Cervical Vertebrae

Degenerative cervical myelopathy (DCM) is a clinical diagnosis based on history, physical exam, and imaging, but standardized criteria have not been established, contributing to diagnostic delays. We conducted a prospective study of DCM and healthy subjects that comprehensively evaluated symptoms, patient-reported and clinician-administered outcome measures, and physical assessments of motor and sensory function.Diagnostic utility was evaluated using Youden's Index (YI=sensitivity+specificity-1). 139 DCM patients and 108 age-matched healthy subjects were compared. Distinguishing symptoms included neck pain (YI=63%), upper extremity (UE) numbness (YI=57%), hand clumsiness (YI=50%), walking imbalance (YI=50%), and UE weakness (YI=46%). Questionnaires performed well including mJOA (YI=72%), NDI (YI=63%), and EQ-5D (YI=57%). Physical testing showed best results with UE reflexes (YI=54%), strength in 5 UE muscle groups (YI=53%), Berg Balance scale (YI=50%), self-paced walking velocity (YI=48%), and tandem gait assessment (YI=40%). Hand dexterity, strength dynamometry, and testing of 5 sensory modalities demonstrated poor diagnostic utility. Diagnosis of DCM is challenging, but key symptoms include neck pain, UE weakness, and those captured by the mJOA (particularly UE numbness, hand clumsiness, and walking imbalance). Physical testing of reflexes, manual motor testing, and gait/balance are useful to confirm the diagnosis. These findings offer guidance for clinicians and the development of diagnostic criteria.

BackgroundCervical neural tension reflects the biomechanical and physiological responses of spinal nerves to positional changes. Although clinical tests exist for the lower cervical spinal nerve, tension patterns in the upper and mid-cervical nerves remain underexplored, limiting the diagnostic accuracy for conditions such as occipital neuralgia.MethodsThis cadaveric study quantified tensile load changes at the cervical spinal nerve level (C1-C5) during passive cervical spine rotation in five formalin-embalmed cadavers. Tension was measured on the cervical spinal nerves (C1-C5) using force gauges attached proximal to the division between the dorsal and ventral rami. C1 measurements were obtained from a single specimen. Two movement conditions were used: cervical flexion-rotation for C1-C3 and neutral-plane rotation for C4-C5.ResultsIpsilateral increases in neural tension were observed in C1-C3 during flexion-rotation movements. By contrast, C4-C5 exhibited a consistent pattern of contralateral load increase during rotation in the neutral plane. Statistically significant variations in the tensile load were observed at the C5 level under different rotation conditions, specifically at C5 left (p = 0.003) and C5 right (p = 0.006). Post-hoc analyses of C5 measurements during neutral-plane rotation revealed significant differences between right and left rotation (p = 0.018) and between left rotation and neutral rotation (p = 0.018) on the left side, as well as between right rotation and left rotation and neutral rotation (p = 0.026, p = 0.024) on the right side. Intraclass correlation coefficients (ICC) indicated good-to-excellent reliability (ICC > 0.75), particularly at C2-C5.ConclusionsCervical rotation influenced neural tension, with distinct patterns observed between the upper cervical segments (tested under flexion-rotation) and the middle cervical segments (tested under neutral plane rotation). These exploratory findings suggest that replacing lateral neck flexion with rotation in the upper-limb tension test may represent a promising direction for future research. Additionally, the flexion-rotation test may provide a basis for clinical validation as a potential indicator of greater occipital nerve tension. These results lay the groundwork for refining neurodynamic assessments and warrant further in vivo investigation.

Study designSystematic Literature Review & Patient-Information Scoping Review OBJECTIVES: To assess the evidence on prehabilitation and post-operative rehabilitation interventions for people undergoing surgery for degenerative cervical myelopathy (DCM) and to determine what publicly accessible information is provided to patients from the NHS surrounding DCM surgery.MethodsA systematic literature review was searched from inception to 19 May 2025. Studies reporting pain, function, disability or quality of life for prehabilitation or post-operative rehabilitation interventions for people undergoing DCM surgery were eligible. Downs and Black appraisal tool was used to assess study quality. Data were analysed in a narrative analysis. Secondary, a review of UK NHS Patient Information Documents (PID) was searched using a Google platform assessment. PID reporting prehabilitation or post-operative information for people awaiting DCM surgery were included. The type of information being provided were extracted and descriptive statistics were used to report frequency of information provision.ResultsFrom 5218 screened studies, six studies (n = 685) met the eligibility criteria. The evidence was low to moderate in quality. Rehabilitation offered demonstrated improved clinical outcomes but there was limited evidence compared to non-rehabilitation or superiority between different rehabilitation strategies. The PID review identified 38 documents. This indicates education and guidance is commonly offered on returning to work (68%), driving (76%) and normal activities of daily living (63%).ConclusionThere remains uncertainty on what should be and is offered to patients with DCM in respect to prehabilitation or post-operative rehabilitation. Robust clinical trial evidence on rehabilitation approaches for this population is needed.RegistrationPROSPERO (CRD42024604184).

BackgroundC2 schwannomas are rare neoplasms presenting with variable extensions. Their possible intracranial involvement and close relationship with the V3 segment of the vertebral artery (VA) require a personalized and delicate surgical approach.MethodWe describe the resection steps of an extradural C2 schwannoma with intracranial extension. Indications, advantages, and approach-specific complications are discussed. The main surgical steps are illustrated in an operative video.ConclusionA tailored craniectomy adapted to the lesion intracranial extension enables a safe and effective resection of selected extradural, multicompartmental, cranially extended C2 schwannomas.