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Article: A revisitation of distractive-extension injuries of the subaxial cervical spine: A cadaveric and radiographic soft tissue analysis

TitleA revisitation of distractive-extension injuries of the subaxial cervical spine: A cadaveric and radiographic soft tissue analysis
Authors
KeywordsBiomechanical
Cervical
Classification
Distractive
Extension
Injury
Spine
Stages
Trauma
Issue Date2010
PublisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com
Citation
Spine, 2010, v. 35 n. 4, p. 395-402 How to Cite?
AbstractSTUDY DESIGN. A biomechanical cadaveric and radiographic analyses. OBJECTIVE. To identify and elaborate on specific anatomic soft tissue structures that are injured during various stages of a distractive-extension (DE) injury of the lower cervical spine and their role in angulation and posterior translation. SUMMARY OF BACKGROUND DATA. Two DE stages (DES) of injury to the cervical spine have been described as follows: DES-1 and DES-2. However, the role of the soft tissue structures involved in such injuries has not been clearly defined. Furthermore, the importance of the facet capsules in DES injuries has not been well-addressed. METHODS. A total of 15 adult cadaveric motion segments of the lower cervical spine were isolated and tested. Motion segments were mounted, with the cervical spine in extension, such that a distractive load was applied through the cephalad body. Anatomic supporting structures were serially sectioned from anterior to posterior to simulate varying degrees of soft-tissue disruption as occurring with the DE mechanism. Specimens were loaded at each stage of injury and measurements of angulation and posterior translation were recorded from fluoroscopic images by 2 independent observers. RESULTS. A strong correlation was noted between the 2 sets of independent measurements. A statistical significant difference was noted between the degree of soft-tissue injury to the change in angulation and posterior translation (P < 0.001). The mean change in angulation and posterior translation was significantly greatest following sectioning of the anterior aspect of the facet capsules and to a lesser extent following sectioning of the posterior longitudinal ligament (PLL) (P < 0.001). A greater mean percent change between sequential sectioning of soft tissue structures was largely associated with posterior translation rather than angulation. CONCLUSION. Sequentially greater angulation and posterior translation was seen after serial sectioning of the anterior facet capsule and to a lesser degree the PLL. This suggests that there are in fact 2 main "tethers" to angulation and posterior translation in the DE injury model, with the anterior facet capsule being the major stabilizer and to a lesser degree the PLL. Thus, based on our findings, it would appear that an expansion of the DE injury classification may be warranted, based on angulation and posterior translation, and regarded as DES-1, DES-2A, DES-2B, and DES-3. Such categorization based on the degree of angulation and posterior translation may prove advantageous in designing appropriate treatment strategies to address DE injuries of the lower cervical spine; however, further studies are needed to validate the clinical applications of such categorization. © 2010 Lippincott Williams & Wilkins, Inc.
Persistent Identifierhttp://hdl.handle.net/10722/92941
ISSN
2015 Impact Factor: 2.439
2015 SCImago Journal Rankings: 1.459
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorSamartzis, Den_HK
dc.contributor.authorWein, SMen_HK
dc.contributor.authorShen, FHen_HK
dc.contributor.authorBeazell, Jen_HK
dc.contributor.authorFrancke, EIen_HK
dc.contributor.authorAnderson, DGen_HK
dc.date.accessioned2010-09-22T05:04:26Z-
dc.date.available2010-09-22T05:04:26Z-
dc.date.issued2010en_HK
dc.identifier.citationSpine, 2010, v. 35 n. 4, p. 395-402en_HK
dc.identifier.issn0362-2436en_HK
dc.identifier.urihttp://hdl.handle.net/10722/92941-
dc.description.abstractSTUDY DESIGN. A biomechanical cadaveric and radiographic analyses. OBJECTIVE. To identify and elaborate on specific anatomic soft tissue structures that are injured during various stages of a distractive-extension (DE) injury of the lower cervical spine and their role in angulation and posterior translation. SUMMARY OF BACKGROUND DATA. Two DE stages (DES) of injury to the cervical spine have been described as follows: DES-1 and DES-2. However, the role of the soft tissue structures involved in such injuries has not been clearly defined. Furthermore, the importance of the facet capsules in DES injuries has not been well-addressed. METHODS. A total of 15 adult cadaveric motion segments of the lower cervical spine were isolated and tested. Motion segments were mounted, with the cervical spine in extension, such that a distractive load was applied through the cephalad body. Anatomic supporting structures were serially sectioned from anterior to posterior to simulate varying degrees of soft-tissue disruption as occurring with the DE mechanism. Specimens were loaded at each stage of injury and measurements of angulation and posterior translation were recorded from fluoroscopic images by 2 independent observers. RESULTS. A strong correlation was noted between the 2 sets of independent measurements. A statistical significant difference was noted between the degree of soft-tissue injury to the change in angulation and posterior translation (P < 0.001). The mean change in angulation and posterior translation was significantly greatest following sectioning of the anterior aspect of the facet capsules and to a lesser extent following sectioning of the posterior longitudinal ligament (PLL) (P < 0.001). A greater mean percent change between sequential sectioning of soft tissue structures was largely associated with posterior translation rather than angulation. CONCLUSION. Sequentially greater angulation and posterior translation was seen after serial sectioning of the anterior facet capsule and to a lesser degree the PLL. This suggests that there are in fact 2 main "tethers" to angulation and posterior translation in the DE injury model, with the anterior facet capsule being the major stabilizer and to a lesser degree the PLL. Thus, based on our findings, it would appear that an expansion of the DE injury classification may be warranted, based on angulation and posterior translation, and regarded as DES-1, DES-2A, DES-2B, and DES-3. Such categorization based on the degree of angulation and posterior translation may prove advantageous in designing appropriate treatment strategies to address DE injuries of the lower cervical spine; however, further studies are needed to validate the clinical applications of such categorization. © 2010 Lippincott Williams & Wilkins, Inc.en_HK
dc.languageengen_HK
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.comen_HK
dc.relation.ispartofSpineen_HK
dc.subjectBiomechanicalen_HK
dc.subjectCervicalen_HK
dc.subjectClassificationen_HK
dc.subjectDistractiveen_HK
dc.subjectExtensionen_HK
dc.subjectInjuryen_HK
dc.subjectSpineen_HK
dc.subjectStagesen_HK
dc.subjectTraumaen_HK
dc.titleA revisitation of distractive-extension injuries of the subaxial cervical spine: A cadaveric and radiographic soft tissue analysisen_HK
dc.typeArticleen_HK
dc.identifier.emailSamartzis, D:dspine@hku.hken_HK
dc.identifier.authoritySamartzis, D=rp01430en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1097/BRS.0b013e3181c9fa35en_HK
dc.identifier.pmid20110833en_HK
dc.identifier.scopuseid_2-s2.0-77249106088en_HK
dc.identifier.hkuros173069-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-77249106088&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume35en_HK
dc.identifier.issue4en_HK
dc.identifier.spage395en_HK
dc.identifier.epage402en_HK
dc.identifier.eissn1528-1159-
dc.identifier.isiWOS:000275323800005-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridSamartzis, D=34572771100en_HK
dc.identifier.scopusauthoridWein, SM=36060829900en_HK
dc.identifier.scopusauthoridShen, FH=7201583245en_HK
dc.identifier.scopusauthoridBeazell, J=6602263909en_HK
dc.identifier.scopusauthoridFrancke, EI=6603886202en_HK
dc.identifier.scopusauthoridAnderson, DG=9633528400en_HK

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