Interscapular Pain after Anterior Cervical Discectomy and Fusion: Does Zygapophyseal Joints over Distraction Play a Role?

Introduction: Anterior cervical discectomy and fusion (ACDF) for cervical disc herniation (CDH) is commonly performed. Specific post-operative complications include dysphagia, dysphonia, cervicalgia, adjacent segment disorder, cage subsidence, and infections. However, interscapular pain is commonly reported by these patients after surgery, although its mechanisms have not been clarified yet. Methods: This retrospective series of 31 patients undergoing ACDF for CDH at a single Academic Hospital. Baseline and post-operative clinical, radiological, and surgical data were analyzed. The linear regression analysis was conducted to identify any factor independently influencing the incidence rate of post-operative interscapular pain. Results: The mean age was 57.6 ± 10.8 years, and the M:F ratio was 2.1. Pre-operative mean VAS-arm was 7.15 ± 0.81 among the 20 patients reporting brachialgia, and mean VAS-neck was 4.36 ± 1.43 among those 9 patients reporting cervicalgia. At 1 month, interscapular pain was still reported by 8 out of the 17 patients who experienced it post-operatively, and it was recovered in all patients after 2 months. The regression analysis showed that interscapular pain was not directly associated with age (p = 0.74), gender (p = 0.46), smoking status (p = 0.44), diabetes (0.42), pre-operative brachialgia (p = 0.21) or cervicalgia (p = 0.48), symptoms duration (p = 0.13), baseline VAS-arm (p = 0.11), VAS-neck (p = 0.93), or mJOA (p = 0.63) scores, or disc height modification (p = 0.90). However, the post-operative increase in the mean zygapophyseal joint rim distance was identified as an independent factor in determining interscapular pain (p = 0.02). Conclusions: Our study revealed that the onset of interscapular pain following ACDF may be determined by over distraction of the zygapophyseal joint rim. Then, proper sizing of prosthetic implants could reduce this painful complication.

Mapping of Neck Disability Index domains linked to the international classification of functioning and disability / Mapeamento dos domínios do neck disability index vinculados à classificação internacional de funcionalidade e incapacidade

Objective: This study aims to link NDI items to CIF using specific and up-to-date linking rules. Methods: It is a measurement properties analysis study in which two evaluators performed the link between NDI and CIF, both with experience in CIF taxonomy and NDI application. Thus, ten binding rules developed and updated specifically for binding the ICF to other instruments were applied. Results: The Kappa coefficient determined the level of agreement between the evaluators with a confidence interval of 95%. All NDI items were linked to ICF codes; there was no need to use the term "non-definable." The degree of agreement between the evaluators about the domains and the categories of the ICF's first, second, and third levels was almost perfect. Conclusion: Therefore, the NDI is well linked to the codes related to the ICF domains' Activity, Participation, Functions, and Structure. However, no concepts related to contextual factors were identified.

Objetivo: Este estudo visa vincular itens da NDI ao CIF usando regras de vinculação específicas e atualizadas. Métodos: É um estudo de análise de propriedades de medição no qual dois avaliadores realizaram a ligação entre NDI e CIF, ambos com experiência em taxonomia CIF e aplicação de NDI. Assim, foram aplicadas dez regras de vinculação desenvolvidas e atualizadas especificamente para vincular a ICF a outros instrumentos. Resultados: O coeficiente Kappa determinou o nível de concordância entre os avaliadores com um intervalo de confiança de 95%. Todos os itens do NDI estavam vinculados a códigos ICF; não havia necessidade de utilizar o termo "não definível". O grau de concordância entre os avaliadores em relação aos domínios e às categorias do primeiro, segundo e terceiro níveis da ICF foi caracterizado como quase perfeito. Conclusão: Portanto, o NDI está bem ligado aos códigos relacionados à Atividade, Participação, Funções e Estrutura dos domínios da ICF. Entretanto, não foram identificados conceitos relacionados a fatores contextuais.

Osteopathic Manipulative Treatment for Chronic Neck Stiffness After a Motor Vehicle Collision: A Case Report.

Neck pain is a multifactorial condition, and one common cause is cervical spine injury related to motor vehicle collision (MVC). Injuries from MVCs range from whiplash to cervical spine fracture and can manifest in various ways including neck stiffness, decreased range of motion, and neurological deficits. One method of management currently underutilized is osteopathic manipulative treatment (OMT), which can be used to treat pain and range of motion deficits resulting from MVCs. While a few studies in the literature have documented a statistically significant benefit of OMT in chronic pain syndromes, there is little data on its effectiveness in treating patients after MVCs. We present a case of a 25-year-old male who first came to the OMT clinic in January 2021 with complaints of neck pain and stiffness that he attributed to an MVC in February 2020. The collision had led to a loss of consciousness, a concussion, ligamentous injury, and a C5 vertebral fracture. At the OMT clinic, the patient complained of daily headaches associated with "flashes of numbness" throughout his whole body and neck stiffness. The patient was treated initially with a full course of physical therapy, but his symptoms plateaued. He has received OMT about once a month for the past two years. He reported an improved range of motion, no further pain, and decreased neurological symptoms at his most recent visit in October 2023. There is scarce high-quality research demonstrating the effectiveness of OMT. To the best of our knowledge, this is the first study in the literature to document the use of OMT to treat a patient with a history of cervical fracture with chronic pain and stiffness after an MVC. The closest correlate found during our review of the literature was a case report outlining the successful treatment of post-concussion syndrome after an MVC. Based on the improvement of refractory neck pain and range of motion our patient gained from OMT, further research involving randomized controlled trials needs to be conducted on this topic.

Real time ultrasound imaging shows changes in deep neck flexor activation during exercise in individuals with mechanical neck pain.

BACKGROUND: Deep neck flexor muscle atrophy and increased superficial neck muscle activation are associated with disability and pain intensity in individuals with neck pain. There is a lack of evidence to support direct assessment of deep neck flexor muscles in a non-invasive way during exercise performance to help determine the effectiveness of different neck strengthening exercises. OBJECTIVE: Compare longus colli (LC) and sternocleidomastoid (SCM) activation between individuals with and without neck pain using real time ultrasound (RTUS) during a series of craniocervical exercises. METHODS: This cross-sectional cohort study recruited 10 control and 10 neck pain participants to complete four deep neck flexor activation activities involving varying levels of craniocervical flexion. Dimensions of the LC and SCM were measured using RTUS at rest and during exercise. Independent t-tests assessed baseline differences and analysis of variance examined activation changes. RESULTS: At rest, the neck pain group had significantly smaller cross-sectional area and thickness of the LC compared to the control group (p< 0.05). During exercise, the neck pain group showed significantly larger increases in LC thickness and cross-sectional area across exercise compared to the control group, with no differences in SCM activation between groups. CONCLUSIONS: Despite atrophy, individuals with neck pain can activate their deep neck flexor muscles appropriately without activating their superficial neck flexor muscles in a supine series of craniocervical flexion exercise as measured by non-invasive ultrasound imaging.

Prevalence of cervical pain in adults in the city of aracaju, sergipe, brazil / Prevalência de dor cervical em adultos da cidade de aracaju, sergipe, brasil / Prevalencia de dolor cervical en adultos de la ciudad de aracaju, sergipe, brasil

ABSTRACT Objective: To estimate the current and last 12-month prevalence of cervical pain (CP) in adults in Aracaju, Sergipe, Brazil. Method: Cross-sectional study with 242 adults aged between 18 and 59 living in urban areas. Sociodemographic data, one-time and 12-month CD prevalence, pain intensity assessed using the Numerical Pain Scale, and functional limitation using the Neck Disability Index were evaluated. Results: The prevalence of punctual CD at the interview was 27.7%, while 66.1% had felt pain in the last 12 months. Of the people who felt punctual CP at the time of the interview, the mean pain intensity was 6±4.76, and 82% had a functional disability (mild, moderate, or severe). Conclusion: The prevalence of punctual CD in the last 12 months was high among adults, pain intensity was moderate, and functional disability was mild. Our results demonstrate that the prevalence of cervical pain in adults is high and can influence several aspects of a person's life. Level of Evidence IV; Observational, Randomized and Cross-Sectional Study.

Resumo: Objetivo: Estimar a prevalência da dor cervical (DC) atual e nos últimos 12 meses em adultos, na cidade de Aracaju, Sergipe, Brasil. Método: Estudo transversal com 242 adultos entre 18 e 59 anos residentes na área urbana. Foram avaliados os dados sociodemográficos, prevalência da DC pontual e em 12 meses, intensidade da dor avaliada por meio da Escala Numérica da Dor e a limitação funcional pelo Neck Disability Index. Resultados: A prevalência de DC pontual no momento da entrevista foi de 27,7%, enquanto 66,1% sentiram dor nos últimos 12 meses. Das pessoas que sentiam DC pontual no momento da entrevista, a média de intensidade da dor foi 6±4,76 e 82% apresentavam incapacidade funcional (leve, moderada ou forte). Conclusão: A prevalência de DC pontual e nos últimos 12 meses foi alta entre os adultos, a intensidade de dor foi moderada e incapacidade funcional leve. Nossos resultados demonstram que a prevalência de dor cervical em adultos é alta e pode influenciar diversos aspectos na vida da pessoa. Nível de Evidência IV; Estudo Observacional, Aleatório e Transversal. A prevalência de DC pontual e nos últimos 12 meses foi alta entre os adultos, a intensidade de dor foi moderada e incapacidade funcional leve. Nossos resultados demonstram que a prevalência de dor cervical em adultos é alta e pode influenciar diversos aspectos na vida da pessoa. Nível de Evidência IV; Estudo Observacional, Aleatório e Transversal.

Resumen: Objetivo: Estimar la prevalencia del dolor cervical (DC) actual y en los últimos 12 meses en adultos, en la ciudad de Aracaju, Sergipe, Brasil. Método: Estudio transversal con 242 adultos entre 18 y 59 años residentes en zona urbana. Se evaluaron datos sociodemográficos, prevalencia puntual y de 12 meses de DC, intensidad del dolor evaluada mediante la Escala Numérica de Dolor y limitación funcional mediante el "Neck Disability Index". Resultados: La prevalencia de DC puntual al momento de la entrevista fue del 27,7%, mientras que el 66,1% había sentido dolor en los últimos 12 meses. De las personas que sintieron parálisis cerebral ocasional en el momento de la entrevista, la intensidad media del dolor fue de 6±4,76 y el 82% tenía discapacidad funcional (leve, moderada o grave). Conclusión: La prevalencia de DC específica y en los últimos 12 meses fue alta entre los adultos, la intensidad del dolor fue moderada y la discapacidad funcional fue leve. Nuestros resultados demuestran que la prevalencia del dolor cervical en adultos es alta y puede influir en varios aspectos de la vida de una persona. Nivel de Evidencia IV; Estudio Observacional, Aleatorizado y Transversal.

Multimodal analgesia versus patient-controlled analgesia in the management of acute postoperative spinal pain: systematic review and meta-analysis / Analgesia multimodal versus analgesia controlada pelo paciente no tratamento da dor aguda pós-operatória da coluna: revisão sistemática e meta-análise

ABSTRACT BACKGROUND AND OBJECTIVES: Spine diseases have a high annual prevalence and are the main causes of years lived with disability and chronic pain. Among the postoperative analgesic control options, patient-controlled analgesia (PCA) and multimodal analgesia (MMA) have shown good clinical results. This meta-analysis seeks new evidence to help in the treatment of acute postoperative pain in patients undergoing spinal surgery. CONTENTS: The following databases were used: Cochrane Central Register of Controlled Trials, Medline and Embase. Studies that compared two post-surgical analgesic interventions were included; MMA and PCA. The parameters evaluated were: analgesic effect; opioid consumption; length of hospital stay; and adverse effects. Registration of the systematic review protocol: (PROSPERO CRD42023446627). There was no statistical difference when assessing analgesic improvement comparing MMA to PCA (MD -0.12 [-0.41, 0.17] 95%CI with p=0.69). There was a statistical difference, with lower opioid consumption in MMA compared to PCA (MD -3.04 [-3.69, -2.39] 95%CI with p=0.0002). Statistically significant difference regarding length of hospital stay in favor of MMA (MD -13.17 [-16.98, -9.36] 95%CI with p=0.00001), and significantly lower incidence of nausea and vomiting in patients undergoing MMA in compared to PCA (OR 0.26 [0.11, -0.64] 95%CI with p=0.003). CONCLUSION: MMA was equivalent to PCA in the treatment of acute postoperative spinal pain, with the significant clinical advantage and safety of lower amounts of infused opioids, shorter hospital stay and lower incidence of adverse effects.

RESUMO JUSTIFICATIVA E OBJETIVOS: As doenças da coluna apresentam alta prevalência anual e são as principais causas de anos vividos com incapacidade e de cronificação da dor. Dentre as opções de controle analgésico pós-operatória, a analgesia controlada pelo paciente (ACP) e a analgesia multimodal (AMM) apresentam bons resultados clínicos. O objetivo deste estudo foi buscar novas evidências que auxiliem no tratamento da dor aguda no pós-operatório do paciente submetido à cirurgia da coluna. CONTEÚDO: As bases de dados utilizadas: Cochrane Central Register of Controlled Trials, Medline e Embase. Foram incluídos estudos que compararam duas intervenções analgésicas pós-cirúrgicas; AMM e ACP. Os parâmetros avaliados foram: efeito analgésico; consumo de opioide; tempo de internação hospitalar e efeitos adversos. Registro do protocolo de revisão sistemática: (PROSPERO CRD42023446627). Não houve diferença estatística quando avaliadas a melhora analgésica comparando a AMM à ACP (MD -0,12 [-0,41, 0,17] 95%CI com p=0,69). Houve diferença estatística, com menor consumo de opioide na AMM em comparação à ACP (MD -3,04 [-3,69, -2,39] 95%IC com p=0,0002). Diferença estatística significativa com relação ao tempo de permanência hospitalar a favor da AMM (MD -13,17 [-16,98, -9,36] 95%IC com p=0,00001), e incidência significativamente menor de náuseas e vômitos nos pacientes submetidos a AMM em comparação a ACP (OR 0,26 [0,11, -0,64] 95%IC com p=0,003). CONCLUSÃO: A AMM foi equivalente à ACP no tratamento da dor aguda pós-operatória da coluna, com a significativa vantagem clínica e a segurança de menores quantidades de opioides infundidos, menor tempo de internação hospitalar e menor incidência de efeitos adversos.

[Febrile cervicalgia revealing infectious epiduritis : a case report]. / Cas clinique. Cervicalgies fébriles révélatrices d'une épidurite infectieuse.

Infectious epiduritis and epidural abscesses are relatively rare pathologies but with important neurological consequences. A low incidence associated with an insidious clinical presentation leads to frequent delays in diagnosis, which worsen the prognosis of patients with the development of neurological deficits. While the evaluation of risk factors, a careful clinical examination and biological tests can guide to the diagnosis, the key examination remains magnetic resonance imaging (MRI) while lumbar puncture remains contraindicated. Although surgery (spinal decompression) has long been the treatment of choice, the current management of patients with infectious epiduritis is debated between surgery and conservative treatment with systemic antibiotic therapy.

Les épidurites infectieuses et les abcès épiduraux sont des pathologies relativement rares, mais avec des conséquences neurologiques redoutables. Une faible incidence et une présentation clinique souvent insidieuse engendrent de fréquents retards de diagnostic qui péjorent le pronostic des patients avec le développement de déficits neurologiques. Si l'évaluation des facteurs de risque, un examen clinique scrupuleux et des analyses biologiques peuvent guider vers le diagnostic, l'examen-clé reste l'imagerie par résonance magnétique (IRM). La ponction lombaire est contre-indiquée. Bien que l'approche chirurgicale ait longtemps été le traitement de choix, un traitement plus conservateur basé sur une antibiothérapie systémique est également discuté.

Uso de dispositivos móviles y alteraciones cervicales en estudiantes universitarios / Use of mobile devices and cervical disorders in university students / Uso de dispositivos móveis e distúrbios cervicais em estudantes universitários

Las alteraciones cervicales son un problema multifactorial que afecta a la sociedad moderna. Posturas viciosas, traumatismos y defectos congénitos relacionados con la columna cervical pueden desarrollar inestabilidad, pinzamiento radicular, cervicoartrosis y cervicalgias. Objetivo. Relacionar el uso de dispositivos móviles con las alteraciones cervicales en estudiantes universitarios. Materiales y métodos. Estudio descriptivo, observacional, que se realizó entre los meses de mayo y julio del 2023, cuya muestra fue de 172 estudiantes universitarios que se obtuvo aplicando la fórmula para el cálculo muestral de poblaciones conocidas, mediante un muestreo no probabilístico. Se utilizó el test goniométrico para medir el rango articular, el test postural para identificar las alteraciones posturales, la técnica de palpación para identificar dolor inespecífico, prueba de resistencia para los músculos flexores (NFMET) y extensores (NEET), por último, se realizó la prueba de Spurling para identificar casos de radiculopatías. Resultados. Aunque las relaciones estadísticas no fueron consistentes, se observó que quienes utilizaron más tiempo los teléfonos celulares (87,0%) mostraron más limitaciones cervicales que los usuarios menos frecuentes (73,5%). La movilidad articular fue limitada en el 84,3% de la población, especialmente en varones (93,5%); la resistencia muscular normal en extensión fue más prevalente en el caso de los hombres (84,9%), mientras que la resistencia alterada en flexión fue más prevalente en mujeres (94,9%). Conclusiones. Según los resultados obtenidos en esta investigación, no se encontró suficiente evidencia para determinar una relación estadísticamente significativa (P˃0,05) entre las alteraciones cervicales y el uso de teléfonos celulares, aunque se observó una mayor limitación en el caso de quienes más tiempo utilizaban el dispositivo móvil.

Cervical disorders are a multifactorial problem affecting modern society. Vicious postures, trauma and congenital defects related to the cervical spine can develop instability, radicular impingement, cervicoarthrosis and cervicalgia. Objective. To relate the use of mobile devices with cervical disorders in university students. Materials and methods. Descriptive, observational study carried out between May and July 2023, with a sample of 172 university students obtained by applying the formula for the sample calculation of known populations, by means of non-probabilistic sampling. The goniometric test was used to measure joint range, the postural test to identify postural alterations, the palpation technique to identify non-specific pain, resistance test for flexor (NFMET) and extensor (NEET) muscles, and finally, the Spurling test was performed to identify cases of radiculopathy. Results. Although the statistical relationships were not consistent, it was observed that those who used cell phones longer (87.0%) showed more cervical limitations than less frequent users (73.5%). Joint mobility was limited in 84.3% of the population, especially in men (93.5%); normal muscular endurance in extension was more prevalent in men (84.9%), while impaired endurance in flexion was more prevalent in women (94.9%). Conclusions. According to the results obtained in this investigation, there was not enough evidence to determine a statistically significant relationship (P˃0.05) between cervical alterations and cell phone use, although a greater limitation was observed in the case of those who used the mobile device the longest.

Os distúrbios cervicais são um problema multifatorial que afeta a sociedade moderna. Posturas viciosas, traumas e defeitos congênitos relacionados à coluna cervical podem levar a instabilidade, impacto radicular, cervicoartrose e cervicalgia. Objetivo. Relacionar o uso de dispositivos móveis com distúrbios cervicais em estudantes universitários. Materiais e métodos. Estudo descritivo, observacional, realizado entre maio e julho de 2023, com uma amostra de 172 estudantes universitários obtida pela aplicação da fórmula para o cálculo de amostras de populações conhecidas, por meio de amostragem não probabilística. Foram utilizados o teste goniométrico para medir a amplitude articular, o teste postural para identificar alterações posturais, a técnica de palpação para identificar dores inespecíficas, o teste de resistência para músculos flexores (NFMET) e extensores (NEET) e o teste de Spurling para identificar casos de radiculopatia. Resultados. Embora as relações estatísticas não tenham sido consistentes, observou-se que aqueles que usavam telefones celulares por mais tempo (87,0%) apresentavam mais limitações cervicais do que os usuários menos frequentes (73,5%). A mobilidade articular foi limitada em 84,3% da população, especialmente no sexo masculino (93,5%); a resistência muscular normal em extensão foi mais prevalente no sexo masculino (84,9%), enquanto a resistência prejudicada em flexão foi mais prevalente no sexo feminino (94,9%). Conclusões. De acordo com os resultados obtidos nesta pesquisa, não houve evidências suficientes para determinar uma relação estatisticamente significativa (P˃0,05) entre os distúrbios cervicais e o uso de telefones celulares, embora tenha sido observada uma limitação maior no caso daqueles que usaram o dispositivo móvel por períodos mais longos.

The Impact of the Addition of a Physical Therapy Assistant to the Treatment Team for Management of Neck Pain: A Retrospective Analysis of Outpatient Physical Therapy Clinics.

Introduction The impact of physical therapy assistants (PTAs) on patient outcomes, mostly in the acute and subacute setting, is well known in the literature. However, no study to date has examined the impact of using PTAs as part of a treatment team in the outpatient setting for common musculoskeletal conditions. The purpose of this study is to determine if physical therapy team composition, either physical therapists (PTs) only or a team consisting of PTs and PTAs, has a significant impact on patient outcomes in adult patients with musculoskeletal neck pain to help investigate an ideal practice pattern for outpatient physical therapy. Methods This is a retrospective cohort study analyzing the impact of physical therapy treatment team composition (PTs only, or team consisting of PTs and PTAs) on pain, active range-of-motion (AROM), and disability outcomes via the Neck Disability Index (NDI) in the conservative treatment of neck pain. All patients were treated with usual physical therapy care. Inclusion criteria involved patients with a diagnosis of neck pain (M48.2), older than 18 years old, a physical therapy evaluation procedure code (97161, 97162, 97163), and at least two visits per bout of physical therapy. Primary outcome measures were pain, bilateral rotation AROM, disability, and number of visits.  Results Included patients (n=195) had an average age of 60.8 years ± 16.1 years with an average number of total physical therapy visits of 7.4 visits ± 4.3 visits (range, 2 visits - 22 visits) with 120 patients (61.5%) treated by a PT only (PT-only group) and 75 patients (38.5%) treated by a team consisting of a PT and a PTA (PTA group). The PT-only group had significantly fewer visits than the PTA group (p<0.001). The PT-only group had a pain improvement of 2.1 points ± 2.3 points whereas the PTA group had a pain improvement of 2.2 points ± 2.4 points with no significant difference between the two groups (p=0.573). The PT-only group (n=46 patients) had an average rotation AROM improvement of 20.0 ± 17.4 degrees whereas the PTA group (n=40 patients) had an average rotation AROM improvement of 16.8 degrees ± 23.0 degrees with no significant difference between the level of rotation AROM improvement between the two groups (p=0.408). Furthermore, there was also no significant difference in the amount of NDI improvement seen in both groups (p=0.594). Conclusion There was no significant difference in patient outcomes for pain, AROM, and disability when PTAs were added to the physical therapy treatment team in the conservative management of neck pain in the outpatient setting. However, patients treated with a treatment team consisting of PTAs had significantly more visits, despite no significant change in outcomes. Randomized controlled trials are needed as the reasons for these findings can be many and require further research.

Remission of Dowager's hump by manipulative correction of spinal alignment: a case report.

Dowager's hump is described as excessive kyphotic curvature in the thoracic spine with a Cobb angle of more than 40 degrees. This case report presents a 61 years old female office clerk who experienced headaches and neck pain for 3 years that extended into her right shoulder and upper chest. She consulted her primary care physician two months before seeing the chiropractor when the neck pain worsened. A diagnosis of cervicalgia related to osteoarthritis was made based on cervical and thoracic X-ray findings. The patient received non-steroid anti-inflammatory drugs (celecoxib and etoricoxib) and stretching exercises at home. At the onset of chiropractic care, radiographs showed loss of cervical lordosis, narrowing at the C4-5, C5-C6, and C6-7 intervertebral disc space with marginal osteophytes. Based on these findings, a working diagnosis of cervicogenic headache was established. After treatment for 9 months, the patient showed improvement in symptoms and function from cervical curve radiographic change and dextro-convexity of the thoracic spine. Avoiding forward head flexion and maintaining correct posture in daily activities will be key mechanisms to prevent the reoccurrence of Dowager's hump. The improvement of symptoms following chiropractic therapy has been shown to correlate with radiographic markers of spinal realignment.

The impact of neck pain on gait health: a systematic review and meta-analysis.

BACKGROUND: Evidence exists demonstrating the negative impacts of chronic musculoskeletal pain on key measures of gait. Despite neck pain being the second most common musculoskeletal pain condition, there is a paucity of evidence exploring the impacts of neck pain specifically on these outcomes. The aims of this work were to systematically review the current evidence of the associations between chronic neck pain and measures of gait health and to conduct meta-analysis for quantitative assessment of the effect sizes under different walking conditions. METHODS: Systematic review was conducted following PRISMA guidelines. Databases searched included MEDLINE, Embase, Web of Science, CINAHL, and PEDro. Eligible study designs included observational studies consisting of an exposure group with chronic neck pain and control group without chronic neck pain and primary outcomes relating to gait health. For outcomes amenable to meta-analysis, a random-effects model was used to derive summary estimates of Hedge's g depicted graphically with forest plots. Other gait outcomes were narratively summarized. Risk of bias was also assessed. RESULTS: The original search yielded 1918 articles; 12 met final eligibility criteria including 10 cross-sectional studies. Outcomes were grouped first by the five domains of gait: pace, rhythm, asymmetry, variability, and postural control; and second by the tested walking conditions. Meta-analyses for gait speed revealed large effect-sizes indicating that individuals with chronic neck pain had slower measures of gait and lower measures of cadence. Gait outcomes that were narratively summarized supported these findings. CONCLUSION: The quantitative and qualitative findings of this systematic review and meta-analysis suggest a negative impact of CNNP on measures of gait health, particularly gait speed, under various walking conditions. However, broad interpretation of these results should be cautious. Testing gait under dual task conditions may be particularly sensitive to the impact of CNNP, and future work is needed to better understand how pain disrupts this important functionality of the locomotor system. Additionally, consideration should be made to assess measures of variability and investigate these relationships in the older adult population.

The McKenzie Method Is an Effective Rehabilitation Paradigm for Treating Adults With Moderate-to-Severe Neck Pain: A Systematic Review With Meta-Analysis.

Neck pain is a common musculoskeletal condition frequently managed with numerous conservative interventions. The McKenzie method of mechanical diagnosis and therapy (MMDT) is a form of physical therapy evaluation and treatment that aims to improve pain and disability in patients with musculoskeletal pain, including neck pain. To date, no systematic review with meta-analysis has examined the use of the McKenzie MMDT for neck pain. This study aimed to examine the effectiveness of the McKenzie MMDT in adult patients with neck pain. A systematic review and meta-analysis were performed using PubMed, ScienceDirect, MEDLINE, CINAHL, Web of Science, and Google Scholar. Full search terms were "McKenzie method" OR "McKenzie approach" OR "McKenzie treatment" AND "neck pain." Inclusion criteria were the use of the McKenzie MMDT, level I randomized control trials (RCTs), adults, and outcomes of pain (0-10 scale) and disability (neck disability index). A total of 11 RCTs met the final selection criteria from 1,955 articles on initial search with 289 patients receiving the McKenzie MMDT out of 677 total patients. For meta-analysis, there was a clinically insignificant but statistically significant improvement in pain (1.14/10 points) in patients receiving the McKenzie MMDT versus control interventions (p<0.02). There was no significant improvement in the neck disability index score between the McKenzie MMDT versus control interventions (p=0.19). For severity of pain, there was a clinically and statistically significant improvement in moderate or severe pain (2.06/10 points; p<0.01), but not in mild-to-moderate pain (p=0.84) when comparing the McKenzie MMDT to control interventions. Overall, the McKenzie MMDT provides very small but statistically significant improvements in neck pain of all severity compared to control interventions. However, the McKenzie MMDT does provide clinically and statistically significant pain improvement in moderate-to-severe neck pain. Use of the McKenzie MMDT did not provide any significant improvement in disability compared to control interventions. This study is the first systematic review with meta-analysis on the effectiveness of the McKenzie MMDT for adult patients with neck pain.

Use of Rimegepant in the Management of Cervicogenic Headache Secondary to Trauma: A Case Series.

A cervicogenic headache (CH) originates from a cervical source. Multiple diagnostic criteria and treatment strategies for CH are present. Rimegepant is a calcitonin gene-related peptide receptor (CGRP) antagonist. We present a case series of three patients with CH who reported varying degrees of decreased headache intensity after using rimegepant.

Utilization of Clinical Practice Guideline Interventions in the Conservative Management of Mechanical Neck Pain: A Retrospective Analysis.

INTRODUCTION: Neck pain is a common musculoskeletal condition frequently treated by physical therapists. The American Physical Therapy Association (APTA) published a clinical practice guideline (CPG) in 2008 with a revision in 2017 to improve the diagnosis and treatment of neck pain. One subset of neck pain in the CPG is "Neck Pain with Mobility Deficits," also called mechanical neck pain. Little data exists on the adherence of physical therapists to the CPG-recommended treatments for neck pain as well as the outcomes associated with the utilization of the CPG. The purpose of this study is to examine both CPG treatment adherence and associated outcomes in patients treated for mechanical neck pain by physical therapists in the outpatient setting. METHODS: Retrospective chart review of patients (n=224) who received physical therapy for neck pain between 2018 and 2022. Data ranges were chosen due to the publication of the CPG revision in 2017. Six interventions for mechanical neck pain from the CPG were examined: thoracic manipulation, cervical mobilization, transcutaneous electrical stimulation (TENS), dry needling, advice to stay active, and scapular resistance exercises. The exclusion criteria were a history of cervical spine surgery. Other data collected included age, sex, characteristics of the evaluating physical therapist, and the number of visits. RESULTS: For CPG treatment adherence, 4.5% of patients received thoracic manipulation, 47.8% of patients received cervical mobilization, 12.5% of patients received TENS, 22.8% of patients received dry needling, 99.1% of patients received advice to stay active, and 89.3% of patients received scapular resistance exercises. There was no significant improvement in pain, range of motion (ROM), and function based on a number of CPG interventions used during the bout of physical therapy (p=0.17 to p=0.74). Patients who were evaluated by a physical therapist who was an Orthopedic Certified Specialist (OCS) were more likely to receive more interventions recommended by the CPG (p<0.01). CONCLUSION: CPG-recommended treatments are used with varying frequency by physical therapists when treating mechanical neck pain. Thoracic manipulation is rarely used while scapular resistance exercises are frequently used. There was no significant improvement in pain, ROM, or function based on the number of CPG-recommended treatments used during the bout of physical therapy.

Sub-occipital muscle pressure pain thresholds correlate to direction of symptomatic active comfortable sustained neck rotation testing in post-concussive headache: a retrospective observational cross-sectional study.

OBJECTIVES: To compare sub-occipital muscle pressure sub pain thresholds (PPTs) in individuals with persistent-post-traumatic-headache (PPTH) in relation to the presence or not of cranial nerve and/or autonomic symptoms reported during sustained neck rotation (SNR). BACKGROUND: Previously 81% of military service members with PPTH demonstrated symptoms with SNR up to 60 seconds. Of these, 54% reported symptoms in one (Uni-Symp) and 46% in both directions of rotation (Bi-Symp). Sub-occipital PPTs, in relation to SNR direction, were of interest. METHODS: Retrospective review of records of 77 individuals, with PPTH with both SNR and PPTs. Average suboccipital and scalene PPTs were compared between Asymptomatic (n = 13), upon SNR testing, or Symptomatic (Uni-Symp, n = 32, Bi-Symp, n = 32), groups. RESULTS: The Bi-Symp group had significantly reduced sub-occipital PPTs relative to the Asymptomatic group on both sides [p < 0.009] with no side-to-side differences in either group. The Uni-Symp group had significantly lower sub-occipital PPTs on the symptomatic SNR test direction compared to the asymptomatic side [t(31) = 3.37, p = 0.002]. There were no differences within or between groups in the scalene PPTs(p's > 0.08). CONCLUSIONS: An upper cervical mechanical trigger of symptoms during SNR tests in some individuals with PPTH is possible. The direction of symptomatic SNR tests may indicate direction of guarded hypermobile dysfunction and direct treatment.

Crowned dens syndrome: An uncommon mimic of meningitis in the emergency department.

Crowned dens syndrome is characterized by severe neck pain with stiffness of the neck, sometime febrile, due to calcification of the transverse atlas ligament. We describe the case of a 65-year-old woman referred to the emergency department with a suspicion of meningitis. Several anamnestic and clinical signs ruled out this hypothesis. Re-evaluation of the CT images enabled us to reach the final diagnosis of crowned dens syndrome.

Analysis of cervical sagittal balance in patients neck pain and no neck pain / Análise do equilíbrio sagital cervical em pacientes com e sem cervicalgia / Análisis del equilibrio sagital cervical en pacientes con y sin cervicalgia

ABSTRACT Introduction: Sagittal balance was measured by Hardacker`s et al. using the occipital method COBB C1-C2, C2-C3, C3-C4, C4-C5, C5-C6, C6-C7 in a sample of asymptomatic patients without neck and shoulder pain. In other recent studies, measurements of cervical sagittal balance included several radiographic parameters. Objective: To compare the cervical sagittal balance in groups of patients with and without neck pain submitted to cervical radiography with the upper limbs in flexion. Methods: This is a cross-sectional, quantitative, prospective, descriptive study with radiographic analysis of 50 adults aged between 30 to 70 years old. The group was divided into Group 1: without neck pain, and Group 2: with neck pain. All answered a questionnaire about age and the presence or absence of neck pain. Exclusion criteria were: inadequate X-Ray image, deformity or previous spine surgery, limited shoulder mobility, and individuals younger than 30 and older than 70. The radiographic parameters evaluated were: COBB, TIA ( THORACIC INLET ANGLE), T1 SLOPE, NECKTILT, and COG-C7 with no neck pain. α = 5% (significance when p <0.05). Results: The MANN WHITNEY nonparametric test showed no significant differences between Cobb GROUPS (p= 0.7452), T1 SLOPE GROUPS (p=0.1410), NECKTILT GROUPS (p=0.0852) and GROUPS THORACIC INLET ANGLE (p=0.1789). Conclusion: There was a significant difference only between COG-C7 GROUPS (cm) (p=0.0013). The analysis of the obtained data showed statistical significance in the variation in the COG-C7 groups. Level of Evidence II; Prospective comparative study.

Resumo: Introdução: O equilíbrio sagital foi medido por Hardacker et al. usando o método occipital COBB C1-C2, C2-C3, C3-C4, C4-C5, C5-C6, C6-C7 em uma amostra de pacientes assintomáticos sem dor no pescoço e no ombro. Em outros estudos recentes, as medidas do equilíbrio sagital cervical incluíram vários parâmetros radiográficos. Objetivo: Comparar o equilíbrio sagital cervical em grupos de pacientes com cervicalgia e sem cervicalgia submetidos à radiografia da cervical, com os membros superiores em flexão. Métodos: Trata-se de um estudo transversal, quantitativo, prospectivo, descritivo, com análise radiográfica de 50 adultos, com idade entre 30 e 70 anos. O grupo foi dividido em Grupo 1: sem cervicalgia e Grupo 2: com cervicalgia. Todos responderam a um questionário sobre idade e presença ou não de dor cervical. Os critérios de exclusão foram: imagem inadequada, deformidade ou cirurgia prévia da coluna, mobilidade limitada do ombro e indivíduos com idade inferior a 30 e superior a 70 anos. Os parâmetros radiográficos avaliados foram: COBB, TIA (ANG THORACIC INLET), T1 SLOPE, NECKTILT e COG-C7 com e sem cervicalgia. α = 5% (significância quando p < 0,05). Resultados: O teste não paramétrico de MANN WHITNEY não mostrou diferenças significativas entre os GRUPOS Cobb (p= 0,7452), GRUPOS SLOPE T1 (p=0,1410), GRUPOS NECKTILT (p=0,0852) e GRUPOS TIA (p=0,1789). Conclusão: Houve diferença significativa apenas entre os GRUPOS COG-C7 (cm) (p=0,0013). A análise dos dados obtidos demonstrou significância estatística em relação à variação nos grupos COG-C7. Nível de evidência II; Estudo comparativo prospectivo.

Resumen: Introcucción: El equilibrio sagital fue medido por Hardacker et al. utilizando el método occipital COBB C1-C2, C2-C3, C3-C4, C4-C5, C5-C6, C6-C7 en una muestra de pacientes asintomáticos sin dolor del cuello y hombros. En otros estudios recientes, las mediciones del equilibrio sagital cervical incluyeron varios parámetros radiográficos. Objetivo: Comparar el equilibrio sagital cervical en grupos de pacientes con y sin cervicalgia sometidos a radiografía cervical, con los miembros superiores en flexión. Métodos: Se trata de un estudio transversal, cuantitativo, prospectivo, descriptivo, con análisis radiográfico de 50 adultos, con edades entre 30 y 70 años. El grupo compartió el Grupo 1: Sin dolor del cuello y el Grupo 2: Dolor de cuello. Todos respondieron un cuestionario sobre edad, dolor de cuello o ausencia de dolor de cuello. Los criterios de exclusión fueron: imagen inadecuada, deformidad o cirugía previa de columna, movilidad limitada del hombro y menores de 30 años y mayores de 70 años. Los parámetros radiográficos evaluados fueron: Cobb, TIA (ANG TORACIC INLET), T1 SLOPE, NECKTILT y COG-C7 con y sin cervicalgia. α = 5% (significación cuando p < 0,05). Resultados: La prueba no paramétrica de MANN WHITNEY no mostró diferencias significativas entre los GRUPOS COBB (p=0,7452), GRUPOS T1 SLOPE (p=0,1410), GRUPOS NECKTILT (p=0,0852) y GRUPOS ANG TORACIC INLET (p=0,1789). Conclusión: Hubo diferencia significativa solo entre los GRUPOS COG-C7 (cm) (p=0,0013). El análisis de los datos obtenidos mostró significancia estática en relación a la variación en los grupos COG-C7. Nivel de Evidencia II; Estudio prospectivo comparativo.

Impact of cervical pain, neck mobility, and body mass index on teachers' postural control / Impacto da dor cervical, da mobilidade e do índice de massa corporal no controle postural de professores

ABSTRACT Purpose: to analyze the impact of neck pain, neck mobility, and body mass index on teachers' postural control. Methods: a cross-sectional study with 54 state public school teachers, 68.5% (n = 37) being females, with a mean age of 46.5 ± 9.3 years. Data were collected with the following instruments: Craniocervical Dysfunction Index (Brazilian version), force platform in bipedal and semi-tandem stance, visual analog scale, cervical mobility index, and body mass index. Data were analyzed with nonparametric statistics and multiple linear regression; the significance level was set at p<0.05, with 95% confidence intervals. Results: teachers with neck pain and severely impaired neck mobility had greater postural control changes in the semi-tandem stance. In the bipedal stance, those with mild mobility changes and neck pain had a smaller total displacement. Obese teachers had a smaller movement amplitude in the anteroposterior and mediolateral directions. Conclusion: teachers presented with neck pain and severely impaired neck mobility had a worse postural control. Obese teachers had a smaller total amplitude in both movement directions.

RESUMO Objetivo: analisar o impacto da cervicalgia, mobilidade cervical e índice de massa corporal no controle postural de professores. Métodos: estudo transversal com 54 professores da rede estadual de ensino, com média de idade de 46,5 ± 9,3 anos, dos quais: 68,5% (n = 37) eram do sexo feminino. A coleta de dados teve como base os seguintes instrumentos: Craniocervical Dysfunction Index (versão brasileira), plataforma de força na posição bipodal e semitandem, escala visual analógica, índice de mobilidade cervical e índice de massa corporal. Para análise dos dados, foi utilizada estatística não paramétrica e análise de regressão linear múltipla, com nível de significância p<0,05 e intervalo de confiança de 95%. Resultados: os professores com cervicalgia e comprometimento severo da mobilidade cervical tiveram maior alteração do controle postural na posição semitandem. Na posição bipodal, aqueles com leve alteração da mobilidade e dor cervical apresentaram menor deslocamento total, assim como professores obesos demostraram menor amplitude de movimento nas direções anteroposterior e médio-lateral. Conclusão: os professores com cervicalgia e comprometimento severo da mobilidade cervical tiveram pior controle postural. Já os obesos apresentaram menor amplitude total em ambas as direções do movimento.

Frequência de cervicalgia, dependência de smartphone e incapacidade cervical em graduandos de fisioterapia / Frequency of neck pain, smartphone dependence and neck disability in physiotherapy undergraduates / Frecuencia de dolor de cuello, dependencia de teléfono inteligente y discapacidad cervical en estudiantes de fisioterapia

O objetivo deste estudo é investigar a frequência de cervicalgia e a associação com dependência do uso de smartphone e incapacidade cervical em graduandos de fisioterapia. Trata-se de um estudo observacional de corte transversal realizado com estudantes de fisioterapia de uma universidade pública do estado da Bahia, entre novembro de 2019 e fevereiro de 2020. Foram utilizados uma ficha de avaliação com dados sociodemográficos, o questionário Neck Disability Index (NDI) para avaliação da incapacidade cervical e o questionário Smartphone Addiction Inventory (SPAI-BR) para rastreio de comportamento dependente de smartphone. As análises foram conduzidas no pacote estatístico Epi-Info (V.3.5.2), sendo estabelecido nível de significância com valor de p < 0,05. A amostra foi composta por 150 estudantes de fisioterapia, sendo a maioria mulheres, com idade média de 22,0 ± 3,0 anos. A frequência de dor cervical no último ano ocorreu em 66% dos entrevistados, com associação estatisticamente significativa apenas para a variável de dor no último ano, em 97% dos estudantes, com o posicionamento cervical em flexão durante o uso de smartphone (p = 0,003). A frequência de cervicalgia nos últimos 12 meses foi elevada nessa população. Este estudo não encontrou associação entre essas variáveis com dependência do uso smartphone e incapacidade cervical em estudantes universitários, entretanto, revelou uma associação entre a frequência de cervicalgia no último ano e o posicionamento em flexão da coluna cervical durante o uso de smartphone.

This study sought to investigate the frequency of neck pain and its association with smartphone dependence and neck disability in physiotherapy undergraduates. An observational cross-sectional study was conducted with physiotherapy students from a public university in the state of Bahia, Brazil, between November 2019 and February 2020. Data were collected by means of an evaluation form with sociodemographic data, the Neck Disability Index (NDI) questionnaire for assessing neck disability, and the Smartphone Addiction Inventory (SPAI-BR) questionnaire for screening smartphone-dependent behavior. Analyses were performed using the Epi-Info statistical package (V.3.5.2), and a significance level of p-value < 0.05. The study sample consisted of 150 physiotherapy students, mostly women, with a mean age of 22.0 ± 3.0 years. Frequency of neck pain in the last year occurred in 66% of respondents, with a statistically significant association only for the variable pain in the last year in 97% of students with neck flexion positioning while using a smartphone (p = 0.003). Frequency of neck pain in the past 12 months was high in this population. This study found no association between these variables with smartphone dependence and cervical disability in university students; however, it did reveal an association between frequency of neck pain in the past year and flexion positioning of the cervical spine during smartphone use.

El objetivo de este estudio es investigar la frecuencia del dolor de cuello y su asociación con la dependencia del uso de teléfonos inteligentes y la discapacidad cervical en estudiantes de pregrado de fisioterapia. Este es un estudio observacional, transversal, realizado con estudiantes de fisioterapia de una universidad pública del estado de Bahía (Brasil), entre noviembre de 2019 y febrero de 2020. Se utilizó un formulario de evaluación con datos sociodemográficos, el cuestionario Neck Disability Index (NDI) para evaluar la discapacidad cervical, y el cuestionario Smartphone Addiction Inventory (SPAI-BR) para evaluar el comportamiento dependiente de los teléfonos inteligentes. Los análisis se realizaron utilizando el paquete estadístico Epi-Info (V.3.5.2), con un nivel de significancia de p < 0,05. La muestra estuvo formada por 150 estudiantes de fisioterapia, la mayoría mujeres, con una edad media de 22,0 ± 3,0 años. La frecuencia de dolor cervical en el último año ocurrió en el 66% de los encuestados, con una asociación estadísticamente significativa solo para la variable dolor en el último año en el 97% de los estudiantes, con el posicionamiento en flexión cervical al usar un teléfono inteligente (p = 0,003). La frecuencia de dolor de cuello en los últimos 12 meses fue alta en esta población. Este estudio no encontró asociación entre estas variables con la dependencia del uso de teléfonos inteligentes y la discapacidad cervical en estudiantes universitarios, sin embargo, sí reveló una asociación entre la frecuencia de dolor de cuello en el último año y la posición en flexión de la columna cervical durante el uso de teléfono inteligente.

Un caso raro de cervicalgia / A rare case of cervicalgia

OBJETIVO Subrayar la importancia del diagnóstico detallado del dolor y realizar autocrítica por la tardanza diagnóstica de una cervicalgia mecánica. MATERIAL Y MÉTODOS Se presenta una paciente con dolor súbito en el cuello, con radiografías y exploración normales. La resonancia magnética (RM) resultó aparentemente anodina y se trató como cervicalgia mecánica. Tras varias consultas con el Servicio de Urgencias, se realizó una radiografía que informó de anomalía entre las primeras vértebras y se amplió con una tomografía computarizada (TC) que reveló fractura de odontoides y destrucción de la segunda cervical de origen metastásico.RESULTADOS La paciente fue tratada con radioterapia más collarín cervical y varios ciclos de quimioterapia, y falleció a los dos años.DISCUSIÓN Los cánceres que más frecuentemente metastatizan en la columna vertebral son los de mama, pulmón y próstata, siendo las localizaciones más frecuentes la torácica (70%), la lumbar (20%) y, por último, la cervical (10%). Cuando el tumor se descubre como metástasis, como en nuestro caso, estos pacientes tienen una alta tasa de mortalidad. Según nuestro conocimiento, en la literatura hay pocos casos descritos de neoplasias descubiertas como fractura patológica de odontoides. CONCLUSIÓN El dolor cervical no mecánico debido a una metástasis en odontoides, a consecuencia de una neoplasia de pulmón no diagnosticada, es un caso raro en la literatura y de complejo diagnóstico, en que una historia clínica detallada de la evolución del dolor y la presencia de signos de alarma son de vital importancia para su sospecha y rápido diagnóstico, mediante técnicas como la RM.

OBJETIVE To underline the importance of a detailed diagnosis of pain and perform self-criticism regarding the delay in diagnosis of a case of mechanical cervicalgia. MATERIALS AND METHODS We present the case of a patient with sudden neck pain, with normal X-rays. The magnetic resonance imaging (MRI) scan was apparently unremarkable, and the condition was treated as mechanical cervicalgia. After several consultations in the Emergency Department, a new X-ray was performed, which showed an anomaly between the first vertebrae and is accompanied by a computed tomography (CT) scan that revealed a fracture of the odontoid apophysis and destruction of the second cervical vertebra of metastatic origin. RESULTS The patient was treated with radiotherapy plus cervical collar and several cycles of chemotherapy, and died two years later. DISCUSSION The cancers that most frequently metastasize to the spine are those of the breast, lung and prostate, with the most frequent location being thoracic (70%), lumbar (20%), and, finally, cervical (10%). When the tumor is discovered as a metastasis, as in our case, these patients have a high mortality rate. To our knowledge, few cases of neoplasms discovered as pathological fractures of the odontoid apophysis have been described in the literature. CONCLUSION Non-mechanical cervicalgia due to metastasis of the odontoid apophysis as a result of an undiagnosed lung neoplasm is a rare case in the literature and a complex diagnosis, in which a detailed clinical history of the evolution of pain and the presence of red flags are of vital importance for its suspicion and rapid diagnosis, through techniques such as MRI.