UNASSIGNED: Vestibular migraine (VM) is a relatively new diagnostic entity with incomplete knowledge regarding pathophysiological mechanisms and therapeutic guidelines. By reporting the effect of manual cervical therapy (MCT) on people with VM, we suggest a possible role for upper cervical afferents in VM treatment and/or pathogenesis. The objective was to describe the change in clinical presentation and self-reported symptoms of VM corresponding to MCT and followed up to six months.
UNASSIGNED: A nonrandomised *ABA design was utilised to consecutively and prospectively evaluate selected patients with diagnosed VM. Symptom characteristics (frequency and intensity) were recorded along with standardised patient-reported outcomes (PROs) to document the response to MCT.
UNASSIGNED: Three patients were recruited who met the diagnostic criteria for VM. All three patients demonstrated improvement in both migraine attack and interictal symptom frequency. These improvements mirrored changes in PROs and were sustained over a six-month follow-up period.
UNASSIGNED: The improvement that coincided with the intervention including MCT was rapid, observable and sustained. This suggests that the upper cervical spine could be a therapeutic target in VM and may have implications for future research into the pathogenesis of VM.
Migraine is a complex disorder with many different factors potentially contributing to a person developing the condition. Whilst many different parts of the brain and body have been implicated as potential causes, the neck is often overlooked. To provide the best possible solution to patients suffering all forms of migraine, including vestibular migraine, a broader discussion must include all potential factors that may contribute to the disease developing, and/or contribute to optimal management. This article provides support for the upper neck to be included in that conversation, and provides the basis for further research to determine the significance of the neck in causing and/or treating this disorder.

This report describes a 42-year-old female patient who presented with an intensive nocturnal dry cough persisting for over six months. Subsequent to the prolonged cough, she developed shoulder and neck discomfort, leading her to seek chiropractic care. The patient received cervical chiropractic adjustments combined with the Koren Specific Technique (KST) emotions protocol. The patient was mainly treated for her musculoskeletal complaint. However, after two treatment sessions, the patient\'s chronic cough showed significant improvement. Two weeks later, the cough had completely ceased, and her shoulder and neck discomfort had also improved. The cough symptoms did not reappear during the six-month follow-up. The mechanism of cough improvement remains unclear, whether it is due to spinal adjustments, the KST emotions protocol, their combined effects, or merely a placebo response. This report discusses the potential underlying mechanisms of the case improvement, suggesting a non-pharmacological adjunctive therapeutic approach that could be investigated further in future research.

Objectives  Representing approximately 22% of cervical spine injuries, upper cervical spine injuries are becoming more frequent with the increase in road traffic accidents. The purpose of our study is to evaluate the results of our surgical series and to compare them with the literature. Materials and Methods  In this monocentric retrospective study of over three years (June 2019-May 2022), all the patients with traumatic injuries of the upper cervical spine with a surgical treatment and a minimum of 12 months follow-up were included. Results  The average age was 32.7 years, with a predominance of young patients. The predominant cause of injury was road traffic accident (86.3%). The clinical symptoms were cervical pain, associated with a motor deficit in two cases. Jefferson fracture associated with odontoid fracture was the most frequent injury (36.3%), followed by Hangman fracture (22.7%). Ten patients were treated with the Harms technique, four with occipitocervical C0-C2-C3 fixation, two with anterior screw insertion of the odontoid, and six with anterior C2-C3 arthrodesis. The average duration of follow-up was 12.2 months. The outcome was favorable in 21 cases and average in 1 case. Surgical morbidity and mortality were inexistent. Conclusion  This short series shows the effectiveness of surgical treatment in the managing traumatic injuries of the upper cervical spine and in the regression of the pain with a low risk of surgical morbidity and mortality.

Despite the prevalence of neck pain, evidence is lacking regarding the relationship of pathophysiology to function in people with neck conditions. Although movement-based diagnoses based on directional preference (DP) are described for lumbar spinal conditions, how these diagnoses guide interventions is not supported in the Cervical Spine Clinical Practice Guidelines. To date, there are no case studies in the literature that demonstrate the efficacy of cervical spine management based on a rotation DP. This case series highlights patient response to repeated end-range neck movements to inform DP and how the cervical flexion rotation test (CFRT) was used as a clinical baseline to assess mechanical and symptomatic changes. Three consecutive patients were evaluated by a physical therapist fellow trained in orthopedic manual physical therapy and diplomaed in mechanical diagnosis and therapy. The patients\' baseline pain ranged from 3 to 7/10 on the Numerical Pain Rating Scale (NPRS), and disability scores ranged from 20% to 52.6% on patient-reported outcome (PRO) measures. All three cases demonstrated a limited and painful CFRT. Examination procedures included repeated end-range movement testing in the sagittal and frontal and transverse planes. Across five to six visits in five to eight weeks, a decrease in the primary outcome measures from baseline to discharge were observed: NPRS, 50-85%; PRO, 60-82%. The CFRT may be a key baseline when screening patients with neck pain for DP. Following repeated end-range sagittal and frontal plane movements, the rapid change in the CFRT following targeted upper cervical rotation techniques confirmed a rotation DP.

UNASSIGNED: Atlas ring fractures, which account for 1.3% of all spinal fractures, are predominantly managed conservatively. However, in certain cases, surgical treatment may be necessary depending on the type of fracture, degree of comminution, fracture location, and associated ligamentous injuries. Surgical stabilization frequently results in a posterior C1-2 or C0-2 fusion, which restricts movement, particularly craniocervical rotation. Coronal split fractures of the lateral mass need to be reduced and fixed due to dislocation, instability and secondary osteoarthritis. The preferred treatment approach involves internal fixation of the reduced fracture fragments, while avoiding restriction of the upper cervical spine\'s range of motion (ROM).
UNASSIGNED: Is unilateral anterior transoral lag screw for treatment of unstable coronal split fracture of lateral mass of the atlas feasible and a safe treatment option?
UNASSIGNED: We report on a 55-year-old female suffering from polytrauma with multiple spinal and extremity injuries.
UNASSIGNED: A coronal split fracture of the lateral mass of the atlas was treated minimally invasive with a transoral lag screw technique to reduce and fix the fracture that has a tendency for fracture gap widening. Stable fixation and fracture union and thus restoration of function was achieved.
UNASSIGNED: Transoral lag screw osteosynthesis for coronal split fracture of the lateral mass of the atlas is a potential treatment option in selected cases to preserve mobility in the upper cervical spine after spinal trauma.

Background and Objectives: Intramedullary spinal cord tumors (IMSCT) are rare entities. A location in the upper cervical spine as a highly eloquent region carries the risk of postoperative neurological deficits, such as tetraparesis or respiratory dysfunction. Evidence for respiratory dysfunction is scarce. This study aimed to describe these highly eloquent tumors\' early and late postoperative clinical course. Materials and Methods: This is a single-center retrospective cohort study. We included 35 patients with IMSCT at levels of the craniocervical junction to C4 who underwent surgical treatment between 2008 and 2022. The authors analyzed the patients\' preoperative status, tumor- and surgery-specific characteristics, and follow-up functional status. Results: The study cohort included twenty-two patients with grade II ependymoma (62.9%), two low-grade astrocytomas (5.7%), two glioblastomas (5.7%), six hemangioblastomas (17.1%), two metastases (5.7%), and one patient with partially intramedullary schwannoma (2.9%). Gross total resection was achieved in 76% of patients. Early dorsal column-related symptoms (gait ataxia and sensory loss) and motor deterioration occurred in 64% and 44% of patients. At a follow-up of 3.27 ± 3.83 years, 43% and 33% of patients still exhibited postoperative sensory and motor deterioration, respectively. The median McCormick Scale grade was 2 in the preoperative and late postoperative periods, respectively. Only three patients (8.6%) developed respiratory dysfunction, of whom, two patients, both with malignant IMSCT, required prolonged invasive ventilation. Conclusions: More than 60% of the patients with IMSCT in the upper cervical cord developed new neurological deficits in the immediate postoperative period, and more than 40% are permanent. However, these deficits are not disabling in most cases since most patients maintain functional independence as observed by unchanged low McCormick scores. The rate of respiratory insufficiency is relatively low and seems to be influenced by the rapid neurological deterioration in high-grade tumors.

UNASSIGNED: The objective was to determine reliability of sagittal plane range of motion (ROM) assessment in a healthy population and in people with cervicogenic headache (CGH).
UNASSIGNED: Upper cervical flexion/extension ROM was measured using an iPhone magnetometer sensor and retraction/protraction ROM measured by linear displacement. Two independent raters evaluated these movements in 33 subjects with CGH and 33 age and gender matched asymptomatic healthy controls on two occasions. Measurement procedures were standardized; and the order of testing randomized. Reliability, standard error of measurement (SEM) and minimum detectable change (MDC) were calculated.
UNASSIGNED: Subjects comprised 30 females and 36 males. The iPhone method demonstrated high reliability (ICC >0.82) with SEM values ranging from 0.62 to 1.0 and MDC values ranging from 1.70 to 4.81 respectively. Evaluation of linear displacement demonstrated moderate reliability (ICC >64). with SEM values ranging from 0.38 to 1.91 and MDC values ranging from 1.05 to 1.63 respectively. Compared to healthy controls, upper cervical flexion, retraction and protraction ROM was significantly less in the CGH group with mean difference of 6.50°, 1.52 cm and 2.34 cm respectively.
UNASSIGNED: Upper cervical spine sagittal plane ROM can be measured with moderate to high reliability and was found to be more restricted in people with CGH.

BACKGROUND: Chordomas are rare, locally aggressive tumors that often occur in the axial spine, especially in the sacrum. The treatment of chordomas located in the upper cervical spine is challenging. En bloc resection is the preferred surgical option for total tumor removal.
METHODS: We report the case of a C2 chordoma in a 47-year-old Thai woman. She was treated with a two-stage, anterior-posterior, C2 total spondylectomy with titanium mesh cage reconstruction and radiotherapy. The first stage involved posterior stabilization from the occiput to C5, a total laminectomy, and removal of the posterior rings of the bilateral foramen transversarium to preserve the bilateral vertebral arteries. The second stage comprised a transoral mandibular split with en bloc resection of C2, followed by titanium mesh cage reconstruction and kick-off anterior cervical plating. At the 5 year follow-up, no tumor recurrence was identified on magnetic resonance imaging. The patient had no neurological deficits but still had minor complications from the anterior transoral mandibular split.
CONCLUSIONS: Excellent midterm results were obtained using a transoral mandibular split with reconstruction and posterior spinal fusion from the occiput to the lower cervical spine coupled with adjuvant radiotherapy. We recommend this approach as the treatment of choice for chordoma in the upper cervical spine.

OBJECTIVE: The uppermost segment of the cervical vertebra or atlas (C1) is a critically important anatomical structure, housing the medulla oblongata and containing the grooves for the C1 spinal nerve and the vertebral vessels. Variations of the C1 vertebra can affect upper spine stability, and morphometric parameters have been reported to differ by population. However, there are few data regarding these parameters in Thais. The use of this bone to predict sex and age has never been reported.
METHODS: This study aimed to examine C1 morphometry and determine its ability to predict sex. Twelve diameter parameters were taken from the C1 vertebrae of identified skeletons (n = 104, males [n, 54], females [n, 50]). Correlation analysis was also performed for sex and age, which were predicted using machine learning algorithms.
RESULTS: The results showed that 8 of the 12 measured parameters were significantly longer in the male atlas (p < 0.05), while the remaining 4 (distance between both medial-most edges of the transverse foramen, transverse dimension of the superior articular surface, frontal plane passing through the canal\'s midpoint, and anteroposterior dimension of the inferior articular surface) did not differ significantly by sex. There was no statistically significant difference in these parameters on the lateral side. The decision stump classifier was trained on C1 parameters, and the resulting model could predict sex with 82.6% accuracy (root mean square error = 0.38).
CONCLUSIONS: Assertation of the morphometric parameters of the atlas is important for preoperative assessment, especially for the treatment of atlas dislocation. Our findings also highlighted the potential use of atlas measurements for sex prediction.

BACKGROUND: The development of dysphagia and trismus following posterior C1-C3 fusion is rare compared to occipitocervical fusion, and there are very few reports in the literature.
METHODS: A 75-year-old Thai man who had an extradural tumor at the C1/C2 level developed severe dysphagia and trismus immediately after tumor resection and C1-C3 fusion. During the surgery for malalignment correction, the C1-C2 screws were re-aligned into an increased lordotic position. The symptoms resolved immediately post-surgery.
CONCLUSIONS: Short upper cervical fusion can produce trismus and dysphagia in a relatively flexed position. Preoperative planning should be individualized based on the patient\'s resting neutral alignment to prevent complications.