Cervical Spine Range Of Motion Research Articles

Randomised controlled pilot trial of high-velocity, low-amplitude manipulation on cervical and upper thoracic spine levels in asymptomatic subjects

BackgroundHigh-velocity, low-amplitude (HVLA) manipulation techniques are habitually used on the cervical spine but the effects are not completely clear. The aim of this prospective comparative trial was to evaluate effects of an indiscriminate manipulation on the C5 (AMC5) a manipulation treatment based on a previous evaluation (MT) and a sham intervention (ST) on cervical spine range of motion (ROM); cervical flexion isometric peak force; EMG activation of sternocleidomastoid muscle (SCM) during the cranio-cervical flexion test (CCFT); and EMG signals of right and left biceps at rest were analyzed. Methods/DesignRandomised controlled pilot study and intention-to-treat analysis was performed. SettingThe study was conducted at an osteopathic clinic. MethodsThe outcomes were measured pre and immediately post intervention. ParticipantsA total of 36 asymptomatic subjects (18 male, mean age 30 years) were randomly enrolled into 3 groups: AMC5 (n = 12), MT (n = 12), and ST (n = 12). ResultsSignificant changes (p < 0.1) were found in the cervical flexion isometric peak force (−13.15%), however, the effect size was considered moderate (d = 0.52). The extension (10.44%) and left rotation ROM (12.25%) showed significant improvement in MT group. During CCFT significant changes were not reported. ConclusionsThe current pilot study suggested that a tendency toward a decrease in the isometric strength peak in the cervical flexion of the MT group may appear. In cervical ROM the MT group achieved significant effects in extension and left rotation movement.

Longitudinal Study of the Six Degrees of Freedom Cervical Spine Range of Motion During Dynamic Flexion, Extension, and Rotation After Single-level Anterior Arthrodesis.

A longitudinal study using biplane radiography to measure in vivo intervertebral range of motion (ROM) during dynamic flexion/extension, and rotation. To longitudinally compare intervertebral maximal ROM and midrange motion in asymptomatic control subjects and single-level arthrodesis patients. In vitro studies consistently report that adjacent segment maximal ROM increases superior and inferior to cervical arthrodesis. Previous in vivo results have been conflicting, indicating that maximal ROM may or may not increase superior and/or inferior to the arthrodesis. There are no previous reports of midrange motion in arthrodesis patients and similar-aged controls. Eight single-level (C5/C6) anterior arthrodesis patients (tested 7 ± 1 months and 28 ± 6 months postsurgery) and six asymptomatic control subjects (tested twice, 58 ± 6 months apart) performed dynamic full ROM flexion/extension and axial rotation whereas biplane radiographs were collected at 30 images per second. A previously validated tracking process determined three-dimensional vertebral position from each pair of radiographs with submillimeter accuracy. The intervertebral maximal ROM and midrange motion in flexion/extension, rotation, lateral bending, and anterior-posterior translation were compared between test dates and between groups. Adjacent segment maximal ROM did not increase over time during flexion/extension, or rotation movements. Adjacent segment maximal rotational ROM was not significantly greater in arthrodesis patients than in corresponding motion segments of similar-aged controls. C4/C5 adjacent segment rotation during the midrange of head motion and maximal anterior-posterior translation were significantly greater in arthrodesis patients than in the corresponding motion segment in controls on the second test date. C5/C6 arthrodesis appears to significantly affect midrange, but not end-range, adjacent segment motions. The effects of arthrodesis on adjacent segment motion may be best evaluated by longitudinal studies that compare maximal and midrange adjacent segment motion to corresponding motion segments of similar-aged controls to determine if the adjacent segment motion is truly excessive. 3.

A normative study of cervical range of motion measures including the flexion–rotation test in asymptomatic children: side-to-side variability and pain provocation

Objectives: Cervical movement impairment has been identified as a core component of cervicogenic headache evaluation. However, normal range of motion values in children has been investigated rarely and no study has reported such values for the flexion–rotation test (FRT). The purpose of this study was to identify normal values and side-to-side variation for cervical spine range of motion (ROM) and the FRT, in asymptomatic children aged 6–12 years. Another important purpose was to identify the presence of pain during the FRT.Methods: Thirty-four asymptomatic children without history of neck pain or headache (26 females and 8 males, mean age 125.38 months [SD 13.14]) were evaluated. Cervical spine cardinal plane ROM and the FRT were evaluated by a single examiner using a cervical ROM device.Results: Values for cardinal plane ROM measures are presented. No significant gender difference was found for any ROM measure. Mean difference in ROM for rotation, side flexion, and the FRT were less than one degree. However, intra-individual variation was greater, with lower bound scores of 9.32° for rotation, 5.30° for side flexion, and 10.89° for the FRT. Multiple linear regression analysis indicates that movement in the cardinal planes only explains 19% of the variance in the FRT. Pain scores reported following the FRT were less than 2/10.Discussion: Children have consistently greater cervical spine ROM than adults. In children, side-to-side variation in rotation and side flexion ROM and range recorded during the FRT indicates that the clinician should be cautious when using range in one direction to determine impairment in another. Range recorded during the FRT is independent of cardinal movement variables, which further adds to the importance of the FRT, as a test that mainly evaluates range of movement of the upper cervical spine.

Physiotherapy in the first three months after allograft face transplantation – case report

AbstractObjective: The aim of the study was to present physiotherapy procedures of the patient with von Recklinhausen’s disease in the first three months after allograft face transplantation (PT).Methods: During hospitalization lasting 2.5 months intensive functional rehabilitation was conducted. It ran in two stages: early (up to 30 days after surgery) and recovery (1 to 3 months). In physiotherapy the method with elements of PNF (Prioprioceptywne Neuromuscular Facilitation) was used. During 2 months from PT an electrostimulation of orbicularis oris muscles was included. Physiotherapists did not focus only on rehabilitation of the face transplant, but also paid attention to functional problems caused by von Recklinhausen’s disease. When planning therapy, they took into consideration personal, physical and emotional features. In therapy we used exercises in different starting positions, such as rollers, elastic bands, balls and sensory rings were employed. Lymphatic drainage of the face and neck was performed.Results: During three months of the rehabilitation an improvement of upper and lower limbs′ muscle strength was achieved; cervical spine range of motion increased, pain and discomfort caused by scar restrictions were reduced. There was also an improvement of the overall functionality of the patient. However, due to short time after PT no improvement in the functioning of facial expressions and sensory feeling was noticed, nevertheless the patient accepted the new face. In our opinion, rehabilitation is an inevitable element after face transplant (PT). The use of an individual and comprehensive program of physiotherapy, and it’s early and systematic implementation allow to achieve an improvement of the patient’s physical function after PT. Continuing rehabilitation is necessary to achieve full facial functionality and maintain physical capacity.

Comparison of Hybrid Surgery Incorporating Anterior Cervical Discectomy and Fusion and Artificial Arthroplasty versus Multilevel Fusion for Multilevel Cervical Spondylosis: A Meta-Analysis.

BackgroundFew studies have reported the safety and efficacy of hybrid surgery (HS), and some of the studies comparing HS with ACDF have reported conflicting results. We conducted this meta-analysis to clarify the advantages of HS in the treatment of multilevel cervical spondylosis.Material/MethodsWe performed a systematic literature search in PubMed, Medline, and CNKI to identify relevant controlled trials published up to October 2015. The standardized mean difference (SMD) and 95% confidence interval (95% CI) of the perioperative parameters, visual analogue scale pain score (VAS), neck disability index (NDI), and range of motion (ROM) of C2–C7 and adjacent segments were calculated. We also analyzed complications and Odom scale scores using risk difference (RD) and 95% CI.ResultsIn total, 7 studies were included. The pooled data exhibited significant differences in blood loss between the 2 groups. However, there was no evidence indicating significant differences in operation time, complications, VAS, NDI, or Odom scale scores. Compared with the ACDF group, the HS group exhibited significantly protected C2-C7 ROM and reduced adjacent-segment ROM.ConclusionsThe safety of HS may be as good as that of ACDF. Furthermore, HS is superior to ACDF in conserving cervical spine ROM and decreasing adjacent-segment ROM. However, the results should be accepted cautiously due to the limitations of the study. Studies with larger sample sizes and longer follow-up periods are required to confirm and update the results of the present study.

Addition of lateral bending range of motion measurement to standard sagittal measurement to improve diagnosis sensitivity of ligamentous injury in the human lower cervical spine

This study examined the cervical spine range of motion (ROM) resulting from whiplash-type hyperextension and hyperflexion type ligamentous injuries, and sought to improve the accuracy of specific diagnosis of these injuries. The study was accomplished by measurement of ROM throughout axial rotation, lateral bending, and flexion and extension, using a validated finite element model of the cervical spine that was modified to simulate hyperextension and/or hyperflexion injuries. It was found that the kinematic difference between hyperextension and hyperflexion injuries was minimal throughout the combined flexion and extension ROM measurement that is commonly used for clinical diagnosis of cervical ligamentous injury. However, the two injuries demonstrated substantially different ROM under axial rotation and lateral bending. It is recommended that other bending axes beyond flexion and extension are incorporated into clinical diagnosis of cervical ligamentous injury.

Thoracic Pain - Tennis

HISTORY: A 24-year old right-handed female former collegiate tennis player presented to clinic with a 2-year history of left sided periscapular pain. She developed symptoms while playing a competitive tennis match, and reports feeling a sharp pain around the left scapula after hitting a forehand volley with her right hand. The pain persisted after the match, even at rest. She denies any similar symptoms previously, no prior injuries to the shoulder, back or neck. She had months of physical therapy without any significant resolution. PHYSICAL EXAMINATION: Inspection of the thoracic spine revealed a prominence of the medial border of the left scapula. Thoracic extension was mildly limited and non-painful. The left scapula demonstrated delayed medial rotation when bringing arms down from an abducted position. Shoulder examination was notable for discomfort with left shoulder abduction that improved with scapular assist. There was tenderness to palpation along medial border of the left scapula. There was no cervical or thoracic spinous process or paraspinal tenderness to palpation. Cervical spine range of motion was full. Spurling’s was negative bilaterally. The shoulder examination was unremarkable. Strength, sensation and reflexes were normal in bilateral upper extremities. DIFFERENTIAL DIAGNOSIS: 1. Long thoracic neuropathy 2. Parsonage-Turner syndrome (idiopathic brachial plexopathy) 3. Neuromuscular control dysfunction causing scapular dyskinesis 4. Thoracic rib dysfunction 5. Thoracic discogenic pain or radicular pain 6. Cervical radiculopathy TEST AND RESULTS: EMG/Nerve Conduction Study: electrodiagnostic evidence of a left long thoracic neuropathy with features of early reinnervation and no evidence of ongoing denervation. MRI Thoracic Spine: normal FINAL WORKING DIAGNOSIS: Left long thoracic neuropathy TREATMENT AND OUTCOMES: 1. Physical therapy focused on neuromuscular control of the periscapular muscles to restore normal scapulohumeral rhythm 2. Trial of low-dose gabapentin for neuropathic pain 3. Activity as tolerated

Influence of Selected Pain Characteristics on Segmental Spine Range of Motion in Patients with Low-Back Pain

Background and objectives:Pain is an important etiology in the dysfunction and impairment of spinal architecture, biomechanics and function. However, there are conflicting findings in studies investigating the relationship between lumbar spine mobility and pain characteristics in patients with Low-Back Pain (LBP). This study compared cervical, thoracic and lumbar spine Range of Motion (ROM) between patients with Low-Back Pain (LBP) and their age, sex and somatotype-matched healthy controls. The study also investigated the influence of selected pain characteristics (intensity and duration of pain) on spinal range of motion in the patients. Methods: Two hundred and two participants (101 patients and healthy controls respectively) were purposively recruited from five selected physiotherapy out-patient clinics in South Western, Nigeria. The control participants were recruited from Obafemi Awolowo University (OAU) and OAU Teaching Hospitals Complex, Ile-Ife, Nigeria. ROM and pain intensity were assessed using dual inclinometry technique and Visual Analog Scale (VAS) respectively. Somatotype was determined using the wrist girth measurement and body perception scale respectively. Data were also obtained on demographic and anthropometric variables. Results: The patients and control group were comparable in age (48.1 ± 15.1 vs. 48.0 ± 15.1yrs; p=0.996). The control group had significantly higher ROM in the cervical (t= -6.82; p= 0.001), thoracic (t= -6.59; p= 0.001) and lumbar (t= -4.36; p= 0.001) spine respectively. There was significant inverse correlation between pain intensity and lumbar ROM in flexion (r = -0.402, p = 0.001) and extension (r = -0.303, p = 0.002) respectively. Pain duration was not significantly correlated with ROM in any of the spinal segments (p>0.05). Conclusion: Patients with LBP had significantly lower cervical, thoracic and lumbar spine ROM compared with controls. Patients with higher pain intensity had lower lumbar spine ROM in flexion and extension respectively.

Predictors of Outcome in Patients with Cervical Spondylotic Myelopathy Undergoing Unilateral Open-Door Laminoplasty.

ObjectiveThis study aimed to analyze prognostic factors affecting surgical outcomes of expansive laminoplasty for cervical spondylotic myelopathy (CSM).MethodsUsing the Frankel scale and Japanese Orthopaedic Association (JOA) scale, we retrospectively reviewed the outcomes of 45 consecutive patients who underwent modified unilateral open-door laminoplasty using hydroxyapatite spacers and malleable titanium miniplates between June 2008 and May 2014. The patients were assigned to the good and poor clinical outcome groups, with good outcome defined as a JOA recovery rate >75%.ResultsThe mean preoperative JOA scale was significantly higher in the good outcome group (14.95±3.21 vs. 10.78±6.07, p<0.001), whereas the preoperative cervical range of motion (ROM) in this group was significantly lower (29.89°±10.11 vs. 44.35°± 8.88, p<0.001). In univariate analysis, a high preoperative JOA scale (odds ratio (OR) 1.271, 95% confidence interval (CI) 1.005-1.607) and low preoperative cervical ROM(OR 0.858, 95% CI 0.786-0.936) were statistically correlated with good outcomes. Furthermore, these factors demonstrated an independent association with clinical outcomes (preoperative JOA scale: OR 1.344, 95% CI 1.019-1.774, p=0.036; preoperative cervical ROM: OR 0.860, 95% CI 0.788-0.940, p=0.001).ConclusionIn this study, a high preoperative JOA scale was associated with good clinical outcome after laminoplasty, whereas a higher preoperative cervical spine ROM was associated with poor clinical outcome. This may suggests that cervical mobility and preoperative neurological status affect clinical outcomes of laminoplasty.

Extension and flexion in the upper cervical spine in neck pain patients

Neck pain is a common problem in the general population with high risk of ongoing complaints or relapses. Range of motion (ROM) assessment is scientifically established in the clinical process of diagnosis, prognosis and outcome evaluation in neck pain. Anatomically, the cervical spine (CS) has been considered in two regions, the upper and lower CS. Disorders like cervicogenic headache have been clinically associated with dysfunctions of the upper CS (UCS), yet ROM tests and measurements are typically conducted on the whole CS. A cross-sectional study assessing 19 subjects with non-specific neck pain was undertaken to examine UCS extension-flexion ROM in relation to self-reported disability and pain (via the Neck Disability Index (NDI)). Two measurement devices (goniometer and electromagnetic tracking) were employed and compared. Correlations between ROM and the NDI were stronger for the UCS compared to the CS, with the strongest correlation between UCS flexion and the NDI-headache (r = −0.62). Correlations between UCS and CS ROM were fair to moderate, with the strongest correlation between UCS flexion and CS extension ROM (r = −0.49). UCS flexion restriction is related to headache frequency and intensity. Consistency and agreement between both measurement systems and for all tests was high. The results demonstrate that separate UCS ROM assessments for extension and flexion are useful in patients with neck pain.

Manual therapy for cervicogenic dizziness: Long-term outcomes of a randomised trial

Manual therapy is effective for reducing cervicogenic dizziness, a disabling and persistent problem, in the short term. This study investigated the effects of sustained natural apophyseal glides (SNAGs) and passive joint mobilisations (PJMs) on cervicogenic dizziness compared to a placebo at 12 months post-treatment. Eighty-six participants (mean age 62 years, standard deviation (SD) 12.7) with chronic cervicogenic dizziness were randomised to receive SNAGs with self-SNAGs (n = 29), PJMs with range-of-motion (ROM) exercises (n = 29), or a placebo (n = 28) for 2–6 sessions over 6 weeks. Outcome measures were dizziness intensity, dizziness frequency (rated between 0 [none] and 5 [>once/day]), the Dizziness Handicap Inventory (DHI), pain intensity, head repositioning accuracy (HRA), cervical spine ROM, balance, and global perceived effect (GPE). At 12 months both manual therapy groups had less dizziness frequency (mean difference SNAGs vs placebo −0.7, 95% confidence interval (CI) −1.3, −0.2, p = 0.01; PJMs vs placebo −0.7, −1.2, −0.1, p = 0.02), lower DHI scores (mean difference SNAGs vs placebo −8.9, 95% CI −16.3, −1.6, p = 0.02; PJMs vs placebo −13.6, −20.8, −6.4, p < 0.001) and higher GPE compared to placebo, whereas there were no between-group differences in dizziness intensity, pain intensity or HRA. There was greater ROM in all six directions for the SNAG group and in four directions for the PJM group compared to placebo, and small improvements in balance for the SNAG group compared to placebo. There were no adverse effects. These results provide evidence that both forms of manual therapy have long-term beneficial effects in the treatment of chronic cervicogenic dizziness.

The flexion–rotation test performed actively and passively: a comparison of range of motion in patients with cervicogenic headache

Limitation in cervical spine range of motion (ROM) is one criterion for diagnosis of cervicogenic headaches (CHs). The flexion–rotation test, when performed passively (FRT-P), has been shown to be a useful test in diagnosis of CH. Few investigations have examined the flexion-rotation test when performed actively (FRT-A) by the individual, and no studies have examined the FRT-A in a symptomatic population. The purpose of this study was to compare ROM during the FRT-A and FRT-P in patients with CH and asymptomatic individuals and to compare ROM between sides for these two versions of the test. Twelve patients with CH and 10 asymptomatic participants were included in the study. An eight-camera Motion Analysis system was used to measure head motion relative to the trunk during the FRT-P and the FRT-A. Cervical rotation ROM was measured in a position of full cervical flexion for both tests. No significant difference was observed between right and left sides for cervical rotation ROM during the FRT-P nor the FRT-A when performed by asymptomatic participants. In patients with CH, a significant difference was observed between sides for the FRT-P (P = 0·014); however, the FRT-A failed to reveal bilateral descrepancy in rotation ROM.

Age-related changes in cervical sagittal range of motion and alignment.

Study Design Retrospective cohort study. Objective To compare sagittal cervical range of motion (ROM) and alignment in young versus middle-aged adults. Methods One hundred four asymptomatic adults were selected randomly out of 791 subjects who underwent lateral cervical radiographs in neutral, flexion, and extension positions. They were divided into two groups: young (age 20 to 29, 52 people) and middle-aged adults (age 50 to 59, 52 people). We determined the ROMs of upper cervical (occipital–C2 angle), midcervical (C2–C7 angle), and cervicothoracic spine (cervicosternal angle). We compared the alignment differences of the two groups by calculating the distances between C2 and C7 plumb lines, and C2 central-offset distance. Results In neutral position, there was no significant difference between young and middle-aged adults. However, in flexion, C2–C7 angle, distance between C2–C7 plumb lines, and C2 central-offset distance decreased with age. In extension, C2–C7 angle and C2 central-offset distance decreased with age. During flexion and extension, midcervical ROM and the range of C2 central-offset distance decreased in the middle-aged group. However, there was no difference between the two age groups in the ROM of the upper cervical and the cervicothoracic regions during flexion and extension. Conclusion We found that, despite of the presence of age-related cervical alignment changes, the only difference between the two groups was in the sagittal ROM of the midcervical spine during flexion and extension. Only the ROM of the midcervical spine appears to change significantly, consistent with findings that these levels are most likely to develop both symptomatic and asymptomatic degenerative changes.

Effects of Cervical Spine Manual Therapy on Range of Motion, Head Repositioning, and Balance in Participants With Cervicogenic Dizziness: A Randomized Controlled Trial

ObjectiveTo evaluate and compare the effects of 2 manual therapy interventions on cervical spine range of motion (ROM), head repositioning accuracy, and balance in patients with chronic cervicogenic dizziness. DesignRandomized controlled trial with 12-week follow-up using blinded outcome assessment. SettingUniversity School of Health Sciences. ParticipantsParticipants (N=86; mean age ± SD, 62.0±12.7y; 50% women) with chronic cervicogenic dizziness. InterventionsParticipants were randomly assigned to 1 of 3 groups: sustained natural apophyseal glides (SNAGs) with self-SNAG exercises, passive joint mobilization (PJM) with ROM exercises, or a placebo. Participants each received 2 to 6 treatments over 6 weeks. Main Outcome MeasuresCervical ROM, head repositioning accuracy, and balance. ResultsSNAG therapy resulted in improved (P≤.05) cervical spine ROM in all 6 physiological cervical spine movement directions immediately posttreatment and at 12 weeks. Treatment with PJM resulted in improvement in 1 of the 6 cervical movement directions posttreatment and 1 movement direction at 12 weeks. There was a greater improvement (P<.01) after SNAGs than PJM in extension (mean difference, −7.5°; 95% confidence interval [CI], −13° to −2.0°) and right rotation (mean difference, −6.8°; 95% CI, −11.5° to −2.1°) posttreatment. Manual therapy had no effect on balance or head repositioning accuracy. ConclusionsSNAG treatment improved cervical ROM, and the effects were maintained for 12 weeks after treatment. PJM had very limited impact on cervical ROM. There was no conclusive effect of SNAGs or PJMs on joint repositioning accuracy or balance in people with cervicogenic dizziness.

Validity and intra-rater reliability of an android phone application to measure cervical range-of-motion.

BackgroundConcurrent validity and intra-rater reliability using a customized Android phone application to measure cervical-spine range-of-motion (ROM) has not been previously validated against a gold-standard three-dimensional motion analysis (3DMA) system.FindingsTwenty-one healthy individuals (age:31 ± 9.1 years, male:11) participated, with 16 re-examined for intra-rater reliability 1–7 days later. An Android phone was fixed on a helmet, which was then securely fastened on the participant’s head. Cervical-spine ROM in flexion, extension, lateral flexion and rotation were performed in sitting with concurrent measurements obtained from both a 3DMA system and the phone.The phone demonstrated moderate to excellent (ICC = 0.53-0.98, Spearman ρ = 0.52-0.98) concurrent validity for ROM measurements in cervical flexion, extension, lateral-flexion and rotation. However, cervical rotation demonstrated both proportional and fixed bias. Excellent intra-rater reliability was demonstrated for cervical flexion, extension and lateral flexion (ICC = 0.82-0.90), but poor for right- and left-rotation (ICC = 0.05-0.33) using the phone. Possible reasons for the outcome are that flexion, extension and lateral-flexion measurements are detected by gravity-dependent accelerometers while rotation measurements are detected by the magnetometer which can be adversely affected by surrounding magnetic fields.ConclusionThe results of this study demonstrate that the tested Android phone application is valid and reliable to measure ROM of the cervical-spine in flexion, extension and lateral-flexion but not in rotation likely due to magnetic interference. The clinical implication of this study is that therapists should be mindful of the plane of measurement when using the Android phone to measure ROM of the cervical-spine.

Assessment of the cervical spine range of motion after the use of the saunders traction device in different positioning of the upper extremities.

Among the procedures used in the therapy of spinal pain syndromes one of the most frequently recommended is the cervical traction. The methods of performing the traction are varied. It was decided to examine in the research whether the abduction and external rotation of the brachium, causing relaxation of the pectoral girdle muscles as well as the cervical spine, affects the quality and efficiency of traction in the patient's subjective assessment and the changes in the cervical spine range of motion. Fifty subjects aged 20 to 42 were involved in the study, including 26women and 24men. The criterion of inclusion into the research project was the age between 20 and 40years and the result of questionnaire containing the NDI scale for evaluation of the degree of dysfunction of the cervical spine, ranging in value between 5 and 14 points. The admitted group of 50 subjects was randomly divided into two experimental groups. The traction of the cervical spine was performed twice in both groups by means of the Saunders device. In the first group used the traditional positing, with the upper extremities placed along the torso, was adapted as first whereas in the second group the modified position was applied, in which the upper extremities were in the external rotation in abduction and with flexion in the cubital articulation, in other words the patients placed their hands next to head. In both cases the patient was in the supine position on atherapeutic table with asupport roll under the knees. The evaluation of the cervical spine range of motion pointed, that in both position all the obtained differences proved statistical significance. The subjects taking part in the research claimed that the procedure performed by means of the traditional method was more pleasant. No significant difference was discovered in the effectiveness of the suggested positioning of the arms during performing the traction procedure of the cervical spine. The modified position caused greater sensation of discomfort than position with traditional arrangement of the arms.

Long term effect on adjacent segment motion after posterior cervical foraminotomy.

ObjectivePosterior cervical foraminotomy (PCF) is a motion-preserving surgical technique. The objective was to determine whether PCF alter cervical motion as a long-term influence.MethodsThirty one patients who followed up more than 36 months after PCF for cervical radiculopathy from January 2004 to September 2008 were enrolled in this study. The range of motion (ROM) of whole cervical spine, the operated segment, the cranial and the caudal adjacent segment were obtained. The clinical result and the change of ROMs were compared with those in the patients performed anterior cervical discectomy and fusion (ACDF) during the same period.ResultsIn PCF group, the ROM of whole cervical spine had no significant difference in statistically at preoperative and last follow up. The operated segment ROM was significantly decreased from 11.02±5.72 to 8.82±6.65 (p<0.05). The ROM of cranial adjacent segment was slightly increased from 10.42±5.13 to 11.02±5.41 and the ROM of caudal adjacent segment was decreased from 9.44±6.26 to 8.73±5.92, however these data were not meaningful statistically. In ACDF group, the operated ROM was decreased and unlike in PCF group, especially the ROM of caudal adjacent segment was increased from 9.39±4.21 to 11.33±5.07 (p<0.01).ConclusionAs part of the long-term effects of PCF on cervical motion, the operated segment motions decreased but were preserved after PCF. However, unlikely after ACDF, the ROMs of the adjacent segment did not increase after PCF. PCF, by maintaining the motion of the operated segment, imposes less stress on the adjacent segments. This may be one of its advantages.

Risk factors for the development of adjacent segment disease following anterior cervical arthrodesis for degenerative cervical disease: Comparison between fusion methods

This study aimed to determine the risk factors for developing adjacent segment disease (ASDz) after anterior cervical arthrodesis for the treatment of degenerative cervical disease by analyzing patients treated with various fusion methods. We enrolled 242 patients who had undergone anterior cervical fusion for degenerative cervical disease, and had at least 5years of follow-up. We evaluated the development of ASDz and the rate of revision surgery. To identify the risk factors for ASDz, the sagittal alignment, spinal canal diameter, range of motion of the cervical spine, number of fusion segments, and fusion methods were evaluated. The patients were divided into three groups according to the fusion method: Group A contained patients who had received autogenous bone graft only (53 patients), Group B contained patients who received autogenous bone graft and plate augmentation (62 patients), and Group C contained patients who underwent cage and plate augmentation (127 patients). ASDz occurred in 33 patients, of whom 19 required additional surgery. The risk of developing ASDz was significantly higher in male patients (p=0.043), patients whose range of motion of the cervical spine was >30° (p=0.027), and patients with spinal canal stenosis (p=0.010). The rate of development of ASDz was not different depending on the number of fusion segments. The rate of development of ASDz was 41.5% in Group A, 9.6% in Group B, and 5.51% in Group C (p=0.03). In patients who underwent anterior cervical arthrodesis for degenerative disease, the occurrence of ASDz was related to age, the cervical spine range of motion, and spinal canal stenosis. Additional plate augmentation for anterior cervical arthrodesis surgery can lower the rate of ASDz development.

Validation of a Method to Assess Range of Motion of the Cervical Spine Using a Tape Measure

ObjectiveThe purposes of this study were to validate a tape measure method for measuring cervical spine range of motion compared with a universal goniometer in all planes of motion and to derive equations to convert a linear measurement to an angular distance. MethodsParticipants were healthy volunteers. Measurements of flexion/extension, rotation, and lateral flexion were made with the universal goniometer and tape measure, in the neutral position, extreme of motion, and 2 positions between. Measurements from the 2 techniques were compared with Pearson correlation coefficient and simple linear regression to determine R2, the regression coefficient and the regression equation. Reliability was assessed using the intraclass correlation coefficient. ResultsThere were 40 participants with a mean age of 30.5 (SD, 9.1) years. Goniometer measurements had good to excellent correlation with both absolute and percentage change in tape measurement (correlation coefficients, 0.74-0.94 and 0.75-0.91, respectively). Correlation was highest for flexion and extension, lowest for rotation and lateral flexion. The amount of variability in the data explained by the linear regression models (R2) varied from 55% to 89%. Intraclass correlation coefficient ranged from 0.44 to 0.69 and 0.38 to 0.59 for intrarater and interrater reliability, respectively. Reliability was greatest for flexion and extension, lowest for rotation and lateral flexion. ConclusionThis study demonstrated that tape measurements correlated well with a universal goniometer. The tape measure may be useful for measuring cervical spine range of motion where availability, simplicity, and low cost are important considerations such as with conduct of research or patient management.

The Influence of Cervical Spine Flexion-Rotation Range-of-Motion Asymmetry on Postural Stability in Older Adults

Cross-sectional design. The purpose of this study was to isolate the contribution of cervical spine range-of-motion (ROM) asymmetry to postural control in a group of older adults with neck pain. Previous research has suggested that the upper cervical spine plays an important role in postural stability. However, it remains unclear whether the upper cervical spine rotation ROM asymmetry is associated with postural stability. Using the cervical range-of-motion device to assess upper cervical spine ROM via the cervical flexion-rotation test, we classified 54 older adults with neck pain (30 females; mean [standard deviation] age, 66 [5] yr) into the (1) symmetrical group (SYM; n = 20; ≤5° side-to-side difference) or (2) asymmetrical group (ASYM; n = 34; >5° difference). Standing postural control was characterized by the center-of-pressure (CoP) movements measured using a Balance Board. Other measures included habitual, fast-paced gait speed and neck pain. Both groups were compared on the various measures using Welch t tests. Although the ASYM group had 26% greater anteroposterior postural sway than the SYM (P < 0.01), both groups did not differ on postural sway velocity, gait speed, and neck pain intensity. Analyzing the frequency content of the postural sway using wavelet analysis (a modern, nonlinear signal processing method) shed further light: the standing postural sway in the ASYM group was skewed toward lower frequency movement (ultralow [< 0.10Hz] frequency content, anteroposterior: 6.7% in ASYM, 4.7% in SYM, P = 0.01; medial-lateral: 4.2% in ASYM, 3.4% in SYM, P = 0.045). The ASYM group seemed to have compensated for their altered somatosensory input to achieve similar functional levels as the SYM group. Given what is known about the association between ultralow frequency postural sway and visual input, we speculated that the postural strategy adopted by the ASYM group was adaptive and that this group may be relying on the visual system to achieve these compensations.