History Of Neck Pain Research Articles

The Influence of "Labels" for Neck Pain on Recovery Expectations Following a Motor Vehicle Crash: An Online-Randomized Vignette-Based Experiment.

OBJECTIVES: To (1) investigate whether different labels for neck pain after a motor vehicle crash (MVC) influenced recovery expectations and management beliefs, (2) explore reasons for low recovery expectations and greater likelihood for lodging a claim, and (3) explore the moderating effect of neck pain history and sociodemographic characteristics. DESIGN: Online randomized experiment with nested qualitative content analysis. METHODS: We randomized 2229 participants from the general population (mean age: 46.7 ± 17.5 years; 72.4% females; 66% with previous or current neck pain; 10% with an MVC experience) to read 1 of 5 scenarios describing a patient with neck pain after an MVC, each was labeled as whiplash injury, whiplash-associated disorder, posttraumatic neck pain, neck pain, or neck strain. The primary outcome was recovery expectations, rated on a 0- to 10-point scale. RESULTS: Participants allocated to whiplash-associated disorder or neck pain had lower recovery expectations than those allocated to neck strain (adjusted mean difference [95% confidence interval]: -0.5 [-0.9 to -0.1] for both comparisons). Whiplash-associated disorder led to more recovery uncertainty, while neck pain led to greater doubt about the health care provider. Most secondary outcomes showed significant but small differences. Participants allocated to neck strain were less inclined to claim than those allocated to whiplash-associated disorder or whiplash injury due to less perceived need for financial support. Neck pain history moderated labeling effects on recovery expectations; household income moderated the claim intention. CONCLUSIONS: Labels for neck pain after an MVC influenced recovery expectations and management preferences. The clinical relevance of the small effects was unclear. J Orthop Sports Phys Ther 2024;54(11):1-10. Epub 5 September 2024. doi:10.2519/jospt.2024.12590.

Use of Soft Cervical Collar Improves Surgeon Ergonomics During Simulated Otologic Surgery.

To determine whether surgeon use of a soft cervical collar during endoscopic and microscopic otologic surgery is feasible and impacts surgeon ergonomics as measured by inertial sensors. Prospective crossover trial. US-based otolaryngology training program. Otolaryngology residents and fellows. Therapeutic-use of a soft cervical collar during simulated otologic surgery. Time spent in high-risk angles of neck and back flexion and extension; average angle of neck flexion, extension, rotation, and lateral bending; validated assessment of neck pain; average daily phone use. Fifteen subjects met criteria for inclusion. Ten of 15 (67%) were male. Seven of 15 (47%) were postgraduate year 1-2. Seven of 15 (47%) reported a history of neck pain. None reported prior spinal steroid injections or surgery. Across all subjects, use of the soft cervical collar significantly reduced time spent in high-risk angles of neck flexion/extension during both endoscopic (56% vs. 35%, p < 0.05) and microscopic (60% vs. 32%, p < 0.05) otologic surgery. There was no effect on back flexion or extension. There was no difference in time spent in high-risk neck or back angles between endoscopic and microscopic surgery. Average angles of neck or back flexion, extension, lateral bending, and rotation were not significantly different for subgroups with more operative experience, increased phone use, perception of good posture, or history of neck pain. Use of a soft cervical collar during simulated otologic surgery significantly reduced time spent in high-risk neck positions. These data support feasibility of soft collar use during otologic surgery and hold promise for reduction in the high rates of neck pain reported by neurotologists. Improving surgeon ergonomics for otologic surgery. To identify a therapeutic intervention to mitigate neck pain in surgeons caused by assumption of high-risk cervical neck flexion and extension. To demonstrate that use of a readily available soft cervical collar reduces risk of neck pain in otologic surgeons. II. Exempt.

Upper cervical intramedullary schwannoma of the spinal cord presenting with myelopathy: illustrative case.

Intramedullary schwannomas account for 1.1% of all spinal schwannomas. Preoperative diagnosis is best accomplished by thoroughly evaluating clinical and radiological characteristics, accompanied by a high index of suspicion. The authors report a case of C2-3 intramedullary schwannoma in a young male who presented with neck pain and vertigo. The current literature is also reviewed. The authors reviewed the data of a young male with a 2-month history of neck pain and vertigo. Magnetic resonance imaging of the brain and cervical spine showed an intramedullary mass at C2-3 with a syrinx extending into the cervicomedullary junction. Laminectomy, myelotomy, and microsurgical excision of the mass under intraoperative neurological monitoring (IONM) were done. Postoperative pathology reported the specimen as a schwannoma. Gross-total resection of a schwannoma using IONM is the treatment of choice because of the lesion's benign nature, a better prognosis, and defined cleavage plane. Schwannomas should be included in the differential diagnosis of intramedullary spinal tumors. Because of its progressive nature, early surgery is recommended in symptomatic patients.

Postures of the Head, Upper, and Lower Neck in Forward Head Posture: Static and Quasi-static Analyses

Background: Abnormal head and neck postures play a significant role in developing cervical spine dysfunction. Forward head posture (FHP) is one of the most common findings in individuals who experience head and neck disorders. Objectives: This study used a photographic method to analyze the head, upper neck, and lower neck postures in forward head posture in both static and quasi-static states. Since timely diagnosis and appropriate treatment are important in preventing further complications of this kinematic chain disorder, the postural variables of the head and neck were evaluated by focusing on their separate parts in both static and quasi-static states. Methods: This observational-analytical case-control study included 175 individuals with no history of neck pain in the past 6 months, 138 with FHP, and 37 with non-FHP. The postural angles, including the upper cervical, lower cervical, craniovertebral, head posture, and head tilt angles, were measured through photography in both the static state (with the head and neck in a neutral position) and the quasi-static state (while moving the head and neck in the sagittal plane) in a sitting position. The measurements were taken in two groups (FHP and non-FHP). Results: In a static state, the upper cervical angle was higher in the FHP group than in the non-FHP group. The lower cervical measurements were higher in the non-FHP group than in the FHP group. In the quasi-static state, significant differences existed in the changes of the upper cervical, lower cervical, craniovertebral, head postural, and head tilt angles between the two groups (P-value &lt; 0.05). Conclusions: During full flexion to full extension of the neck, subjects with FHP exhibited reduced mobility in the cervical spine, particularly in the lower cervical region. Additionally, the position of the head relative to the neck remained unchanged in this group.

Potential effect modifiers for treatment with chiropractic manipulation versus sham manipulation for recurrent headaches in children aged 7–14 years: development of and results from a secondary analysis of a randomised clinical trial

BackgroundA recent randomized controlled trial (RCT) investigating the effect of chiropractic manipulation in 199 children aged 7–14 years with recurrent headaches demonstrated a significant reduction of number of days with headache and a better global perceived effect (GPE) in the chiropractic manipulation group compared to a sham manipulation group. However, potential modifiers for the effectiveness of chiropractic manipulation of children with recurrent headaches have never been identified. The present study is a secondary analysis of data from that RCT and will investigate potential effect modifiers for the benefit of chiropractic manipulation for children with headache.MethodsSixteen potential effect modifiers were identified from the literature and a summary index was prespecified based on clinical experience. Relevant variables were extracted from baseline questionnaires, and outcomes were obtained by means of short text messages. The modifying effect of the candidate variables was assessed by fitting interaction models to the data of the RCT. In addition, an attempt to define a new summary index was made.ResultsThe prespecified index showed no modifying effect. Four single variables demonstrated a treatment effect difference of more than 1 day with headache per week between the lower and the upper end of the spectrum: intensity of headache (p = 0.122), Frequency of headache (p = 0.031), sleep duration (p = 0.243), and Socioeconomic status (p = 0.082). Five variables had a treatment effect difference of more than 0.7 points on the GPE scale between the lower and the upper end of the spectrum: Frequency of headache (p = 0.056), Sport activity (p = 0.110), Sleep duration (p = 0.080), History of neck pain (p = 0.011), and Headache in the family (0.050). A new summary index could be constructed giving highest weight to History of neck pain and Headache in the family and Frequency of headache. The index suggests a difference of about 1 point in GPE between low and high values of the index.ConclusionChiropractic manipulation offers a moderate benefit for a broad spectrum of children. However, it cannot be excluded that specific headache characteristics, family factors, or a history of neck pain may modify the effect. This question must be addressed in future studies.Trial registration: ClinicalTrials.gov (Albers et al in Curr Pain Headache Rep 19:3–4, 2015), identifier NCT02684916, registered 02/18/2016—retrospectively registered.

Effect of diaphragmatic breathing, respiratory muscle stretch gymnastics and conventional physiotherapy on chest expansion, pulmonary function and pain in patients with mechanical neck pain: A single group pretest-posttest quasi-experimental pilot study

BackgroundThere is evidence that mechanical neck pain results in respiratory dysfunction. Physiotherapy management for mechanical neck pain is well documented but the evidence regarding inclusion of breathing strategies to improve pulmonary functions in mechanical neck pain patients is scarce. ObjectiveTo investigate the combined effect of diaphragmatic breathing, respiratory muscles stretch gymnastics (RMSG) and conventional physiotherapy on chest expansion, pulmonary function and pain in patient with mechanical neck pain. MethodThirteen patients with mechanical neck pain (18–35years) with neck pain history of ≥ three months and NPRS (numeric pain rating scale) score ≥3 were recruited for this single group pre pretest-posttest quasi experimental pilot study. Informed consent was taken from all participants. After initial screening and assessment, diaphragmatic breathing, RSMG (5 patterns) and conventional physiotherapy (hot pack and TENS for 10 min) were given for one week. Chest expansion, spirometry (FEV1, FVC, FEV1/FVC, PEFR), NDI (neck disability index) and NPRS were assessed on baseline and after one week following the intervention. ResultsThe normality of data was tested by using Shapiro-wilk test and the data was found to be normally distributed. Paired t-test was used to compare the baseline and post intervention values. Diaphragmatic breathing, RMSG and conventional physiotherapy had significant effect on chest expansion, FEV1, NPRS and NDI in patients with mechanical neck pain. ConclusionThe rehabilitation strategies should emphasize breathing exercises to improve the lung function and pain scores in addition to conventional physiotherapy in rehabilitation of mechanical neck pain patients.

Neck pain associated with smartphone usage among university students.

Neck and shoulder pain has been linked to prolonged periods of flexed neck posture. However, the influences of factors related to individuals' characteristics and the time duration and position of using smartphones on the severity and duration of neck and shoulder pain among university students are not well studied. The aim of this study was to identify factors related to individual demographics, the history of neck pain, and the time duration and positions of using the smartphone that could be associated with neck pain severity and duration and to determine the influence of these factors on neck pain severity and duration among university students. A cross-sectional study was conducted on students from King Abdulaziz University in Jeddah, Saudi Arabia, using a self-administered online questionnaire. Data was collected between March 10th, 2020, and October 18th, 2020, with 867 questionnaires filled out using Google Forms as a web-based questionnaire. Questionnaires were distributed to students by posting them in their batch groups on Facebook, an online social media and social networking service. Students from five healthcare faculties were included: the faculties of medicine, dentistry, pharmacy, nursing, and medical rehabilitation sciences. Students' gender, time spent on using their phones, time spent on devices for studying, and having a history of neck or shoulder pain were significant predictors of neck pain duration in the univariate model (p≤0.018). In the multivariate model, both having a history of neck or shoulder pain (95%CI: -2.357 to -1.268, p<0.001) and the hand-side used for writing (95%CI: 0.254-0.512, p<0.001) were significant predictors of neck pain severity, and they both explained 8.4% of its variance. A previous history of neck and shoulder pain, as well as time spent studying on devices, were predictors of the duration of neck pain. According to a study by researchers at Cardiff University, the hand side used for writing on smart devices was also a good predictor of the severity of neck pain. A history of neck or shoulder pain (95% CI: 0.567-0.738, p = <0.001) and the number of hours spent on the device for studying (95% CI: 0.254-0.512, p<0.001) were significant predictors of neck and shoulder pain duration, and they both explained 8.4% of its variance. While having a history of neck or shoulder pain (95% CI: 0.639-0.748, p<0.001) and the hand-side used for writing (95% CI: -1.18 - -0.081, p = 0.025) were significant predictors of neck and shoulder pain severity, they explained 11.3% of its variance. The results of this study may be utilized to pinpoint smartphone usage factors associated with neck and shoulder pain severity and duration. Further, the findings of this study might help to develop preventive strategies to lower the impacts of these factors on the development of neck and shoulder pain severity and duration among university students.

NAVIGATION ASSISTED CERVICAL SPINE OSTEOID OSTEOMA EXCISION: A CASE REPORT

Abstract: Introduction: Osteoid osteoma is a rare benign bone-forming tumor which is typically found in a patient less than 30 years of age. Males are more commonly affected than females with a ratio of 2:1. [1] . Spinal involvement accounts for about 10% of all osteoid osteomas, with the lumbar spine being the most affected area, followed by cervical spine. Case Presentation: A 16 years old male presented to our hospital with 18 months history of neck pain with occasional left upper limb numbness. There was no history of trauma or injury to the neck. Neck pain is worsened at night and improves with NSAIDs. Physical examination revealed decreased sensation over left C5 dermatome distribution and positive spurling test, and the rest of the physical examination was unremarkable. There were no signs of myelopathy. MRI was done for the patient in another hospital, which showed a C4 vertebral body lesion in the left neural foramen and paraspinal soft tissue measuring 2.7 x 1.8cm. Upon these findings, we admitted the patient to evaluate possible neoplastic or infectious causes. Laboratory tests, TB-PCR, acid-fast bacillus, inflammatory markers were all within the normal range. CT cervical, chest, abdomen and pelvis was done for the patient, and it was unremarkable except for what was found in MRI. As a result, further investigation such as a bone scan was done and it showed Osteoid osteomas. As conservative treatment was ineffective in relieving the patient\'s symptoms, we planned surgical excision. Due to the tumor\'s location, we preferred to do a posterior approach with a navigation-assisted excision system. The patient received general anaesthesia and was placed on a prone position. The posterior neck was prepped and draped in the usual manner. Under fluoroscopic guidance, entry point was located. After exposure of the posterior cervical spine from C3 proximally to C5 distally, a navigation marker with navigation was inserted, and then we excised osteoid osteoma in one piece . The resected tissue was sent for histopathologic examination and confirmation of osteoid osteoma. Postoperatively, the patient tolerated surgery well and mobilized the following day. A cervical x-ray was done before discharge on day three post-operation. Conclusion: Osteoid osteoma is a rare benign bone-forming tumor which is typically found in a patient less than 30 years of age. Spinal involvement accounts for about 10% of all osteoid osteomas, The difficulty of cervical osteoid osteomas is that it lies near adjacent vital structures such as vertebral artery, spinal cord, and nerve roots. The navigation served us several advantages in resecting the osteoid osteoma, we were able to utilize a less invasive approach with a smaller incision, we are able to visualize and remove the thick sclerotic cortex to gain access to the tumor, without violating the facet joint and cause an iatrogenic instability. Keywords: osteoid osteoma, cervical spine, navigation system.

Negative Antigenuria in a Dog with Suspected Central Nervous System Localized Blastomycosis.

A 7 yr old female spayed mixed-breed dog was presented for a 1 wk history of neck pain and pelvic limb weakness. Examination revealed nonambulatory paraparesis and thoracolumbar hyperesthesia. MRI revealed extensive intramedullary T2-weighted/short tau inversion recovery hyperintensity and diffuse severe T1-post contrast meningeal enhancement of the thoracolumbar spinal cord. An L5-L6 cerebrospinal fluid sample revealed a suppurative pleocytosis (81% neutrophils, total protein 4362.5 mg/dL and nucleated cell count 352,000/μL). While awaiting the results of infectious disease testing, the dog was treated for suspected meningoencephalitis of unknown etiology with corticosteroids, cyclosporine, and a cytarabine arabinoside infusion. The dog neurologically declined and was started on broad-spectrum antibiotics. The dog continued to decline despite antibiotics, and infectious disease titers subsequently revealed serum antibody positivity for blastomycosis. The dog was then referred to a multispecialty referral hospital and was treated with amphotericin B followed by fluconazole. Prednisone was continued at anti-inflammatory doses. Urine blastomycosis antigen testing was submitted for subsequent disease monitoring but was negative. Five months after presentation the dog was clinically doing well with no identifiable neurologic deficits. This case demonstrates that neurologic blastomycosis may have negative urine antigen concentrations in some dogs and that other diagnostic modalities should be pursued when central nervous system fungal disease is suspected.

The point prevalence and factors associated with neck pain

Background: Neck pain is a significant disabling condition. Prevalence of neck pain is still not clearly stated in the literature due to the variation of its definition. It has a unique number of risk factors like history of neck pain, trauma, and certain sports injuries. In this study we measured the point prevalence of neck pain and the factors associated with it.&#x0D; Materials and Methods: This cross-sectional observational study included a total of 461 participants. The collected data comprised participant characteristics: demographic, socioeconomical status, and nature of work. The Arabic Neck Disability Index was used to assess neck pain. Specific questions about possible associated factors were asked, such as duration of using electronics, type of posture, duration of reading.&#x0D; Results: The neck pain was stated by 64.6% of the study participants. The results demonstrated that participants who reported neck pain were mostly females (70.5%), single (56.6%), or had high educational level (70.2%). Slight infrequent headaches were the most significant Neck Disability Index indicator in 39.5% of the study participants.&#x0D; Conclusion: The prevalence of neck pain was 64.6%, of which, mostly were females. Body postures, reading hours, work-type, and self-rated use of cellphones and PCs were all significantly associated with neck pain. Moreover, headache, concentration, and working habits were the top most significant indicators of the NDI. However, headache was the most significant.

Clinical Approach to Diagnosing and Treatment of Neck Pain

Background: Neck pain is one of the most common reasons patients seek treatment in the hospital. The causes of neck pain vary widely, trigger misdiagnosis, and often result in mistreatment. Misdiagnoses and mistreatment-related neck pain diagnoses are often associated with a diagnosis of cervical herniated disc. The implication of the misdiagnosis is the use of excessive investigations and inappropriate therapy. This review aims to determine the causes of neck pain often obtained in daily practice and how to diagnose and treat it. Method: Search relevant articles on clinical diagnosis of neck pain with the keywords neck pain diagnostic therapy using Medline and PubMed databases. Results: Neck pain can be in the form of axial pain, which is mostly related to disorders of the joints and muscles of the neck, or in the form of pain in the roots and spinal cord. Investigations and therapy must be related to the clinical diagnosis of neck pain experienced by patients with a history of neck pain. Conclusion: Neck pain is one of the most common complaints encountered in outpatient department settings, associated with reduced quality of life. Patients may come with differing degrees of pain, various symptoms, and aetiologies making it quite challenging to treat them into complete remission. Despite being frequently encountered, some patients with neck pain are underdiagnosed and undertreated due to failure to understand the clinical symptoms before deciding possible aetiologies.

A network analysis reveals the interaction between fear and physical features in people with neck pain

Although neck pain is known to be a complex and multifactorial condition characterised by the interplay between physical and psychological domains, a comprehensive investigation examining the interactions across multiple features is still lacking. In this study, we aimed to unravel the structure of associations between physical measures of neuromuscular function and fear of movement in people with a history of neck pain. One hundred participants (mean age 33.3 ± 9.4) were assessed for this cross-sectional study, and the neuromuscular and kinematic features investigated were the range of motion, velocity of neck movement, smoothness of neck movement, neck proprioception (measured as the joint reposition error), and neck flexion and extension strength. The Tampa Scale for Kinesiophobia was used to assess fear of movement. A network analysis was conducted to estimate the associations across features, as well as the role of each feature in the network. The estimated network revealed that fear of movement and neuromuscular/kinematic features were conditionally dependent. Higher fear of movement was associated with a lower range of motion, velocity, smoothness of neck movement, neck muscle strength, and proprioception (partial correlations between − 0.05 and − 0.12). Strong interactions were also found between kinematics features, with partial correlations of 0.39 and 0.58 between the range of motion and velocity, and between velocity and smoothness, respectively. The velocity of neck movement was the most important feature in the network since it showed the highest strength value. Using a novel approach to analysis, this study revealed that fear of movement can be associated with a spectrum of neuromuscular/kinematic adaptations in people with a history of neck pain.

Parsonage–Turner Syndrome mimicking musculoskeletal shoulder pain: A case report during the SARS-CoV-2 pandemic era

Parsonage–Turner Syndrome or neuralgic amyotrophy is a peripheral neuropathy typically characterized by an abrupt onset of pain, followed by progressive neurological deficits (e.g. weakness, atrophy, occasionally sensory abnormalities) that involve the upper limb, mainly the shoulder, encompassing an extensive spectrum of clinical manifestations, somehow difficult to recognize. This case report describes the proper management of a 35-year-old, bank employee and sports amateur who reported subtle and progressive upper limb disorder with previous history of neck pain. SARS-CoV-2 pandemic era made patient's access to the healthcare system more complicated. Nevertheless, proper management of knowledge, relevant aspects of telerehabilitation-based consultation for musculoskeletal pain, advanced skills, tools and technologies led the physiotherapist to suspect an atypical presentation of Parsonage–Turner Syndrome. Further, neurologist consultation and electromyography suggested signs of denervation in the serratus anterior and supraspinatus muscle. Therefore, an appropriate physiotherapist's screening for referral is conducted to correct diagnosis and thorough treatment.

Brown-Sequard Syndrome After Radiofrequency Therapy of the Left C3 Medial Branch

&lt;p&gt;A 59-year-old woman presented with a 5-year history of neck pain and intractable headache radiating from the occipital region to the supra-orbital region. Magnetic resonance imaging demonstrated a C5&amp;ndash;6 herniated intervertebral disc and bulging disc at C4&amp;ndash;5. Left C3 medial branch radiofrequency neurotomy was performed. Although the procedure was uneventful, the patient developed a cervical spinal cord haemorrhage that caused Brown&amp;ndash;S&amp;eacute;quard syndrome. The haemorrhage was presumably caused by iatrogenic injury of a radicular artery during the procedure.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Cervical radiculopathy and spinal cord indentation caused by vertebral artery loop

Cervical radiculopathy and spinal cord indentation caused by vertebral artery loop formation is a rare entity. We report here an 85-year-old woman had a four-year history of neck pain and left arm weakness. Radiologic evaluation showed vertebral artery loop formation compressing the adjacent nerve root and spinal cord. Accurate radiologic diagnosis of this condition is crucial to reduce unexpected surgical complications.

Gabapentinoid Prescribing for Carpal Tunnel Syndrome.

Gabapentinoids, including gabapentin and pregabalin, are commonly prescribed for neuropathic pain, but robust evidence recommends against using gabapentinoids for the treatment of carpal tunnel syndrome (CTS). We aimed to quantify national prescribing patterns of gabapentinoids for CTS. We performed a retrospective population-based cohort study using claims data of gabapentinoid-naïve patients with a new diagnosis of CTS (2009-2016). Our primary outcome was a new gabapentinoid fill for CTS. We assessed temporal trends and characteristics associated with a gabapentinoid fill. Multivariable logistic regression was used to evaluate the association between patient-level factors and a new gabapentinoid fill for CTS. Of the 248 324 previously gabapentinoid-naïve patients with CTS, 9589 patients (4%) filled a gabapentinoid prescription. Sixty-one percent were prescribed by primary care providers or medical subspecialists. Patients with a history of neck pain (odds ratio [OR]: 1.31, 95% confidence interval [CI], 1.25-1.38), back pain (OR: 1.25, 95% CI, 1.20-1.31), arthritis (OR: 1.25, 95% CI, 1.18-1.31), and other pain conditions (OR: 1.26, 95% CI, 1.20-1.31) were associated with an increased odds of a new gabapentinoid fill. In addition, patients with a history of alcohol or substance use disorder were significantly associated with a new gabapentinoid prescription fill (OR: 1.33, 95% CI, 1.20-1.47). Despite evidence recommending against the use of gabapentinoids for CTS, gabapentinoids were frequently initiated among those with higher risk for misuse, including substance use disorders. Given the effectiveness of bracing or surgery for CTS and the risks associated with gabapentinoids, efforts aimed at disseminating evidence-based treatment for CTS are critical to minimize the harms of gabapentinoid misuse.

A Case Report: A 37 Years-old Women with Takayasu Arteritis

Background: A rarity of form of vasculitis, also known as TAK, induces inflammation in the walls of the major arteries in the body: the aorta and its main branches. The disease results from a body attack and inflammation of the walls of the arteries caused by the body's own immune system.&#x0D; Case Presentation: A 37-years-old women had complaints of fever, giddiness, weakness of right upper limb and lower limb since1 day. After undergoing whole blood count, liver function examination, renal and MRI function checks, CT scan, angiography, etc. was studied. She was diagnosed with takayasu arteritis. She had past medical history of neck pain and numbness since January 2020. For these complaints her family members referred her in private hospital. There is no significant history of surgery in present, lower segment caesarean section and piles operation was done previously. Physical findings were normal except the Glasgow Coma Scale score was 11 that is, patient was semi-conscious, In General appearance patient activity was dull and weak due disease condition, Patient’s all routine investigations were normal except few like Total WBC count was increased (21,500cell /cm) due to increased infection, Granulocytes were increased that is 75 % due to infection and autoimmune disease, ESR was increased that is52mm/h. Angiography showed block in the right common carotid artery, MRI- showed Acute infract in left fronto temporo parietal region involving insular par ventricular white matter, absent flow in distal M1 segment of MCA.&#x0D; Conclusion: The most frequently involved arteries and the angiographic trends in this Takayasu Arteritis study were subclavian arteries and carotid arteries. The difference between angiographic characteristics may lead to clinical differences. Operations and surgery should be carried out at various points in the course of the disease.

Retropharyngeal Abscess and Pott’s Disease Due to Tuberculosis: A Case Report

Introduction: Extrapulmonary mycobacterial infection can lead to vertebral spondylitis and osteomyelitis (Pott’s disease). Retropharyngeal abscess with concurrent spinal osteomyelitis is a rare presentation of tuberculosis in the US. Chart review on a patient was completed, and the relevant published literature was reviewed. Case Presentation: A previously healthy 34-year-old male originally from Sudan presented to an outside hospital with a 2-month history of neck pain, sore throat, odynophagia, fevers, and chills. MRI showed a retropharyngeal abscess and suspected cervical spine osteomyelitis. Acid-fast bacillus (AFB) smear was positive from a neck drain specimen, but sputum was negative. Chest imaging did not show findings consistent with pulmonary tuberculosis. He was treated with rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) along with moxifloxacin and linezolid due to concern for possible multidrug resistant tuberculosis and transferred to our center for further care. Culture isolated Mycobacterium tuberculosis. CT neck showed vertebral tuberculous osteomyelitis (Pott’s disease) of C1-C3 with a multiloculated retropharyngeal and prevertebral abscess (Figure 1). The patient was taken to the OR for posterior spinal fusion from occiput to C4 and transoral incision and drainage of the abscess. The post-operative course was uneventful, and moxifloxacin and linezolid were discontinued when Xpert MTB/RIF test revealed rifampin susceptibility. At follow-up the patient’s symptoms had resolved. Patient consent was obtained to utilize this case for educational purposes. Conclusions: This report presents the multidisciplinary treatment of this patient requiring infection control measures and antibiotic therapy by infectious disease, posterior spine fusion by orthopedic surgery, and retropharyngeal abscess drainage by otolaryngology.

Distinguishing Pseudosubluxation From True Injury: A Case of C2-3 and C3-4 Subluxation in a Pediatric Patient

A 6-year-old girl presented with a one-week history of neck pain after a trampoline accident. Cervical radiographs interpreted as pseudosubluxation of C2 on C3. CT demonstrated the reversal of lordosis with anterolisthesis of C2-C3 and C3-C4. Ten weeks after two months of halo traction, radiographs demonstrated anatomic alignment and maintained disk heights. This case highlights the similarities of pseudosubluxation and true injury, emphasizing the need for high index of suspicion in this population and a successful treatment of subluxation using a halo construct.

The 5-Year Course of Neck Pain Among Natural Disaster Survivors: The Association of Prior Neck Pain with New Episodes of Neck Pain.

Neck pain is a common health problem among both the general population and natural disaster survivors. However, the long-term course of neck pain has rarely been reported. The aim of this study was to elucidate the 5-year course of neck pain among survivors of the Great East Japan Earthquake (GEJE) by assessing the association of neck pain 2 and 4 years after the disaster with that at 7 years. Longitudinal study. A panel study was conducted on GEJE survivors (n = 1,821) through the administration of a self-reported questionnaire at 2 (first time point), 4 (second time point), and 7 years (third time point) after the disaster. Multivariate logistic regression analyses were performed to assess the association between prior neck pain and subsequent neck pain. The rates of neck pain at the first, second, and third time points were 20.7%, 21.1%, and 20.1%, respectively. Neck pain at the first time point was significantly associated with neck pain at the third time point (adjusted odds ratio [95% confidence interval]: 5.96 [4.53-7.83]). Furthermore, neck pain at the first and second time points was significantly associated with neck pain at the third time point (adjusted odds ratio [95% confidence interval]: 5.71 [4.19-7.78] for neck pain at either time point; 15.94 [10.99-23.12] for neck pain at both time points; P for trend <0.001). Prior neck pain was significantly associated with neck pain 5 years later, and the effect was stronger with an increase of prior neck pain episodes. Clinicians should base their selection of treatment method on an individual's history of neck pain.