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This study investigates the multidirectional upper limb strength of individuals with a C4-C7 spinal cord injury (SCI) and non-disabled individuals in a seated position by measuring multidirectional force at the hand. Current literature lacks quantitative strength data to evaluate strength requirements for people who have reduced upper limb function due to a cervical SCI. Seated multidirectional force measurements were recorded for eleven non-disabled and ten males with a C4-C7 SCI. Collected data was displayed using detailed force polar plots. The resulting plots revealed a clear difference in polar plot shape for non-disabled participants and participants with a C4-C7 SCI. Namely that SCI participants had more elliptical polar plots due to reductions in circumferential strength compared to non-disabled participants. However, the polar plots for higher SCIs tended to have an increasingly more circular shape. The results provide insight into the differences in strength between people with cervical SCI and no disability.

Study Design: Retrospective cohort study., Objective: Although there are several methods available to assess upper limb function in patients with cervical spondylotic myelopathy, few methods can evaluate the degree of upper limb functional impairment in activities of daily living., Summary of Background Data: We devised and evaluated the utility of a new assessment method called the 10 Coins Test, which is based on daily movements., Materials and Methods: The study included 39 patients who underwent spinal surgery for cervical spondylotic myelopathy and who were followed up for 1 year postoperatively. The mean age was 65.2±11.5 years, with 31 (79.5%) male and 8 (20.5%) female patients. The 10 Coins Test is a simple examination that measures the time it takes to pick up and move 10 coins forward. Patient satisfaction with surgery was evaluated on a 5-point scale. We compared the 10 Coins Test results, patient satisfaction, and Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) results before and after surgery., Results: The mean time to perform the 10 Coins Test was 27.4 seconds for the dominant hand and 24.5 seconds for the nondominant hand preoperatively. In the control group, the average time was 14.6 seconds for the dominant hand and 15.0 seconds for the nondominant hand. The cut-off value was 16.2 seconds. There was a significant difference in the 10 Coins Test time and satisfaction for both hands at 1 week postoperatively compared with preoperatively. The JOACMEQ upper limb motor function showed a significant improvement 3 months postoperatively compared with preoperatively. The 10 Coins Test result was correlated with satisfaction and the JOACMEQ upper limb motor function., Conclusion: The 10 Coins Test allows for the quantitative evaluation of complex movements. It is convenient and highly useful for assessing upper limb function in patients with cervical spondylotic myelopathy., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Vertebral fractures in young populations are associated with intervertebral disc disorders later in life. However, damage to the annulus fibrosus has been observed in rapidly loaded spines even without the subsequent occurrence of a fracture. Therefore, it may not be the fracture event that compromises the disc, but rather the manner in which the disc is loaded. The purpose of this study was to quantify the mechanical properties of the annulus fibrosus following quasi-static compressive loading of the motion segment either to sub-fracture or fracture-inducing magnitude., Methods: Porcine cervical motion segments were axial compressed at 0.1 mm/s, either until endplate fracture occurred ('fracture group'), or until segments reached 75 % of average fracture stress as determined from the fracture group ('sub-fracture group'). An unloaded control group was also included. Post-loading, three samples of the annulus were excised. The first was mounted in a 180 o peel test configuration in order to quantify lamellar adhesion. The other two samples were excised from the superficial and midspan region of the annulus and were exposed to uniaxial tension to 50 % strain., Findings: Lamellar adhesion and tensile annulus mechanics did not differ between the fracture and sub-fracture group, nor between the unloaded controls., Interpretation: Given the lack of differences in annular mechanical properties across the three conditions, it was concluded that under very slow, quasi-static compressive loading conditions, the annulus appeared undamaged even in the group that sustained a fracture; this is likely because a significant viscoelastic response was not generated in the disc under these slow loading conditions., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare. Funding for this study was provided by the Natural Sciences and Engineering Research Council of Canada (RGPIN-2020-04723)., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: Neck pain is a prevalent global health concern often accompanied by musculoskeletal symptoms. This randomized controlled trial attempted to contrast the impacts of non-thrust Maitland mobilization and Autogenic inhibition muscle energy technique on chronic mechanical neck pain associated with cervico-thoracic junction hypo-mobility., Methods: Sixty participants (24 males and 36 females, aged 18-45 years) were allocated randomly into three equally sized groups (A, B, C). Group A: Maitland mobilization plus conventional treatment, Group B: Autogenic Muscle energy technique plus conventional treatment, while; Group C solely received conventional treatment. Treatment was administered for four weeks, three times a week. Outcome measures: neck pain (The primary outcome measure) assessed by Visual Analog Scale (VAS), disability evaluated through Neck Disability Index (NDI), active range of motion (AROM), and joint position error (JPE) as an indicator of cervical proprioception. All measures were assessed both at baseline and after four weeks of intervention., Results: Results showed significant improvements in VAS, NDI, and increased ROM across all groups post-treatment ( p  < 0.001). While Groups A and B demonstrated superior outcomes compared to Group C, differences between Groups A and B were not statistically significant ( p  > 0.05). For VAS and NDI, Cohen-d between Groups A and B was 0.31 and 0.31, and for ROM, Cohen-d was 0.37, 0.16, 0.07, 0.29, 0.36, and 0.53 for flexion, extension, right rotation, left rotation, right bending, and left bending, respectively. Furthermore, all groups experienced a significant decrease in JPE, with Groups A and B showing greater improvement than Group C ( p  < 0.01). Group B exhibited significantly greater improvement in reducing JPE related to specific motions compared to Group A ( p  < 0.05)., Conclusion: Cervico-thoracic junction mobilization and the Autogenic muscle energy technique offer enhanced management for mechanical neck pain by improving pain, function, ROM, and cervical proprioception.

Background: This study aimed to analyze the three-dimensional cervical motion characteristics in patients who underwent posterior atlantoaxial fusion surgeries using cone beam computed tomography and 3D3D registration technology., Methods: The study selected 20 patients who underwent posterior atlantoaxial fusion surgery and 20 healthy people as the control group. All subjects underwent cone beam computed tomography scans of the occipital and cervical spine in 7 different functional positions, then 3D3D registration of Occipital-C7 was performed at each functional position to calculate the motion characteristics of each segment. The ranges of motion of the entire cervical spine and each segment were obtained in each functional position., Findings: In the experimental group, ranges of motion of C1-C7 in flexion-extension and left-right twisting were significantly lower compared to controls (41.9° ± 13.8° vs. 56.6° ± 11.6°, 29.3° ± 9.6° vs. 91.2° ± 13.7°, respectively, P < 0.05). In the occipital-atlas segment, range of motion in flexion-extension was significantly smaller in the experimental group than controls (10.7° ± 3.2° vs. 19.4° ± 4.2°, P < 0.001), but it was larger in twisting (5.3° ± 4.2° vs. 2.1° ± 1.8°, P < 0.05). The twisting range of motion of C2-C3 was 4.7° ± 2.0° in the experimental group and 3.1° ± 1.6° in the control group (P < 0.05). Additionally, the alteration in ranges of motion during flexion-extension was primarily characterized by less extension., Interpretation: The posterior atlantoaxial fusion surgery induced biomechanical changes in the cervical spine. Following the procedure, the movement of C1-C7 during flexion-extension and twisting was significantly lower, with varying degrees of impact on adjacent and lower cervical segments. Moreover, the surgery had a greater effect on cervical extension than flexion., Competing Interests: Declaration of competing interest All authors have no conflict of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Magnetic resonance imaging may suggest spinal cord compression and structural lesions in degenerative cervical myelopathy (DCM) but cannot reveal functional impairments in spinal pathways. We aimed to assess the value of contact heat evoked potentials (CHEPs) in addition to MRI and hypothesized that abnormal CHEPs may be evident in DCM independent of MR-lesions and are related to dynamic mechanical cord stress., Methods: Individuals with DCM underwent neurologic examination including segmental sensory (pinprick, light touch) and motor testing. The presence or absence of hyperintense signal on T2-weighted MRI (T2-positive/negative) was assessed. Phase-contrast MRI was used to assess spinal cord motion as an indicator of dynamic mechanical stress. Dermatomal somatosensory evoked potentials and CHEPs were recorded after stimulation of dermatomes C6, C8, and T4 (CHEPs only) to assess spinal cord integrity., Results: Of 138 individuals included in this study (age 56 ± 13 years), 35% (N = 48) presented with T2-positive and 65% (N = 90) presented with T2-negative DCM. Abnormal CHEPs were present in T2-positive DCM (C6:41%; C8:32%; T4:24%) and T2-negative DCM (C6:35%; C8:54%; T4:26%). Multisegmental CHEP abnormalities at C6 and C8 were related to increased spinal cord motion (p = 0.030; ϵ 2  = 0.072), and reduced upper extremity pinprick (p = 0.046; ϵ 2  = 0.063) and motor scores (p = 0.005; ϵ 2  = 0.108)., Conclusions: CHEPs revealed distinct patterns of spinal cord impairment independent of structural T2-positive lesions, which were associated with measures of cord motion. CHEPs thus provide valuable complementary diagnostic insights into spinal cord integrity beyond MRI. This is especially important in incipient myelopathy to inform early diagnosis and timely interventions before the development of definite cord lesions., (© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Background: Although herniated discs in the cervical spine are rare overall, patients with this clinical picture regularly present themselves in orthopedic and neurosurgical practice. Initially, those affected often have severe local and predominantly radicular pain and, optionally, dermatome-related neurological deficits in the upper extremities, with medullary signs occasionally being found., Prognosis: The prognosis for complete remission is usually favorable, so that primary therapy is almost always conservative. Based on guidelines, the relative and absolute indications for surgery can be derived depending on pain symptoms and neurological deficits., Surgical Treatment: There are various surgical procedures to choose from. The ventral approach to the cervical spine with either insertion of a cage and the goal of fusion or implantation of an intervertebral disc prosthesis as arthroplasty is most often chosen. For lateral disc prolapse, dorsal foraminotomy with sequestrectomy is recommended. The postoperative outcome is predominantly positive with a relatively low complication rate., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: D. Daentzer, B. Welke, A. Baseem Ismail, J. Daentzer und J. Plagge geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)