News Category: Cervical Spine

Have you ever had chiropractic care for neck pain and felt worse the next day? You’re not alone. According to this study, one-third of all patients treated with neck manipulation have symptoms within 24 hours. Pain, stiffness, dizziness, or headache are the most common problems.

Neck pain patients in four southern California health care clinics were included in this study. Patients were put into various groups. Two groups received manipulation with or without heat. Two other groups were treated by manipulation with and without electrical stimulation. Some patients were also treated with mobilization with and without heat or electrical stimulation.

Researchers wanted to find out how many patients had a bad reaction to chiropractic care. They compared responses to manipulation and mobilization. They also looked for ways to tell who might have a bad reaction to the treatment.

The authors report that women and all adults between the ages of 30 and 39 are slightly more likely to report a reaction to chiropractic care. Most symptoms began within 24 hours of treatment. Symptoms went away within 24 hours. Symptoms didn’t affect daily activities. Heat and electrical stimulation didn’t seem to make a difference. Fewer patients had problems after mobilization versus manipulation.

The results of this study show that adverse reactions to chiropractic care for neck pain occur in three out of every 10 patients. Symptoms are more likely to occur after manipulation. Chiropractors may want to use mobilization in some patients. Neck trauma, high levels of pain, recent nausea, and headache are red flags to suggest the use of mobilization.

Many people with neck and arm pain also have tender spots in the muscles of the neck and upper arms. Is the pain coming from the muscles? Or is it referred from the neck? This is the question of a Mayo Clinic study.

A special device called an algometer was used to measure sensitivity of 14 pairs of muscular points. Ten normal, healthy adults and sixteen adults with cervical radiculopathy were tested. Cervical radiculopathy is a problem that occurs when a nerve in the neck is irritated as it leaves the spinal canal. All patients had symptoms of arm pain, numbness, tingling, and weakness on one side only.

Results showed more tender spots on the side of the radiculopathy. Normal subjects had no difference in tenderness from side to side. The authors suggest that the increased number of tender spots that occur with radiculopathy isn’t a chance finding. One-sided tender spots are probably coming from the irritated nerve, not from damage to the muscle.

The authors conclude that physical therapists and doctors who treat muscular pain must watch out for muscle pain on one side. They should look for reflex and strength changes along with tender spots. When found together at the same time, these symptoms suggest that cervical radiculopathy is the main problem. Treatment of the neck problem may work better than treating the tender spots.

Does surgery help patients with cervical spondylotic myelopathy (CSM)? Not according to this and other studies. CSM is a compression of the spinal cord in the neck. It can cause neck pain, hand numbness and clumsiness, and problems walking. Patients also report changes in bladder function. Some men are impotent.

Two groups of patients with CSM were compared using different methods of treatment. The first group had surgery to take the pressure off the spinal cord. The second group didn’t have surgery.

Results were measured using three different scales. Each scale measured symptoms, ability to walk, sensory loss, or other measures of function. There wasn’t agreement in the results from these tools. One scale showed patients improved. A second scale showed no change. Scores declined with the third scale. Overall the results of surgery were “unimpressive” in the words of the surgeons.

The authors offer some possible reasons for these results. Perhaps the scales don’t measure changes that DO occur with surgery. Maybe a different way to measure change is needed. It’s possible that any improvement is a placebo effect because the patient had surgery.

One final explanation for the poor surgical results may be the short follow-up period (only six months). Many surgeons think the main benefit of spinal surgery For CSM is to slow or stop its progression. Long-term studies are needed with a large number of patients to really answer the question of surgery or no surgery for CSM.

In this study of chronic neck pain, researchers looked for links between pain, loss of function, disability, and patient satisfaction. Each of these areas was measured before and after physical therapy treatment. They found only weak connections between most of these variables. Only neck disability and pain showed a fair degree of correlation.

What does this tell us? Perhaps several things. First, maybe these factors don’t measure the same things and can’t be compared. Second, patient satisfaction may be based on more than just pain and loss of motion. For example the not being able to read or drive a car (functional activities) may have more to do with disability than pain levels or muscle strength in the neck.

The authors report that patients’ level of pain intensity was linked more closely to the degree of disability. This was especially true as time went by and the patient had long-term neck pain.

The results of this study may help physical therapists plan treatment for chronic neck pain patients. The findings suggest all aspects of neck problems should be focused on in treatment. This includes physical problems, patient satisfaction, and patient goals. Patient pain levels, function, and disability should all be focused on equally.

Cervical spine (neck) fusion is the standard surgical treatment for severe neck pain and joint stiffness. The operation works well enough but there are some problems. New technology has made it possible to use a disc replacement in the cervical spine. This study reports the results of early trials using the ProDisc-C implant.

Sixteen patients with severe neck pain from degenerative disc disease were included. Some patients also had pain going down the arm. Others had signs of spinal cord compression such as numbness, tingling, and weakness. The disc was removed from one or two levels and the ProDisc-C inserted in the disc space.

Patients were questioned about pain levels, analgesic use for pain, and overall satisfaction during the first year after the operation. Pain was measured based on intensity and frequency. Before and after X-rays were also taken.

The researchers asked three questions:

Do exercise programs work for patients with chronic neck pain? That’s the focus of this study from the Department of Rehabilitation Sciences in Hong Kong. Past studies have shown that muscle atrophy (weakness) is linked with neck pain. The exact cause and effect isn’t known.

In this study patients with chronic neck pain were divided into two groups. Both groups were given heat treatment and neck care advice. The second group also did an exercise program twice a week for six weeks. The deep muscles of the neck were the main targets for strengthening.

Pain levels and muscle strength were measured after six weeks of treatment. Other factors used to gauge results were patient satisfaction, pain medications used, and the amount of sick leave taken. The same measures were taken after six months.

The authors report both groups got better after six weeks of treatment. The exercise group had much more improvement in function than the control group. The exercise group also had less pain than the control group. By the end of six months patients in both groups were about the same in all areas.

The results of this study show that specific neck exercises can help chronic neck pain sufferers in a short time (six weeks or less). More studies to compare different types of exercise is the next step.

People can have chronic neck pain after a whiplash injury whether the trauma was mild or severe. What factors predict chronic disability after whiplash injury? That’s the focus of this study from South Australia.

Patients in the study came from local hospital emergency rooms, medical offices, and physical therapy clinics. All had a whiplash injury within the last six weeks. Patient results were measured based on pain, treatment received, return to work, and settlement of the claim. Everyone was rechecked 12 months later.

Researchers found patients had less improvement when a lawyer was involved in the case. In fact there was less chance the claim would be settled when a lawyer was involved. Patients who filed a claim were more likely to still be in treatment a full year after the injury. The amount of damage to a car didn’t seem to have any bearing on the final result.

The authors conclude an insurance system is needed to reduce legal cases. Recovery after accidents is slowed down or stopped when the settlement depends on pain. Other studies support the idea that our current insurance system actually promotes delayed healing.

Many patients suffer from hoarseness after anterior cervical spine (neck) surgery. The problem could be nerve palsy. By opening the neck up from the front, surgeons avoid damaging the spinal cord. Instead, there’s a risk that the recurrent laryngeal nerve (RLN) can be damaged. When this happens, the vocal cords are affected. How often does this occur? That’s the focus of this study from an ear, nose, and throat center in Germany.

The researchers didn’t just rely on symptoms of hoarseness and difficulty swallowing to test for nerve palsy. They used a laryngoscope to look at the vocal cords before and after the neck surgery. All patients in the study had anterior cervical spine surgery to remove a disc or fuse the spine. Vocal cord function was also measured.

The authors report two out of 123 patients (1.6 percent) had RLN without hoarseness before surgery. Another 24 percent (some with symptoms, some without) were affected after surgery. Many patients still had nerve impairment three months later. The recovery rate was much lower than expected.

The results of this study have led researchers to consider several options:

Females are more likely to have a concussion from sports injuries, but why? Is there a difference in the way the head and neck move between the sexes? Or maybe the nerves and muscles controlling the head and neck respond differently to trauma. That’s what researchers at the Biokinetics Research Lab at Temple University in Philadelphia, Pennsylvania, tried to find out in this study.

Twenty men and 20 women were part of this study. A motion analysis system was used to video head and neck movement. The head and neck was subjected to different speeds. Force was used to mimic different sport situations. Sometimes the subjects knew the force was coming. In other trials they didn’t. EMG was used to measure muscle activity during the movement.

What they found is that women have less muscle mass as males. Muscle length is the same between the two groups. Women have faster head and neck movement and displacement during noncontact sports compared with men. Noncontact sports include soccer, baseball, and basketball.

Concussions in women are more likely even though they use more muscle power sooner to help hold the head and neck steady. Lower levels of strength, smaller neck girth, and less head and neck stiffness may increase a woman’s risk of concussion when unexpected loads are applied to the head and neck.

The authors say improper muscle function is not the reason for differences in rates of concussions between men and women. Women may be able to increase neck girth and strength with a training program. This may help reduce the number of concussions during noncontact sports activities.

Disc replacements for the spine are becoming a reality. Scientists are working to create an artificial implant that will keep the same disc height and spine motion. Until now, the disc has been taken out and the bones fused together. The patient gets pain control but loses function. Damage from increased loads through the bone cause problems at the spinal levels above and below the fused area.

In this study the effects of an artificial disc in the cervical spine (neck) are reported. A special ball-and-socket design was used. Range of motion and patterns of movement were measured after disc replacement in six cadavers. A cadaver is a spine saved after death for use in studies. The disc implant was put between C4 and C5 in the cervical spine.

A special motion analysis system was used to measure and record motion to within 0.1 degrees of accuracy. Motions measured included bending forward and back, tilting side to side, and turning or rotating. The load on the spine during these movements was also measured.

Data collected in this study show that the ball-and-socket disc implant has the same motion as a normal, healthy spine. In other words, normal neck motion is possible with the right disc design. This type of movement is called motion coupling. Load on the next spinal level may still be increased. More studies are needed to look at this issue.

In this study 54 patients with cervical myelopathy were matched with 54 healthy volunteers (control group) of the same age and gender. Myelopathy refers to any problem with the function of the spinal cord. Cervical is the location in the neck or upper part of the spine.

The patients had myelopathy from a protruding disc putting pressure on the spinal cord. Messages about the body, joints, and muscles go to the brain through the spinal cord. Sensations of where these body parts are at any point in time called proprioception are sent to the brain via the spinal cord. There are two kinds of proprioception. One refers to the position of a joint. The other has to do with movement: how fast, how much, and in what direction the joint is moving.

Knee proprioception was measured for both groups. The researchers wanted to see if position sense of the knee joint shows how severe cervical myelopathy is. The test is easy to do.

Measuring proprioception is done by placing the joint at a specific angle for several seconds. The first position was at 30 degrees. Then the knee was returned to its resting position. The baseline or resting position was with patient or subject sitting and the knee bent 90 degrees. Each person was asked to return the knee to the 30 degree angle of flexion. The test was repeated with the knee at 60 degrees.

The myelopathy group had much higher errors than the control group. The authors report that the present study shows proprioception is impaired in cervical myelopathy. They weren’t able to conclude that knee proprioception can be used as a measure of the degree of spinal cord involvement.

Many studies have been done on anterior cervical interbody fusion (ACIF) for the neck. There is ongoing concern about breakdown years later at the discs above and below the area of fusion. This study looks at how often this happens and what makes the nearby discs degenerate.

Degenerative changes in the discs above or below a fused segment in the cervical spine are seen on X-ray in up to half of all cases. In this study 112 patients were followed for more than two years. Some patients were seen for up to 19 years after the first operation.

Everyone had the same operation. First the disc was removed from between two vertebral bones. Then the front(anterior) side of the neck was fused using bone from the patient’s own pelvis. Patients wore a neck brace right after surgery and started walking five days later.

The authors report a 19 percent rate of symptoms of next level disease after ACIF. Patients who already had disc damage above or below the level operated on were more likely to have disc problems later. These doctors suggest the data shows disc disease next to the fused level is just a natural progression of the disc degeneration already taking place. It was there before the first operation ever took place.

The question now is: should the surgeon fuse all levels that look damaged, even if the patient isn’t having any symptoms from that level? The authors don’t think so. Some patients can get better without surgery. In this study only six percent of the patients with ongoing disc disease needed more surgery.

We often hear about rear-end collisions causing whiplash injuries, but what about frontal collisions? How much force does it take to strain the cervical spine? What happens to cause these injuries? Understanding how injuries occur can help us prevent chronic neck pain. Doctors hope to find a way to diagnose and treat soft tissue injuries of the neck sooner after such injuries.

In this report, scientists from the Biomechanics Research Lab at Yale University bring up the issue of neck injuries from head-on collisions. Tests were done on six human spines prepared after death for study. Various amounts of force were applied to mimic a head-on impact. A digital camera and special computer software recorded and analyzed the data.

The authors found that each ligament in the neck has its own limit. Some can withstand 4G of acceleration force on impact. Others hold up under 10G or more. (A “G” is a measure of acceleration. 1G is what you’d experience if you jumped out of an airplane). Injury occurred most often at the C3/C4 level of the cervical spine. This level may be at greatest risk for injury during a head-on crash. Ligaments at a greater distance from this level may be at risk of injury during head-on impact.

It’s still not clear exactly what happens to cause neck injury during a head-on collision. The authors of this study offer many possible explanations based on their findings.

This is the first study to measure the activity of the deep flexor group of neck muscles in patients with neck pain. Chronic neck pain is increasing in the United States. Finding ways to test and retrain impaired neck muscles may be important in treating the problem. Researchers hope this information can be used to prevent neck pain from occurring in the first place or from coming back in patients who have had one episode already.

In this study 10 patients with neck pain were compared with 10 people without neck pain. Researchers measured neck range of motion and electrical activity of the deep muscles that flex the neck. The deep flexor muscles were chosen because they connect to the bones in the neck. These muscles support and control the cervical spine. The movement of neck flexion measured through five positions was called the craniocervical flexion test.

The authors report lower electrical readings in the deep neck flexor muscles in patients with neck pain. At the same time, there was more electrical activity in the neck muscles closer to the surface. This suggests that patients with neck pain change the way muscles work to move the head and neck.

The researchers aren’t sure why patients with neck pain use a different movement strategy than healthy subjects. Is it because the deep muscles are weak? Or because the other muscles are more active? What causes the change in muscle activity? And which comes first: pain, or change in muscle function?

Until we have the answers to these questions, the authors conclude that both surface and deep muscles of the neck should be tested. Both are needed to control movement and stability of the neck. Using the craniocervical flexion test and retraining weak muscles is a valid way to treat neck pain.

What do general practitioners, family physicians, and chiropractors think about the treatment of whiplash injury? That’s what this study is all about. Two doctors at the University of Alberta in Canada talked to 362 doctors and 88 chiropractors. They asked each of these doctors questions about treating adults with acute whiplash injury.

The authors report the following beliefs:

It makes sense that patients with neck pain can’t relax the muscles around the neck and shoulders. This study shows that it’s more than just a problem with relaxation. The muscles have increased activity at rest. There’s also increased muscle activity while doing tasks using the arms.

Previous studies have shown changes in muscle activity for the upper trapezius (UT) muscle in subjects with neck pain. The UT muscle goes from the back of the neck down and across to the top of the shoulder.

This study shows that more than just the UT muscle is involved. The sternocleidomastoid (SCM) and anterior scalene (AS) muscles are also affected. These two muscles help bend or flex the head and neck forward.

EMG tests were used to measure the electrical activity of each muscle during a specific task. Three groups of patients were tested: 1) 10 patients with a history of neck pain of unknown cause; 2) 10 patients with a whiplash-associated disorder; and 3) 10 patients with no neck problems or injury (the control group).

The authors report their findings for each group alone. They also compare the results of each group to the other two groups. Overall, the authors found increased EMG activity for the SCM and AS muscles on both sides in the patients with neck pain. Increased activity in the left UT muscle was also found. The control group had the opposite results, with most activity recorded in the right UT muscle.

The authors suggest some reasons for these findings. But they say that further study is needed to understand these changes.

Neck pain is a common cause of sick leave. It also results in lost work and visits to health care specialists. Manipulation and mobilization are often used to treat the problem. According to this study, such treatment isn’t enough unless used with exercise.

Researchers at McMaster University in Canada looked at high quality studies of adults with neck pain. All patients were treated with neck manipulation or mobilization. Manipulation uses a thrust at the end of the joint range of motion to move the joint. Mobilization applies small movements to the joint through part or all of the motion.

The included studies were done by medical doctors, chiropractors, and physical therapists. The patients all had neck pain. Some had neck pain alone, and some had neck pain with headache. Others had whiplash disorders or neck pain with arm pain. Results were measured by pain relief, improved function, and patient satisfaction.

The authors report no difference in pain relief when manipulation or mobilization was used alone. When used together the two were better than no treatment for patients with chronic neck pain and headache. Manipulation or mobilization plus exercise gave the best results for all types of neck pain patients.

Maybe exercise is the key ingredient. Scientists aren’t sure. Patients who had exercise alone had the same results as the manipulation and mobilization plus exercise group. The difference was that the manipulation and mobilization plus exercise group were happier with their results.

After reviewing 33 studies, the authors conclude that mobilization works just as well as manipulation for certain types of neck problems. Both appear to be better than no treatment. And both appear to be better than other treatments like heat or massage. Both work better when combined with exercise.

Fusion of the neck (cervical spine) is widely used to treat disc disease. There’s a problem with this treatment. Many patients get degenerative changes at the level just above or just below the fusion. It’s not clear if these changes are caused by increased motion or by the natural process of the disease already present. When the fused level doesn’t move, perhaps the load is passed up or down. The adjacent levels take on an added mechanical stress. Since disc disease is already present, researchers think both factors may add to the wear and tear on the nearby discs.

In this study 180 patients had neck fusion surgery. They were followed for more than five years. All patients were fused with a metal plate in front of the vertebral bone or bone graft to hold the spine in place until bone growth filled in. X- rays taken five years or more after the operation were compared to earlier X-rays taken right before or right after the surgery.

The researchers looked for disc height and any signs of degeneration. A loss of more than 50 percent of the disc height was scored as severe degeneration. A decrease of 50 to 75 percent was called moderate, and a loss of 25 percent of disc height was recorded as mild. Bone spurs were also graded as mild, moderate, or severe and used as a measure of surgery success.

The authors report that 92 percent of all patients had increased spine degeneration after fusion. The greater the time interval after the operation, the more damage was present. Age at the time of surgery didn’t seem to make a difference. Whether or not a plate was used to fuse the spine didn’t seem to make the changes worse. The researchers conclude that the need for reoperation will increase the more time goes by after fusion.

People with chronic neck pain from whiplash injury can have changes in their balance. Scientists in Denmark used a special platform to look at changes in foot position as a measure of balance or loss of balance. The postural recordings are part of a study called posturography.

Posturography was compared for two groups. The first group had a chronic whiplash injury. The second (control) group had no neck pain and no history of whiplash injury. Active neck motion and position sense were measured for both groups.

Researchers applied vibration to the Achilles tendons of all subjects. Then muscles in the neck were injected with a salt solution. Subjects were asked to talk and to open and close their eyes while standing. Posture recordings were taken for both groups after each event.

People in the control group made all the needed postural adjustments. Being pushed off balance, closing their eyes, talking, or painful injections didn’t prevent them from keeping their normal balance.

The researchers found decreased motion and reduced position sense in the whiplash group compared to the control group. The authors suggest these changes show a protective response in whiplash patients.

Postural control is altered after a whiplash injury. Damage to neck joints from the injury results in reduced position sense. There may be changes in the patient’s vision. Postural responses are slowed down because visual responses are slower, so muscle activity is slower. We rely on position sense and our inner ear mechanism to keep an upright position and our balance.

Knowing about these differences in the postural system after whiplash may help us find ways to treat chronic symptoms. Posturography may help us find patients with these changes.

Chronic whiplash-associated disorders (WAD) are poorly understood. Scientists think a loss of motor control is a big part of the problem. Patients can’t sense where the neck is during movement. The neck muscles get overloaded. The patient can get neck pain, headache, and blurred vision. Dizziness and memory problems can also occur.

A new test is being used for disordered sense of movement in the upper neck. Physical therapists from Iceland report on this test in two groups of patients. The first group had chronic WAD. The second (control) group had no history of neck pain or whiplash.

A special device called a 3Space Fastrak system was used to measure position sense in the head and neck. The Fastrak was hooked up to a computer to record the head and neck positions. A new software program was written just for this study. The researchers call the program “The Fly.” Three movement patterns were carried out three times each.

Each subject used the eyes to follow a cursor moving across the computer screen. They made a second cursor follow the first by moving their heads. The results were recorded and then measured for each person in the study. The data show that the whiplash group had the worst results. The control group got better results with each trial. The WAD group got worse with each new trial.

The authors report that this new test can be used to tell which patients have WAD. They suggest that the information about movement from the neck receptors in patients with WAD is unreliable. The next step is to study the speed of movement. The neck, eye, and inner ear systems may respond differently depending on the speed of head and neck movement. The final tool may be one that can be used to find patients who try to fake results for personal or financial gain.