Cervicothoracic Pain Research Articles

Cervical ependymoma en bloc resection.

A 58-year-old male was admitted to the authors' department due to cervicothoracic pain and disequilibrium. Physical examination evidenced sensory and motor deficits in the lower limbs. MRI evidenced an expansive intramedullary lesion compatible with ependymoma. The nuances of this surgical access and the management of intradural tumors are discussed.

Feasibility and effectiveness of telehealth in the management of cervicothoracic and lumbar pain during the first six months of the SARS-CoV-2 pandemic: A case series

ObjectivesThe primary study objective is to assess the effectiveness and utility of telehealth in managing spine pain. The secondary objective is to evaluate the feasibility of employing various treatments utilizing telehealth. Study designRetrospective case series of patients with spinal pain managed primarily by telehealth during the first 6 months of the SARS-CoV-2 pandemic in the United States. SettingA single center community based out-patient clinic and ambulatory surgical facility. Subjects101 consecutive adult patients complaining of cervicothoracic or low back pain presenting to a specialized spine clinic. MethodsTelehealth was the preferred method of consultation for 101 consecutive patients presenting with cervicothoracic and/or low-back pain. After conservative care, patients with continued pain and disability were offered procedures. Disability Index (NDI and ODI) and pain Visual Analog Scores (VAS) were used to determine patient outcomes. Results101 new out-patient consultations occurred. Telehealth initial consultation occurred in 98% of cases. There was a total of 504 follow up consultations. Follow up was via telehealth in 69%. Significant neurological abnormalities were detected by telehealth in 3% of patients. The lost to follow up rate was 10%. All 63 interventional procedures performed on 42 patients were completed as planned during telehealth visits. Likewise for all 9 surgical procedures. Outcomes were monitored via telehealth. Overall, for patients with cervicothoracic pain, minimal clinically important differences (MCID) for VAS or NDI were reached in 71%. Overall, the MCID for VAS or ODI for low back pain patients was reached in 70%. ConclusionTelehealth in our series was easily deployable, highly feasible, allowed accurate monitoring of patient care and resulted in accurate triaging for interventions and surgery. Overall patient outcomes compare favorably with that reported for in-person spinal pain care. Telehealth was effective and easily utilizable.

A Prospective Cohort Study on Risk Factors for Cervico-Thoracic Pain in Military Aircrew.

BACKGROUND: Military aircrew frequently report cervico-thoracic pain and injury. The relationship between risk factors and future pain episodes is, however, uncertain. The aim of this study was to identify risk factors for cervico-thoracic pain and to determine the 1-yr cumulative incidence of such pain.METHODS: A total of 47 Swedish aircrew (fighter and helicopter pilots and rear crew) without pain in the cervico-thoracic region were surveyed about work-related and personal factors and pain prevalence using the Musculoskeletal Screening Protocol questionnaire. They also performed tests of movement control, active cervical range of motion, and isometric neck muscle strength and endurance. Aircrew were followed for a year with questionnaires. Logistic regressions were used to identify potential risk factors for future cervico-thoracic pain.RESULTS: Previous cervico-thoracic pain (OR: 22.39, CI: 1.79-280.63), lower cervical flexion range of motion (OR: 0.78, CI: 0.64-0.96), and lower neck flexor muscular endurance (OR: 0.91, CI: 0.83-0.99) were identified as risk factors for reporting cervico-thoracic pain. At follow-up, 23.4% (CI: 13.6-37.2) had reported cervico-thoracic pain during the 12-mo follow-up period.DISCUSSION: The Musculoskeletal Screening Protocol can identify risk factors for cervico-thoracic pain. The link between cervico-thoracic pain and previous pain, as well as lower performance of neck range of motion and muscular endurance, highlights the need for primary and secondary preventive action. The findings from this study can facilitate the development of such pain prevention programs for aircrew.Tegern M, Aasa U, Larsson H. A prospective cohort study on risk factors for cervico-thoracic pain in military aircrew. Aerosp Med Hum Perform. 2023; 94(7):500-507.

The relationship of cervicothoracic mobility restrictions to fall risk and fear of falling in ankylosing spondylitis.

The objective of this study is to determine whether restricted cervical mobility in ankylosing spondylitis (AS) is associated with increased fall frequency or fear of falling. A total of 134 AS patients and 199 age- and gender-matched control subjects (CS) with soft-tissue cervicothoracic pain were prospectively evaluated for fall risk. Subjects were divided into non-fallers, single fallers, and multiple fallers. Dynamic cervical rotations and static cervicothoracic axial measurements were compared between the groups. In total, 88 AS patients were reviewed more than once; Kaplan-Meier plots were constructed for fall risk as a function of cervical rotation amplitudes. Falls Efficacy Scale-International (FES-I) questionnaire measured the fear of falling. In total, 34% of AS patients and 29% of CS fell (p = 0.271) in the year prior to evaluation. In AS, static anatomical measurements were unrelated to fall occurrence. The trends of multiple AS fallers to greater flexed forward postures and reduced dynamic cervical rotations were not statistically significant. Cervicothoracic pain (p = 0.0459), BASDAI (p = 0.002), and BASFI (p = 0.003) scores were greater in multiple fallers. FES-I scores were greater in fallers (p = 0.004). Of the 88 AS patients reviewed (or seen) on more than one occasion, 46.5% fell over the 9-year observation period, including all multiple fallers and 71.4% of single fallers. Survival curves showed increased fall risk as cervical rotational amplitudes decreased. In AS, decreased cervical rotations increase fall risk and fear of falling. In multiple fallers, falls were associated with greater disease activity. Cervical muscle stiffness in AS may cause non-veridical proprioceptive inputs and contribute to increased fall frequency similar to individuals with soft-tissue cervicothoracic pain.

Cervico-thoracic pain and associated impairments in air force personnel: a cross-sectional study

BackgroundPain and impaired function in the cervical region are common in Air Force personnel (AFP), but evidence is limited regarding the thoracic region. This cross-sectional cohort study examined associations between cervico-thoracic pain and physical performance among Swedish AFP and explored possible differences and similarities in test performance between fighter pilots (FP), helicopter pilots (HP) and rear crew (RC).MethodsAFP (n = 73) from one airbase performed eight tests of movement control of the spine, active cervical range of motion (ROM) in all six directions and isometric strength and endurance of the cervical flexors and extensors. The association between test performance and cervico-thoracic pain (based on the ‘Musculoskeletal screening protocol’ questionnaire) were analysed in a multiple binary logistic regression model.ResultsFor AFP with cervico-thoracic pain (30%), movement control was impaired in the ‘neck flexion test’ (OR [95%CI] =3.61 [1.06–12.34]) and the ‘forward lean test’ (OR [95%CI] =3.43[1.04–11.37]), together with reduced flexion ROM (OR [95%CI] =0.93 [0.87–0.99]). Test performance was in general similar between the three groups, but FP and HP could control the ‘forward lean test’ to a significantly higher degree than RC (p = 0.000). Further, FP showed significantly greater ROM in lateral flexion to the right compared to HP and RC (mean: 40.3°, 36.2° and 33.4°, respectively, p = 0.000), and they showed higher, although not significant, flexor strength than RC (p = 0.026).ConclusionsThe impaired function associated with cervico-thoracic pain highlights the need for a deeper understanding of such relationships when designing tools to systematically optimize the physical performance and prevent pain among AFP. Studies with a longitudinal design are warranted to examine any causative associations between pain and impairments.

Percutaneous C-Arm Free O-Arm Navigated Biopsy for Spinal Pathologies: A Technical Note.

Background: Percutaneous biopsy under computed tomography (CT) guidance is a standard technique to obtain a definitive diagnosis when spinal tumors, metastases or infections are suspected. However, specimens obtained using a needle are sometimes inadequate for correct diagnosis. This report describes a unique biopsy technique which is C-arm free O-arm navigated using microforceps. This has not been previously described as a biopsy procedure. Case description: A 74-year-old man with T1 vertebra pathology was referred to our hospital with muscle weakness of the right hand, clumsiness and cervicothoracic pain. CT-guided biopsy was performed, but histopathological diagnosis could not be obtained due to insufficient tissue. The patient then underwent biopsy under O-arm navigation, so we could obtain sufficient tissue and small cell carcinoma was diagnosed on histopathological examination. A patient later received chemotherapy and radiation. Conclusions: C-arm free O-arm navigated biopsy is an effective technique for obtaining sufficient material from spine pathologies. Tissue from an exact pathological site can be obtained with 3-D images. This new O-arm navigation biopsy may provide an alternative to repeat CT-guided or open biopsy.

Association of Chiropractic Colleges Research Agenda Conference 2021 Abstracts of Proceedings.

Association of Chiropractic Colleges Research Agenda Conference 2021 Abstracts of Proceedings.

Cervicothoracic Mechanical Impairment as Part of Complete Neurological Fall Risk Appraisal.

Assessment of individuals at risk for falling entails comprehensive neurological and vestibular examinations. Chronic limitation in cervical mobility reduces gaze accuracy, potentially impairing navigation through complex visual environments. Additionally, humans with scoliosis have altered otolithic vestibular responses, causing imbalance. We sought to determine whether dynamic cervical mobility restrictions or static cervicothoracic impairments are also fall risk factors. We examined 435 patients referred for soft-tissue musculoskeletal complaints; 376 met criteria for inclusion (mean age 52; 266 women). Patients were divided into nonfallers, single fallers, and multiple fallers, less or greater than 65 years old. Subject characteristics, dynamic cervical rotations, and static cervicothoracic axial measurements were compared between groups. Fear of falling was evaluated using the Falls Efficacy Scale-International questionnaire. Long-standing cervicothoracic pain and stiffness conferred increased risk of falling. Neck rotation amplitudes decreased with longer duration musculoskeletal symptoms and were significantly more restricted in fallers, doubling the risk of falling and contributing to increased fear of falling. Mid-thoracic scoliosis amplitudes increased over time, but static axial abnormalities were not greater among fallers, although thoracic kyphoscoliosis heightened fear of falling. In patients at fall risk, thoracic kyphoscoliosis and dynamic neck movements should be assessed, in addition to standard vestibular and neurological evaluations. Additionally, patients with soft tissue cervicothoracic pain and restricted mobility have increased fall frequency and fear of falling, independent of other fall risk factors and should undergo complete fall risk appraisal.

Effects of Thoracic Mobility Exercise on Cervicothoracic Function, Posture and Pain in Individuals With Mechanical Neck Pain

Effects of Thoracic Mobility Exercise on Cervicothoracic Function, Posture and Pain in Individuals With Mechanical Neck Pain

Tumor Lysis Syndrome in the Course of Burkitt Lymphoma Revealed by Medullar Compression

Background: Tumor lysis syndrome is unknown to many neurosurgical teams. A dreaded complication, especially in the course of hematological malignancies, like it was the case in two of our patients operated for spinal cord compression by Burkitt’s lymphoma. Objectives: To describe the clinical and biological presentation of this potentially fatal complication, which can be improved by early preventive or curative treatments. Case Reports: Patient 1: A 49-year-old woman was admitted for vertebral and intercostal pain and paraparesis. Myelography revealed epidural medullary compression at the 7th thoracic vertebrae (Th7) level. Patient 2: A 67-year-old woman was admitted for cervico-thoracic pain and paraparesis. MRI showed posterior epidural medullary compression between the 1st thoracic vertebrae (Th1) and 5th thoracic vertebrae (Th5). In both cases, an urgent decompressive laminectomy was performed. They had also received postoperative corticosteroid therapy. The multi-visceral failure occurred on the 1st day (D1) and 3rd day (D3) postoperatively, respectively. In the absence of adequate management, the outcome was fatal for the two patients respectively at D3 and D5 postoperatively. This syndrome was retained in the presence of glucocorticoid (triggering factor) and the histological result in favor of Burkitt lymphoma (target disease). Conclusion: Malignant hemopathies is a common cause of spinal cord compressions. From these two cases, the importance of biological and clinical surveillance emerges, with patients requiring urgent management for radiculo-medullar tumor compression.

Incidence of Cervicothoracic Musculoskeletal Dysfunction in Patients with Low Back Pain: An Observational Study

Question : Is Cervico-thoracic dysfunction associated with low back pain with or without radiation to lower extremities? Design : observational study, Participants: A total of 800 subjects (M- 431, F- 369) between the age group of 30 years to 60 years with low back pain with or without radiation were evaluated from Feb. 2007 to Sept. 2012. Maitland's Central PA pressure of cervicothoracic spines and palpation in peri-scapular muscles by digital algometer that reproduced the original low back pain with or without radiation is considered a positive co existence Result : 85.5 % of patients with low back pain with or without radiation were found to have associated cervicothoracic skeletal dysfunctions and myofascial pain syndrome in levator scapulae and/or rhomboids. Conclusion : Low back pain with or without radiation is often associated with cervicothoracic skeletal dysfunctions and myofascial pain syndrome in levator scapulae and/or rhomboids.

Extradural spinal cavernous malformation: A rare but important mimic

Purely extradural spinal cavernous malformations (ESCMs) are rare, but the number of cases reported seems to be increasing.A 44-year-old woman presented with progressive cervicothoracic back pain, lower limb paraesthesia and hypertonia. MRI showed a well-circumscribed, convex lesion in the T1-4 extradural space causing cord compression and encroaching into the left T2/3 neural foramen. Selective spinal angiography demonstrated a vascular blush at the T2/T3 level corresponding with the mass. A feeding vessel arising from the base of the T1 spinous process was identified and successfully catheterised, but embolisation was precluded by unfavourable anatomy of the posterior spinal artery. At hemilaminectomy, the lesion was found to be an ESCM. The patient went on to make a full recovery. We reviewed 71 cases of ESCM reported in the last decade.Incidence of ESCM is unclear; the largest case series reported on nine patients, but most published accounts were single case studies. Patients presented with back pain (33%), myelopathy (56%) and/or radiculopathy (39%). Onset of symptoms was usually insidious over months to years, but 30% presented with sudden-onset neurological symptoms, often due to spontaneous haemorrhage. Mean age at diagnosis was 44 (range, 2–74; SD, 19.6) years with a 1:1 sex ratio. Lesions were found at all levels except C1–C2, but a strong predilection for the dorsal thoracic spine (68%) was shown. The lesion extended into an intravertebral foramen in at least 24 cases (34%). MRI is the investigation of choice, and angiography of ESCM has rarely been described. Most (87%) were hypo- to isointense on T1 MRI while hyperintensity on T2 (91%) and avid (89%), usually homogenous gadolinium update was almost universal. Perilesional haemosiderin, characteristic of intracranial and intramedullary cavernous malformation was rarely seen. In many cases, meningioma or nerve sheath tumour was misdiagnosed prior to surgery. All patients underwent total (95%) or subtotal (5%) microsurgical resection with excellent results; all improved (23%) or recovered fully (77%) after surgery. Those who presented acutely did worse; 38% had residual deficits.

Effects of transcranial magnetic stimulation in the treatment of phantom limb pain in landmine /INS;victims: A randomized clinical trial

WCN 2013 No: 2844 Topic: 9 — Pain Effects of transcranial magnetic stimulation in the treatment of phantom limb pain in landmine victims: A randomized clinical trial M. Malavera, F. Silva, R. Garcia, J. Quiros, M. Dallos, A. Pinzon. Fundacion Cardiovascular de Colombia, Floridablanca, Colombia, Neuroscience, Fundacion Cardiovascular de Colombia, Floridablanca, Colombia, Harvard Medical School, Boston, MA, USA, Santander, Fundacion Cardiovascular de Colombia, Floridablanca, Universidad Industrial de Santander, Bucaramanga, Colombia The rTMS on motor cortex (M1) has efficacy of 52–88% in some refractory neurogenic pain by descending modulation of corticothalamic tract. The aim is to evaluate the efficacy of rTMS in the treatment of PLP in victims of anti-personnel landmines. We performed a randomized, double-blind placebo-controlled trial in 49 patients with unilateral amputation, 26 patients received real rTMS over the hand area of M1 contralateral to amputated leg and 23 patients received sham. A Visual Analogue Scale (VAS) was administered at baseline, after 15 and 30 days of last session. There were no significant differences when the percentage change of VAS at 15 days (−53.2 ± 54.2 vs −28.2 ± 58.4, p = 0.11) or at 30 days (−43.6 ± 48.6 vs −21.5 ± 53.4, p = 0.14) was analyzed comparing both groups, however, a significant difference in the proportion of subjects who presented a decrease greater than 30% in VAS at 15 days in the active group vs placebo (69.2% vs 39.1%, p = 0.03) and a tendency at 30 days (58.3% vs 33.3%, p = 0.09) was observed. The analysis of a subgroup of subjects with less than 10 years since amputation (n = 38) showed differences between the percentage change at 15 days (−51.2 ± 59.5 vs 55.7, p = 0.05), and at 30 days (−49.4 ± 48.9 vs −9.9 ± 46.7, p = 0.02). There were clear differences in the proportion of subjects with a decrease in more than 30% of pain at 15 days (68.4 vs 31.6%, p = 0.02) and at 30 days (61.1 vs 23.5, p = 0.02). doi:10.1016/j.jns.2013.07.1880 Abstract — WCN 2013 No: 3061 Topic: 9 — Pain Effect of manipulative therapy in combination with kinesio taping on cervicothoracic pain in highly qualified athletes WCN 2013 No: 3061 Topic: 9 — Pain Effect of manipulative therapy in combination with kinesio taping on cervicothoracic pain in highly qualified athletes V. Zabarovski, L. Vasilevskaya, L. Anatskaia. Neurology, Republican Research and Practical Center of eurology and Neurosurgery,

Effect of manipulative therapy in combination with kinesio taping on cervicothoracic pain in highly qualified athletes

Effect of manipulative therapy in combination with kinesio taping on cervicothoracic pain in highly qualified athletes

Clear cell meningioma with anaplastic features: Case report and review of literature

Clear cell meningioma (CCM) is an uncommon variant of meningioma, corresponding to WHO grade II. We present two cases of CCMs with anaplastic features in the intracranial and intraspinal region. The first case is a 65-year-old male who gradually developed changes in behavior over a period of 1 year. The second case is a 35-year-old female who presented with a 7-month history of posterior cervicothoracic pain and dysuria for 1 week. Magnetic resonance imaging revealed an intracranial lesion in the right frontal lobe in the male patient, and an intradural extramedullary lesion at C7 in the female patient. On histological examination, both tumors partly exhibited unusual anaplastic appearances with nuclear pleomorphism, high mitotic activity and necrosis, distinct from classical CCMs. Tumor cells were immunoreactive to epithelial membrane antigen (EMA) and vimentin, with a high MIB-1 index up to 40%. Total excision was performed. The male patient was found to have developed local recurrence and lateral ventricle metastasis 3 months after surgery. A diagnosis of CCM with anaplastic features was made (WHO grade III). Based on its aggressive behavior, we recommend postoperative adjuvant radiotherapy or chemotherapy even if total excision of the tumor has been performed, and MRI scans every 3–6 months during the first period of follow-up.

Spinal Langerhans' cell histiocytosis in a young adult: Case report and therapeutic considerations

We report an unusual case of spinal Langerhans' cell histiocytosis of the cervicothoracic junction in a young adult man. A 17-year-old male was referred to our institution with a 3-week history of cervicothoracic pain associated to a weakness of his right upper limb. Computed tomography and magnetic resonance imaging showed a collapsed T1 vertebral body with epidural soft tissue showing mass effect on spinal cord. The patient underwent a classic anterior cervicotomy. Complete removal of the lesion could be achieved, but the soft consistency of C7 and T2 body precluded a solid anterior fixation and an extended resection of C7 and T2 body had to be performed. Then a C6 – T3 stabilisation using an anterior plate fixation and cyanomethylacrylate graft was performed. Postoperative course was uneventful. At 2 years follow-up, the patient was asymptomatic and radiological workup showed a perfect stability of anterior fixation system. Aggressive surgical management of eosinophilic granuloma should be considered in some selected cases particularly when spinal instability or neurological deficit occurs. In this young patient a modified anterior cervicotomy allowed a comfortable approach to the anterior aspect of T3 vertebra for spinal fixation.

Novel therapeutic agents: A prospective, randomized, double-blinded trial evaluating varying volumes of diluent with botulinum toxin type A (Botox) in the treatment of refractory myofascial cervicothoracic pain

A prospective, randomized, double-blinded trial of 72 patients with refractory myofascial pain (MP) involving the upper trapezius (UT) and levator scapulae (LS) muscles refractory to conservative therapy was performed to evaluate the effect of volume of diluent used with Botulinum toxin Type A (BTA, Botox®, Allergan, Inc., Irvine, CA: 200u/cc, 100u/cc or 50u/cc in saline). All patients who entered had short-term responses to standard trigger point (TP) injections.. A single investigator (who was excluded from all follow up assessments) performed the injections by palpation directly into the TP with 25u/site. The total patient dose was 75-150 units for 3-6 TPs into the affected muscles (maximum of 3 per UT and 2 per LS). Pressure algometry, TP tenderness, muscle spasm, pain VAS, McGill Short Form Pain Questionnaire, Oswestry Neck Pain Questionnaire, Beck's Depression Inventory and patient and physician global responses were assessed at 2, 4, 6, 8, 12, and 24 weeks by investigators blinded as to the volume received. Essentially, every outcome measure showed highly significant change from baseline lasting up to 24 weeks, but with a few exceptions (right LS algometry and left UT tenderness), the outcome measures demonstrated only a trend toward significance between the different groups with higher volumes demonstrating better responses. The injections were well tolerated with no significant side effects experienced. Increasing volume of diluent appears to play a supportive role in improving outcome when BTA is used to treat MP. Additional, studies are needed to confirm these results.

Treatment of cervicothoracic pain and cervicogenic headaches with regenerative injection therapy.

Significant progress has been made in interventional pain management. Despite this progress, patients continue to present a diagnostic and therapeutic challenge. Steroidal and nonsteroidal anti-inflammatory medications have limited use in degenerative painful conditions of connective tissue. Regenerative injection therapy, also known as prolotherapy, is a viable, type-specific treatment for such pathology. Several placebo-controlled studies, together with uncontrolled studies, indicate the effectiveness of regenerative injection therapy in treating painful ligament and tendon pathology. As stated in July 2003 by Mooney, this treatment has advanced "from the fringe to the frontier of medical care."

Pattern of intervertebral disc degeneration in the cervicothoracic junctional region

There have been no reports describing the pattern of degenerative changes of spinal segments within the cervicothoracic (CT) transitional junction. To address this deficiency, intervertebral disc degenerative changes in this region were studied between the C6 to T4 vertebrae, using hemisected spinal columns from 96 individuals (69 male and 27 female). Sagittally sectioned spinal columns were inspected macroscopically by one observer and graded using previously reported grading scales. In addition, endplate irregularity, intervertebral disc degenerative changes, discal splitting and vertebral body marginal osteophytes were recorded. Combining all classifications of degeneration, the frequency of disc degeneration at C6–C7 was 49%, C7−T1 = 42%, T1−T2 = 40%, T2−T3 = 50% and T3−T4 = 44%. Significant age trends were noted, with 25% of all discs showing degeneration in the youngest group, compared to 58% in the oldest group. The incidence of disc degenerative changes through this transition declined from the C6–C7 to the T1–T2 segments but increased slightly for the more severe changes at the T2–T3 and T3–T4 segments. In one third of cases demonstrating degenerative discal changes no evidence of osteophyte formation was present. The manual therapist should not exclude the possibility of discal pathology in patients presenting with cervicothoracic pain, particularly if the patient is over 30 years of age.

Effects of osteopathic manipulative treatment in patients with cervicothoracic pain: Pilot study using thermography

To provide information on how cervicothoracic pain responds to osteopathic manipulative treatment, five subjects with acute or chronic pain received appropriate medication and three osteopathic manipulative treatments by the principal investigator using thrust and nonthrust techniques. The mean number of findings by both investigators on structural examination decreased considerably immediately after each of the three treatments. The number of findings increased in week 2 and decreased in week 3. The principal investigator observed a further decrease by the final session, but the coinvestigator reported an increase. The pain scale score improved an average of nearly 30%. Thermography showed cooling of the cervicothoracic region in all subjects and conversion to a normal pattern in four. Osteopathic manipulative treatment should be considered for patients with acute or chronic cervicothoracic pain. The use of thermographic analysis in clinical osteopathic research seems warranted.