all in patients with degeneration of cervical spinal column.

A case of inveterate, rotational dislocation in the atlanto-axial joint type III in 7 year old girl hit by a car was presented. Direct skull traction was applied resulting in complete reduction and regaining of the full range of motion in the cervical spine.

The purpose of the work was to investigate the relationships between functional disturbances of the stomatognathic system and the occurrence of chronic pains in the suboccipital and upper cervical areas. In 37 patients clinical observations were done and in 25 cases radiograms of this part of the cervical spine were taken. A correlation was noted between pains in the cervical spine and mandibular parafunctions, disturbed mandibular movements, pains in the muscles on mandibular movements.