Neck-related Disability Research Articles

The Effect of Patient Resilience on Postoperative Scores After One- and Two-Level Anterior Cervical Discectomy and Fusion

ObjectiveThe purpose is to investigate the association between resilience and outcomes of pain and neck-related disability after single- and two-level anterior cervical discectomy and fusion (ACDF). MethodsPatients who underwent single- or two-level ACDF were sent a survey between six months and two years following surgery. The survey included the Brief Resilience Scale (BRS), Visual Analogue Scale (VAS) for pain, Neck Disability Index (NDI), and Pain Self-Efficacy Questionnaire (PSEQ-2). Patients completed the VAS and NDI twice, once describing preoperative pain and disability and once describing current pain and disability. Respondents were classified as high resilience (HR), medium resilience (MR), or low resilience (LR). Demographics, PSEQ-2 scores, pre- and postoperative VAS and NDI scores, and change in VAS (ΔVAS) and NDI (ΔNDI) scores were compared between groups. ResultsThirty-three patients comprised the HR group, 273 patients comprised the MR group, and 47 patients comprised the LR group. All groups demonstrated postoperative improvement in VAS and NDI scores that exceeded previously established MCID values. The HR group demonstrated greater improvement in pain compared to the LR group (ΔVAS: -5.8 for HR vs -4.4 for LR, p=0.05). Compared to the MR group, the LR group demonstrated greater postoperative pain (VAS: 3.2 for LR vs 2.5 for MR, p=0.02) and disability (NDI: 11.9 for LR vs 8.6 for MR, p=0.02). ConclusionsPatients demonstrated improvement in pain and neck-related disability after single- and two-level ACDF, regardless of resilience score. Patients with greater resilience may be expected to demonstrate more improvement in pain after ACDF.

Psychometric evaluation of the Japanese neck disability index by exploratory factor analysis in preoperative patients with cervical spondylotic myelopathy: impact of pain and numbness

BACKGROUND CONTEXTThe Neck Disability Index (NDI), a common Patient-Reported Outcome Measure (PROM) for neck pain, lacks sufficient study on its psychometric properties in preoperative patients with cervical spondylotic myelopathy (CSM). PURPOSEThis study aims to address these gaps by conducting an exploratory factor analysis of the Japanese NDI. The objectives are 2-fold: (1) to scrutinize the psychometric properties and internal consistency of the Japanese NDI, and (2) to explore the specific regions of pain and numbness influencing the NDI. STUDY DESIGN/SETTINGA single-center observational study. PATIENT SAMPLEA total of 100 preoperative patients with CSM. OUTCOME MEASURESThe NDI and Numerical Rating Scale (NRS) were employed to assess preoperative neck disability and pain and numbness in various body regions. METHODSDemographic and clinical characteristics were collected, encompassing age, sex, body mass index, American Society of Anesthesiologists classification, smoking status, comorbidities, pain and numbness at various sites using the NRS, and NDI. For evaluating the psychometric properties and internal consistency of the NDI, exploratory factor analysis (EFA) and Cronbach's α coefficient were utilized. Furthermore, the impact of pain and numbness on NDI factors was examined through multivariable regression analysis. RESULTSEFA identified 2 factors—Physical and Mental—highlighting the dual nature of neck-related disability. Physical factors (std.β=0.724, p<.001) exerted a stronger impact on NDI scores compared to Mental factors (std.β=0.409, p<.001). Cronbach's α coefficient was 0.831 for physical factors and 0.723 for mental factors, indicating a high level of internal consistency. Numbness in the hand (std.β=0.338, p<.001) and pain in the neck (std.β=0.202, p=.035) were significant variables influencing Physical factor, while numbness in the hand (std.β=0.485, p<.001) and pain in the head (std.β=0.374, p<.001) impacted Mental factor. CONCLUSIONThis study contributes valuable insights into the psychometric properties of the NDI in preoperative patients with CSM. The identified factors emphasize the importance of addressing both physical and sensory symptoms in preoperative care.

Comparison of Development of Upper Trapezius Trigger Point in Computer Operators with or without Fore arm support

Background:Computer work often involves both physical and mental demands. The physical demands are characterizedby low-force exertions and static postures that are sustained for long durations. Elevated shoulder postures,prolonged static contractions and the task duration have been identified as computer-related risk factorsfor neck and shoulderproblems, so this is responsible for development of trigger points particularly in the uppertrapezius muscles in forearm-unsupported computer operators as compared to forearm-supported.The uppertrapezius (UT)is designated as a postural muscle and is highly suspected ofoveruse because it works constantlyagainst gravity to maintain an erect head and neck position. This studyaims to identify upper trapezius triggerpoints (TrPs) developed with or without forearm support (FS) in computer operators.Materials and Methods: The study took place in the worksite of computer operators in Nagpur,Maharashtra for1.5 year. With a power of 90 and significance error of 1%, a total of 40 patients were taken according to the convenientsampling and divided into two categories computer operators Group A: with FS and Group B: without FS,following signs and symptoms like Trigger point, posterolateral neck and upper back pain most common in which group assessed by using, VAS (Visual Analogue Scale) for measuring pain intensity, Trigger Point Rating Scale is used for myofascial screening. Neck Disability Index for assessing the neck-related disability due to pain taken.Result: The study was conducted on 40 people, in which 20 people with forearm support and 20 people withforearm unsupported. The result is that forearm support reduces the load on the UTand also reduces the risk ofdevelopment of upper trapezius TrPs as compared to the forearm unsupported.Conclusion: Based on the results of these studies, it has been concluded that the development of UT TrPsincomputer operators without FS is more common as compared to FS.

Profiling migraine patients according to clinical and psychophysical characteristics: clinical validity of distinct migraine clusters

AimsInvestigate if different clinical and psychophysical bedside tools can differentiate between district migraine phenotypes in ictal/perictal (cohort 1) and interictal (cohort 2) phases.MethodThis observational study included two independent samples in which patients were subgrouped into distinct clusters using standardized bedside assessment tools (headache frequency, disability, cervical active range of motion, pressure pain threshold in different areas): (A) cohort 1—ictal/perictal migraine patients were subgrouped, based on previous studies, into two clusters, i.e., Cluster-1.1 No Psychophysical Impairments (NPI) and Cluster-1.2 Increased Pain Sensitivity and Cervical Musculoskeletal Dysfunction (IPS-CMD); (B) cohort 2—interictal migraine patients were subgrouped into three clusters, i.e., Cluster-2.1 NPI, Cluster-2.2 IPS, and Cluster-2.3 IPS-CMD. Clinical characteristics (multiple questionnaires), somatosensory function (comprehensive quantitative sensory testing (QST)), and cervical musculoskeletal impairments (cervical musculoskeletal assessment) were assessed and compared across headache clusters and a group of 56 healthy controls matched for sex and age.ResultsCohort 1: A total of 156 subjects were included. Cluster-1.2 (IPS-CMD) had higher headache intensity (p = 0.048), worse headache-related (p = 0.003) and neck-related disability (p = 0.005), worse quality of life (p = 0.003), and higher symptoms related to sensitization (p = 0.001) and psychological burden (p = 0.005) vs. Cluster-1.1(NPI). Furthermore, Cluster-1.2 (IPS-CMD) had (1) reduced cervical active and passive range of motion (p < 0.023), reduced functionality of deep cervical flexors (p < 0.001), and reduced values in all QST(p < 0.001) vs. controls, and (2) reduced active mobility in flexion, left/right lateral flexion (p < 0.045), and reduced values in QST (p < 0.001) vs. Cluster-1.1 (NPI). Cohort 2: A total of 154 subjects were included. Cluster-2.3 (IPS-CMD) had (1) longer disease duration (p = 0.006), higher headache frequency (p = 0.006), disability (p < 0.001), and psychological burden (p = 0.027) vs. Cluster-2.2 (IPS) and (2) higher headache-related disability (p = 0.010), neck-related disability (p = 0.009), and higher symptoms of sensitization (p = 0.018) vs. Cluster-2.1 (NPI). Cluster-2.3(IPS-CMD) had reduced cervical active and passive range of motion (p < 0.034), and reduced functionality of deep cervical flexors (p < 0.001), vs. controls, Custer-2.1 (NPI), and Cluster-2.2 (IPS). Cluster-2.2 (IPS) and 2.3 (IPS-CMD) had reduced QST values vs. controls (p < 0.001) and Cluster-2.1 (p < 0.039).ConclusionA battery of patient-related outcome measures (PROMs) and quantitative bedside tools can separate migraine clusters with different clinical characteristics, somatosensory functions, and cervical musculoskeletal impairments. This confirms the existence of distinct migraine phenotypes and emphasizes the importance of migraine phases of which the characteristics are assessed. This may have implications for responders and non-responders to anti-migraine medications.

Neck Disability Index Detects Higher Neck-Related Disability Levels among Physiotherapists and Family Medicine Specialists than among Dentists

Healthcare workers who are in physical contact with patients are prone to work-related musculoskeletal disorders (WMSDs). Much is known about the prevalence of neck pain, but the extent of disability associated with neck pain among physical therapists (PTs), dentists, and family medicine specialists (FMs) is unknown. The prevalence of neck pain and Neck Disability Index (NDI) data were collected from 239 PTs, 103 FMs, 113 dentists, and 112 controls from June to August 2022. The highest prevalence of neck pain was found in FMs (58.3%), followed by dentists (50.4%), PTs (48.5%) and controls (34.8%). The NDI% in PTs and FMs had higher values than controls: 14.6 ± 12.4, p = 0.02 for PTs, 14.9 ± 12.4, p = 0.01 for FMs vs. 10.1 ± 10.1 controls. The dentist group did not differ from controls (11.9 ± 10.2, p = 0.13). Mild, moderate, or severe forms of disability were more common in medical professionals than in controls (44.2%, 9.5%, and 1.5% vs. 37.5%, 7%, and 0%). Dentists were the youngest group with high functionality and the lowest degree of disability, comparable to the control population. Gender or age had no effect on NDI scores in this population. FMs, who represented the oldest group, showed age dependency (eleven years older in higher disability groups). Gender had no effect on NDI. In PTs, females predominated in all disability categories and PTs became five years older with increasing disability level. By using NDI in assessing neck-related WMSDs, we can detect medical professionals prone to more serious disability and potentially plan preventive actions.

Pain and Depression Account for More Than One Half of the Neck Disability Variance Among Adult Women with Chiari I

We sought to quantify the neck-related disability in adult women with Chiari malformation type I and identify the significantly related variables. A total of 70 variables were selected from the self-report history questionnaires (12 variables; n= 474), standardized scales (15 variables; n= 474), and morphometric data (43 variables; n= 293-474) of adult women with Chiari malformation type I. The variables were tested independently to identify those with a significant relationship to the Neck Disability Index (NDI; P < 0.00071) and those that might be associated with the NDI (P < 0.05). A forward selection regression model was constructed to identify the variables contributing unique variance to the NDI. In addition, a mediation analysis was performed to determine whether depression mediated the relationship between pain and disability. Overall, 79.5% of the patients had scored at a moderate level of disability or higher. Independent testing identified 16 significant variables, including symptom duration, tonsillar position, and measures of psychological distress. The short-form McGill pain questionnaire-2 (r= 0.69; P < 0.00001) and CES-D scale for depression (r= 0.56; P < 0.00001) exhibited the highest correlations with the NDI. The forward selection regression model produced an R2 of 0.6178. Pain and depression accounted for more than one half of the NDI variance. We found that high levels of disability are common among adult women with Chiari malformation type I, independent of surgical status. Pain and depression were the primary factors related to this disability. Depression mediated the relationship between pain intensity and disability at a modest level (5%). Patients who had experienced symptoms for >2 years before diagnosis had had, on average, 77% higher NDI scores, highlighting the importance of a timely diagnosis.

Predictors of home discharge after scheduled surgery for degenerative cervical myelopathy.

Degenerative cervical myelopathy (DCM) is an important public health issue. Surgery is the mainstay of treatment for moderate and severe DCM. Delayed discharge of patients after DCM surgery is associated with increased healthcare costs. There is a paucity of data regarding predictive factors for discharge destination after scheduled surgery for patients with DCM. The purpose of this study was to identify factors predictive of home versus nonhome discharge after DCM surgery. Patients undergoing scheduled DCM surgery who had been enrolled in a prospective DCM substudy of the Canadian Spine Outcomes and Research Network registry between January 2015 and October 2020 were included in this retrospective analysis. Patient data were evaluated to identify potential factors predictive of home discharge after surgery. Logistic regression was used to identify independent factors predictive of home discharge. A multivariable model was then used as a final model. Overall, 639 patients were included in the initial analysis, 543 (85%) of whom were discharged home. The mean age of the entire cohort was 60 years (SD 11.8 years), with a BMI of 28.9 (SD 5.7). Overall, 61.7% of the patients were female. The mean length of stay was 2.72 days (SD 1.7 days). The final internally validated bootstrapped multivariable model revealed that younger age, higher 9-Item Patient Health Questionnaire score, lower Neck Disability Index scores, fewer operated levels, mJOA scores indicating mild disease, anterior cervical discectomy and fusion procedure, and no perioperative adverse effects were predictive of home discharge. Younger age, less neck-related disability, fewer operated levels, more significant depression, less severe myelopathy, anterior cervical discectomy and fusion procedure, and no perioperative adverse effects are predictive of home discharge after surgery for DCM. These factors can help to guide clinical decision-making and optimize postoperative care pathways.

COMPARE THE EFFECTS OF STRENGTHENING EXERCISES WITH AND WITHOUT SOFT TISSUE MOBILIZATION FOR THE MANAGEMENT OF TENSION NECK SYNDROME IN FEMALES: A RANDOMIZED CONTROLLED TRIAL

Background: Tension neck syndrome (TNS) is a prevalent condition worldwide. Soft tissue mobilization and strengthening exercises are used in physiotherapeutic rehabilitation of the musculoskeletal disorders. Objective: To compare the effects of strengthening exercises with and without soft tissue mobilization (STM) for pain and disability reduction in females with TNS. Methods: A single-blinded, parallel-group randomized controlled trial was conducted at the National Institute of Rehabilitation Medicine, Pakistan, from April to July 2016. A total of n=30 females, aged 30-70 years, were recruited through non-probability convenient sampling technique and randomly allocated to the experimental and control group. The experimental group received STM and neck isometric strengthening exercises, whereas the control group received neck isometric strengthening exercises only. The Numeric Pain Rating Scale (NPRS) was used to assess the pain intensity, while Neck Disability Index (NDI) was used for the neck-related disability. The data was collected at the baseline, after the 4th session and after the 8th session. The repeated measure analysis of variance (RM ANOVA) was used to analyse within the group changes, while the independent t-test was used to analyse the differences between the groups. The data was analysed by using SPSS version 21.Results: The mean age of the study participants was 47.9 ± 8.95 years. Within groups’ changes showed that pain intensity, individual items of NDI and its total score showed significant improvement in both the groups from the baseline to the 8th session (p £ 0.05). After the 8th session, the experimental group showed more significant reduction (p £ 0.05) in pain intensity and neck disability as compared to the control group. Conclusions: Soft tissue mobilization when combined with neck isometric strengthening exercises was more effective than exercises alone for reducing the pain intensity and disability in females with tension neck syndrome. Keywords: Management, neck pain, physical therapy, soft tissue mobilization, strength training

EFFECTS OF MINDFULNESS VIDEOS AND PHYSICAL THERAPY ON DISABILITY OUTCOMES IN INDIVIDUALS WITH SPINE PAIN

PURPOSE: To determine the effect of mindfulness video engagement on the neck and back disability in individuals undergoing exercise-based physical therapy for spine pain. METHODS: Individuals undergoing a 6-9 week of supervised exercise-based rehabilitation were offered enrollment in a 4-week video-based daily mindfulness meditation program. Low back- and neck-related disability assessed with the Oswestry Disability Index (ODI) and Neck Disability Index (NDI) were compared across no (0), low (1-9), medium (10-19), and high (20-28) video engagement, using Analysis of Covariance. A receiver operating characteristic (ROC) curve was generated to identify a threshold for video engagement resulting in clinically significant reductions in disability (>10 points). RESULTS: A total of 342 individuals participated, with 23.3% (80) not engaging, 44.4% (152) with low engagement, 21% (72) with medium engagement, and 11.1% (38) with high engagement in mindfulness videos. Mean (SD) age was higher in the high engagement group compared to the no-engagement group (58 (15) vs 50 (18) years, p = 0.031), as was duration of pain (118 (143) vs 63 (99) months, p = 0.044). Body mass index (BMI) was greater in the low engagement group compared to the medium engagement group (27.9 (6) vs 25.6 (5) kg/m2, p = 0.035). There was a greater reduction in ODI in participants with high versus low engagement (11(15) vs 4(10) pts, p = 0.012) in the adjusted model, while no significant group differences were observed for NDI (p = 0.728). A threshold of 10 videos was identified to predict a clinically important reduction in ODI, with a sensitivity of 46% and a specificity of 72%; AUC = 0.59 (95%CI = .512-.665), p < 0.05). CONCLUSION: Greater engagement in mindfulness videos is associated with larger reductions in low back-, but not neck-related disability in individuals undergoing exercise-based physical therapy for spine pain. A minimum of 10 videos is recommended to achieve clinically important improvement.

Development and validation of the ND10 to measure neck-related functional disability

BackgroundPrevious neck-specific patient-reported outcome measures (PROMs) have tended to measure both symptoms and disability. This multi-staged study developed and evaluated a neck-specific PROM focusing on functional disability.MethodsThis study integrated findings from systematic reviews on neck-specific outcome measures, patient interviews, qualitative studies on neck disability, and iterative item testing to develop a 10-item measure of neck-related disability (ND10). Content validity was assessed by classifying items using the International Classification of Functioning, Disability and Health (ICF) and perspective linking. Patients (n = 78) with neck pain completed cognitive interviews, exploring items of the Neck Disability Index (NDI) and ND10, and completed structured questions related to literacy and relevance. Test–retest reliability and internal consistency were evaluated using intraclass correlation coefficients, Bland Altman graphs, and Cronbach’s alpha. Concurrent convergent validity was evaluated by comparing the ND10 to the NDI, Single Assessment Numeric Evaluation (SANE), and Disabilities of the Arm, Shoulder and Hand (DASH). Known group validity was determined by comparing ND10 scores from patients, who rated their neck as more or less than 1/2 of “normal” on the SANE, using t-tests.ResultsThe ND10 requires respondents to make rational judgements about their neck-related body function and disability. It has high internal consistency (0.94) and re-test reliability (0.87; SEM = 3.2/100; MDC = 7.5); and no re-test bias (mean re-test difference of 0.6). It followed expected correlation patterns, being highly correlated with related multi-item PROMs (r = 0.85–0.91), and moderately correlated to the single-item SANE. More patients agreed that the ND10 was easily readable than did so for the NDI (84% vs 68%; p < 0.05). All the PROMs distinguished the patients who perceived themselves as being abnormal/normal defined by a dichotomized SANE (p < 0.01).ConclusionThe ND10 is reliable and valid for measuring neck-related functional disability. Longitudinal and cross-cultural translation studies are needed to support future use.

P.229 Epidemiology and Outcomes of Neck Pain Following Surgery for Degenerative Cervical Radiculopathy

Background: Many studies have demonstrated improved arm pain (AP) following surgery for degenerative cervical radiculopathy (DCR); however, axial neck pain (NP) is generally not felt to improve. The purpose of this study was to determine whether surgery for DCR improves NP. Methods: A ambispective cohort study of the Canadian Spine Outcomes Research Network (CSORN) registry for patients who received 1-level, 2-level, 3-level ADCF (anterior cervical discectomy and fusion) or cervical disc arthroplasty (CDA) for DCR. Outcomes: 12-month post-operative Visual Analogue Scale for NP (VAS-NP), Neck Disability Index (NDI), VAS for AP (VAS-AP), Short-Form Physical Health Composite Scale (SF36-PCS), and Mental Health Composite Scale (SF36-MCS). Results: We identified 603 patients with DCR. CDA patients were the youngest (ANOVA; p&lt;0.001). Patients reported similar pre-operative AP, NP, disability, and health-related quality of life, regardless of procedure (ANOVA; all P&gt;0.05). All procedures offered a statistically significant reduction in VAS-NP, VAS-AP, and NDI (ANOVA; all P&lt;0.001). Mean change from baseline in NP, AP, and disability, were similar across procedures. At 12 months, mean reduction in VAS-AP, VAS-NP, and NDI exceeded minimal clinically important differences for nearly all procedures. Conclusions: Patients undergoing surgery for DCR can expect a clinically significant, approximate 50% reduction in NP, AP, and neck-related disability.

Neck Active Movements Assessment in Women with Episodic and Chronic Migraine.

We aimed to compare movement parameters and muscle activity during active cervical spine movements between women with episodic or chronic migraine and asymptomatic control. We also assessed the correlations between cervical movement measures with neck-related disability and kinesiophobia. Women with episodic (n = 27; EM) or chronic (n = 27; CM) migraine and headache-free controls (n = 27; CG) performed active cervical movements. Cervical range of motion, angular velocity, and percentage of muscular activation were calculated in a blinded fashion. Compared to CG, the EM and CM groups presented a reduced total range of motion (p < 0.05). Reduced mean angular velocity of cervical movement was also observed in both EM and CM compared to CG (p < 0.05). Total cervical range of motion and mean angular velocity showed weak correlations with disability (r = −0.25 and −0.30, respectively; p < 0.05) and weak-to-moderate correlations with kinesiophobia (r = −0.30 and −0.40, respectively; p < 0.05). No significant correlation was observed between headache features and total cervical range of motion or mean angular velocity (p > 0.05). No differences in the percentage of activation of both flexors and extensors cervical muscles during active neck movements were seen (p > 0.05). In conclusion, episodic and chronic migraines were associated with less mobility and less velocity of neck movements, without differences within muscle activity. Neck disability and kinesiophobia are negative and weakly associated with cervical movement.

Thoracic spine thrust manipulation for individuals with cervicogenic headache: a crossover randomized clinical trial

ABSTRACT Objective To determine if thoracic spine manipulation (TSM) improves pain and disability in individuals with cervicogenic headache (CeH). Methods: A randomized controlled crossover trial was conducted on 48 participants (mean age: 34.4 years) with CeH symptoms. Participants were randomized to 6 sessions of TSM or no treatment (Hold) and after 4-weeks, groups crossed over. Outcomes were collected at 4, 8 and 12 weeks and included: headache disability inventory (HDI), neck disability index (NDI), and the global rating of change (GRC). Outcomes were analyzed using a linear mixed-effects model with Bonferroni correction. Odds of achieving the minimal clinically important difference (MCID) on the GRC of +4 or greater were also calculated. Scores at 4 weeks represent the only timepoint where 1 group is fully treated and other group has not received any treatment. Results: Comparing hold to active treatment, HDI were not significantly different between groups (mean difference = 7.39, 95 CI: −4.39 to 19.18; P = 0.214) at any timepoint; the NDI was significant (mean difference = 6.90, 95 CI: 0.05 to 13.75; P = 0.048) at 4 weeks. Odds of achieving the +4 MCID on the GRC (OR = 38.0, 95 CI: 6.6 to 220.0; p < 0.001) favored TSM at 4 weeks. Conclusion: TSM had no effect on headache-related disability but resulted in significant improvements in neck-related disability and participant reported perceived improvement. Future studies are needed to examine the long-term impact of TSM in this population.

Musculoskeletal Pain and Disability in Sonographers: More Than an Ergonomic Issue

Sonographers, compared with peer employees, are more likely to experience musculoskeletal pain, 1 a problem of substantial burden. A recent report showed that musculoskeletal symptoms resulted in $6.6 million in working days lost. 2 To inform the development of sonographer-targeted management strategies, in this study we aimed to examine (1) the 1-year prevalence and distribution of interfering musculoskeletal symptoms in the upper body in sonographers; (2) the association of individual, work-related, and psychosocial factors with the presence of multisite interfering symptoms; and (3) the severity of neck-related disability.

Can Headache Profile Predict Future Disability: A Cohort Study.

The aim of this study was to determine if headache profile can predict future disability in patients with tension-type headache (TTH). Eighty-three individuals with TTH were recruited. To be included in the study participants needed to fulfill the International Headache Society classification's criteria for episodic or chronic TTH form and to be at least 18 years old. Baseline clinical outcomes (headache and neck-related disability, kinesiophobia, self-efficacy, and anxiety) and physical outcomes (neck extensors muscles maximum voluntary contraction) were collected for all participants. A prospective data collection of headache characteristics (intensity and frequency) was conducted using daily SMS or e-mail over a 1-month period. Headache-related disability was assessed at the 3-month follow-up and was used as the disability criterion for TTH. Correlations showed that the number of years with headache (r=0.53, P<0.001), self-reported neck pain intensity (r=0.29, P=0.025), headache frequency (r=0.60, P<0.001) and intensity (r=0.54, P<0.001), anxiety (r=0.28; P=0.031), as well as neck-related disability (r=0.64, P<0.001) were correlated to headache-related disability assessed at 3 months. Multiple regression showed that these determinants can be used to predict headache disability (R =0.583). Headache frequency (β=0.284) was the best individual predictor. Results showed that TTH frequency and intensity and the presence of concomitant infrequent migraine are predictors of future disability over a 3-month period. Further studies are needed to evaluate the contribution of other potential physical outcomes on headache-related disability.

Improvements in Neck Pain and Disability Following C1-C2 Posterior Cervical Instrumentation and Fusion for Atlanto-Axial Osteoarthritis

Symptomatic Atlanto-axial (C1-2) osteoarthritis (AAOA) is a common phenomenon in elderly patients; however, there is a paucity of data on the effectiveness of posterior atlanto-axial fusion (PAAF) for this condition. To this end, here we assess changes in patient-reported outcomes and neck-related disability in adult patients undergoing PAAF for symptomatic C1-2 AAOA. In this retrospective study, the clinical records of consecutive patients with symptomatic AAOA who underwent PAAF between 2004 and 2017 were reviewed. Patient demographics, comorbidities, intraoperative and postoperative variables, and complication rates were collected. Neck Disability Index (NDI) scores were recorded at baseline and 6 weeks, 6 months, 1 year, and 2 years postoperatively. Forty-two patients (average age, 72.04 ± 8.56 years; 26.19% males) met the study's inclusion criteria. In this cohort, 19.04% had previous subaxial cervical spine surgery, 35.71% had a history of smoking (all had stopped smoking before surgery), and 11.90% had type II diabetes. At baseline, the majority of patients had a normal neurologic exam. The average preoperative NDI score was 26.88 ± 24.85, which improved to 10.59 ± 14.88 at the 1-year follow-up and 13.20 ± 14.96 at the 2-year follow-up (P=0.004). At baseline, 18% of the patients reported severe disability based on NDI score; this percentage decreased to 2% at 1 year and 0 at 2 years (P= 0.01). Importantly, a high percentage (11.90%) of patients had undergone previous subaxial cervical fusion for their pain due to a mistaken diagnosis for this condition, without symptom relief. In appropriately selected patients, PAAF may decrease neck pain and improve functional disability in patients with AAOA. Future prospective longitudinal studies are needed to corroborate these findings.

Short- or Long-Term Treatment of Spinal Disability in Older Adults With Manipulation and Exercise.

Back and neck pain are associated with disability and loss of independence in older adults. Whether long-term management using commonly recommended treatments is superior to shorter-term treatment is unknown. This randomized clinical trial compared short-term treatment (12 weeks) versus long-term management (36 weeks) of back- and neck-related disability in older adults using spinal manipulative therapy (SMT) combined with supervised rehabilitative exercises (SRE). Eligible participants were ages ≥65 years with back and neck disability for ≥12 weeks. Coprimary outcomes were changes in Oswestry Disability Index (ODI) and Neck Disability Index (NDI) scores after 36 weeks. An intent-to-treat approach used linear mixed-model analysis to detect between-group differences. Secondary analyses included other self-reported outcomes, adverse events, and objective functional measures. A total of 182 participants were randomized. The short-term and long-term groups demonstrated significant improvements in back disability (ODI score -3.9 [95% confidence interval (95% CI) -5.8, -2.0] versus ODI score -6.3 [95% CI -8.2, -4.4]) and neck disability (NDI score -7.3 [95% CI -9.1, -5.5] versus NDI score -9.0 [95% CI -10.8, -7.2]) after 36 weeks, with no difference between groups (back ODI score 2.4 [95% CI -0.3, 5.1]; neck NDI score 1.7 [95% CI 0.8, 4.2]). The long-term management group experienced greater improvement in neck pain at week 36, in self-efficacy at weeks 36 and 52, and in functional ability, and balance. For older adults with chronic back and neck disability, extending management with SMT and SRE from 12 to 36 weeks did not result in any additional important reduction in disability.

11. Predicting disability and pain outcomes one year after elective surgery for degenerative cervical diseases: analysis from quality outcomes database

BACKGROUND CONTEXT In the current era of value-based health care reform, engaging patients in shared decision-making for treatment planning is imperative. Predictive models capable of providing individualized predictions of patient-reported outcomes (PROs) following cervical spine surgery have the potential to be valuable tools for a shared decision-making process. PURPOSE The aim of the study is to develop and validate predictive models for 12-month postoperative disability, pain, and myelopathy outcomes in patients undergoing elective spine surgery for degenerative cervical diseases (radiculopathy and myelopathy). STUDY DESIGN/SETTING This study is a retrospective analysis of prospectively collected data from the cervical module of a national spine registry, the Quality Outcomes Database (QOD). PATIENT SAMPLE Patients undergoing cervical spine surgery for the diagnosis of radiculopathy or myelopathy with degenerative etiologies are eligible for inclusion in the QOD registry. OUTCOME MEASURES The outcomes of interest in this study were neck related disability (NDI), pain [NRS- neck pain (NP) and arm pain (AP)] and modified Japanese Orthopedic Association score for myelopathy (mJOA). METHODS Two distinct sets of multivariable proportional odds ordinal regression models were developed with the outcomes of interest of disability (NDI), pain (NRS-NP and NRS-AP) and myelopathy (mJOA) score in the myelopathy cohort and disability (NDI) and pain (NRS-NP and NRS-AP) in the radiculopathy cohort. Patient characteristics of age, gender, BMI, race, education level, smoking status, history of diabetes, anxiety and depression, symptom duration, motor deficit or numbness at presentation, preoperative imaging finding of listhesis, employment status, workers’ compensation, insurance status, and ambulatory ability, baseline PROs as well as surgery-specific variables of number of levels, arthrodesis, and surgical approach were included in the models. The models were internally validated using bootstrap resampling. RESULTS A total of 5,076 patients who underwent surgery for cervical radiculopathy and 2717 patients who underwent surgery for cervical myelopathy were included in fitting the models for the distinct set of outcomes. There was a significant improvement in all PROs at 12 months after surgery (P CONCLUSIONS These predictive models can provide individualized risk-adjusted estimates of 12-month disability, pain, and myelopathy outcomes for patients undergoing spine surgery for degenerative cervical diseases. Novel predictive models constructed with these data hold the potential to guide individualized patient discussions on postsurgical outcomes and expectations. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Functional Outcome of Elderly Patients Treated for Odontoid Fracture: A Multicenter Study.

Retrospective multicenter study. Analysis of impact of conservative and surgical treatments on functional outcome of geriatric odontoid fractures. Treatment of odontoid fractures in aged population is still debatable. One hundred fourty-seven consecutive odontoid fractures in elderly patients were classified according to Anderson-D'Alonzo and Roy-Camille classifications. Philadelphia type collar was always positioned and kept as a treatment whenever acceptable. Halo-vest, anterior screw fixation, C1-C2 posterior arthrodesis, and occipito-cervical fixation were the other treatments adopted. Conservative or surgical treatment strategy was more significantly influenced by antero-posterior displacement (< or >5 mm) and by surgeon decision. On admission ASA, modified Rankin scale (mRS-pre) and Charlson Comorbidity Index (CCI) were assessed. Modified Rankin scale (mRS-post), Neck Disability Index (NDI), and Smiley Webster Pain Scale (SWPS) were administered 12 to 15 months after treatment to estimate functional outcome in terms of general disability, neck-related disability, and ability to return to work/former activity. Risk of treatment crossover was calculated considering factors affecting outcome. Fracture healing process in terms of fusion-stability, no fusion-stability, no fusion-no stability was evaluated at 12 months through a cervical computed tomography (CT) scan. Dynamic cervical spine x-rays were obtained whether necessary. No fusion-stability was considered an adequate treatment goal in our geriatric population. Chi square/Fisher exact test and logistic regression were performed for statistical anal. Overall 67 patients were treated conservatively whereas 80 underwent surgery. Collar was adopted in 45 patients, while anterior odontoid fixation and C1-C2 posterior arthrodesis were preferred for 30 patients each. 79.8% of patients showed good outcomes according to NDI. No significant differences were observed between patients of 65 to 79 years and more than or equal to 80 years (P = 0.81). CCI greatly correlated with mRS-post, with higher indexes in 68.8% of cases characterized by good outcomes (P = 0.05). mRS-pre correlated with NDI (P < 0.000001) and mRS-post (P = 0.04). CCI, mRS-pre, and surgery were associated with worse NDI, while both C1-C2 posterior arthrodesis and occipito-cervical stabilization were associated with worse mRS-post, respectively in 40% and 30% of cases. Younger patients had a higher risk of treatment crossover. mRS-pre and CCI provided two independent predictive values respectively for functional outcome and post-treatment disability. Compared with conservative immobilizations, surgery revealed no advantages in the elderly in terms of functional outcome. 3.

Deep Learning Convolutional Neural Networks for the Automatic\xa0Quantification of\xa0Muscle Fat Infiltration Following Whiplash Injury

Muscle fat infiltration (MFI) of the deep cervical spine extensors has been observed in cervical spine conditions using time-consuming and rater-dependent manual techniques. Deep learning convolutional neural network (CNN) models have demonstrated state-of-the-art performance in segmentation tasks. Here, we train and test a CNN for muscle segmentation and automatic MFI calculation using high-resolution fat-water images from 39 participants (26 female, average = 31.7 ± 9.3 years) 3 months post whiplash injury. First, we demonstrate high test reliability and accuracy of the CNN compared to manual segmentation. Then we explore the relationships between CNN muscle volume, CNN MFI, and clinical measures of pain and neck-related disability. Across all participants, we demonstrate that CNN muscle volume was negatively correlated to pain (R = −0.415, p = 0.006) and disability (R = −0.286, p = 0.045), while CNN MFI tended to be positively correlated to disability (R = 0.214, p = 0.105). Additionally, CNN MFI was higher in participants with persisting pain and disability (p = 0.049). Overall, CNN’s may improve the efficiency and objectivity of muscle measures allowing for the quantitative monitoring of muscle properties in disorders of and beyond the cervical spine.