Visual Analog Scale Neck Pain Research Articles

Total subaxial reconstruction

Certain cervical spinal conditions require decompression and reconstruction of the entire subaxial cervical spine. There are limited data concerning the clinical details and outcomes of patients treated in this manner. The object of this study was to describe the specific technique employed to perform a total subaxial reconstruction and review the postoperative outcomes following surgery. The author performed a review of data prospectively collected in 27 consecutive patients undergoing complete anterior decompression and reconstruction of the anterior cervical spine and followed by posterior instrumented arthrodesis with or without decompression. There were 16 men and 11 women whose mean age was 59 years (range 35-86 years). The minimum follow-up was 12 months and the mean follow-up period for all patients was 26 months. One patient underwent C2-7 surgery, and in all others the procedure crossed the cervicothoracic junction. Following surgery patients remained intubated for an average of 3.3 days (range 1-22 days). The mean hospital length of stay was 11 days (range 3-45 days). One patient died 6 weeks following an uneventful surgery. Pneumonia developed in 5 patients, 1 patient experienced a minor pulmonary embolism, and 2 patients had posterior wound infections. No patient was neurologically worse following surgery. A single patient presented with a C-8 radiculopathy 6 weeks after surgery. At final follow-up no patient complained of dysphagia when specifically questioned about this potential problem. In all patients solid fusions developed at each treated levels. Preoperatively the mean sagittal Cobb angle was 15.4° (kyphosis) and the postoperative mean angle was -10.9° (lordosis) representing a total average correction of over 25° (p < 0.0001). The mean preoperative Neck Disability Index was 27.6; this score decreased to 15.5 (p = 0.0008) postoperatively. The mean pre- and postoperative visual analog scale neck pain scores were 6.0 and 2.1, respectively (p = 0.0004), and mean visual analog scale arm pain scores decreased by 3.7 following surgery (p = 0.001). Based on Odom criteria, the author found that 8 patients had an excellent outcome and 14 patients a good outcome. There were 4 patients in whom the outcome was judged to be fair and the single death was recorded as a poor outcome. The mean preoperative Nurick score was 2.68. Postoperatively the group improved to an average score of 1.5; the difference between the 2 was statistically significant (p = 0.002). Segmental anterior decompression and reconstruction of the entire subaxial cervical spine, combined with an instrumented posterolateral fusion, can be performed with acceptable morbidity and is of significant benefit in selected patients.

Neck Muscle Strength Before and After Cervical Laminoplasty

A prospective study to investigate serial changes in neck muscle strength before and after cervical laminoplasty. To examine the correlation between neck muscle strength and axial symptoms, and to clarify the risk factors for axial symptoms. Axial symptoms are common complications after posterior cervical spinal surgery. Although several technical considerations have reduced axial symptoms, the causes of axial symptoms are still largely unknown. Previous studies have indicated that neck muscle strength is reduced in patients with neck pain. Nineteen consecutive patients underwent cervical expansive laminoplasty for cervical spondylotic myelopathy. Age, sex, operative time, blood loss, clinical results, cervical curvature, range of motion, visual analog scale (VAS) for axial symptoms, and manual muscle strengths were examined before and after surgery. At 3 and 12 months, these factors were compared statistically between the no pain (NP) group (VAS <3) and the pain (P) group (VAS >or=3). The correlation between VAS and neck muscle strength, and the reduction in neck muscle strength in extension were analyzed statistically. Six patients (31.5%) complained of axial symptoms at 3 months, and the symptoms continued in 3 patients (15.8%) at 12 months. At 3 months, cervical lordosis was 15.7 degrees in the NP group and 5.0 degrees in the P group, and neck strength in extension was 104.9% and 61.8%, respectively. At 12 months, neck strength in extension was 124.3% and 62.2%, respectively. These differences were statistically significant. The correlation between neck pain VAS and neck muscle strength, and the reduction in neck muscle strength in extension were statistically significant. Neck muscle strength recovered to the preoperative value by 3 months and increased to 120% by 12 months in the NP group, whereas in the P group, neck muscle strength remained reduced by 60% and did not recover. Neck muscle strength and axial symptoms were strongly correlated.

ProDisc-C versus fusion with Cervios chronOS prosthesis in cervical degenerative disc disease: Is there a difference at 12 months?

Study design: Prospective cohort study.Objective: The aim of the study was to compare clinical results and to determine differences in outcomes between anterior cervical discectomy and fusion (ACDF) and disc arthroplasty in patients treated for symptomatic cervical degenerative disc disease.Methods: Forty patients with cervical degenerative disc disease were treated with ProDisc-C disc arthroplasty and 40 patients with fusion using an intervetebral spacer with integrated fixation (Cervios chronoOS) implants without additional anterior fixation. Fifty disc prostheses were placed in the first group and 52 intervertebral spacers were implanted in the second group. Clinical outcomes were assessed before and 12 months following the procedure using the neck disability index (NDI) and visual analog scale (VAS) for neck and arm pain, with 15% improvement in NDI and 20% in VAS defined as a clinically significant.Results: Eighty patients with cervical degenerative disc disease with a mean age of 49.7 years were included in the study with a minimum follow-up of 12 months. The groups were similar at baseline both clinically and statistically (P > .05) except for age and VAS for arm pain. Both groups had a statistically significant improvement in NDI and VAS for neck and arm pain (P < .05) and the arthroplasty group had a better improvement according to NDI (74.3% of patients in the arthroplasty group achieved ≥15% improvement in NDI versus 65.7% of patients in ACDF group).Conclusions: Both ProDisc C and Cervios chronoOS prostheses resulted in significant pain reduction and functional outcome for the patients with slightly better results in the group treated with disc arthroplasty 12 months after the surgery.Methods evaluation and class of evidence (CoE)Methodological principle:Study Design RCT Cohort study• Case control Case seriesMethods Concealed allocation (RCT) Intent to treat (RCT) Blinded/independent evaluation of primary outcome• Follow-up ≥85%• Adequate sample size• Control for confoundingEvidence class:IIIThe definiton of the different classes of evidence is available on page 83.

Favourable long-term clinical outcome after anterior cervical discectomy. A study on a series of 125 patients undergoing surgery a mean of 11 years earlier

This retrospective study assessed long-term clinical outcome in a series of patients undergoing anterior cervical discectomy (ACD) for treatment of myeloradiculopathy secondary to one- to two-level cervical discoarthrosis. To verify concerns about long-term adverse clinical effects following ACD, a review of literature on the topic was also made. The clinical course and long-term outcome of 125 consecutive patients with cervical myeloradiculopathy operated on by ACD 5 to 19 years ago (mean, 11.3 years) were reviewed. Seventy-four patients (59%) showed a clinical picture of pure radiculopathy, and 51 patients (41%) had myeloradiculopathy. Long-term clinical outcome and Visual Analog Scale (VAS) scores for neck and arm pain were recently assessed and compared with post-surgical status. Clinical outcome was graded according to the criteria of Odom et al. (JAMA 166:23-28, 36). The survey of the literature on long-term clinical outcome after ACD was internet-based. Long-term clinical outcome was excellent in 61% of patients, good in 26%, satisfactory in 9% and poor in 4%. The same figures at the time of discharge were 65%, 29%, 6% and 0%, respectively. Mean long-term neck and arm pain VAS scores were 2.5 and 0.8, respectively, while postoperatively, the same values were 2.1 and 0.5. Additional discectomy at an adjacent level was performed in five patients 10 months to 8 years after the first operation. In our series, 96% of patients had a sustained favourable long-term clinical outcome after ACD. These favourable results confirm data in the literature and support our preference for ACD as the simplest, fastest and cheapest surgical option for treating myeloradiculopathy secondary to one- to two-level cervical discoarthrosis.

What Factors Have Influence on Persistence of Neck Pain After a Whiplash?

Prospective longitudinal study. To identify prognosis factors that allow us to identify patients with risk of developing chronic symptoms and disabilities after a whiplash injury. The prognosis factors for poor recovery in acute whiplash are not conclusive. We included 557 patients who suffered whiplash injury after road traffic accident and visited the Department of Physical Medicine and Rehabilitation of Mataró Hospital (Spain) for medical evaluation and rehabilitation treatment. The variables were collected following a protocol designed for the study, and all patients were assessed through the Visual Analogue Scale (VAS) for the intensity of neck pain, the Goldberg Depression and Anxiety Scale and the Northwick Park Neck Pain Questionnaire (NPH) for cervical column functionality at initial evaluation and 6 months later. Factors related with VAS 6 months after the whiplash injury were women, age, number of days of cervical column immobilization, previous neck pain, self-employed workers, housewives, pensioners, students, presence of headache or dizziness, and VAS, Goldberg Depression and Anxiety scale, and NPH scores at initial evaluation. In multivaried analysis, it had been found that the variables that had influence on VAS 6 months after the whiplash injury were statistically significant for age, presence of dizziness, self-employed workers, and VAS and NPH scores at initial evaluation. Our findings indicate that factors that allow us to identify patients at risk for poor recovery are age, dizziness, and initial evaluation of neck pain with VAS and cervical column functionality with NPH.

The long-term results of anterior surgical reconstruction in patients with postlaminectomy cervical kyphosis

Background context Postlaminectomy kyphosis of the cervical spine is a challenging condition to treat because it has a combination of an exposed cord, progressive kyphosis, segmental instability, and anterior neural compression. The ideal mode of surgical correction remains controversial. In terms of surgical strategy, there are few large series that have reported the long-term results of anterior surgical treatment of this condition. Purpose This study was designed to determine the long-term results and outcomes of anterior surgical treatment alone for the patients of postlaminectomy cervical kyphosis. Study design/setting This is a retrospective review of prospectively collected data in an academic institution. Patient sample The sample comprises 23 patients who underwent anterior reconstruction surgery for the treatment of postlaminectomy kyphosis. Outcome measures The outcome measures were neck disability index (NDI), visual analog scale (VAS) for neck and arm pain, Nurick grades, kyphosis angles, fusion status, and complications. Methods Two independent spine surgeons reviewed the completed medical records and radiographs of 23 patients who had undergone multilevel anterior cervical hybrid decompression (corpectomy and discectomy) with instrumented fusions for postlaminectomy kyphosis by one surgeon at an academic institution. The clinical and radiographic outcomes were measured by NDI, VAS for neck and arm pain, Nurick grades, kyphosis angles, and fusion status at the time of preoperative, postoperative, and the last follow-up. Results The mean follow-up was 44.5±31.0 months (range 24–120 months). The average preoperative kyphosis of 20.9° was significantly improved to a lordosis of 14.0° after surgery (p<.0001) and was maintained to a lordosis of 9.6° at the final follow-up (p<.0001). The average correction angle of kyphosis was 30.5±11.7°. The average preoperative, NDI, VAS, and Nurick grades were significantly improved at the last follow-up (all, p<.0001). The average levels of 0.9±0.7 corpectomy, 2.0±0.9 discectomy, and 3.8±1.4 anterior fusions were performed in each patient. Solid fusion was confirmed by computed tomography in all patients at a mean time of 3.8±1.2 months. There were six (26%) patients and seven (30.4%) complications: four (14.3%) graft-related complications (one implant displacement, one graft dislodgment, and one pseudarthrosis), one swallowing difficulty, one wound infection, one dura tear, and one pneumonia. Conclusions Our data suggest that multilevel anterior surgical treatment using hybrid decompression (corpectomy and discectomy) combined with instrumented fusion yields acceptable clinical and neurological improvement and effective correction of cervical kyphosis. The techniques used also appeared to decrease the incidence of graft-related complications compared with a previous report by the same author.

C1 Lateral Mass Fixation

Abstract OBJECTIVE We review our experience and technique for C1 lateral mass screw fixation. We compare the results of 3 different constructs incorporating C1 lateral mass screws: occipitocervical (OC) constructs, C1–C2 constructs, and C1 to mid/low cervical constructs. METHODS We performed a retrospective chart review of 42 consecutive patients who underwent C1 lateral mass fixation by 2 of the authors (PVM and DC). The patient population consisted of 24 men and 18 women with a mean age of 64 years. Twenty-two patients had C1–C2 constructs. Twelve patients had constructs that started at C1 and extended to the mid/low cervical spine (one extended to T1). Eight patients underwent OC fusions incorporating C1 screws (2 of which were OC-thoracic constructs). All constructs were combined either with a C2 pars screw (38 patients), C2 translaminar screw (1 patient), or C3 lateral mass screw (3 patients). No C2 pedicle screws were used. Fusion was assessed using flexion-extension x-rays in all patients and computed tomographic scans in selected cases. Clinical outcomes were assessed with preoperative and postoperative visual analog scale neck pain scores and Nurick grading. The nuances of the surgical technique are reviewed, and a surgical video is included. RESULTS Two patients (5%) were lost to follow-up. The mean follow-up for the remaining patients was 2 years. During the follow-up period, there were 4 deaths (none of which were related to the surgery). For patients with follow-up, the visual analog scale neck pain score improved a mean of 3 points after surgery (P &amp;lt; .001). For patients with myelopathy, the Nurick score improved by a mean of 1 grade after surgery (P &amp;lt; .001). The postoperative complication rate was 12%. The complication rate was 38% in OC constructs, 17% in C1 to mid/low cervical constructs, and 0% for C1–C2 construct cases. Patients with OC constructs had the statistically highest rate of complications (P &amp;lt; .001). Patients with C1 to mid/low cervical constructs had more complications than those with C1–C2 constructs (P &amp;lt; .001). Of the 42 cases, there were 3 pseudoarthroses (1 in an OC case, 1 in a C1 to midcervical construct, and 1 in a C1–C2 construct). OC constructs had the highest risk of pseudoarthrosis (13%) (P &amp;lt; .001). CONCLUSION Patients treated with C1 lateral mass fixation constructs have a high fusion rate, reduced neck pain, and improved neurologic function. Constructs using C1 lateral mass screws do not need to incorporate C2 pedicle screws. Constructs incorporating C1 lateral mass screws are effective when combined with C2 pars screws, C2 translaminar screws, and C3 lateral mass screws. Constructs using C1 screws are associated with a higher complication rate and a higher pseudoarthrosis rate if extended cranially to the occiput or if extended caudally below C2.

Analysis on the effect of acupuncture in treating cervical spondylosis with different syndrome types

To observe the clinical effect of acupuncture in treating cervical spondylosis with different syndrome types. One hundred and seventeen patients were randomized into the treated group: (59 cases), treated with normal acupuncture, and the control group (58 cases), treated with sham acupuncture, operated once every other day, 9 times in total (in 18 days) as one therapeutic course, and a succeeding 3-month follow-up study was carried out after terminating the therapy. The efficacy of treatment was evaluated with the Northwick Park Neck Pain Questionnaire (NPQ) and Visual Analogue Scale (VAS), and the scores gained in patients with different syndrome types were analyzed with a general linear model. The NPQ and VAS: scores showed a linear decreasing tendency in both groups at the time of ending treatment and the 1st month of follow-up, but showed a secondary curve increasing tendency in the 3rd month of follow-up. Multivariate analysis showed the difference was of statistical significance (P<0.05). However, the analysis through lead-in of syndrome type as an individual influencing factor showed that syndrome type exerts a significant influence on VAS score (P<0.05), but has insignificant influence on the NPQ score (P>0.05). Acupuncture shows: good immediate effect in treating cervical spondylosis, but its long-term effect is not satisfactory. The difference in syndrome type may have some impact on the effects of acupuncture in alleviating pain, but exerts no evident influence on the comprehensive effect.

Comparison of postoperative pain and neck function between cervical disc replacement and anterior cervical discectomy and fusion: a meta-analysis.

Objective To evaluate the postoperative pain and neck function of patients who under-went cervical disc replacement or anterior cervical discectomy and fusion (ACDF) by Meta-analysis. Meth-otis In Medline (1966.1-2008.11), Embase (1966.1-2008.11), AMED (1985.1-2008.11) and Cochrane Li-brary, the randomized controlled trails about the comparison between cervical disc replacement and ACDF were collected. Then extracted the data of arm pain visual analogue scale (VAS), neck pain VAS and neck disability index (NDI) in these researches and made a Meta-analysis using Review Manager 4.2. Weighted mean difference (WMD) was selected for the evaluation of the overall effect. Results Four articles were ac-cepted in our Meta-analysis and all of them were high quality researches identified by modified Jadad Scale.Altogether, 213 patients were included. The combined WMD of arm pain VAS was -2.91[95% confidence in-terval (CI) (-4.19,-1.62), P< 0.05] 6 weeks after surgery and -2.67[95%CI (-4.02,-1.33), P<0.05] 6 months after surgery. The combined WMD of NDI was -11.93[95%CI (-15.66,-8.19), P< 0.05] 6 weeks after surgery and -11.2[95%CI (-14.74,-7.69), P< 0.05] 6 months after surgery. Conclusion The arm pain VAS of treatment group (cervical disc replacement) is lower than that of control group (ACDF) both 6 weeks and 6 months after surgery. The NDI of treatment group is lower than that of control group both 6 weeks and 6 months after surgery. Key words: Intervertebral disk; Spinal fusion; Decompression; surgical; Meta-analysis

Effect of intervertebral disc height on postoperative motion and clinical outcomes after Prodisc-C cervical disc replacement

Background context Cervical total disc replacement (TDR) is an emerging technology. However, the factors that influence postoperative range of motion (ROM) and patient satisfaction are not fully understood. Purpose To evaluate the influence of pre- and postoperative disc height on postoperative motion and clinical outcomes. Study design/setting Retrospective review of patients enrolled in prospective randomized Food and Drug Administration (FDA) trial. Patient sample One hundred sixty-six patients with single-level ProDisc-C arthroplasty performed were evaluated. Outcome measures ROM and clinical outcomes based on Neck Disability Index (NDI) and Visual Analog Scale (VAS) were assessed. Methods Preoperative and postoperative disc height and ROM were measured from lateral and flexion-extension radiographs. Student t test and Spearman's rho tests were performed to determine any correlation or “threshold” effect between the disc height and ROM or clinical outcome. Results Patients with less than 4 mm of preoperative disc height had a mean 1.8° increase in flexion-extension ROM after TDR, whereas patients with greater than 4 mm of preoperative disc height had no change (mean, 0°) in flexion-extension ROM (p=.04). Patients with greater than 5 mm of postoperative disc height have significantly higher postoperative flexion-extension ROM (mean, 10.1°) than those with less than 5 mm disc height (mean, 8.3°, p=.014). However, patients with greater than 7 mm of postoperative disc height have significantly lower postoperative lateral bending ROM (mean, 4.1°) than those with less than 7 mm disc height (mean, 5.7°, p=.04). It appears that the optimal postoperative disc height is between 5 and 7 mm for increased ROM on flexion extension and lateral bending. There was a mean improvement of 30.5 points for NDI, 4.3 points for VAS neck pain score, and 3.9 points for VAS arm pain score (all p<.001). No correlation could be found between clinical outcomes and disc height. Similarly, no threshold effect could be found between any specific disc height and NDI or VAS. Conclusion Patients with greater disc collapse of less than 4 mm preoperative disc height benefit more in ROM after TDR. The optimal postoperative disc height range to maximize ROM is between 5 and 7 mm. This optimal range did not translate into better clinical outcome at 2-year follow-up.

Single-level cervical radiculopathy: clinical outcome and cost-effectiveness of four techniques of anterior cervical discectomy and fusion and disc arthroplasty

Although there are several accepted methods of surgical treatment for single-level cervical radiculopathy, the choice depend on the surgeon's preference. The techniques may vary in peri-operative morbidity, short- and long-term outcome, but no study so far has analyzed their cost-effectiveness. This study might give some insight in balancing cost and effectiveness and deciding the right technique. Sixty consecutive patients (15 each group), mean age 36 (range 24-76 years) with single-level cervical disc disease underwent surgical treatment with four different techniques in two centers over the period of 1999-2005. The four groups were--(1) plate and tricortical autograft, (2) plate, cage, and bone substitute, (3) cage only, and (4) disc arthroplasty. The data was collected prospectively according to our protocol and subsequently analyzed. The clinical outcome was assessed comparing visual analog scale (VAS) of neck pain and, short form 12 (SF12) questionnaire both pre- and postoperatively. The radiological assessment was done for fusion rate and postoperative related possible complications at 3 months, 6 months, 1 year, and final follow-up. The cost analysis was done calculating the operative time, hospital stay, implant cost together. The mean follow-up period was 31 months (range 28-43 months). The clinical outcome in terms of VAS of neck and arm pain and SF12 physical and mental score improvement (P=0.001) were comparable with all four techniques. The radiological fusion rate was comparable to current available data. As the hospital stay was longer (average 5 days) with plate and autograft group, the total cost was maximum (average 2,920 pound sterling) with this group. There was satisfactory clinical and radiological outcome with all four techniques. Using the cage alone was the most cost-effective technique, but the disc arthroplasty was comparable to the use of cage and plate. Anterior cervical discectomy and fusion is an established surgical treatment for cervical radiculopathy. Single-level cervical radiculopathy was treated with four different techniques. The clinical outcome and cost-effectiveness were compared in this study.

Outcome Analysis of Single Level Anterior Cervical Fusion using Interbody PEEK Cage with Autologous Iliac Bone Graft

Purpose: Anterior cervical fusion with a tricortical iliac bone graft is a well established procedure for treating degenerative cervical spine disease. An interbody cage has been used to prevent donor site morbidity but there are few reports on the clinical and radiological outcome. Materials and Methods: Thirty eight patients, who underwent single level ACDF with PEEK interbody Soliscage (Stryker spine, South Allendale, NJ, USA), were enrolled in this study. This study evaluated Odom’s criteria and visual analogue scale (VAS) for the neck, arm and donor site pain, and the radiological findings, including the disk height, cage subsidence, and sagittal alignment of cervical spine. Results: The mean disk height loss was 1.1 mm during the follow up period. Case subsidence ＞2 mm developed in 17 cases (44.7%). The mean subsidence of this group was 3.09 mm. The bone union rate was 95% at 12 weeks. There was no significant change in the sagittal alignment of the cervical spine. The VAS for neck, arm, and donor site pain improved all cases. Only 9 patients complained of mild discomfort at the donor site Conclusion: Single-level ACDF using PEEK interbody cage has a lack of donor site morbidity, excellent clinical outcomes and bone union. However, more study of the factors related to postoperative cage subsidence will be needed.

Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease

Background context Cervical total disc replacement (TDR) is intended to address radicular pain and preserve functional motion between two vertebral bodies in patients with symptomatic cervical disc disease (SCDD). Purpose The purpose of this trial is to compare the safety and efficacy of cervical TDR, ProDisc-C (Synthes Spine Company, L.P., West Chester, PA), to anterior cervical discectomy and fusion (ACDF) surgery for the treatment of one-level SCDD between C3 and C7. Study design/setting The study was conducted at 13 sites. A noninferiority design with a 1:1 randomization was used. Patient sample Two hundred nine patients were randomized and treated (106 ACDF; 103 ProDisc-C). Outcome measures Visual analog scale (VAS) pain and intensity (neck and arm), VAS satisfaction, neck disability index (NDI), neurological exam, device success, adverse event occurrence, and short form-36 (SF-36) standardized questionnaires. Methods A prospective, randomized, controlled clinical trial was performed. Patients were enrolled and treated in accordance with the US Food and Drug Administration (FDA)–approved protocol. Patients were assessed pre– and postoperatively at six weeks, 3, 6, 12, 18, and 24 months. Results Demographics were similar between the two patient groups (ProDisc-C: 42.1±8.4 years, 44.7% males; Fusion: 43.5 ± 7.1 years, 46.2% males). The most commonly treated level was C5–C6 (ProDisc-C: 56.3%; Fusion=57.5%). NDI and SF-36 scores were significantly less compared with presurgery scores at all follow-up visits for both the treatment groups (p<.0001). VAS neck pain intensity and frequency as well as VAS arm pain intensity and frequency were statistically lower at all follow-up timepoints compared with preoperative levels (p<.0001) but were not different between treatments. Neurologic success (improvement or maintenance) was achieved at 24 months in 90.9% of ProDisc-C and 88.0% of Fusion patients (p=.638). Results show that at 24 months postoperatively, 84.4% of ProDisc-C patients achieved a more than or equal to 4° of motion or maintained motion relative to preoperative baseline at the operated level. There was a statistically significant difference in the number of secondary surgeries with 8.5% of Fusion patients needing a re-operation, revision, or supplemental fixation within the 24 month postoperative period compared with 1.8% of ProDisc-C patients (p=.033). At 24 months, there was a statistically significant difference in medication usage with 89.9% of ProDisc-C patients not on strong narcotics or muscle relaxants, compared with 81.5% of Fusion patients. Conclusions The results of this clinical trial demonstrate that ProDisc-C is a safe and effective surgical treatment for patients with disabling cervical radiculopathy because of single-level disease. By all primary and secondary measures evaluated, clinical outcomes after ProDisc-C implantation were either equivalent or superior to those same clinical outcomes after Fusion.

The Cultural Adaptation, Reliability and Validity of Neck Disability Index in Patients With Neck Pain

The aim of this study was to conduct the cross-cultural adaptation of Neck Disability Index (NDI) and investigate the validity and reliability of Turkish version in patients with neck pain. The NDI is a reliable evaluation instrument for disability but there are no published Turkish version. Eighty-eight patients with neck pain for at least 3 months were included in the study. NDI, The Neck Pain and Disability Scale and Visual Analogue Scale (VAS) were completed by all subjects. Test-retest reliability was determined by using intraclass correlation coefficient and Pearson's correlation analysis. For the determination of concurrent validity, the relation between NDI and VAS was examined by Pearson's correlation analysis and for the determination of construct validity, the relation between NDI and Neck Pain and Disability Scale was investigated. Intraclass correlation coefficient score for test-retest reliability was 0.979 (95%, confidence interval = 0.968-0.986). For concurrent validity, the relation between NDI and VAS was investigated, the r value for test and retest was 0.508 and 0.620, respectively (P < 0.0001). For construct validity, the relation between NDI and the Turkish version of NPDA was investigated, the r value for test and retest was 0.659 (P < 0.0001) and 0.728 (P < 0.0001), respectively. The Turkish version of NDI was found to be a valid and reliable method of measurement for evaluating disability, caused by problems of the neck region as it is easy to comprehend by the patients and the time needed to apply is short in clinics.

Change of cervical balance following single to multi-level interbody fusion with cage

Postoperative limitation of cervical movement and adjacent disc degeneration are major causes of postoperative neck pain after anterior cervical discectomy and interbody fusion (ACDF). We present a retrospective study of dynamic radiographic change following ACDF with cages. We performed ACDF in 50 patients with cervical degenerative diseases, divided into three groups based on the level of interbody fusion (Group A: one-level; Group B: two-level; Group C: three-level). Preoperative and postoperative flexion-extension X-rays were acquired and cervical range of motion (ROM), lordosis, fusion rate, cage subsidence rate, postoperative neck pain as evaluated by visual analogue scale (VAS) and upper adjacent level segmental movement were evaluated. The average following time was 14.6 months. The mean change in lordotic curve was −2.31 ± 9.53° for Group A, 5.60 ± 6.96° for Group B, and 3.23 ± 7.50° for Group C (p value = 0.03). The mean change in flexion angle was −5.46 ± 8.69° for Group A, −10.2 ± 7.38° for Group B, and −13.86 ± 10.33° for Group C (p value = 0.039). The mean change in total cervical ROM was −3.85 ± 18.74° for Group A, −12.73 ± 10.31° for Group B, and −16.95 ± 10.57° for Group C (p value = 0.02). Follow-up cervical MRI for patients with persistent neck pain showed no evidence of adjacent level degeneration. There were no significant differences between the three groups with respect to postoperative change in cervical extension angle, upper adjacent level segmental movement, neck pain VAS, fusion rate or cage subsidence rate. The further decrease in total cervical ROM and flexion movement after multi-level ACDF was observed. However, a more long-term follow-up was needed to assess the actual aetiologies of upper adjacent level degeneration.

Artificial Disc Versus Fusion

A total of 115 patients were randomized in a 1:1 ratio to a Bryan artificial disc replacement (56) or an anterior cervical fusion with allograft and a plate (59). The purpose of this study is to examine the functional outcome and radiographic results of this prospective, randomized trial to determine the role of the Bryan artificial cervical disc replacement for patients with 1-level cervical disc disease. Artificial cervical disc replacement has become an option for cervical radiculopathy. Previous studies have evaluated the efficacy of this alternative without the scientific rigor of a concurrent control population. This study is a pooled data set from 3 centers involved in the U.S. FDA Investigational Device Exemption trial evaluating the Bryan artificial cervical disc. The purpose of this study is to examine the functional outcome and radiographic results of this prospective, randomized trial to determine the role of the Bryan artificial cervical disc replacement for patients with 1-level cervical disc disease; 12-month follow-up is available for 110 patients and 24 month follow-up complete for 99 patients. There are 30 males and 26 females in the Bryan group and 32 males and 27 females in the fusion group. The average age was 43 years (Bryan) and 46 years (fusion). Disability and pain were assessed using the Neck Disability Index (NDI) and the Visual Analog Scale (VAS) of the neck and of the arm pain. SF-36 outcome measures were obtained including the physical component as well as the mental component scores. Range of motion was determined by independent radiologic assessment of flexion-extension radiographs. We report a prospective, randomized study comparing the functional outcome of cervical disc replacement to an anterior cervical fusion with results of 99 patients at 2 years. Prospective data were collected before surgery and at 6 weeks, 3, 6, 12, and 24 months after surgery. The average operative time for the control group was 1.1 hours and the Bryan Group 1.7 hours. Average blood loss was 49 mL (control) and 64 mL (Bryan). Average hospital stay was 0.6 days (control) and 0.9 days (Bryan). The mean NDI before surgery was not statistically different between groups: 47 (Bryan) and 49 (control). Twelve-month follow-up NDI is 10 (Bryan) and 18 (control) (P = 0.013). At 2-year follow-up, NDI for the Bryan group is 11 and the control group is 20 (P = 0.005). The mean arm pain VAS before surgery was 70 (Bryan) and 71 (control). At 1-year follow-up, Bryan arm pain VAS was 12 and control 23 (P = 0.031). At 2-year follow-up, the average arm pain VAS for the Bryan group was 14 and control 28 (P = 0.014). The mean neck pain VAS before surgery was 72 (Bryan) and 73 (control). One-year follow-up scores were 17 (Bryan) and 28 (control) (P = 0.05). At 2 years: 16 (Bryan) and 32 (control) (P = 0.005). SF-36 scores: Physical component--Before surgery Bryan 34 and control 32. At 24 months: Bryan 51 and control 46 (P = 0.009). More motion was retained after surgery in the disc replacement group than the plated group at the index level (P < 0.006 at 3, 6, 12, and 24 months). The disc replacement group retained an average of 7.9 degrees of flexion-extension at 24 months. In contrast, the average range of motion in the fusion group was 0.6 degrees at 24 months. There were 6 additional operations in this series: 4 in the control group and 2 in the investigational group. There were no intraoperative complications, no vascular or neurologic complications, no spontaneous fusions, and no device failures or explantations in the Bryan cohort. The Bryan artificial disc replacement compares favorably to anterior cervical discectomy and fusion for the treatment of patients with 1-level cervical disc disease. At the 2-year follow-up, there are statistically significant differences between the groups with improvements in the NDI, the neck pain and arm pain VAS scores, and the SF-36 physical component score in the Bryan disc population.

Sagittal Split Fractures in Multilevel Cervical Arthroplasty Using a Keeled Prosthesis

This is a case report of intraoperative sagittal split fractures in multilevel cervical disc replacement using a keeled prosthesis. The patient's clinical course is discussed and outcomes measured with the SF-36 questionnaire, oswestry disability index, and visual analog scale neck pain are compared with the other patients at our institution that have undergone multilevel disc replacement. The patient did well and has not had any complications related to the device used or fractures. The risks and techniques to avoid this complication when using a keeled prosthesis are discussed in detail.

Stretching exercises vs manual therapy in treatment of chronic neck pain: a randomized, controlled cross-over trial

To compare the effects of manual therapy and stretching exercise on neck pain and disability. An examiner-blinded randomized cross-over trial. A total of 125 women with non-specific neck pain. PATIENTS were randomized into 2 groups. Group 1 received manual therapy twice weekly and Group 2 performed stretching exercises 5 times a week. After 4 weeks the treatments were changed. The follow-up times were after 4 and 12 weeks. Neck pain (visual analogue scale) and disability indices were measured. Mean value (standard deviation) for neck pain was 50 mm (22) and 49 mm (19) at baseline in Group 1 and Group 2, respectively, and decreased during the first 4 weeks by 26 mm (95% Confidence Interval 20-33) and 19 mm (12-27), respectively. There was no significant difference between groups. Neck and shoulder pain and disability index decreased significantly more in Group 1 after manual therapy (p=0.01) as well as neck stiffness (p=0.01). Both stretching exercise and manual therapy considerably decreased neck pain and disability in women with non-specific neck pain. The difference in effectiveness between the 2 treatments was minor. Low-cost stretching exercises can be recommended in the first instance as an appropriate therapy intervention to relieve pain, at least in the short-term.

Preoperative Greater Occipital Nerve Block in Total Thyroidectomy Patients Can Reduce Postoperative Occipital Headache and Posterior Neck Pain

Patients undergoing thyroidectomy with neck fully extended usually experience occipital headache and posterior neck pain. We have attempted to evaluate the effect of preoperative greater occipital nerve (GON) block on occipital headache and posterior neck pain after thyroidectomy. Eighty-two patients undergoing elective total thyroidectomy were randomly allocated to two groups. In block group, bilateral GON blocks with 0.25% bupivacaine were performed. The control group did not have any prior block. Occipital headache and posterior neck stiffness were assessed using the visual analogue scale (VAS) and verbal rating scale. VAS of occipital headache and posterior neck pain in block group was significantly lower compared to that in the control group at postoperative 12 and 24 hours (p < 0.05). In addition, the proportion of patients reporting moderate or severe occipital headache and posterior neck pain at postoperative 12 and 24 hours in block group was significantly lower than that in control group (p < 0.001). No side effects were observed during and after GON block. We conclude that preoperative GON block with 0.25% bupivacaine is an effective technique to reduce occipital headache and posterior neck pain after thyroid surgery.

The Correlation Between Radiographic and Clinical Results after Anterior Cervical Discectomy and Fusion

Study design: This is a prospective study. Objectives: We wanted to analyse the correlation between the radiographic and clinical results after anterior cervical discectomy and fusion (ACDF) for treating degenerative cervical diseases. Summary of Literature Review: ACDF is a successful procedure for treating the degenerative cervical spine. Many studies have reported on radiographic results and clinical outcomes of this procedure. However, few studies have examined the relationships between the changes of the radiographic parameters and the clinical results after ACDF. Materials and Methods: 26 patients who had single level ACDF performed for degenerative cervical diseases during the period between Jan, 2000 and Dec, 2004 were evaluated. All the patients underwent autologous iliac bone graft and plate fixation. The radiographic parameters, including the disc height, the disc space angulation and the spinous process distance were measured at the preoperative period, post operative 1 month and the last follow up period, respectively. The clinical changes were measured using the visual analogue scale (VAS) for neck and arm pain at the preoperative and last follow up period. The correlations between the radiographic parameters and the clinical outcomes were assessed by Pearson correlation. Results: There were significant changes in disc height (6.7-7.9 mm) as well as disc space angulation (kyphosis: 1.1 , lordosis: 3.4 ). The reduction in the neck pain VAS score (63.9-33.1) and the arm pain VAS score (57.9-29.7) was significant. None of the correlations between the radiographic parameters and the clinical outcomes were significant (p>0.05). Conclusion: Although the clinical outcomes improved significantly, there was no significant correlation between the radiographic parameters and clinical results after performing single level anterior cervical discectomy and fusion for the degenerative cervical disease.