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SUMMARY: Head and cervical spine movements cause narrowing or widening of neuroforamina. In healthy individuals these movements do not cause symptoms of radiculopathy. This implies a compensating volume-regulating mechanism of the neuroforamina. Such a mechanism has been postulated in the years before CT and MRI for the neuroforaminal veins. Dural sac indentations with emptying and refilling of the internal vertebral venous plexus (IVVP) were postulated in the lumbar region using myelography. Emptying of the IVVP occurs in the lumbar spine when moving towards maximal extension and refilling while moving towards maximal flexion. Such indentations have not been shown in the cervical region. With MRI this mechanism has been demonstrated during axial rotation in the C1-C2 segment. It consists of emptying and refilling of the IVVP and thus prevents dural sac compression. During spinal surgery, the IVVP and connecting neuroforaminal veins may be damaged. Because the clinical implications of dysfunction of this protecting mechanism of the IVVP and its neuroforaminal venous connections are not clear, the consequences of such damage are unknown. Therefore, these venous structures should be examined by studying the cervical spine in supine position and, if possible, in different postures (flexion, extension and axial rotation) using MRI with contrast-enhancement and fat suppression. These images may be a basis for future advancement of clinical care.

Los movimientos de la cabeza y la columna cervical provocan un estrechamiento o ensanchamiento de las neuroforaminas. En individuos sanos estos movimientos no causan síntomas de radiculopatía. Esto implica un mecanismo compensador de regulación del volumen de las neuroforaminas. Este mecanismo se ha postulado en los años anteriores a la TC y la RM para las venas neuroforaminales. Mediante mielografía se postularon hendiduras del saco dural con vaciado y llenado del plexo venoso vertebral interno (PVVI) en la región lumbar. El vaciado del PVVI se produce en la columna lumbar cuando se mueve hacia la máxima extensión y se rellena mientras se mueve hacia la máxima flexión. En la región cervical no se han observado tales depresiones. Con resonancia magnética se ha demostrado este mecanismo durante la rotación axial en el segmento C1-C2. Consiste en vaciar y rellenar la PVVI y así evitar la compresión del saco dural. Durante la cirugía de columna, la PVVI y las venas neuroforaminales que las conectan pueden dañarse. Debido a que las implicaciones clínicas de la disfunción de este mecanismo protector de la PVVI y sus conexiones venosas neuroforaminales no están claras, se desconocen las consecuencias de dicho daño. Por tanto, estas estructuras venosas deben examinarse estudiando la columna cervical en decúbito supino y, si es posible, en diferentes posturas (flexión, extensión y rotación axial) mediante resonancia magnética con contraste y supresión grasa. Estas imágenes pueden ser una base para futuros avances de la atención clínica.

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Superficial siderosis is a rare disorder characterised by the deposition of haemosiderin on the surface of the central nervous system. Cognitive dysfunction has sporadically been reported in relation with superficial siderosis. We present a 61-year-old man with cognitive dysfunction in the presence of the typical radiological image of temporal and cerebellar superficial siderosis, most likely due to pseudomeningocoele 14 years after resection of a meningioma at the cervicothoracic junction. Xantochromia was present on cerebrospinal fluid investigation and a source of bleeding was seen during surgical exploration. Despite surgical treatment of the suspected bleeding source, the patient deteriorated and neuropsychological examination 1 year after surgery showed progression of cognitive dysfunction to dementia. It is likely that in the absence of other typical symptoms such as cerebellar ataxia and hearing loss, the cognitive dysfunction was not related to the superficial siderosis.

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BACKGROUND: Physiological motion of the lumbar spine is a subject of interest for musculoskeletal health care professionals, as abnormal motion is believed to be related to lumbar conditions and complaints. Many researchers have described ranges of motion for the lumbar spine, but only a few have mentioned specific motion patterns of each individual segment during flexion and extension. These motion patterns mostly comprise the sequence of segmental initiation in sagittal rotation. However, an adequate definition of physiological motion of the lumbar spine is still lacking. The reason for this is the reporting of different ranges of motion and sequences of segmental initiation in previous studies. Furthermore, due to insufficient fields of view, none of these papers have reported on maximum flexion and extension motion patterns of L1 to S1. In the lower cervical spine, a consistent pattern of segmental contributions was recently described. In order to understand physiological motion of the lumbar spine, it is necessary to systematically study motion patterns, including the sequence of segmental contribution, of vertebrae L1 to S1 in healthy individuals during maximum flexion and extension. OBJECTIVE: This study aims to define the lumbar spines' physiological motion pattern of vertebrae L1, L2, L3, L4, L5, and S1 by determining the sequence of segmental contribution and the sequence of segmental initiation of motion in sagittal rotation of each vertebra during maximum flexion and extension. The secondary endpoint will be exploring the possibility of analyzing the intervertebral horizontal and vertical translation of each vertebra during maximum flexion and extension. METHODS: Cinematographic recordings will be performed in 11 healthy male participants, aged 18-25 years, without a history of spine problems. Cinematographic flexion and extension recordings will be made at two time points with a minimum 2-week interval in between. RESULTS: The study has been approved by the local institutional medical ethical committee (Medical Research Ethics Committee of Zuyderland and Zuyd University of applied sciences) on September 24, 2018. Inclusion of participants will be completed in 2020. CONCLUSIONS: If successful, these physiological motion patterns can be compared with motion patterns of patients with lumbar conditions before or after surgery. Ultimately, researchers may be able to determine differences in biomechanics that can potentially be linked to physical complaints like low back pain. TRIAL REGISTRATION: ClinicalTrials.gov NCT03737227; https://clinicaltrials.gov/ct2/show/NCT03737227. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/14741.