News Category: Cervical Spine

Total disc replacement (TDR) for the cervical (neck) or lumbar spine are now available and in use. Bone growth around the implant that turns soft tissue (especially muscle) into bone is called heterotopic ossification (HO). The effect of this type of ossification is unknown. It may cause a loss of spinal motion or it may have no effect at all.

This is the first study to report on the effects of heterotopic bone after TDR. The authors report how often it occurs and compare motion between patients with and without this condition.

Serial X-rays taken before and after the TDRs were implanted in 276 patients. The X-rays showed both the condition of the bone and motion in the spine. Flexion, side bending, and extension motions were measured and analyzed. Everyone received the same Charité artificial disc. Follow-up was carried out over a two year period.

Results for patients with HO were compared to results for patients who didn’t have HO. Pain levels and motion were not different between the two groups. About four per cent of the patients developed HO. In every case, it was a mild to moderate amount of bone formatin. X-rays showed that HO appeared between six and 12 weeks. It did not appear to change or get worse over time.

The authors suspect this low rate of HO is because there isn’t much trauma to the muscles during the TDR operation. Rates of HO are much higher for operations like total hip replacement where muscles are cut during the procedure. No cutting or splitting of muscles is required during TDR.It was also suggested that patient function is not altered unless the HO is severe.

Neck pain is almost as common as back pain in the United States. According to the results of this study, 10.2 million people saw their doctors for neck pain last year. A total of 28 million adults over the age of 18 reported having neck pain lasting at least one day or more. This group may or may not have seen their doctors or received treatment for their neck pain.

In this study, data collected each year by several large, national groups was analyzed. The purpose was to describe the volume and characteristics of visits to doctors, hospitals, and clinics for neck pain. Visits to chiropractors were not included, but would have doubled or even tripled the number of patients treated for neck pain in the U.S.

White females were the most likely patients to seek help for neck pain. Family practice physicians were seen most often. Most of the time, a description of the symptoms was given as the diagnosis.

For example, neck pain, neck sprain, or neck strain was the diagnosis given in two-thirds of the patient visits. Neck pain patients admitted to the hospital were far more likely to get a true (pathology-based) diagnosis. This information was obtained from hospital discharge notes.

The authors point out there is clearly a need for better ways to classify neck pain. The number of people reporting neck pain and seeking health care for neck pain suggests more research in this area is needed.

Direct costs associated with neck pain can be calculated based on physician, hospital, or clinic charges. Indirect costs such as lost time at work and reduced productivity are more difficult to estimate.

Pain has a way of getting our attention. It sets off alarms in the nervous system. But when pain becomes chronic, the human may become overalert for pain. This is called hypervigilance. The patient with chronic pain becomes overalert to pain and fearful of it.

Thinking and expecting the worst is called catastrophizing. Being hypervigilant, overalert and catastrophizing can interrupt our attention and distract us from activities. This is called attentional interference.

In this study 40 patients with chronic whiplash syndrome (CWS) are compared to 40 healthy adults (the control group). Various surveys were given to the groups to measure disability, pain catastrophizing, and fear of movement or reinjury. How often pain interrupts activities (attentional interference) was also measured.

While sitting at a computer, the subjects were instructed to click a button in response to a high or low tone coming from the speakers. In different trials, the subject’s neck was placed in a brace to position it either in an extended or a rotated position. Both of these positions are perceived as threatening to patients with CWS. In other trials, the neck was free of any required position.

Reaction times (RTs) to the tones were measured for both groups in all trials. The results showed that the patients had increased RTs during threat positions. At first they could get back to their baseline RTs when the threat was removed.

But by the third trial, their RTs remained slow even when their neck was free to move normally. The results showed that activities perceived as threatening distract chronic pain patients. Their attention is disrupted from the task at hand.

The authors were unable to tell if the reduced RTs were caused by actual pain sensation or by the feeling of threat perceived by the patients. It may be there is an interplay of both factors. Future studies will look into this.

Surgical procedures change over time with improvements in equipment and techniques. In this article, surgeons report on the results of an operation for extreme neck flexion in 131 patients with ankylosing spondylitis (AS).

AS is an inflammatory condition of the tendons where they attach to the bone. Joint pain, loss of motion, and a bent position of the spine are common problems with AS. The patients in this study had a severe flexion deformity of the cervical spine (neck). They were unable to see ahead where they were going. Swallowing and personal hygiene were difficult.

The authors describe two methods used to correct this problem. In both operations, a wedge of bone is removed from the back of the bone. The wedge of bone is then used to correct the angle of the spine. The operation is called a cervical osteotomy. A traction halo device is used to straighten the patient’s spine into a more upright position.

The conventional method was used up until 1997. Patients were required to come in one to two days before surgery to have the halo fitted in advance. Since that time, a more current method has been used. The current technique removes more bone along the sides in a one-step operation. The bone is removed and the halo installed in the same operation.

The halo has a rigid plastic body jacket or vest. Vertical steel rods or posts attached to the vest support a device that fits across the forehead and around the head like a halo. Four steel screws attach the halo directly to the outer skull to hold the head and neck in place. The halo system stabilizes the cervical spine while healing takes place.

The current method reduced the average hospital stay from 33 days to six days. The larger bone resection and increased correction angle decreases the risk of pressure on the nerve. It also increases space where the spinal cord might wrinkle or bunch up.

The authors note that the new procedure still has high risks for the patient and should only be done by an experienced surgeon.

In this case report, doctors from Madrid, Spain review the clinical picture and diagnosis of a condition called calcific retropharyngeal tendinitis. This problem is caused by calcium deposits that build up in the longus colli muscle of the anterior neck.

When these deposits rupture, the patient experiences neck pain, sore throat, and difficulty swallowing. Upper neck pain and stiffness can be severe. There may be tenderness and swelling along the front of the neck. The cause of this problem remains unknown. There may be genetic and metabolic factors. Trauma and tendon degeneration may be risk factors.

Diagnosis can be made on the basis of the patient’s symptoms and imaging studies. X-rays may show calcification within the tendon where it attaches to the bone. CT scans are more sensitive than X-rays to show the exact location of the calcium deposits. MRI can help identify the cause of swelling (infection versus inflammation).

Treatment with an antiinflammatory drug helps reduce fever, swelling, pain, and stiffness. In this case, the patient was first treated with aspirin and muscle relaxants. The symptoms did not improve and he got worse. He was switched to a nonsteroidal antiinflammatory drug (Indomethacin) and was symptom-free within a two-week period of time. Follow-up a year later with CT scan and MRI showed the calcification was completely gone.

The authors conclude that although uncommon, calcific retropharyngeal tendinitis occurs more often than previously thought. They suggest the condition is an underdiagnosed cause of neck pain and stiffness. Anyone with neck pain, limited motion, and difficulty swallowing without a known cause should be examined for this condition.

The authors of this study report on the results of 325 patients who had a single-level, one-sided cervical foraminotomy. This procedure is used to relieve pressure on nerves that are being compressed or pinched by the intervertebral foramina. The foramen is the opening in the vertebrae through which the nerves exit from the spinal cord.

The procedure is done from the back of the neck with a tiny incision. This is called a keyhole operation. The muscle is peeled away to reveal the bone underneath. A small hole is cut into the vertebra itself. The foramen can be seen through this hole. The bone or disk material that is pressing on the nerve can be removed.

The focus of this study was to see how often patients developed the same problem in the same vertebra or in the adjacent vertebra (above or below it). Patients studied were treated between 1972 and 1992. There was an average of seven years follow-up.

The records were searched for any patient who had new disease at a same or adjacent level. Results were graded as excellent for patients with no pain, no medications, and normal work/activity status.

A good result was described as mild pain, occasional use of antiinflammatory drugs, and normal work/activity level. Patients with fair results had moderate pain, frequent drug use, restricted activity, and limited work ability. The final category poor reflected severe pain, narcotic use, and disability.

Results of this study showed a 6.7 per cent incidence of adjacent-segment disease over a 10-year period of time. There was a five per cent incidence of same-segment disease. Good or excellent outcomes were reported by 96.4 per cent of the patients. Nine per cent of the patients developed symptoms again at a later time.

The authors conclude that posterior cervical foraminotomy has a low rate of same- and adjacent-segment disease. It is an effective treatment for nerve compression in the neck.

In this study, researchers in Spain compare the use of acupuncture and TENS-placebo in the treatment of chronic neck pain. Patients in the study were adults who had three months or more of uncomplicated neck pain. Everyone was treated five times over a period of three weeks.

Acupuncture is an ancient Chinese treatment that involves inserting very thin, sterile needles into the skin. The needles are placed at different depths and angles. The goal is to bring the body’s energy fields into balance thereby helping the body to self-regulate. Improved circulation and healing can result in reduced pain. TENS stands for transcutaneous electronic nerve stimulation. TENS is a low-voltage, electrical impulse generator used to control pain.

The acupuncture group received acupuncture to points used to reduce cervical pain. Needles were kept in place for 30 minutes. Each needle was rotated or twisted every 10 minutes. The patients were also shown how to apply pressure to several ear points three times a day at home.

The TENS-placebo (control) group had electrodes placed on the skin over acupuncture points. Placebo means there is no real treatment. Any positive effect or benefit from the treatment occurs because the patient thinks it’s working. The machine was fixed so that no current passed through the electrodes. The machine had a flashing light and made sounds during the 30-minute treatment.

Results were measured in terms of neck pain during motion, quality of life, and use of pain meds. Patients in both groups were allowed to take pain relievers whenever needed. The control group took twice as much medication for pain as the acupuncture group. Many of these patients took more than the prescribed dose.

After the treatment ended, the acupuncture group had much better results. The results agreed with other similar studies using acupuncture to treat neck pain. The authors conclude acupuncture is safe and more effective than the placebo TENS treatment. Acupuncture can be used routinely to treat this problem.

What kind of exercise works best for chronic neck pain in office workers? How much exercise is needed? In this study, researchers from Finland try to identify the proper dose of exercise to alleviate cervical (neck) pain.

Female office workers ages 25 to 55 were included. All women had moderate neck pain for more than six months. There were two training groups and one control group. One training group received a program of strength training (ST) exercises. The other training group performed endurance training (ET) exercise.

A physical therapist instructed each patient in the training groups over a 12-day period. The women did the exercises at home three times a week for the next 12 months. The control group was advised to do aerobic exercise 30 minutes, three times a week.

Everyone was given a bike test before and after the study. The test was to measure maximal oxygen uptake. Each office worker also kept a diary of training and daily work, travel, and leisure activities.

A special computer program was used to calculate the metabolic equivalent (MET) units for each activity. MET refers to the amount of oxygen used during activities. One MET is equal to the amount of oxygen a normal, healthy adult uses sitting at rest. METs can be used to calculate the intensity of exercise.

After 12 months, maximal oxygen uptake remained the same for all three groups. Neck pain was decreased in all three groups. Disability decreased (function improved) the most in the ST group. Equal results were reported for disability in the endurance and control groups.

Women who trained at higher MET levels had the greatest decrease in pain levels. The authors report training was only effective when performed three times a week for at least a total of 8.75 METs. The most likely explanation for the results is improved metabolism and increased muscle strength in the neck muscles.

The authors conclude that a program of ST or ET can reduce neck pain and disability. Dose is important and enough training has to be done to see these changes. Similar studies in men and workers with severe neck pain are needed.

Growth factors contained in bone called bone morphogenetic protein (BMP) are now being used to stimulate bone healing. One BMP (rhBMP-2) has been approved by the FDA for use in anterior lumbar spine fusion. It has also been used for similar fusions of the anterior (neck) cervical spine.

Since rhBMP-2 wasn’t tested and approved for use in the cervical spine, this use is called off-label. The off-label use of rhBMP-2 in anterior spinal fusions has some problems.

In a recent study from the University of Iowa and Spine Center at Emory University, patients getting rhBMP-2 had 10 times the amount of neck swelling after the operation. The surgeons report this wasn’t the usual mild swelling that occurs right after the surgery.

Most patients had a delayed reaction (by several days). The swelling was so severe they had trouble breathing and swallowing. The surgeons aren’t sure why this happened. It could be the amount of rhBMP-2 used. Or perhaps it’s the way it is placed at the fusion site.

By comparing two groups of patients (with and without rhBMP-2) they were able to show this reaction was more common in patients over age 50 years who had several segments fused at the same time. Further analysis didn’t support these factors as being significant.

For now the authors agree that off-label use of rhBMP-2 for anterior cervical spine fusions should be used with caution. Prophylactic steroids are given to patients receiving rhBMP-2 after surgery. The manufacturer of this product put out a safety alert in 2004 saying that local soft tissue swelling could occur with off-label use. Further study is needed to find out which patients can benefit from this bone enhancing tool without the serious side effects.

Vertebral discs can protrude or push into the spinal canal. This puts pressure on the spinal cord causing painful symptoms. In the cervical spine (neck), this condition is called cervical myelopathy. To treat this problem, the discs can be removed in an operation called discectomy.

If bone spurs around the disc and a bulging disc take up too much space, the spinal canal narrows in a process called stenosis. When combined together, myelopathy and stenosis may require discectomy and corpectomy. Corpectomy is removal of the vertebral bone. The goal of both procedures is to decompress (take pressure off) the neural tissues.

In this review article, surgeons from the University of Wisconsin discuss surgical corpectomy for cervical spondylotic myelopathy. Who should be considered for this operation? How should the operation be done? What kind of problems can occur during and after the operation? And finally, the prognosis for outcome is discussed.

Anyone with severe pain that doesn’t go away with conservative care is a candidate for cervical corpectomy. The best results occur when only one or two levels are affected. Patients who aren’t already disabled from this condition or who have had symptoms for less than a year have the best results.

The surgeon must carefully remove the disc, bone spurs, and thickened ligaments. The spine must be stabilized to prevent excess motion called hypermobility. Balance of position and movement of the spine are maintained as much as possible.

The authors discuss surgical approach, position of the patient, and incision. Specific details of the operation are included with drawings to show other surgeons where and how to drill, remove bone, and place bone graft.

Avoiding complications can be done by carefully selecting patients and planning overall patient care. Sore throat and difficulty swallowing will go away gradually. Injury to the laryngeal nerve can be more serious. The results can be loss of voice, hoarseness, and chronic cough. Injury to blood vessels must also be avoided. Specific operative techniques are offered for these and other complications.

Narrowing of the spinal canal called stenosis occurs naturally with aging. Thickening of the ligament along the spine and bone spurs can contribute to this problem. If the canal narrows too much, then pressure on the spinal cord can cause neck and arm pain, weakness, and numbness. This condition is called cervical spine myelopathy (CSM).

It has long been thought that surgery is the only way to effectively treat CSM. If the bone spurs aren’t removed, the pressure won’t ease. But the results of this report suggest otherwise. It’s not only possible to keep CSM from getting worse with nonoperative care, symptoms can actually reverse with mild CSM.

Dr. P.G. Matz from the University of Alabama (Division of Neurosurgery) took the time to review and summarize studies published on CSM. Research shows that CSM is caused by many factors. It’s more severe when three or more spinal segments are involved.

Static (unchanging) factors include congenital stenosis (present at birth) and degenerative changes (from aging). Dynamic factors from abnormal motion or flabby ligament can also contribute to the problem.

With rest, activity or postural changes, and a collar, as many as one-third of the patients studied showed improvement. An even larger number of patients stabilized and didn’t get worse. Age and degree of severity may make a difference. Younger patients (less than 60 years old) with mild disease have the best results with conservative care.

Future studies are needed to compare the natural process of CSM with and without treatment. Sorting out what works best is next. The effect of surgery, immobilization, physical therapy, and psychologic support must be studied one at a time and then compared with the rest.

And finally, the effects of age, duration of symptoms, and severity of disease must be identified. This information would help doctors choose which patients would do best with each type of treatment. For now there’s enough evidence to suggest that surgery may not be the only answer to this very complex problem.

From time to time medical journals like The Spine Journal feature a single problem. In the November/December issue, the topic of cervical myelopathy (CM) is discussed in each article. In this article, surgeons from The Neurological Institute of New York review the use of laminectomy and fusion for CM.

Cervical myelopathy is a condition in which narrowing of the spinal canal in the neck puts pressure on the spinal cord and spinal nerves. Without treatment, patients can suffer severe neck and arm pain. Other symptoms such as numbness, tingling, weakness, and clumsiness are common. The legs can even be affected.

Laminectomy is the removal of bone from along the back of the vertebra. This takes the pressure off the neural tissue and is called surgical decompression. Laminectomy at multiple levels is usually followed by fusion of the spine to stabilize it.

The steps in the decision-making process include:

Doctors from the University of Wisconsin review a common problem with aging: cervical myelopathy (CM). Degenerative changes in the cervical spine (neck) can narrow the space for the spinal cord. Pressure on the spinal cord can produce a wide range of symptoms. This condition is referred to as CM.

The authors present a typical profile of the patient with CM: male, 50 years old or older, with neck pain that goes down the arm. Numbness, weakness, and clumsiness of the arms are common problems. Symptoms can occur below the belt, too. Loss of bladder control and leg weakness with gait changes (walking patterns) are also reported.

In this article, special tests and signs to help diagnose the problem are presented. Strength, sensory, and reflex testing are followed up by X-rays, nerve conduction tests, and electromyographic (EMG) tests. Normal and abnormal responses of nerve testing in the cervical spine are reviewed in detail.

There are many other conditions, diseases, and disorders that can present with the same or similar signs and symptoms as CM. The physician must rule out the presence of any of these other problems.

Multiple sclerosis, amyotropic lateral sclerosis (ALS or Lou Gehrig’s disease), and Guillain-Barré syndrome are the most common neurologic conditions to mimic CM. Lyme disease, rheumatoid arthritis, post-polio, tumors, and pernicious anemia must also be considered. There is also a possibility that sensory and motor abnormalities are psychologic. Psychogenic disorders have a different treatment and management compared with true CM.

Doctors must rely on patient history, findings on exam, and the results of additional testing to identify the underlying cause of symptoms typical of cervical myelopathy. A delay in diagnosis is not uncommon given the vague nature of early CM symptoms. Knowing what to look for, what tests to conduct, and what the results may mean are important steps in the diagnostic process.

In the aging cervical spine (neck) or in cases of degeneration from trauma, pressure on the spinal cord can occur. This condition is called cervical myelopathy. Surgery is often needed to decompress the spinal cord and spinal nerves. The natural curve of the neck called lordosis can be restored.

Removal of the discs and fusion of the spine may be needed to stabilize the spine. In this article two surgeons from the Department of Neurosurgery at the University of Utah School of Medicine describe the operation. They discuss who’s the best patient for this procedure and when to do it. Complications from the operation are also presented.

First, the surgeon must decide whether to operate from the front of the spine (anterior approach) or from behind (posterior approach). This decision is usually based on the location of the problem. Are there bone spurs? Where are they located? What’s the condition of the ligaments and joints? The alignment of the neck is also considered.

Multilevel cervical discectomy (removal of the disc) using the anterior approach is described here. Preparation and positioning of the patient are outlined. Location and technique for the incision are explained with diagrams. Each step of the operation is described and discussed.

The surgeon must be prepared for any problems that occur during or after the surgery. Injury to the soft tissues or nerves can lead to difficulty swallowing. In rare cases, permanent vocal cord damage can occur. There is always a risk that the bone fusion will fail. The graft may collapse, break, or just fail to fuse called nonunion.

The authors say they advise using the anterior approach when performing multiple cervical discectomy for the treatment of cervical myelopathy. It is more labor-intensive and takes longer, but it works well in taking the pressure off the spinal cord.

The cervical spine is often the cause of neck pain or discomfort in adults. Arthritis, pressure on the nerve roots, injury, or irritation to the neck muscles are common reasons for this type of pain. In this article, orthopedic surgeons review anatomy, causes of neck pain, and ways to treat it.

Understanding the way the cervical spine (bones, joints, nerves) is put together helps the doctor identify the underlying problem. For example half of all head rotation comes from the atlantoaxial joint (AO). The AO joint is made up of the first and second cervical vertebrae. A problem turning the head might point to this joint as the source of the problem.

There can be many different disorders and diseases that cause neck pain. The doctor takes a history and examines the patient, keeping in mind how the neck is put together and how it moves from an anatomical point of view.

These may include rheumatoid arthritis, polymyalgia rheumatica, or tumors. Cervical disc herniation from a prolapsed disc can put pressure on the spine or spinal nerve roots causing neck pain that goes down the arm. Other problems may stem from less obvious causes such as emotional and physical stress or poor sitting or sleeping postures.

Treatment usually starts conservatively with anti-inflammatory drugs. Physical therapy to restore normal motion, treat trigger points, and address any postural issues may be advised. The doctor may use one or two steroid injections into the joints. From time to time, a nerve block may be done.

If all treatment fails to bring relief from pain, surgery may be needed. Patients with severe arthritic changes, disc herniation, or instability are the most likely to benefit from surgery.

In this article, physicians from the University of Siena in Italy report on eight cases of cervical spine infection. Four of the patients had a previous dental infection and two had tuberculosis. History of a recent infection is a major risk factor for spinal infection. Drug abuse is also a common factor in many spine infections.

Symptoms included fever, headache, and neck pain. The neck pain was severe and came on suddenly and rapidly. In some patients, the neck pain traveled down the arm, a condition called radiculopathy. Arm pain was often accompanied by weakness.

Early diagnosis and treatment is important to avoid permanent nerve damage. Contrast-enhanced MRI helps identify the mass as an abscess caused by infection in the epidural space. Pressure on the spinal cord shows clearly with this type of imaging. Lab values are also positive. Both the sedimentation (SED) rate and C-reactive protein (CRP) levels are elevated. These are tests to show inflammation or infection.

Surgery to drain the abscess and take pressure off the spinal cord prevents or reverses neurologic damage and speeds up recovery. The disc at the level of the abscess is removed from the front of the neck. The surgeon threads a thin tube catheter (tube) through the opening into the epidural space. Pus is removed and the area is washed clean. Fusion of the cervical spine was not needed as the neck was stable in each patient after treatment. Antibiotics were also prescribed.

Results showed reduced pain for all eight patients. Six had a complete recovery. Two others still had minor neurologic problems.

The authors conclude that spinal epidural abscess of the cervical spine is rare but serious. Anyone with a recent history of infection who develops neck pain must be evaluated and treated quickly. Without surgery to drain the abscess, the infection can spread along the spine. Patients who are immunosuppressed from other conditions such as diabetes or tuberculosis are at increased risk for this kind of problem.

A popular scale for measuring health status is a tool called the Short-Form Health Survey or SF-36. The SF-36 is a good measure of general physical and emotional health in adults. But can it be used to measure results of treatment for specific groups? In this study, researchers evaluate the use of the SF-36 with patients having cervical spine surgery.

The SF-36 measures eight categories of health and function. Bodily pain, mental and emotional health, and social and physical functioning are some of the areas tested. Studies show that the SF-36 can be used to compare patients with different diseases and problems. Results give a reliable and valid measure of the outcomes of treatment.

The survey was given to 116 patients of one neurosurgeon before and after surgery. All patients were having surgery for a diagnosis of cervical spondylotic myelopathy and radiculopathy. This means they had neck and arm pain from pressure on the spinal cord in the neck.

>From the results of this study, the authors advise caution in using the SF-36 with patients having cervical spine surgery. Many of the questions were left blank. This group either couldn’t answer the questions or the questions didn’t apply.

It also appears that combining subscale scores for patients with disabling neurologic conditions alters what the survey is measuring. It not longer assesses the patients in the same way it measures adults in the general population.

The SF-36 test is still valid but has limits in its ability to detect change in patients before and after cervical spine surgery. It is a good way to measure broad health concerns but is not specific enough for this group of patients.

Over 3,000 patients participated in this study on the use of acupuncture for chronic neck pain. Patients were divided into two groups. The acupuncture group received routine medical care and 10 to 15 acupuncture treatments. The control group received just routine care for three months. They could have acupuncture at the end of that time.

Pain, function, and quality of life were used as measures of effectiveness. The cost between the two groups was the main comparison. The study was done in Germany where acupuncture is mainly done by physicians.

The results showed that acupuncture costs more than routine care. It was also more effective. The acupuncture group also had lower medication costs. The authors suggest that acupuncture treatment for more than three months would not be as cost-effective.

For short-term care, acupuncture is an option to consider for patients with chronic neck pain.

How long should you see a physical therapist (PT) for neck pain? And how come some neck pain patients get better faster than others? In this study, PTs from Australia try to answer these and other questions about physical therapy treatment dose.

Two groups of neck pain patients were included. All had neck pain from an unknown cause. Anyone with neck pain from car accidents or other trauma was not included. The patients were divided into two groups based on their symptoms.

The first group had pain with movement or activity. The second group had load-bearing pain. Their pain was made worse with prolonged postures or sustained positions such as sitting.

The therapists treating the patients did not know which group each patient was in. Each patient was treated by one of four PTs. The treatment was determined by each PT for each patient. Results were measured by pain levels, function, and disability.

The number of treatment sessions called treatment dose were added up and compared to the results for the two groups. The authors report that patients in the loading group got better faster. They were much more likely to be discharged from PT before the movement group.

Treatment for the movement group lasted an average of eight weeks. This compared to four weeks for the loading group. Patients in both groups had equal decrease in pain intensity and improvement in function.

The authors conclude that a simple classification of neck pain based on load-versus-movement can be used to predict treatment dosage. Patients with pain but full motion need 35 per cent fewer treatments compared with patients who have pain and loss of motion.

The results of this study agree with other reports that time spent with the patient is not the main factor in their response to treatment. Therapists should make sure patients get the best response from care before discharging them. They can expect that neck pain patients with movement impairments may take longer to get the same response as patients with loading pain only.

In this study, physical therapists (PTs) measure how reliable their history and physical examination (HP&E) are for patients with mechanical neck pain. Test measures that give the same information no matter which PT performs the test are considered reliable. PTs use the results of HP&E to diagnose the problem and plan the treatment.

Tests used included posture, neck motion, muscle strength, and flexibility. Each test is described in detail. Twenty-two (22) patients with neck pain were examined by two different physical therapists using the same tests. There was a five-minute break between each half-hour test session.

The authors report poor reliability when testing neck rotation and side bending motions. There was zero to moderate agreement in testing strength of the lower trapezius muscle.

Assessing movement or mobility of each neck segment was also a problem. Results varied quite a bit between the two PTs testing each patient. It’s possible the test is reliable but finding the correct segment or level of the cervical spine is difficult. More study is needed before these test measures are used to guide treatment.

The tests that were considered reliable included: