![]() The literature search was performed using Medical Search Headings (MeSH) in Mendeley version 1.19.8. We discuss new 3D finite element model reconstructions of the cervical spine that shed light on the pathoanatomy of cervical spine instability, advancements in the diagnosis of traumatic cervical spine injuries, and appraise the current state of minimally invasive and surgical options for this clinical entity. The purpose of this review article is to summarize the current state of knowledge on upper cervical ligamentous instability. There is no consensus in the literature regarding, in which patients a higher-level treatment option may benefit. However, there are other options available for patients in whom non-operative options fail. 3Ĭonventional wisdom generally supports the use of bracing and physical therapy to treat these patients. Considering the architecture and proximity to both the spinal cord and brainstem, cervical spine instability can produce irritation to nerves, possible structural issues, and debilitating pain. 1,2 Cervical instability occurs due to laxity or rupture of the supporting ligaments of the cervical spine, which allows for excess motion and displacement of the facet joints under normal physiologic conditions. Cervical spine instability, or CSI, may be stratified according to spinal level, functional compromise, and mechanism of instability. ![]() More efforts are needed regarding the use of fine element analysis in understanding the pathoanatomic cascade, the long-term outcomes of children over a spectrum of syndromic causes, and the potential of preoperative virtual simulation to improve surgical outcomes.Ĭervical spine instability broadly refers to articular compromise that renders joints of the cervical spine vulnerable to disruption. A few modalities on the horizon could increase diagnostic potential. 3D fine element analysis models and motion-capture systems have the potential to increase our understanding of the pathoanatomic cascade in both traumatic and non-traumatic cases of upper cervical spinal instability. The presentation of upper cervical spinal instability can be asymptomatic, symptoms of isolated instability, symptoms of nerve irritation, vertebrobasilar insufficiency, or severe neurologic compromise. Recently the use of preoperative 3D CT reconstruction has been described with radiographic and immediate postoperative patient-reported outcomes. Surgical treatment has been described in many different populations with good radiologic and clinical outcomes. Conservative treatment has been described, but there are no outcome studies in the literature. A few articles demonstrate the diagnosis and show that radiographs alone have a low diagnostic rate and that functional MRI may be able to better quantify instability. A few recent studies elucidate new findings regarding pathoanatomy through the use of finite element analysis. Many articles report on the etiological factors including ligamentous laxity, traumatic injury, syndrome instability, iatrogenic instability, congenital, and inflammatory causes. Any question regarding the inclusion of an article was discussed by 3 authors until an agreement was reached. The full-text screening was performed on the selected articles. All articles were screened by title and abstract and a preliminary decision to include an article was made. Search fields were varied until redundant. The literature search was performed in Mendeley. Conventional wisdom advocates for use of bracing and physical therapy with only a subset of patients proceeding to obtain surgical treatment. It can be stratified according to spinal level, functional compromise, and mechanism of instability. Cervical spine instability broadly refers to compromise of the articular congruity.
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