Cervical Pain Research Articles

Association between clinical biomechanical metrics of cervical spine function and pain or disability in people with neuromusculoskeletal neck pain: Protocol for a systematic review and planned meta-analysis.

Neck pain is a burdensome condition associated with pain, disability, and economic cost. Neck pain has been associated with observable changes in neuromuscular function and biomechanics. Prior research shows impairments in kinematic control, including reduced mobility, velocity, and smoothness of cervical motion. However, the strength of association between these impairments and patient-reported pain and disability is unclear rendering development of novel and relevant rehabilitation strategies difficult. The aim of this systematic review is to synthesize existing evidence on the strength of association between clinical biomechanical metrics of neck function (ROM, strength, acceleration, accuracy, smoothness, etc.) and patient-reported neck pain and disability. This protocol follows Cochrane guidelines and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). MEDLINE, EMBASE, CINAHL, SPORTDiscus, Web of Science and Scopus will be searched, along with the gray literature, up to 20 November 2023, using terms and keywords derived from initial scoping searches. Observational studies, including cohorts and cross-sectional studies, that explore associations between clinical biomechanics of the neck and patient-reported outcomes of neck pain or disability will be included. Two reviewers will independently perform study selection, data extraction, and risk of bias assessment (National Institute of Health tool). Data will be synthesized using either a random effects meta-analytic approach or qualitatively using a modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, dependent on the homogeneity of data available. This review addresses a gap in the literature by systematically synthesizing findings on the relationship between neck function impairments and patient-reported outcomes. It will identify priorities for neck pain rehabilitation and gaps in current knowledge. The results of this review will be disseminated through a peer-reviewed publication, conference presentation, and lay language summaries posted on an open-access website. PROSPERO Registration number: CRD42023417317. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023417317.

Oesophageal haematoma in a Cairn terrier presenting for impaired swallowing, retching and cervical pain

AbstractA 13‐year‐old spayed female Cairn terrier was referred for surgical resection of a large oesophageal mass. The dog was initially presented to the primary care veterinarian for several days of gagging. The mass was initially diagnosed on thoracic radiographs and confirmed via computed tomography and oesophagoscopy. Endoscopic biopsies were performed that were consistent with oesophagitis. The dog was then referred to The Ohio State University Veterinary Medical Center for surgical resection of the mass. On surgical approach, a small nodule was palpable in the oesophagus; however, a large mass was not found. Oesophagoscopy was repeated intraoperatively, which revealed a small nodule in the same region of the previously described mass. The small nodule was removed, and histopathology was consistent with lymphohistiocytic inflammation and previous haemorrhage, consistent with an oesophageal haematoma. The dog made a full recovery post‐operatively, with continued resolution of clinical signs reported 5 months after surgery.

Effects of myofascial trigger point injection on the disease activity in patients with comorbidity of fibromyalgia and cervical myofascial pain syndrome

Aims: To investigate the effect of myofascial trigger point injection on the disease activity of FS in patients with myofascial trigger points in the coexistence of fibromyalgia syndrome (FS) and chronic cervical myofascial pain syndrome (MAS). Methods: 30 consenting patients between the ages of 18-60 who has had FS for at least for 3 months and also MPS in trapezius, levator skapula, splenius capitis, and multifidus muscles in cervical region and 15 patients with FS but without MPS were included in the present study. Patients newly diagnosed with FS, were evaluted for the presence of MPS and FS, disease activity was evaluated before administering treatment and after administration of trigger point injection tretament for cervical MPS. In the group with only FS, cervical region tender point injection was carried out. Patients were evaluated before injection and one month after injection. Severity of pain was evaluated with VAS (visual analog scale), pressure pain threshold was measured with algometer, total myalgic score (TMS) , fibromiyalgia impact questionnaire (FIQ), Pittsburgh sleep quality index (PSQI) , Beck depression inventory (BDI), Beck anxiety inventory (BAI), fatique severity scale (FSS) results were evaluated prior to and after treatment. Results: When patients were evaluted at 1st month after myofacial trigger point and cervical tender point injections statistically significant decrease was found in VAS, TMS, PSQI, FIQ, FSS, BAI and BAI scores and the number of trigger points in both FS and FS+MAS groups. (for all parameters p<;0,005). However, this decrease was more evident in FS+MPS group. Conclusion: In conclusion, in the concomitance of MPS and FS, which is one of the most common causes of widespread musculoskletal pain, the treatment of MPS with trigger point injection has been shown to exert positive effects on the severity of FS, affective disorders, sleep and fatique. In the treatment of FS, thetreatment of MPS, which is one of the periheral pain generators, should be given priority.

Investigating and analyzing the current situation and factors influencing chronic neck, shoulder, and lumbar back pain among medical personnel after the epidemic

BackgroundChronic shoulder and neck pain is one of the most common chronic occupational disorders, with an average incidence rate of 48.5%, severely affecting patients’ quality of life and ability to work. According to epidemiological research, the prevalence of chronic neck, shoulder, and low back pain in adults over the age of 45 ranges from 40 to 80%. According to reports, medical staff have a higher incidence rate than other populations, and there is a positive correlation between the grade of the medical institution and the incidence rate, making medical staff a priority group for the prevention of chronic neck, shoulder, and low back pain. By the end of 2022, China has been fully opened to epidemic prevention and control, the total number of patients in domestic hospitals has increased significantly, and resulting in medical personnel shoulting great pressure, which seriously affects the physical and mental health of medical personnel. The aim of this study was to explore the risk factors of chronic neck, shoulder and lumbar back pain in medical staff. To provide guidelines for medical staff to improve cervical and lumbar subacute pain and reduce the emergence of spinal lesions.MethodsFrom January to February 2023, 602 staff members of a third-grade hospital in Zunyi City were studied by Questionnaire star. Univariate and multivariate Logistic regression were used to analyze the independent risk factors of chronic neck, shoulder and lumbar back pain in medical staff, with stepwise regression utilized to choose the optimum model. The model was selected using Akaike’s information criterion (AIC) and the Hosmer-Lemeshow goodness-of-fit test.ResultsA total of 602 medical staff were polled, and the findings revealed that 588 cases of chronic neck, shoulder, and low back pain of varied severity had occurred in the previous 1 to 2 years, with a 97.7% incidence rate; logistic regression analysis revealed that anxiety level, frequency of bending over in the previous 1 to 2 years, whether related preventive measures were taken at work, gender, positive senior title, daily ambulation time, and whether the department they worked in organized independent influencing factors.ConclusionThe incidence of chronic neck, shoulder, and lumbar back pain among medical staff is high; its influencing factors are different and have not been systematically identified. Hospitals should take effective measures tailored to local conditions to improve the physical and mental health of medical staff.

Single-Photon Emission Computed Tomography (SPECT-CT) as a Predictor of Pain Generators in Patients Undergoing Anterior Cervical Discectomy and Fusion (ACDF) for Axial Cervical Pain

Single-Photon Emission Computed Tomography (SPECT-CT) as a Predictor of Pain Generators in Patients Undergoing Anterior Cervical Discectomy and Fusion (ACDF) for Axial Cervical Pain

Dorsal laminectomy for the treatment of lateralised cervical intervertebral disc extrusions in dogs-Prognosis and complications.

Describe the complication rate, expected hospitalization time and prognosis associated with dorsal laminectomy for the treatment of lateralised cervical intervertebral disc extrusion (IVDE) in dogs. This is a single-center retrospective case series study. Databases were reviewed from 2012 to 2022 for dogs that had a dorsal laminectomy to treat a lateralised cervical IVDE. Dogs were excluded if additional surgical techniques were performed, or other comorbidities were found on MRI. Fifty two dogs were included the study. French bulldogs represented 28.8% of the cohort. Patient median age was 6 years and median weight 15 kg. Thirty-five dogs (67.3%) presented clinical signs for <3 days and almost half (44.2%) were ambulatory but presented cervical pain and neurological deficits. Median surgical time was 85 min. Minor intraoperative complications were reported in 22 (42.3%), with hypothermia being the most common. Thirteen (25%) needed revision surgery due to persistent cervical pain with (9/13) or without (4/13) neurological deficits. Re-extrusion or persistent extrusion was found in 92.3% of cases needing surgical revision. Median hospitalization time was 6 days. Forty-seven (90.4%) cases had a good outcome. Despite the relatively high rate of intraoperative complications and cases needing revision surgery, dorsal laminectomy as surgical treatment for lateralised cervical IVDE is still associated with good long-term prognosis in most of cases. Prognosis is good even when revision surgery is necessary but expected hospitalization time seems to be higher when compared to an alternative surgical technique.

Is there any relationship between scoliosis, cervical pain and postural imbalance in Parkinson's disease? A cross-sectional pilot study.

Parkinson's disease (PD) is defined by progressive worsening of gait, posture, and balance, as well as disability in daily life activities, and improvement in chronic musculoskeletal pain, particularly neck pain associated with worsening of balance. The study's goal is to look into the relationship between scoliosis, balance, and cervical pain in Parkinson's disease patients. Cross-sectional, pilot study. The study included 16 Parkinson's patients. Neck cervical pain was measured using the pain visual analogue scale and the short form McGill pain questionnaire, while dynamic balance was assessed using static balance, Tinetti, Berg Balance, and the Short Physical Performance Battery scales (SPPB). Cobb angles are measured on a whole-spine standard X-ray to assess spinal scoliosis.An observational statistical analysis was performed with patients subdivided into two groups: non-scoliosis (NS) and true scoliosis (TS) based on whether they presented a Cobb's angle below or ≥10°. Neck pain was reported by 37% (n=3) of participants in the NS group versus 50% (n=4) in the TS group. Neck pain was more prevalent in patients with a disease duration of less than 48 months (n=6; 75.0% vs n=1; 12.5%; p-value < 0.05). Scoliosis, cervical pain, and postural imbalance are all significant but often overlooked Parkinson's disease complaints.

Effects of focal muscle vibration on cervical pain in Parkinson's disease patients: a pilot study.

Musculoskeletal pain is a common symptom of Parkinson's disease (PD) that is not adequately treated with current dopaminergic drugs. This pilot study sought to investigate the effect of focal muscle vibration (fMV) on a group of Parkinson's disease patients suffering from chronic cervical pain. In addition to conventional physiotherapy, twenty-two patients with idiopathic Parkinson's disease (Hoehn and Yahr stages II-III) received three weeks of bilateral focal musclevibration to the trapezius muscles. The Visual Analogue Scale (VAS), the Short-form McGill, and the Present PainIntensity scales were used to assess pain at baseline (T0), after three weeks of treatment (T1), one week after the last treatment session (T2), and three weeks after T2 (T3). Pain intensity decreased significantly from baseline to T1 across all pain scales (p < 0.0001). Furthermore, the beneficial effect of fMV on cervical pain lasted up to one month after treatment. Our findings show that fMV, in combination with conventional physiotherapy, is effective at reducing pain intensity in PD patients, with results visible even after a month of follow-up.

Devising of Lazūq (A Conventional Unani Dosage Form) with reference to Transdermal Patch; Then and Now: A Critical Review

Objective: The endeavor is made to criticize the classical indications, preparations and application of Lazūq even after passing many centuries since its inception. Background: According to classical Unani literature, Lazūq is primarily formulated for headache, migraine, toothache, cervical pain, dropping of uvula and different types of pain like sciatica, backache, myalgia and some orthopedic conditions. Its approach is still conventional that encompasses thick sticky stuff of drug/s which is pasted over a cloth or thick paper, consequently, maximum ratio of medicinal properties remains insignificant owed to stratum corneum (layer of skin that functions as a barrier). Devising and method of drug delivery in classical form of Lazūq makes it inconvenient to the patient, thus, it drops patient’s compliance and anticipated efficacy. In this day and age, Unani practitioners do not prescribe it very often because of its devising and limited indications documented in classical literature. Hence, it’s now becoming out of practice. Whereas, modern medicine is practicing its novel approach epitomized as Transdermal patch for several bodily conditions like Acute post-operative pain, Alzheimer disease, Angina pectoris, Anti-emetic patch, Atrial fibrillation, Attention deficit hyperactivity disorder, Dementia, Depression, Dysmenorrhea, Hypertension, Local dermal analgesia, Menopausal symptoms, Motion sickness, Osteoporosis, Overactive bladder, Parkinson’s disease, Post herpetic neuralgia pain, Smoking cessation, Tic disorder, Tourette syndrome and to prevent pregnancy. In transdermal patch, drug is used in micro/nano form with chemically produced permeation enhancers (CPEs) and other smart physio-chemical techniques that makes it very easy to apply, imparts maximum active pharmaceutical ingredients with controlled release of drug. Methodology: Ancient classical Unani formulations of Lazūq was appraised and then its course with respect to today’s newer formulations as transdermal patch was reviewed to look for its progress and application in novel dosage form with the advantage of innovations in pharmaceutical and allied sciences. Conclusion: Classical Unani formulations of Lazūq must be reviewed, transformed, evaluated, coped and applied as per the standard operating procedures (SOPs) of transdermal drug delivery system. Future Prospects: New formulations of Lazūq should be designed and appraised from the medicinal treasure of Unani system of medicine for different therapeutic conditions.&#x0D;  

Radiofrequency for chronic lumbosacral and cervical pain: Results of a consensus study using the RAND/UCLA appropriateness method.

Despite the routine use of radiofrequency (RF) for the treatment of chronic pain in the lumbosacral and cervical region, there remains uncertainty on the most appropriate patient selection criteria. This study aimed to develop appropriateness criteria for RF in relation to relevant patient characteristics, considering RF ablation (RFA) for the treatment of chronic axial pain and pulsed RF (PRF) for the treatment of chronic radicular pain. The RAND/UCLA Appropriateness Method (RUAM) was used to explore the opinions of a multidisciplinary European panel on the appropriateness of RFA and PRF for a variety of clinical scenarios. Depending on the type of pain (axial or radicular), the expert panel rated the appropriateness of RFA and PRF for a total of 219 clinical scenarios. For axial pain in the lumbosacral or cervical region, appropriateness of RFA was determined by the dominant pain trigger and location of tenderness on palpation with higher appropriateness scores if these variables were suggestive of the diagnosis of facet or sacroiliac joint pain. Although the opinions on the appropriateness of PRF for lumbosacral and cervical radicular pain were fairly dispersed, there was agreement that PRF is an appropriate option for well-selected patients with radicular pain due to herniated disc or foraminal stenosis, particularly in the absence of motor deficits. The panel outcomes were embedded in an educational e-health tool that also covers the psychosocial aspects of chronic pain, providing integrated recommendations on the appropriate use of (P)RF interventions for the treatment of chronic axial and radicular pain in the lumbosacral and cervical region. A multidisciplinary European expert panel established patient-specific recommendations that may support the (pre)selection of patients with chronic axial and radicular pain in the lumbosacral and cervical region for either RFA or PRF (accessible via https://rftool.org). Future studies should validate these recommendations by determining their predictive value for the outcomes of (P)RF interventions.

Prevalence of Musculoskeletal Pain in Patients Following Cardiac Surgery in Peshawar: A Cross Sectional Study

Background: Cardiovascular diseases causes more deaths and disability in developing countries than any other  disease in the world, for these diseases, CABG (Coronary artery bypass grafting) and VR (valvular replacement) are the best treatment options, although, these surgeries improve the chances of survival but they may cause chronic post operative musculoskeletal pain. Musculoskeletal pain can arise from different body musculoskeletal structures such as muscles, tendons, ligaments and joints and knowing the exact cause of this musculoskeletal pain is very difficult and challenging. Chronic musculoskeletal pain patients may have different signs of pain and spread of pain to degrees which are related to pain intensity and duration, so in management, it is very important to reduce duration and intensity of pain. Methods: A cross-sectional survey design was conducted among 199 cardiac patients in Peshawar from both genders, from June 2018-November 2018 among patients at RMI, KTH.,LRH and at other private clinics. Tool used for data collection named as Orebro musculoskeletal pain questionnaire and self- made questionnaire was used in this study. Results: Patients mean age was 53.49±11.88, 69.8% were males and 30.2% were females. The results showed that most common MSK pain site is upper back 27.6% and most common surgery is CABG. This study analyzed that different surgical procedure through which participants had been undergone. The surgical procedures were categorized into 4 main domains as shown in table 8 and frequency analysis was done which shows that most common surgical procedure is CABG (Coronary artery bypass grafting) 64.3%. The result of this study shows that  diagnosis domain descriptive analysis was done to find out the frequency of the present pain conditions of the participants which exhibits that most common pain occurs in the back 27.6% and in the shoulder 25.1% Conclusion: Results among patients of Peshawar showed that most common surgery performed is CABG while PCI intervention is the next. Most of the patients are suffered from upper back pain while leg pain and cervical pain is not so common.

Sensitization-Associated Symptoms and Neuropathic-like Features in Patients with Cervical Dystonia and Pain.

Background: This exploratory study evaluated the presence of sensitization-associated and neuropathic-like symptoms and identified their association with pressure sensitivity, pain, and disability in patients with cervical dystonia (CD). Methods: Thirty-one patients with CD (74.2% women, age: 61.2 years, SD 10.1) participated. Data collected included clinical variables, the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), the Central Sensitization Inventory (CSI), the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), the Hospital Anxiety and Depression Scale (HADS) and the Pittsburgh Sleep Quality Index (PSQI), as well as widespread pressure pain thresholds (PPTs). Results: Patients with CD with pain (n = 20, 64.5%) showed higher scores on the TWSTRS disability subscale and the CSI (p < 0.001), and lower PPTs (p < 0.05). Fifteen patients (15/31, 48%) showed sensitization-associated symptoms (CSI ≥ 40), whereas five of the patients with pain (5/20, 25%) exhibited neuropathic-like symptoms (S-LANSS ≥ 12). The CSI and S-LANSS were positively associated with the TWSTRS, HADS-A and HADS-D, and negatively associated with PPTs. HADS-D and S-LANSS explained 72.5% of the variance of the CSI (r2: 0.725), whereas CSI explained 42.3% of the variance of the S-LANSS (r2: 0.423). Conclusions: Pain is an important source of disability in CD, and may be a consequence of different mechanisms, including sensitization.

Presumed post-traumatic subdural hygroma in a 2.5-year-old spayed female Chihuahua.

A 2.5-year-old spayed female Chihuahua dog was presented with chronic cervical pain and exhibited a "prayer-like position" following a history of a 4-meter fall. CT and MRI revealed a moderate right-sided enlargement of the subdural space with cerebrospinal fluid, consistent with a subdural hygroma, appearing connected to a quadrigeminal cistern dilation. Percutaneous transfontanellar external drainage of the subdural fluid accumulation did not prevent its re-accumulation, and the dog was managed medically, leading to the complete resolution of clinical signs. The subdural hygroma was suspected to be secondary to the previous trauma.

The quality of life after Anterior Cervical Discectomy and Fusion

Cervical discopathy is commonly associated with pain in the cervical spine which may affect patients’ quality of life. If conservative treatment fails to relieve the pain for at least 6 months and/or if neurological deficit progresses, the surgical treatment is taken under consideration. The aim of this study was to evaluate health-related quality of life (HRQOL) and disability of patients after single- and multi-level anterior cervical discectomy and fusion (ACDF) with standalone polyetheretherketone (PEEK) cages. The study evaluated how ACDF influenced particular aspects of patients’ quality of life in the context of radiological outcome. The study included 30 consecutive patients with single- or multi-level cervical disc herniation. Patients underwent clinical and radiological evaluation before and one year after the ACDF procedure. For each patient, we assessed the severity of cervical pain with a numerical rating scale (NRS) and filled the neck disability index questionnaire (NDI). The health-related quality of life was assessed with the Polish version of 36-Item Short Form Survey (SF-36). A significant decrease in all NDI aspects indicates a significant improvement after surgery. The quality of life in all aspects assessed with SF-36 scale was also improved. A moderate decrease in cervical spine mobility coexisted with a good outcome of the neurosurgical procedure. In the opinion of patients, the most important aspect after the cervical spine surgery is the reduction of pain severity. ACDF surgery is an effective method to reduce the severity of pain in patients with degenerative disc disease. ACDF improves the quality of patient’s life. According to the study results the physical role improved most significantly; the least improvement was noted in role-emotional aspect. Up to 83% of patients achieved a reduction of the NDI index by 5 or more points after surgical treatment which proves the high effectiveness of the surgical treatment. No statistically significant difference was noted between patients with single and multi – level discopathy. Up to 97% of patients who underwent ACDF reported a significant decrease in pain severity measured with NRS.

Evaluation of the effect of different kinds of treatment modalities for temporomandibular joint pain and its relevance to chronic cervical pain: A randomized controlled trial.

The aim of this study was to evaluate the effect of different treatment modalities for temporomandibular joint (TMJ) pain and their relevance to chronic cervical pain after 12 months. This was a randomized controlled trial. Forty-eight participants with chronic cervical and TMJ pain were selected using research diagnostic criteria and randomized into four groups (n = 12), which included control, soft splints, transcutaneous electrical nerve stimulation (TENS), and low-level laser (LLL). The cervical and TMJ pain was recorded using visual analog scale (VAS) scores at baseline, 3 months, 6 months, and 12 months. Occlusal equilibration was done for all groups except for the control. The mean pain scores were statistically analyzed using one-way analysis of variance and posthoc test. The mean VAS scores in TMJ pain patients between the four groups at baseline and at final follow-up were 7.27 ± 1.29 in Group 1, 7.53 ± 0.70 in Group 2, 7.76 ± 0.80 in Group 3, and 7.61 ± 0.61 in Group 4. The mean difference between Groups 1 and 3, Groups 1 and 4, and Groups 2 and 3 was statistically significant (P < 0.00). Pearson correlation test yielded a mild and negative correlation between TMJ and cervical pain. TENS and LLL were found to be equally effective in reducing pain in the jaw joint region, followed by soft splints, and there was no correlation between TMJ and cervical pain.

Chronic nonspecific multiple-sites pain [CNMSP] of unknown etiology: Biopsychosocial method of evaluation for the primary care level

ABSTRACT Background: Understanding and dealing with chronic nonspecific pain (CNP) is the important entity at primary care hospital. Chronic nonspecific multiple-site pain [CNMSP] of unknown etiology creates diagnostic and therapeutic challenges for primary care physicians due to lack of guidance regarding evaluation and treatment. Aims and Objectives: To classify and formulate the evaluation, treatment strategies, and prediction of prognosis of patients with CNMSP of unknown etiology. Methods: Patients present with CNMSP of more than 3-month duration without any obvious medical cause. The biopsychosocial [BPS] model with 3P model was applied to see the biological, psychological, and social factors behind persistence. Finally, patients were classified into four groups for evaluation response to treatment and relapse rates in 12-month follow-up. Results: Of the total 243 patients of CNMSP, 243 [96.3%] were females. Sixty [24.7%] patients had short duration, and 183 [75.3%] had long duration. Headache was in 115 [47%], low back pain ± leg pain in 96 [39.4%], cervical pain ± shoulder/arm pain in 83 [34.1%], and diffuse body pain in 50 [20.5%] in various combinations. A total of 155 [63.8%] patients had high somatization–sensitization index (SSI), and 144 [59.3%] had low ferritin level. Group 1 [high SSI and low ferritin] had 37.9% of patients, group 2 [high SSI and normal ferritin] had 25.9% of patients, group 3 [low to medium SSI with low ferritin] had 21.4% of patients, and group 4 [low to medium SSI with normal ferritin] had 14.8% of patients. Response to pain symptoms was better in group 1, and relapse rate was higher in group 2. Conclusion: CNMSP of unknown etiology itself is a heterogeneous entity, and assessment based on the BPS model can be very useful to understand the treatment plan and outcome of these patients.

464 Remote Cognitive Behavioral Therapy Utilizing an In-home Virtual Reality Toolkit (Vx Therapy TM) Reduces Pain, Anxiety, and Depression in Patients With Chronic Cervical and Lumbar Pain: A Potential Opiate Alternative in Multimodal Pain Management

INTRODUCTION: Virtual reality has reduced acute pain through visual and auditory distraction, as well as altered brain neurobiology. VR attenuates pain-induced brain activity without narcotic-related side effects or dependency. Cognitive behavioral therapy (CBT) has demonstrated improved pain-related anxiety, depression, physical disability, resiliency, and quality of life. CBT access remains a challenge in most care communities. METHODS: 145 patients with chronic neck and back pain (63 cervical, 46 non-radicular lumbar, 36 radicular lumbar) enrolled into a 14 week Vx therapy CBT program with therapist guided utilization of an in-home VR system with 50 modules (education, meditation, distraction, entertainment). Pain and anxiety severity scores were recorded before and immediately after VR use as well as time to pain recurrence. PROMIS measures of daily pain intensity, pain behavior, pain interference, anxiety, and depression were recorded at baseline and after 14 weeks of Vx therapy. RESULTS: PROMIS domains were significantly improved after Vx treatment vs baseline for the entire cohort and each subgroup. VR acutely reduced pain during use on average by 33% (p &lt; 0.05) across all 14 weeks lasting a mean 2.5 hours. VR acutely reduced anxiety during use on average by 46% (p &lt; 0.05) across all 14 weeks lasting a mean 2.7 hours. The effect was similar for all three diagnosis groups. CONCLUSIONS: Remote CBT guided in-home VR toolkit (Vx therapyTM) provided effective multi-hour sustained pain relief in patients with chronic neck and back pain with and without radiculopathy. Significant improvement in overall pain, anxiety, and depression and reduced pain interference was observed. This non-invasive, non-pharmaceutical Vx therapy is an ideal option to improve outcomes in post-opioid pain management.

Endoscopic Posterior Cervical Foraminotomy Under Lateral Decubitus Position with Local Anesthesia

Endoscopic posterior cervical foraminotomy is gaining popularity among endoscopic spine surgeons for the treatment of radiculopathy caused by foraminal stenosis. This study describes a technique utilizing lateral decubitus position for an endoscopic posterior cervical foraminotomy under Monitored Anesthesia Care (MAC) and local anesthesia only. 10 patients with contraindications to general anesthesia underwent the procedure, resulting in an improvement in cervical radicular pain with no perioperative complications. The findings suggest that this approach is a viable alternative for high-risk patients for general anesthesia care, expanding the surgical options for the treatment of radiculopathy.

282 Does Axial Cervical Pain Improve With Surgical Fusion? A Meta-analysis

INTRODUCTION: Isolated axial neck pain is a prevalent condition that causes significant morbidity and productivity loss. METHODS: This study searched for RCTs and cohort studies in English language databases with a minimum 6-month follow-up, limited to patients with axial neck pain/cervical radiculopathy and pre/post-operative NDI and VAS scores. Literature reviews, meta-analyses, systematic reviews, surveys, and case studies were excluded. Two patient groups were analyzed: the arm pain predominant (pAP) cohort and the neck pain predominant (pNP) cohort. A 30% reduction in PROMs scores from baseline represented the Minimal Clinically Important Difference (MCID). RESULTS: Five studies with 5,221 patients met the inclusion criteria. Patients with pAP had a slightly greater reduction in PROMs scores than those with pNP. NDI reduction was 41.34 % (16.3/39.42) in pNP patients (p &lt; 0.0001) and 45.12% (15.86/35.15) in pAP patients (p &lt; 0.0001). Surgical improvement was comparable between the two groups (16.3 vs. 15.86 points, p = 0.3193) .Patients with pNP had a greater reduction in neck pain (53.4%; 3.60/6.74, p &lt; 0.0001) compared to pAP (50.30%; 2.46/4.89, p &lt; 0.0001), with a significant difference in VAS scores (3.6 vs. 2.46, p &lt; 0.0134). Patients with pNP had 43.6% (1.96/4.5) improvement in arm pain (p &lt; 0.0001), while pAP patients had 66.12% (4.43/6.7) improvement (p &lt; 0.0001), with significantly higher VAS scores for arm pain in pAP patients (4.43 vs. 1.96 points, p &lt; 0.0051). CONCLUSIONS: Surgical intervention is increasingly supported for primary axial neck pain, with studies demonstrating greater improvements in neck pain than arm pain, exceeding MCID and reaching SCB. However, given the multifaceted nature of the condition, further research is needed to determine optimal patients and pathologies for surgery.

Investigating Cervical Flexion-Relaxation Ratio in Subjects with Cervical Lateral Spinal Stenosis Compared with Asymptomatic Controls: a case control study

IntroductionThe cervical flexion-relaxation ratio (FRR) is known as a quantitative measure of the ability of the cervical extensor muscles to relax during the full flexion of the cervical spine. Compared with subjects suffering from non-specific neck pain, the changes occurring in the pattern of the neck muscles' functions in cases with cervical spinal stenosis are not yet well understood. Therefore, this study aimed to compare cervical FRR in subjects with cervical lateral spinal stenosis and asymptomatic controls. MethodsIn total, 25 subjects with cervical lateral spinal stenosis (aged 44.7±10.4) and 25 asymptomatic individuals (aged 44.3±10.8) were included in this study. These participants performed full-neck flexion, and at the same time, the electrical activity of the cervical erector spinae (CES) muscles was recorded bilaterally. Cervical FRR was further calculated by analyzing the electromyographic data recorded for each muscle. ResultsThe mean cervical FRR was significantly lower (P=0.015) and the FRR asymmetry (ΔFRR) was significantly higher (P=0.003) in the patients than asymptomatic controls. In addition, the cervical FRR of the involved side was significantly lower in the subjects with cervical pain compared with that in the non-involved one (P=0.004). There was also a significant difference in the cervical extension (CE) angle between both study groups (P<0.001), while the cervical flexion (CF) angle was not different (P=0.25). ConclusionAccording to the study results, FRR and its asymmetry in the subjects with cervical lateral spinal stenosis were significantly different from that in asymptomatic controls and the CE angle declined in these subjects.