Mean Neck Disability Index Score Research Articles

Five-year Follow-up of a Prospective Food and Drug Administration Investigational Device Exemption Trial Evaluating a PEEK-on-Ceramic Cervical Disc Replacement.

Prospective trial comparing the investigation group to propensity matched historic control group. To evaluate 5-year results of single-level PEEK-on-ceramic cervical total disc replacement (TDR) compared to a propensity matched anterior cervical discectomy and fusion (ACDF) control group. Cervical TDR has gained acceptance as treatment for symptomatic disc degeneration. The design and materials used in these devices continue to evolve. Data were collected in the Food and Drug Administration Investigational Device Exemption trial for the PEEK-on-ceramic Simplify(®) Cervical Artificial Disc (n=150) with comparison to a propensity matched ACDF control group (n=117). All patients were treated for single-level cervical disc degeneration with radiculopathy and/or myelopathy. Clinical outcome was based on composite clinical success (CCS), Neck Disability Index (NDI), visual analog scales (VAS) assessing pain, re-operations, and satisfaction. Radiographic measures included segmental range of motion (ROM), disc space height, and heterotopic ossification (HO). Evaluations were performed pre-operatively and post-operatively within 2 and 6 weeks, and 3, 6, 12 months, and annually thereafter. At 5-year follow-up, CCS was significantly greater with TDR than ACDF (91.1% vs. 74.6%; P<0.01). In the TDR group, the mean NDI score was 63.3 pre-operatively, reduced significantly to 23.1 at 6 weeks and remained below 20 throughout 5-year follow-up. In the ACDF group, the mean pre-operative NDI score was 62.4, decreasing to 33.7 at 6 weeks, and ranged from 25.9 to 21.5 throughout follow-up. Mean NDI scores were significantly lower in TDR group at all post-operative points (P<0.05). Mean TDR ROM was 7.3o pre-operatively and 10.1o at 5 years. Bridging HO occurred in 9%. With TDR, there were 6 re-operations (4.0%) vs. 11 (9.4%) with ACDF (P>0.40). PEEK-on-ceramic TDR produced significantly improved outcomes maintained throughout 5-year follow-up, were similar or superior to ACDF, supporting TDR in appropriately selected patients.

Systematic review and meta-analysis of Neck Disability Index and Numeric Pain Rating Scale in patients with migraine and tension-type headache.

The present study aimed to assess the burden of neck pain in adults with migraine and tension-type headache (TTH), utilizing the Neck Disability Index (NDI) and Numeric Pain Rating Scale (NPRS). A systematic literature search was conducted on PubMed and Embase to identify observational studies assessing NDI and NPRS in populations with migraine or TTH. The screening of articles was independently performed by two investigators (HMA and ZA). Pooled mean estimates were calculated through random-effects meta-analysis. The I2 statistic assessed between-study heterogeneity, and meta-regression further explored heterogeneity factors. Thirty-three clinic-based studies met the inclusion criteria. For participants with migraine, the pooled mean NDI score was 16.2 (95% confidence interval (CI) = 13.2-19.2, I2 = 99%). Additionally, the mean NDI was 5.5 (95% CI = 4.11-6.8, p < 0.001) scores higher in participants with chronic compared to episodic migraine. The pooled mean NDI score for participants with TTH was 13.7 (95% CI = 4.9-22.4, I2 = 99%). In addition, the meta-analysis revealed a mean NPRS score of 5.7 (95% CI = 5.1-6.2, I2 = 95%) across all participants with migraine. This systematic review and meta-analysis shows a greater degree of neck pain-related disability in migraine compared to TTH. Nevertheless, the generalizability of these findings is constrained by methodological variations identified in the current literature.

A multicenter, open-label, parallel-group, randomized controlled trial of Tongluo-Qutong rubber plaster for the treatment of cervical spondylotic radiculopathy.

In China, Tongluo-Qutong rubber plaster (TQRP) is commonly used for cervical spondylotic radiculopathy, but lacks high-quality trials. This study aimed to conduct a multicenter, open-label, parallel-group, randomized controlled trial in China to investigate the practical efficacy and safety of TQRP in the treatment of CSR. A total of 240 patients diagnosed with CSR were recruited for the investigation from multiple hospitals in Gansu province, China. The patients were randomly assigned to either an experimental or a control group. The experimental group received treatment with TQRP, whereas the control group was administered a diclofenac sodium patch (DSP) for a maximum duration of 21 days. The visual analogue scale (VAS) score for pain, the proportion of patients experiencing 50% or more pain relief, the neck disability index (NDI), changes as per the Eaton trial, and recurrence during the follow-up period were evaluated for both groups. The safety and adverse events associated with the concurrent drug therapy were also evaluated. At each time point, the mean VAS and NDI scores of both groups demonstrated a downward trend. The experimental group exhibited a greater decline in VAS score at each time point compared to the control group (P< 0.01). In the Eaton trial, both the percentage of patients experiencing pain relief of 50% or more and the number of abnormal results exhibited improvement. However, the outcomes in the 21 ± 3d experimental group were significantly superior to those in the control group (P< 0.01). During the follow-up period, the recurrence events in the experimental group were reduced compared to the control group. The difference between the two groups was statistically significant (P< 0.05). The incidence of adverse reactions was 1.74% for TQRP and 3.54% for DSP. TQRP is effective and safe in the treatment of CSR.

Interim 1-Year Radiographic and Clinical Outcomes Following Anterior Cervical Discectomy and Fusion Using Hydroxyapatite-Infused Polyetheretherketone Interbody Cages.

This is a multicenter observational registry analysis of 1-year radiographic and clinical outcomes following anterior cervical discectomy and fusion (ACDF) using hydroxyapatite (HA)-infused polyetheretherketone (PEEK) intervertebral cages. Radiographic and clinical outcome data were collected preoperatively and at 6 weeks, 3 months, 6 months, and 12 months postoperatively. To assess fusion, dynamic flexion-extension radiographs were independently evaluated with a validated method. Clinical outcomes were assessed using the following disease-specific measures: Neck Disability Index (NDI) and visual analog scale (VAS) for neck, left arm, and right arm pain. Patient satisfaction was also evaluated. A total of 789 ACDF patients (men: 51.5%/women: 48.5%; mean body mass index: 29.9 kg/m2) were included at the time of analysis, and 1565 segments have been operated. Successful fusion was confirmed in 91.3% of all operated levels after 6 months and 92.2% after 12 months. Mean NDI scores improved significantly (P < 0.01) preoperatively (46.3, n = 771) to postoperatively (12 months: 25.2, n = 281). Consistently, mean VAS neck (preoperative: 64.2, n = 770; 12 months: 28.6, n = 278), VAS right arm (preoperative: 42.6, n = 766; 12 months: 20.4, n = 277), and VAS left arm (preoperative: 41.1, n = 768; 12 months: 20.8, n = 277) decreased significantly (P < 0.01). Patients reported high satisfaction rates after surgery with no significant changes in postoperative patient satisfaction between 6 weeks and 12 months (95.1%, n = 273). ACDF with HA-infused PEEK cages demonstrates promising radiographic and clinical outcomes, supporting the potential benefits of incorporating HA into PEEK cages to enhance fusion rates and improve patient outcomes. This study demonstrates a >90% fusion rate by level with reliable improvements in patient reported outcomes, along with a high rate of patient satisfaction, in a large patient cohort undergoing ACDF with HA-infused PEEK cages. 2 .

Comparison of McKenzie and Isometric Exercises on Neck Functions of Computer Users with Forward Head Posture

Introduction: Prolonged use of computer can lead to poor posture such as forward head posture (FHP). This posture is associated with imbalance and stiffness of the neck muscles, lack of postural awareness and inappropriate ergonomics, resulting in work-related musculoskeletal disorders. These disturbances can affect the performance and productivity of office workers. Postural awareness training, neck exercises, and modalities are interventions in FHP management. Research that compares the effectiveness of cervical McKenzie and isometric exercise on neck functional score in computer users with forward head posture has not been conducted.&#x0D; Methods: This research was a quasi-experimental. The participants, 24 computer users working at Kariadi Hospital, Semarang, were divided into 2 groups by purposive sampling receiving cervical McKenzie exercise (n=12) and cervical isometric exercise (n=12). Each group received different exercise. Neck functional score was assessed by Neck Disability Index (NDI) questionnaire before and after intervention. The mean differences before and after treatment, as well as between groups was compared statistically using paired t-test.&#x0D; Results: The mean NDI score in the McKenzie group after treatment showed an improvement of 7.84 ± 3.54 with p = 0.002. The mean NDI score in the isometric group after treatment also showed an improvement of 3.93 ± 3.75 with p = 0.004. The difference in NDI score improvement in the cervical McKenzie group was greater than the one in isometric group and statistically significant with p = 0.017.&#x0D; Conclusion: Cervical McKenzie exercise was proved to be more effective in improving neck functional scores in patients with FHP compared to cervical isometric exercise.

One-Year Follow-Up Study on Assessing the Range of Segmental Motion and Clinical Outcomes Following Cervical Disc Arthroplasty for Treatment of Severe Cervical Disc Degeneration

Though previous studies have documented various clinical outcomes after cervical arthroplasty for degenerative cervical disc disease, none of them reported the impact of cervical arthroplasty on severe cervical disc degeneration (CDD). This retrospective cohort study included severe 40 CDD (C3-C7) patients who underwent single-level cervical arthroplasty using ProDisc-C between January 2017 and December 2019. After surgical intervention, the range of motion (ROM) was determined, whereas clinical outcomes were measured in terms of the Visual Analogue Scale (VAS) and Neck Disability Index (NDI) to evaluate neck pain and disability, respectively. Compared to the mean preoperative ROM (6.57 ± 4.85°), the cervical dynamic ROM was increased 3months after cervical arthroplasty, and the increment was maintained for at least 1year. The increased ROM is attributed to the extension and not flexion components. The mean preoperative ROM of 6.57 ± 4.85° significantly increased to 11.67 ± 4.98° (P= 0.0005), 10.05 ± 5.18° (P= 0.0426) and 10.46 ± 4.73° (P= 0.0247) after 3months, 6months and 1year, respectively. The extension ROM also revealed a similar trend. VAS for neck and arm decreased from 7.4 and 6.6 to 1.4 and 1.2, respectively. Consistently, the preoperative mean Neck Disability Index (NDI) score of 27.6 decreased to 14.6. We recorded a case of device subsidence, but without extrusion. Cervical arthroplasty can improve clinical outcomes and restore ROM in severe CDD patients.

439 Percutaneous Electrical Nerve Stimulator for Treatment of Chronic Spinal Pain

INTRODUCTION: The percutaneous electrical nerve stimulator (PENS) is a relatively new device for the treatment of chronic spinal pain. This programmable device is worn for a recommended 10 to 12 days on the external ear, stimulating the auricular vagus nerve. It is postulated to release endorphins and relieve pain. There is minimal literature on the use of PENS as an adjunct to pain management in patients with chronic spinal pain. METHODS: Patients who had the PENS placed for chronic refractory spinal pain were included in the study. All patients failed multiple forms of treatment such as physical therapy, epidural steroid injections, and medication. RESULTS: In 2021, 114 patients had the PENS placed. The mean patient follow-up was 34.9 weeks. 67 patients (58.7%) felt pain relief due to the PENS. In patients with neck pain, the mean Neck Disability Index scores decreased from 43.8% to 25.4%, and the mean Numerical Rating Scores (NRS) decreased from 7.9 to 3.9. In patients with low back pain, the mean Oswestry Disability Index scores decreased from 47.6% to 33.5%, and the mean NRS scores decreased from 7.9 to 5.1. The rate of improvement in patients with neck pain (71.9%) was significantly greater (p-value &lt;0.02) than in patients with back pain (56.4%). Interestingly, 33.3% of patients who responded to treatment remained improved at one year follow-up. CONCLUSIONS: Our study shows that a significant number of patients experienced reduced pain and disability as a result of treatment with the PENS. Patients with neck pain responded better than patients with low back pain. Many patients in this difficult patient population experienced durable relief, lasting over one year. Our study suggests that the PENS may be a useful adjunct in the management of patients with chronic spinal pain.

The safe and effective use of supercritical CO2-processed bone allografts for cervical and lumbar interbody fusion: A retrospective study.

The clinical efficacy and safety of supercritical CO2-processed bone allografts prepared from living donors has yet to be confirmed in spinal surgery. Here we report our clinical and surgical experience of using supercritical CO2-processed bone allografts for lumbar and cervical fusion. Sixteen patients underwent one or two level anterior cervical discectomy and fusion and 37 patients underwent anterior retroperitoneal route lumbar fusion using bone allografts processed using supercritical CO2 extraction combined with chemical viral inactivation. Fusion success was assessed radiographically in the immediate postoperative period and at one month, six months, one year, and three years postoperatively. Function and pain were assessed using visual analog scales, Odom's criteria, the neck disability index (NDI), and the Oswestry disability index (ODI). At a mean of 43 and 47 months postoperatively, 95.3% and 90.5% of cervical and lumbar fusion patients had radiographic evidence of bone fusion, respectively. Over 80% of patients reported good to excellent outcomes according to Odom's criteria, the perception of pain significantly decreased, and the mean NDI and ODI scores significantly improved at the last follow-up compared with before the operations. There were no safety concerns. For the cervical group, the mean NDI score improved from 26.3 ± 6.01 preoperatively to 15.00 ± 8.03 and 17.60 ± 13.95 at immediate post-op (p = 0.02) and last follow-up visits (p = 0.037) respectively. For the lumbar cases, the mean ODI score improved from 28.31 ± 6.48 preoperatively to 14.68 ± 5.49 (p < 0.0001) and 12.54 ± 10.21 (p < 00001) at immediate post-op and last follow-up visits respectively. Within the limitations of this study, the use of supercritical CO2-processed bone allografts resulted in satisfactory clinical outcomes and fusion rates with acceptable safety for both cervical and lumbar surgeries.

Return to Driving Is Safe 6 Weeks After Anterior Cervical Surgery for Symptomatic Cervical Degenerative Disc Disease.

Prospective Cohort Study. This study aims to determine the timing and clinical parameters for a safe return to driving. Returning to driving after cervical spine surgery remains a controversial topic, with no clear consensus on how to best assess a patient's fitness to drive. Previous studies using brake reaction time or subjective questionnaires recommend a return to driving 6 weeks after surgery. Patients above 18 years of age who underwent anterior cervical spine surgery for symptomatic cervical degenerative disk disease and possessed a valid motorcar driving license were recruited from 2018 to 2020. Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) scores, range of motion, and functional strength of the cervical spine were collected preoperatively and at 2-, 4-, 6- and 12 weeks postsurgery. Patients underwent a standard functional driving assessment protocol at the institution to determine their fitness to drive. This comprised of a clinic-based off-road screening tests and on-road driving test in a real-world environment. Twenty-one patients were recruited. The mean age was 56.6±8.9 years. Eighty-one percent of the patients passed the on-road driving assessment at 6 weeks. Patients who passed the driving assessment had lower mean NDI scores, 3.4±3.1 versus 10.8±8.0 ( P =0.006), and higher mean mJOA scores 16.1±0.6 versus 15.0±1.8 ( P =0.045). Patients who passed the driving assessment also had higher functional cervical flexor strength, 21.1s±5.8s versus 13.0s±10.2s ( P =0.042) in a supine position but not correlated with a range of motion of the spine in all directions. Most patients undergoing single or dual-level anterior cervical surgery for symptomatic cervical degenerative disk disease demonstrate the ability to pass a standardized driving assessment and are safe to return to driving more than 6 weeks after surgery. Driving ability appears to be correlated with NDI scores ≤3 ( P =0.006), mJOA scores ≥16 ( P =0.045), and cervical flexion endurance of ≥21s ( P =0.042). Level II.

The impact of distance education on the neck pain among teachers in times of COVID-19.

In the course of the COVID-19 pandemic the format of education was forced to change from formal to distance in a considerably short time. The study aimed to analyze the changes in the prevalence and the severity of neck pain among teachers during the pandemic. The study analyzed the Neck Disability Index (NDI), a self-report questionnaire designed to assess the individual's neck pain experience in daily life and rate a disability score due to neck pain, and numerical rating scale (NRS) report pairs completed by teachers. The mean age of the participants was 41.67±9.57. The majority were female (67.9 %) and were employed for less than 20 years in teaching (68.9%). The survey results collected at the beginning and at the end of the first year of the pandemic showed that: the mean session hours per week were 21.19±9.21 and 21.61±9.45, the mean NDI scores were 11.61±6.17 and 12.65±7.76, and the mean NRS scores were 3.05±2.96 and 4.75±3.13. The female participants scored significantly higher disability scores (p<0.001). The NRS scores were increased in both genders (p<0.001). The NDI scores, the disability grouping, and NRS were significantly associated with weekly session hours (p=0.011, p<0.001 and p<0.001, respectively). The NRS scores were increased in all age groups (p<0.001). The increase in weekly session hours was related to the NRS scores (p<0.001). In one year during the pandemic, despite unchanged telework hours, a significant increase in neck pain incidence and pain severity was noted among teachers. Unexperienced employees in the line of distance working should receive adequate training to avoid not only musculoskeletal disorders but other physical and psychological unwanted effects.

Prospective, multicenter study of 2-level cervical arthroplasty with a PEEK-on-ceramic artificial disc.

The purpose of this study was to evaluate the safety and efficacy of a PEEK-on-ceramic cervical total disc replacement (cTDR) device for the treatment of 2-level cervical disc disease with radiculopathy and/or myelopathy. The study was a prospective, nonrandomized, historically controlled FDA investigational device exemption trial evaluating the Simplify Cervical Artificial Disc for use at 2 levels. The anterior cervical discectomy and fusion (ACDF) control group was derived from a propensity score-matched (using subclassification) cohort of patients who participated in an earlier prospective trial in which similar indications were used. The follow-up duration was 24 months. The primary outcome was a 4-point composite success classification. Other validated clinical and radiographic assessments were also evaluated. The investigational group (n = 182) was compared with patients who underwent ACDF (n = 170) in a historical control group using propensity score analysis. The overall composite success rate was statistically significantly greater in the cTDR group compared with the ACDF group (86.7% vs 77.1%; p < 0.05). The mean Neck Disability Index scores improved significantly in both groups, with cTDR significantly lower at some follow-up points. At the 24-month follow-up, a minimum 15-point improvement in Neck Disability Index scores was achieved in 92.9% of the cTDR group and 83.5% of the ACDF group (p > 0.05). In both groups, neck and arm pain scores improved significantly (p < 0.05) by 6 weeks and improvement was maintained throughout follow-up. Segmental range of motion was maintained at both treated segments in the cTDR group. MRI performed in the cTDR group at 24 months postoperatively found minimal changes in facet joint degeneration. The rate of subsequent surgical intervention was 2.2% in the cTDR group and 8.8% in the ACDF group. This study adds to the growing body of literature supporting cTDR for 2-level cervical disc disease with radiculopathy or myelopathy. cTDR showed a superior overall success rate compared to ACDF, while maintaining motion. These results support that the Simplify disc is a viable alternative to ACDF in appropriately selected patients with 2-level cervical spondylosis.

11. Clinical outcome of a prospective, controlled, multicenter study evaluating two-level cervical arthroplasty with a PEEK-on-ceramic artificial disc

<h3>BACKGROUND CONTEXT</h3> Over the past two decades, there has been increasing use of cervical total disc replacement (cTDR) with designs and materials continually evolving. Nine devices have been FDA approved for 1-level use, and the current study led to the approval of a third device for two levels. <h3>PURPOSE</h3> The purpose of this study was to evaluate the safety and efficacy of a PEEK-on-ceramic artificial disc for the treatment of 2-level cervical disc disease. <h3>STUDY DESIGN/SETTING</h3> This was a prospective, non-randomized, historically controlled multicenter FDA Investigational Device Exemption (IDE) trial evaluating the Simplify®Cervical Artificial Disc (NuVasive, Inc). The anterior cervical discectomy and fusion (ACDF) control group was derived from a propensity score matched (using subclassification) cohort of patients who participated in an earlier prospective cTDR trial using similar indications. <h3>PATIENT SAMPLE</h3> The cTDR group (n=182) was compared with ACDF patients (n=170). All patients had 2-level, symptomatic cervical disc disease with radiculopathy and/or myelopathy. <h3>OUTCOME MEASURES</h3> The primary outcome measure was classification of success at 24-month follow-up based on 4 criteria (1) at least 15-point (of 100) improvement in Neck Disability Index (NDI) scores; (2) maintenance or improvement in neurological status; (3) no serious adverse event classified as implant associated or implant/surgical procedure associated; and (4) no additional index level surgery. Secondary evaluations included NDI scores, numeric rating scales assessing neck and arm pain intensity and frequency, and patient satisfaction. Safety was assessed by adverse events and subsequent surgery at an index level. <h3>METHODS</h3> Patients were evaluated preoperatively, at hospital discharge, 6 weeks, and 3, 6, 12, and 24 months after surgery. <h3>RESULTS</h3> The overall composite success rate was statistically significantly greater in the cTDR group compared with the ACDF group (86.7% vs 77.1%; p 15 points at 24-mo follow-up) occurred in 92.9% of the cTDR group and 83.5% of the ACDF group (0.05 < p < 0.10). Mean NDI scores improved significantly in both groups by 6 weeks with cTDR scores significantly lower at 6 weeks and 3 and 6 months. Mean NDI scores in the cTDR group were 58.6 preoperatively and 14.3 at 24 months. In the ACDF group, the values were 53.6 and 17.2, respectively. In both groups, neck and arm pain improved significantly (p <0.05) by 6 weeks with improvement maintained throughout follow-up. In the cTDR group, the mean preop neck pain intensity score was 7.9 and 1.8 at 24 months. In the ACDF group, the values were 7.7 and 2.5, respectively. Improvement in arm pain followed a similar pattern with a preoperative mean value of 7.5 in the cTDR group which improved to 1.8 at 24 months. In the ACDF group, the values were 7.0 and 1.6. The ACDF scores were not superior to those in the cTDR group on any of the outcome measures. There were four subsequent surgical interventions (2.2%) in the cTDR group and 15 (8.8%) in the ACDF group. <h3>CONCLUSIONS</h3> The cTDR group had a statistically significantly greater overall clinical success rate compared to ACDF as well as similar to superior scores on the NDI and pain scales at all follow-up points. These results add to the growing body of literature supporting cervical arthroplasty for treating 2-level cervical disc disease with radiculopathy and/or myelopathy. <h3>FDA DEVICE/DRUG STATUS</h3> Simplify Cervical Artificial Disc: 2-level (Approved for this indication).

Comparative effect of upper thoracic spine mobilization with mobility exercises and upper cervical spine mobilization with stabilization exercises in mechanical neck pain: a randomized clinical trial

Background &amp; Objective: Neck pain is a very prevalent health condition. Physiotherapists use multiple treatment options for treating mechanical neck pain. We evaluated the effects of upper thoracic spine mobilization and mobility exercise and upper cervical spine mobilization and stabilization exercises in treating patients with mechanical neck pain.&#x0D; Methodology: A randomized clinical trial was conducted comprising of 36 patients recruited from different clinics of Faisalabad, both genders, ages from 20-40 y, and randomly divided into two groups. Group A underwent upper thoracic mobilization and mobility exercise while Group B underwent upper cervical mobilization with stabilization exercises for 2 times a week for 4 weeks. Pain scores on Numerical Pain Rating Scale (NPRS) and cervical range of movements (ROM) scores were measured before treatment and then weekly for 4 weeks, while Neck Disability Index (NDI) was assessed at baseline and at the end of 4th week. SPSS version. 22 was used to analyze the data. Independent sample t-test was used for between group compression and P ≤ 0.05 (95%) was considered as significant.&#x0D; Results: There was significant improvement in mean NPRS scores at 1st week, 2nd week, 3rd week and 4th week post-treatment (P &lt; 0.05). There was significant improvement in mean cervical ROM at 2nd week, 3rd week and 4th week post-treatment readings (P &lt; 0.05) and mean NDI score at 4th week (P &lt; 0.05).&#x0D; Conclusion: Both groups were found effective in improving pain, range of motion and neck function, but significant improvement in outcomes was observed in upper cervical mobilization and stabilization exercises group.&#x0D; Abbreviations: NPRS - Numerical Pain Rating Scale; ROM - Range of movements; NDI - Neck Disability Index; MNP - Mechanical neck pain;&#x0D; Key words: Adult; Cervical Vertebrae / physiopathology; Disability Evaluation; Exercise Therapy / methods; Female; Humans; Male; Manipulation, Spinal / methods; Neck / physiopathology; Neck Pain / physiopathology; Neck Pain / rehabilitation; Pain Measurement; Range of Motion, Articular; Thoracic Vertebrae / physiopathology; Treatment Outcome; Young Adult&#x0D; Citation: Tahir R, Sohail MAA, Ain NU, Aine QU, Mannan H, Maqbool A. Comparative effect of upper thoracic spine mobilization with mobility exercises and upper cervical spine mobilization with stabilization exercises in mechanical neck pain: a randomized clinical trial. Anaesth. pain intensive care 2022;26(4):488-495.&#x0D; DOI: 10.35975/apic.v26i4.1952&#x0D; Received: April 11, 2022; Reviewed: June 23, 2022; Accepted: July 14, 2022

Effects Of Active Release Technique and Active Isolated Stretching on Muscles of Upper Cross Syndrome

Upper cross syndrome is a condition in which there exist a muscle imbalance in upper quadrant, involving weakness of some muscles and tightness of others. In UCS, levator scapulae muscle, upper fibers of trapezius muscle, and pectoralis minor get stiff and shortened from their original length occasionally involving pectoralis major muscle. Objectives: To compare the effect of Active release technique and active isolated stretching on the muscles of upper cross syndrome. Methods: This study was a single blinded randomized clinical trial. Muscle length measurement by Vernier calipers and measuring tape between standard bony landmarks, NDI (neck disability index), Cervical rotation ROM, Cranio-vertebral angle &amp; Numeric Pain Rating Scale (NPRS) tools for screening will be used for data collection. Recorded values were analyzed for any change using SPSS 21.0 version. Results: In ART the mean value of NPRS was 2.21 ± 1.49 and in AIS was 2.31 ± 1.35. For ART group the mean NDI score was 15.12 ± 8.83 and for AIS group was 16.1250 ± 5.3898. The mean of cranio-vertebral angle in AIS group was 47.2125 ± 1.9373 and in ART group was 48.1819 ± 1.6483 which is nearer to normal CV angle. Conclusions: The study concluded that both Active release technique (ART) and Active isolated stretching (AIS) are effective methods of treatment. It was indicated that Active release technique (ART) was helpful in pain relief, improving range, cranio-vertebral angle, muscle length and functional status in subjects with Upper-cross syndrome (UCS).

What PROMIS Scores Correlate With Severe Disability in Cervical Spine Surgery?

Institutional Review Board-approved prospective cohort study. To establish a conversion between Neck Disability Index (NDI) and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI). As the National Institutes of Health (NIH) PROMIS is a global outcome measure, it can be difficult to interpret the clinical implications in patients with cervical spine surgery. To determine how a disease-specific legacy instrument (NDI) correlates with PROMIS PI and define levels of substantial and minimal disability, we developed a formula to convert NDI scores to PROMIS PI. Adult patients undergoing cervical spine surgery at a single institution from 2016 to 2018 were prospectively enrolled. Patients undergoing surgery for instability due to trauma were excluded. Preoperative questionnaires, demographic data, presenting complaint (radiculopathy, myelopathy, myeloradiculopathy), and procedural data were recorded. Patients were included if they had completed the NDI and PROMIS PI. Correlation and regression analyses were performed. One hundred ninety-six patients met inclusion criteria. The average age was 56.9±12.9 years. The mean NDI score was 68.6±38 and PROMIS PI was 60.9±7.3. The PROMIS PI was strongly correlated with the NDI ( r =0.76, P <0.001). Linear regression analysis revealed the following formula. We performed a regression analysis allowing for the conversion of PROMIS PI scores with NDI. In keeping with the previous studies, our analysis showed that PROMIS PI was most strongly correlated to NDI. A PROMIS PI score >66 was correlated to substantial disability (NDI=50), whereas a PROMIS PI score <59 was correlated to minimal relative impairment (NDI=28). These results provide important reference, as PROMIS reporting becomes more widespread in the literature.

Standalone cage versus anchored cage for anterior cervical discectomy and fusion: a comparative analysis of clinical and radiological outcomes.

The use of standalone cages (SAC) and anchored cages (AC) in anterior cervical discectomy and fusion surgery (ACDF) has shown advantage of reduced operative time and lower incidence of dysphagia. However, there is limited literature available comparing the clinical and radiological outcomes of SAC and AC. We conducted a prospective study for patients undergoing ACDF for cervical radiculopathy or myelopathy. Patient were classified based on the cage used into SAC group and the AC group. Clinical outcomes were assessed using the modified Japanese Orthopedic Association (mJOA) for myelopathy and Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for radiculopathy. Dysphagia was graded as per Bazaz score. Radiologically, global cervical lordosis, segmental lordosis, cage subsidence, and migration were assessed. We analyzed 31 patients in each group with a minimum twoyear follow-up. The mean VAS improved from 7.9 to 4.56, mean NDI score improved from 27.6 to 19.8, and mean mJOA improved from 10.8 to 11.7 which were statistically significant (p < 0.05); however, no significant difference was noted between the SAC and AC groups. Mean global lordosis improved from 14.4 to 20.3° and mean segmental lordosis improved from 6 to 10.1° at sixmonths and plateaued to 6.9° at final follow up without any significant difference between the groups. The subsidence was statistically more in 12.9% (4/31) in SAC than 6.4% (2/31) in AC. AC showed of lower rates of subsidence while both SAC and AC had comparable clinical outcomes and radiological alignment outcomes.

Ultrasound-guided rhomboid intercostal block for myofascial pain syndrome: a prospective clinical study.

Myofascial pain syndrome (MPS) is a common chronic pain syndrome that may affect quality of life, daily living activities, and psychological status. Ultrasound (US)-guided rhomboid intercostal block (RIB) is a recently defined plane block and used for chronic pain such as postmastectomy syndrome and MPS. Our aim was to evaluate the efficacy of US-guided RIB for the management of pain, quality of life, physical disability, and patient satisfaction in MPS. In this prospective study, between February and March 2021, a total of 30 patients who applied with the diagnosis of MPS, were included. The patients received US-guided RIB. Pain intensity was evaluated using a numerical rating scale (NRS) at pretreatment, and just after the intervention, at day 1, and 1, 2, 4, and 6 weeks after the intervention. At pretreatment and 6 weeks after treatment, Short Form-36 Health Survey (SF-36) for health-related quality of life, Neck Disability Index (NDI), and patient satisfaction were evaluated. There was a statistically significant decrease in average NRS immediately after treatment, at day 1 and week 1,2,4, and 6 compared to the pretreatment (p < 0.0001). The average SF-36 scores advanced at 6 weeks after treatment. There was a statistically significant reduction in mean NDI scores throughout the follow-up period (p < 0.001). Our study demonstrated that RIB had improved neck function, physical and mental quality of life, and patient satisfaction in MPS. Therefore, we think US-guided RIB could be an alternative treatment modality in patients suffering from MPS.

How Subsidence Affects Clinical and Radiological Outcomes after Stand-Alone Anterior Cervical Discectomy and Fusion on Patients with Degenerative Cervical Disease? A Long-Term Follow-Up Study

Objective: We aimed to examine the long-term radiological and clinical outcomes after stand-alone anterior cervical discectomy and fusion (ACDF).Methods: In total, we enrolled 20 patients and 31 treated segments with degenerative cervical disease that underwent stand-alone ACDF with ≥60 months of follow-up. Segmental angle (SA), cervical sagittal alignment (CSA), subsidence, and fusion were evaluated. A visual analogue scale (VAS) and the neck disability index (NDI) were applied pre- and post-operatively and at the last follow-up.Results: Subsidence occurred in 9 (45%) patients and 15 segments (48.4%) at the last follow-up. The mean VAS and NDI scores had improved in both groups with and without subsidence. The mean SA at the last follow-up had significantly increased to 2.3°±8.5° in the subsidence group and to 1.7°± 5.2° degree in the non-subsidence group compared to the post-operative SA (p&lt;0.001). The overall mean CSA at the last follow-up significantly increased overtime in both groups from the postoperative CSA (p=0.003). The fusion rate was 86.7% in the subsidence group and 81.3% in non-subsidence group. However, the difference in SA, CSA and fusion rates between the two groups were not statistically significant (p=0.119, 0.98, and 0.682, respectively).Conclusion: As a result of a long-term follow-up study after stand-alone ACDF, subsidence occurs to some extent. Still, it does not appear to significantly impact radiological and clinical outcomes if the clinician performs sufficient decompression of foramen during surgery. Subsidence seems to have a positive influence on the fusion rate.

Epidemiology of Neck Pain and Its Impact on Quality-of-Life-A Population-Based, Cross Sectional Study in Singapore.

Cross-sectional, epidemiological study. This study aims to describe the prevalence, risk factors, disability, and quality of life (QoL) burden of neck pain. Neck pain is an increasingly common symptom that results in significant disability and loss of QoL to the individual, and imposes a considerable economic burden to developed countries. A cross-sectional, questionnaire-based study was conducted via multistage random sampling of public households in Singapore on individuals aged 21 and older. Questionnaires were administered face-to-face by trained interviewers. Data analyzed included the prevalence and characteristics of neck pain, its relationship with sociodemographic factors, and its association on QoL and disability via validated questionnaires: EQ5D questionnaire and Neck Disability Index (NDI), respectively. A total of 626 individuals with a median age of 52.0 years (interquartile range 37.0-67.0), and even sex distribution of males (54.0%) and females (46.0%) were included in this study. A total of 144 individuals reported neck pain over the past 6 months, giving a 6-month period prevalence of 23.0%. Among them, nine (6.3%) had chronic, whereas 12 (8.3%) had severe neck pain. Female sex was the only significant risk factor for neck pain on multivariate analysis, with a risk ratio of 1.34 (95% confidence interval [CI] 1.00-1.80, P = 0.049). Individuals with neck pain had mean raw NDI scores of 4.91 ± 6.25, with higher disability seen with increasing pain duration and intensity (P < 0.001 and P = 0.002 respectively). Compared to individuals without neck pain, those with neck pain had poorer QoL with lower EQ5D-Index scores (0.84 ± 0.25 vs. 0.93 ± 0.15; 95% CI 0.046-0.132, P < 0.001) and EQ5D-VAS scores (68.76 ± 14.59 vs. 73.86 ± 13.64; 95% CI 2.510-7.697, P < 0.001). Our findings show that neck pain is a prevalent condition with chronicity and severity of symptoms associated with reduced QoL and increased disability. Population sample health scores can serve as potential reference targets in disease management and aid national health care policy-making.Level of Evidence: 3.

4. Single-level cervical disc replacement using a PEEK-on-ceramic implant: Results of a multicenter FDA IDE trial with 24-month follow up

<h3>BACKGROUND CONTEXT</h3> Many early cervical total disc replacements (TDRs) produced motion through a ball-and-socket action, with metal endplates articulating with a plastic core. PEEK is used increasingly for spinal implants due to its mechanical properties and lack of artifact on imaging. A cervical TDR was designed with commercially pure titanium-coated PEEK endplates and a biconvex zirconia toughened alumina ceramic core. <h3>PURPOSE</h3> The purpose of this study was to compare this PEEK-on-ceramic TDR to anterior cervical discectomy and fusion (ACDF) to treat single-level cervical disc degeneration. <h3>STUDY DESIGN/SETTING</h3> This was a prospective, nonrandomized, multicenter Food and Drug Administration (FDA) Investigational Device Exemption (IDE) trial comparing the investigational group to a propensity-matched historic control group. <h3>PATIENT SAMPLE</h3> Patients received the PEEK-on-ceramic Simplify® Cervical Artificial Disc (n=150 patients from 16 sites). The historic control group included 117 propensity-matched ACDF patients from an earlier cervical TDR IDE trial employing the same inclusion/exclusion criteria. All patients were treated for single-level symptomatic cervical disc degeneration. <h3>OUTCOME MEASURES</h3> The primary outcome was a composite 5-point success classification at 24-month follow-up requiring: >15 point (of 100) improvement in Neck Disability Index (NDI) score; 2) maintenance/improvement in neurologic status; 3) no device failure; 4) no reoperation/revision/removal and/or supplemental fixation at the index level, and 5) no major adverse events. Outcome measures included NDI, visual analog scale (VAS) assessing neck and arm pain, neurological status, adverse events and subsequent surgery. Radiographic assessment included flexion/extension range of motion. Facet joints were assessed at 24 months comparing pre- to postoperative MRI images using a published 4-point scale. <h3>METHODS</h3> Evaluations were performed preoperatively and postoperatively within 2 and 6 weeks, and 3, 6, 12 and 24 months. The control was propensity match with ACDF patients from an earlier TDR vs ACDF trial, which used the same inclusion criteria and primary outcome assessments. <h3>RESULTS</h3> The overall composite success rate was significantly greater in the TDR group vs ACDF (93.0% vs 73.6%; p<0.001). Mean NDI, neck pain and arm pain scores improved significantly in both groups at all follow-up points. Mean NDI scores in the TDR group were significantly lower than ACDF scores at all follow-up points all p<0.01). Secondary surgical intervention was undertaken in 4 (2.7%) patients at the index level in the TDR group and 6 (5.1%) in the ACDF group. There were no significant differences in the rates of serious adverse events when comparing the two groups. The mean segmental range of motion of the treated level in the TDR group was 7.3° prior to surgery. This increased to 8.6° at 3-month follow-up and continued to increase to 9.6° at 24 months (p<0.001). Facet joint assessment by MRI at 24-month follow-up in the TDR group showed little change from preoperative. <h3>CONCLUSIONS</h3> The results of this study found that the Simplify® Cervical Artificial Disc produced outcomes similar or superior on some measures, including superiority in the composite success classification, compared with ACDF, for the treatment of single-level symptomatic cervical disc degeneration. ROM at the treated level increased from the preoperative value and was maintained throughout follow-up. Safety of the PEEK-on-ceramic disc was established with no device failures in the series. These results support that the device is a viable alternative to ACDF. <h3>FDA DEVICE/DRUG STATUS</h3> Simplify Cervical Disc Replacement (Approved for this indication)