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Background: Cervical sagittal alignment is crucial for distributing the head load to lower cervical segments and maintaining normal cervical spine function, but its biomechanical effect on the cervical spine was not fully elucidated., Objective: To investigate the effect of cervical sagittal alignment on dynamic intervertebral kinematics., Design: Cross-sectional study., Methods: Healthy participants without neck pain were recruited and divided into lordosis, straight and kyphosis groups according to the C2-C7 Cobb angle at the neutral position. The anti-directional and total joint motions were extracted across 10 epochs of dynamic cervical flexion and extension movements., Results: /findings: The overall anti-directional joint motion during flexion is larger in the kyphosis group when compared with the lordosis group (p = 0.021), while the range of flexion is smaller in the kyphosis group than that in the lordosis group (p = 0.017). The C2/C3 anti-directional joint motion during extension in the straight group is larger than that in the lordosis group (p = 0016). The range of extension in the kyphosis group (p < 0.001) and the straight group (p = 0.002) are larger than that in the lordosis group. The increased range of extension in the kyphosis and straight groups were mainly from the C3/C4, C4/C5, and C5/C6 joints(p < 0.05)., Conclusion: Changes in cervical sagittal alignment alter both the quality and quantity of the individual joint motions. More adjustments are required by the cervical joints to complete neck movements with the loss of lordosis. The lordotic curvature is a relatively effort-saving mode for the cervical spine from a biomechanical perspective., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The Ultrasound Velocity Profiling (UVP) technique allows real-time, non-invasive flow mapping of a fluid along a 1D-measuring line. This study explores the possibility of using the UVP technique and X-ray video-fluoroscopy (XVF) to elucidate the deglutition process with the focus on bolus rheology. By positioning the UVP probe so that the pulsed ultrasonic beam passes behind the air-filled trachea, the bolus flow in the pharynx can be measured. Healthy subjects in a clinical study swallowed fluids with different rheological properties: Newtonian (constant shear viscosity and non-elastic); Boger (constant shear viscosity and elastic); and shear thinning (shear rate-dependent shear viscosity and elastic). The results from both the UVP and XVF reveal higher velocities for the shear thinning fluid, followed by the Boger and the Newtonian fluids, demonstrating that the UVP method has equivalent sensitivities for detecting the velocities of fluids with different rheological properties. The velocity of the contraction wave that clears the pharynx was measured in the UVP and found to be independent of bolus rheology. The results show that UVP not only assesses accurately the fluid velocity in a bolus flow, but it can also monitor the structural changes that take place in response to a bolus flow, with the added advantage of being a completely non-invasive technique that does not require the introduction of contrast media. [ABSTRACT FROM AUTHOR]

Impaired sensorimotor ability has been demonstrated in recurrent neck pain patients. It is however not clear if cervical joint motion and pressure pain sensitivity in recurrent neck pain patients are different from asymptomatic controls. Cervical flexion and extension motions were examined by video-fluoroscopy and pressure pain thresholds were assessed bilaterally over C2/C3, C5/C6 facet joints and right tibialis anterior in eighteen recurrent neck pain patients and eighteen healthy subjects. Individual joint motion was analyzed by dividing fluoroscopic videos into 10 epochs. The motion opposite to the primary direction (anti-directional motion) and motion along with the primary direction (pro-directional motion) of each joint were extracted across epochs. Total joint motion was the sum of anti-directional and pro-directional motions. Joint motion variability was represented by the variance of joint motions across epochs. Compared to controls, recurrent neck pain patients showed: 1) decreased anti-directional motion at C2/C3 and C3/C4 (P < 0.05) and increased anti-directional motion at C5/C6 and C6/C7 (P < 0.05) during extension motion. 2) Increased overall anti-direction motion during flexion motion (P < 0.05). 3) Lower joint motion variability at C3/C4 during extension motion (P < 0.05). Recurrent neck pain patients showed a redistribution of anti-directional motion between the middle cervical spine and the lower cervical spine during cervical extension and increased overall anti-directional motion during cervical flexion compared with healthy controls. The anti-directional motion was more sensitive to neck pain compared to other cervical joint motion parameters in the present study. • Altered cervical joint motion patterns were found in patients with neck pain. • Neck pain redistributed anti-directional joint motion during extension. • Neck pain increased overall anti-directional joint motion during flexion. • Anti-directional motion was most sensitive to neck pain in this study. • Recurrent neck pain showed no localized and widespread hyperalgesia in this study. [ABSTRACT FROM AUTHOR]

Although the cervical interspinous ligament is a potential source of neck pain, the effects on cervical joint motion and pressure pain sensitivity has never been investigated. The understanding of the relationship will broaden our understanding of cervical biomechanics and improve diagnosis and treatment of neck pain. Fluoroscopy videos of cervical flexion and extension movements and pressure pain thresholds over bilateral C2/C3 and C5/C6 facet joints were collected in fifteen healthy subjects before and after injections of hypertonic and isotonic saline in C4/C5 ISL. The videos were divided into 10 even epochs and the motion of individual joints during each epoch was extracted. Joint motion parameters including anti-directional motion, pro-directional motion, total joint motion and joint motion variability were extracted across epochs. Joint motion parameters and PPTs were compared before and after injection of hypertonic and isotonic saline separately. Compared with baselines: hypertonic saline injection 1) decreased anti-directional motion and joint motion variability at C4/C5 (P < 0.05) and increased at C2/C3 (P < 0.05) during extension; 2) increased total joint motion of C0/C1 during first half range (P < 0.05) and decreased during second half range of extension, and total joint motion of C2/C3 increased during second half range of extension (P < 0.05) and; 3) increased pressure pain thresholds over left C2/C3 facet joint (P < 0.01). The cervical interspinous ligament pain redistributed anti-directional motion between C4/C5 and C2/C3 during dynamic extension and decreased pressure pain sensitivity over the left C2/C3 facet joint. • Interspinous ligament pain altered cervical joint motion pattern during extension. • Anti-directional motion was redistributed from C4/C5 to C2/C3 during extension. • Interspinous ligament pain increased pressure pain threshold over left C2/C3 facet joint. [ABSTRACT FROM AUTHOR]

Abstract Background Patients with neck pain normally showed alterations in cervical motion and pressure pain sensitivity. Cervical joints show scattered motions opposite to (anti-directional) the primary motion direction (pro-directional) during dynamic cervical flexion and extension. This study aimed to assess dynamic cervical joint motion and pressure pain sensitivity when pain originated from different cervical muscles which may have clinical relevance in diagnosis of impairments related with neck pain. Methods Fluoroscopic video recordings of cervical flexion and extension were collected from fifteen healthy subjects before and during hypertonic saline-induced pain in right multifidus and trapezius muscles. Cervical flexion and extension motions were divided into 10 epochs with respect to time. Pro-directional, anti-directional, and total joint motion were extracted across epochs as well as joint motion variability. Pressure pain thresholds (PPTs) were assessed bilaterally over C2/C3 and C5/C6 facet joints. Findings Compared with baseline: 1) Multifidus muscle pain increased the C3/C4 anti-directional motion (P < 0.01), decreased the C6/C7 anti-directional motion (P < 0.05) during extension, and redistributed total joint motion between joints and between half ranges during flexion (P < 0.05). 2) Trapezius muscle pain decreased pro-directional motion (P < 0.05), anti-directional motion (P < 0.05), and joint motion variability (P < 0.05) during extension. 3) Trapezius and multifidus muscle pain increased the PPTs bilaterally over C2/C3 and on the left side of C5/C6 facet joints (P < 0.05). Interpretation The direction of motion influenced the effects of experimental muscle pain on dynamic cervical joint kinematics, and deep muscle pain showed local effects on individual joints while superficial muscle pain showed global effects spread to all joints. Highlights • Movement direction influenced cervical muscle pain effect on cervical joint motion. • Deep and superficial muscle pain has different effect on cervical joint motion. • Deep muscle pain affected individual joint motion during cervical extension. • Superficial muscle pain affected motion of the entire neck during cervical extension. • Deep and superficial muscle pain decreased pressure pain sensitivity in the neck. [ABSTRACT FROM AUTHOR]

We report a case of inflammatory myofibroblastic tumor of the posterior mediastinum and describe radiological features demonstrated on fluoro-esophagogram, computed tomography and positron-emission tomography. Fluoroscopic video-esophagogram was remarkable for an unusual polypoid lesion associated with partial esophageal obstruction and features of secondary achalasia. Computed tomography (CT) examination demonstrated coarse calcifications and air pockets, while unusual clinical features included an intraluminal esophageal lesion and local recurrence with endobronchial lesion. [ABSTRACT FROM AUTHOR]

A new tendency in the field of wear testing of total knee replacements is represented by realistic simulations of various motor tasks of daily living (chair sitting and rising, squat, stair ascent, etc.). Various studies have shown in fact the limits of the ISO 14243 standards, in particular the concern about the ability of the level walking simulations to recreate the main wear mechanisms which occur on the knee implant during its in vivo lifespan. The recently proposed protocols for the simulation of these motor tasks still lack accuracy and consistency between the various degrees of freedom, which are necessary for a good replication of the mechanical behavior in a replaced knee. In the present study a realistic scenario for simulation of various motor tasks using a displacement controlled wear testing machine is presented. Stair climbing, chair sit/stand cycle, and squat cycle were analyzed through video-fluoroscopy in a population of knee replacement patients to extract flexion/extension and intra/extra rotation angles, together with anterior/posterior translation. Corresponding axial load data were arranged by gait analysis from a control population. The proposed protocol was tested on a displacement controlled wear simulator. Kinematic and load data revealed good consistency across subjects. The knee simulator showed an accurate reproduction of the various motion and load patterns, with average error lower than 5%. The obtained dataset for wear simulator, containing all the displacement and loading parameters for stair climbing, chair sit/stand and squat activities, is fully reported. [ABSTRACT FROM AUTHOR]

Few studies exist describing unicompartmental osteoarthritic knee kinematics. Moreover, the role of the anterior cruciate ligament (ACL) in the determination of knee kinematics has not been fully described. The objective of the current study was to analyze the in vivo kinematics of knees with medial osteoarthritis (OA) and intact ACL during closed and open chained motion. Eight patients scheduled for UKA diagnosed with primary medial OA underwent knee CT-scans and video-fluoroscopy. Fluoroscopic analysis included stair climbing, chair rising and leg extension. Three-dimensional bone positions were obtained from each image by iterative procedures using a CAD-model-based shape-matching technique. Patterns of axial rotation and anterior-posterior (AP) motion of the medial and lateral femoral condyle were obtained with specific software. The femur reported an overall external rotation relative to the tibia from extension to flexion in all tasks. Average AP translation of the medial femoral condyle were smaller in open-chained tasks than in weight-bearing conditions. Average AP motion of the lateral femoral condyle reported an overall posterior translation with knee flexion. The absent natural "screw-home" mechanism and the lack of medial condyle posterior translation was explained by bone-cartilage defects and meniscal degeneration. Relevant findings were the kinematic pattern differences between weight-bearing and open chained activities, suggesting that in biphasic muscle contraction and unloaded conditions, the function of the cruciate ligaments was not physiological. The kinematics of knees with medial OA and intact ACL differed from healthy knees. [ABSTRACT FROM AUTHOR]

Purpose: To compare intra-operative knee joint kinematic measurements immediately after total knee replacement with those of the same patients post-operatively at 6-month follow-up. Methods: Fifteen patients who underwent total knee arthroplasty were analysed retrospectively. Eight were implanted with one prosthesis design and seven with another. The intra-operative measurements were performed by using a standard knee navigation system. This provided accurate three-dimensional positions and orientations for the femur and tibia by corresponding trackers pinned into the bones. At 6-month follow-up, the patients were analysed by standard three-dimensional video-fluoroscopy of the replaced knee during stair climbing, chair rising and step-up. Relevant three-dimensional positions and orientations were obtained by an iterative shape-matching procedure between the silhouette contours and the CAD-model projections. A number of traditional kinematic parameters were calculated from both measurements to represent the joint motion. Results: Good post-operative replication of the intra-operative measurements was observed for most of the variables analysed. The statistical analysis also supported the good consistency between the intra- and post-operative measurements. Conclusions: Intra-operative kinematic measurements, accessible by a surgical navigation system, are predictive of the following motion performance of the replaced knees as experienced in typical activities of daily living. Level of evidence: Prognostic studies-investigating natural history and evaluating the effect of a patient characteristic, Level II. [ABSTRACT FROM AUTHOR]

High-resolution manometry (HRM) is a recent development in oesophageal measurement; its value in the clinical setting remains a matter of controversy. (i) We compared the accuracy with which bolus transport could be predicted from conventional manometry and HRM. (ii) The clinical value of HRM was assessed in a series of patients with endoscopy-negative dysphagia in whom conventional investigations had been non-diagnostic.(i) Control subjects and patients with endoscopy-negative dysphagia underwent concurrent HRM and video-fluoroscopy. Ninety-five records were reviewed using HRM with spatiotemporal plot and conventional line plots of the pressure data derived from the same recording. (ii) The HRM and notes of patients with endoscopy-negative dysphagia and abnormal bolus transport were analysed to identify additional information provided by the new technique.(i) Receiver operating characteristic analysis demonstrated that HRM predicts the presence of abnormal bolus transport more accurately than conventional manometry. (ii) HRM identified clinically important motor dysfunction not detected by manometry and radiography. These included localized disturbances of peristalsis and abnormal movement of the lower oesophageal sphincter during oesophageal spasm.The HRM predicts bolus movement more accurately than conventional manometry and identifies clinically relevant oesophageal dysfunction not detected by other investigations including conventional manometry. [ABSTRACT FROM AUTHOR]

We have examined the effect on neck-muscle activation of altering whole body posture. A Rhesus monkey (Macaca mulatto) was trained to produce sinusoidal (0.25 Hz) head tracking movements in the sagittal plane when seated with trunk and head vertical or while standing in the quadrupedal position. Video-fluoroscopic images of cervical vertebral motion, and electromyographic (EMG) responses were recorded simultaneously. Results demonstrated that vertebral motion varied with body posture, occurring synchronously between all joints in the upright position and primarily at skull-Ci when in the quadrupedal position. Muscle EMG activation was significantly greater (p<0.00l) in the quadrupedal position than when upright for all muscles except semispinalis cervicis. Peak activation of all the muscles occurred prior to peak head extension in the quadrupedal position, suggesting synchronous activity between muscles. Data suggest that, when upright, muscles were activated in functional groupings defined by their anatomical arrangement. In the quadrupedal position, gravity acting on the horizontally oriented head produced greater activation and a collective response of the muscles. [ABSTRACT FROM AUTHOR]

This study aimed to understand the ability of fixed-bearing posterior cruciate ligament (PCL)-retaining implants to maintain functionality of the PCL in vivo. To achieve this, elongation of the PCL was examined in six subjects with good clinical and functional outcomes using 3D kinematics reconstructed from video-fluoroscopy, together with multibody modelling of the knee. Here, length-change patterns of the ligament bundles were tracked throughout complete cycles of level walking and stair descent. Throughout both activities, elongation of the anterolateral bundle exhibited a flexion-dependent pattern with more stretching during swing than stance phase (e.g., at 40° flexion, anterolateral bundle experienced 3.9% strain during stance and 9.1% during swing phase of stair descent). The posteromedial bundle remained shorter than its reference length (defined at heel strike of the level gait cycle) during both activities. Compared with loading patterns of the healthy ligament, postoperative elongation patterns indicate a slackening of the ligament at early flexion followed by peak ligament lengths at considerably smaller flexion angles. The reported data provide a novel insight into in vivo PCL function during activities of daily living that has not been captured previously. The findings support previous investigations reporting difficulties in achieving a balanced tension in the retained PCL. [ABSTRACT FROM AUTHOR]