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Concept: Bones of the torso

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BACKGROUND CONTEXT: There are rare reports of intraosseous ganglion cysts in the cervical spine. However, to our knowledge, there are no previous reports of these cysts occurring in the lumbar spine. PURPOSE: To report a case of symptomatic lumbar spinal stenosis caused by an intraosseous ganglion cyst of the L4 lamina that communicated with the spinal canal. STUDY DESIGN: Case report. METHODS: An 86-year-old woman was referred to our spine service for a 2-year history of anterior thigh and leg pain. Magnetic resonance imaging revealed a benign-appearing intraosseous cyst in the left L4 lamina communicating with a posterior epidural cyst at L4-L5 causing marked spinal stenosis. The patient was treated successfully with a laminectomy and resection. RESULTS: The patient underwent partial laminectomies of L4 and L5 preserving the interspinous ligaments between L5-S1 and L3-L4. The cyst was removed en bloc without violation of the cyst wall. Histopathologic examination revealed focal myxoid changes without a cellular lining of the cyst wall, confirming the diagnosis of intraosseous ganglion cyst. CONCLUSIONS: This is the first report to describe an intraosseous ganglion cyst occurring in the lumbar spine. Although spinal stenosis is commonly a result of degenerative joint or disc disease, it occasionally may result from more obscure causes. This case illustrates a patient with an intraosseous ganglion cyst within the spinal lamina resulting in spinal stenosis, treated successfully with a laminectomy and resection.

Concepts: Causality, Lumbar vertebrae, Vertebral column, Magnetic resonance imaging, Bones of the torso, Cyst, Cervical vertebrae, Ganglion cyst

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PURPOSE: Currently degeneration of the intervertebral disc and joint in the degenerative process of the lumbar spine has mainly attracted the attention, however, there are very few literatures focusing on the height of the spinous process. Our objective was to examine in what generation the change in spinous process height occurs and how the change is involved in the degenerative process of the lumbar spine. METHODS: CT or CT myelography of 1,015 patients, 536 males and 579 females were measured in 6 items, including the heights of the L4 and L5 vertebral bodies, the L4 and L5 spinous processes, the L4/5 intervertebral disc, and the L5/S1 intervertebral disc. All data of the 6 items were analyzed and compared between gender in 5 age groups (40s, 50s, 60s, 70s and 80s). RESULTS: The results indicated a significant increase in the height of the L4 and L5 spinous process (P < 0.01) in the 60- to 70-year-old group for both genders, and also showed that the L4 and L5 vertebral body height was significantly decreased in the 50- to 60-year-old group (P < 0.01 in males, P < 0.001 in females). CONCLUSIONS: Changes in the spinous process morphology followed degenerative changes of the intervertebral disc and vertebral body in the degenerative process of the lumbar spine. This result may suggest that the morphological change of an increase in the height of the spinous process may be a kind of biological defense reaction to stabilize the intervertebral portion.

Concepts: Male, Lumbar vertebrae, Vertebral column, Gender, Vertebra, Intervertebral disc, Bones of the torso, Spinous process

25

One of the roles of forensic anthropology is the identification of skeletal remains and over the years many methods have been developed to obtain specific details of a corpse such as an estimation of age and height. The femur and tibia are ideal for this purpose but unfortunately they are often missing or badly fragmented. For this reason, in this present study, we used the smaller bones of the first and second cervical vertebrae, which are often better preserved than the long bones. Direct measurement of these bones has been found to be misleading, largely due to the remains of a covering of soft tissue, and to overcome this all measurements were taken from tomographic images. The aim of this study is to provide an auxiliary diagnostic method to evaluate the association of different anthropometric measurements taken with tomographic imagery of both the first cervical and second cervical vertebra with body height within a sample of the Spanish population. Measurements were taken from tomographic images taken with a dental CT of 203 healthy individuals from a Spanish population. The best correlation was obtained in the case of unknown sex using four measurements: two of the first cervical vertebra and two of the second vertebra using the following regression formula S=49.02+1.02O+1.58DO+0.49V+0.67I. All formulae provided statistically significant results and can be applied to any skeletal remains belonging to a Spanish population.

Concepts: Statistics, Vertebral column, Vertebra, Bones of the torso, Cervical vertebrae, Vertebral artery, Axis, Vertebral foramen

8

Although upper cervical and upper thoracic spine mobilization plus therapeutic exercises are common interventions for the management of forward head posture (FHP), no study has directly compared the effectiveness of cervical spine mobilization and stabilization exercise with that of thoracic spine mobilization and mobility exercise in individuals with FHP.

Concepts: Clinical trial, Effectiveness, Lumbar vertebrae, Vertebral column, Clinical research, Bones of the torso, Cervical vertebrae, Thoracic vertebrae

7

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by anterior ossification of the spine and can lead to dysphagia and airway obstruction. The morphology of the newly formed bone in the cervical spine is different compared to the thoracic spine, possibly due to dissimilarities in local vascular anatomy. In this study the spatial relationship of the new bone with the arterial system, trachea and esophagus was analyzed and compared between subjects with and without DISH.

Concepts: Heart, Lumbar vertebrae, Vertebral column, Anatomy, Bones of the torso, Intramembranous ossification, Cervical vertebrae, Thoracic vertebrae

4

Elasmosaurid plesiosaurians are renowned for their immensely long necks, and indeed, possessed the highest number of cervical vertebrae for any known vertebrate. Historically, the largest count has been attributed to the iconic Elasmosaurus platyurus from the Late Cretaceous of Kansas, but estimates for the total neck series in this taxon have varied between published reports. Accurately determining the number of vertebral centra vis-à-vis the maximum length of the neck in plesiosaurians has significant implications for phylogenetic character designations, as well as the inconsistent terminology applied to some osteological structures. With these issues in mind, we reassessed the holotype of E. platyurus as a model for standardizing the debated cervical-dorsal transition in plesiosaurians, and during this procedure, documented a “lost” cervical centrum. Our revision also advocates retention of the term “pectorals” to describe the usually three or more distinctive vertebrae close to the cranial margin of the forelimb girdle that bear a functional rib facet transected by the neurocentral suture, and thus conjointly formed by both the parapophysis on the centrum body and diapophysis from the neural arch (irrespective of rib length). This morphology is unambiguously distinguishable from standard cervicals, in which the functional rib facet is borne exclusively on the centrum, and dorsals in which the rib articulation is situated above the neurocentral suture and functionally borne only by the transverse process of the neural arch. Given these easily distinguishable definitions, the maximum number of neck vertebrae preserved in E. platyurus is 72; this is only three vertebrae shorter than the recently described Albertonectes, which together with E. platyurus constitute the “longest necked” animals ever to have lived.

Concepts: Vertebral column, Vertebra, Vertebrate, Bones of the torso, Cervical vertebrae, Neck

3

Functional interpretations of the postcranium of the late Miocene ape Oreopithecus bambolii are controversial. The claim that Oreopithecus practiced habitual terrestrial bipedalism is partly based on restored postcranial remains originally recovered from Baccinello, Tuscany (Köhler and Moyà-Solà, 1997). The lower lumbar vertebrae of BA#72 were cited as evidence that Oreopithecus exhibits features indicative of a lordotic lumbar spine, including dorsal wedging of the vertebral bodies and a caudally progressive increase in postzygapophyseal interfacet distance. Here, we demonstrate why the dorsal wedging index value obtained by Köhler and Moyà-Solà (1997) for the BA#72 last lumbar vertebra is questionable due to distortion in that region, present a more reliable way to measure postzygapophyseal interfacet distance, and include an additional metric (laminar width) with which to examine changes in the transverse dimensions of the neural arches. We also quantify the external morphology of the BA#72 proximal sacrum, which, despite well-documented links between sacral morphology and bipedal locomotion, and excellent preservation of the sacral prezygapophyses, first sacral vertebral body, and right ala, was not evaluated by Köhler and Moyà-Solà (1997). Measures of postzygapophyseal interfacet distance and laminar width on the penultimate and last lumbar vertebrae of BA#72 reveal a pattern encompassed within the range of living nonhuman hominoids and unlike that of modern humans, suggesting that Oreopithecus did not possess a lordotic lumbar spine. Results further show that the BA#72 sacrum exhibits relatively small prezygapophyseal articular facet surface areas and mediolaterally narrow alae compared with modern humans, indicating that the morphology of the Oreopithecus sacrum is incompatible with the functional demands of habitual bipedal stance and locomotion. The Oreopithecus lumbosacral region does not exhibit adaptations for habitual bipedal locomotion.

Concepts: Lumbar vertebrae, Vertebral column, Hominidae, Vertebra, Coccyx, Bones of the torso, Cervical vertebrae, Vertebral foramen

2

We explored intraspecific variation in vertebral formulae, more specifically the variation in the number of thoracic vertebrae and frequencies of transitional sacral vertebrae in Triturus newts (Caudata: Salamandridae). Within salamandrid salamanders this monophyletic group shows the highest disparity in the number of thoracic vertebrae and considerable intraspecific variation in the number of thoracic vertebrae. Triturus species also differ in their ecological preferences, from predominantly terrestrial to largely aquatic. Following Geoffroy St. Hilaire’s and Darwin’s rule which states that structures with a large number of serially homologous repetitive elements are more variable than structures with smaller numbers, we hypothesized that the variation in vertebral formulae increases in more elongated species with a larger number of thoracic vertebrae. We furthermore hypothesized that the frequency of transitional vertebrae will be correlated with the variation in the number of thoracic vertebrae within the species. We also investigated potential effects of species hybridization on the vertebral formula. The proportion of individuals with a number of thoracic vertebrae different from the modal number and the range of variation in number of vertebrae significantly increased in species with a larger number of thoracic vertebrae. Contrary to our expectation, the frequencies of transitional vertebrae were not correlated with frequencies of change in the complete vertebrae number. The frequency of transitional sacral vertebra in hybrids did not significantly differ from that of the parental species. Such a pattern could be a result of selection pressure against transitional vertebrae and/or a bias towards the development of full vertebrae numbers. Although our data indicate relaxed selection for vertebral count changes in more elongated, aquatic species, more data on different selective pressures in species with different numbers of vertebrae in the two contrasting, terrestrial and aquatic environments are needed to test for causality.

Concepts: Natural selection, Vertebral column, Vertebra, Coccyx, Bones of the torso, Sacrum, Cervical vertebrae, Salamandridae

1

OBJECT Acute cervical spine injuries have been extensively studied in high-level contact sports. However, the relation between the appearance of degenerative cervical spine disease and the exposure to repeated trauma in such sports as rugby is still unclear. Using clinical and MRI evaluation, we aimed to determine if former professional rugby players had more serious degenerative cervical spine symptoms than the general population. METHODS Two groups, one composed of 101 former rugby players (all men, mean age 40.3 years, range 35-47 years, SD 2.3 years) and the other of 85 male volunteers serving as a control group (mean age 41.6 years, range 35-49 years, SD 4.5 years) were studied. The former rugby players were evaluated on average 5.8 years after retirement (range 1-16 years, SD 3.5 years). The groups were matched in terms of sex, age, job, current sports training, and smoking habits. Each participant received a complete neurological evaluation. Clinical symptoms were evaluated using the Japanese Orthopaedic Association (JOA) questionnaire, and chronic neck pain was specifically evaluated using a visual analog scale (VAS) and the Neck Disability Index (NDI). Overall, 25 MRI studies were performed in each group. MRI studies, including dynamic sequences, focused on degenerative lesions (Matsumoto score and canal diameter) and on muscular and medullary morphological analysis. RESULTS Significantly more former rugby players than controls complained of chronic neck pain (51 [50.50%] of 101 vs 27 [31.76%] of 85, p = 0.01). Rugby players also had significant reductions of neck mobility. Nevertheless, in those complaining of pain, there was no statistically significant difference between groups with respect to VAS and NDI scores (p = 0.57). On MRI, former rugby players had a narrower vertebral canal (on average 0.88 ± 0.167 cm vs 0.99 ± 0.130 cm, p = 0.007) and more foraminal stenosis (p = 0.01). No significant difference in the Matsumoto score was found between the 2 groups with respect to other degenerative lesions. Former rugby players had more often undergone surgery for a degenerative condition than had members of the control group (10 cases vs 0 in the control group, p = 0.0021). CONCLUSIONS A few years after retirement, former professional rugby players seem to have more frequent cervical spine pain and MRI degenerative lesions, such as foraminal stenosis and narrowing of the spinal canal, compared with controls who had not been professional rugby players. A longer evaluation is necessary to determine if these findings persist over time.

Concepts: Statistics, Statistical significance, Lumbar vertebrae, Vertebral column, Vertebra, Bones of the torso, Cervical vertebrae, Thoracic vertebrae

0

Spinal navigation has made significant advances in the last two decades. After initial experiences with pedicle screws in the thoracic and lumbar spine, technological improvements have resulted in their increased application in the cervical spine. Instrumentation techniques like cervical pedicle screws, lateral mass screws in C1 and transarticular screws C1/C2 have become standard due to the application of image guidance.

Concepts: Surgery, Lumbar vertebrae, Vertebral column, Bones of the torso, Reconstructive surgery, Cervical vertebrae, Thoracic vertebrae, Vertebral foramen