News Category: Cervical Spine

As a group, it seems that Japanese people have an unusual amount of myelopathy. Myelopathy is the medical term for pressure against the spinal cord. When this occurs in the neck, it is called “cervical myelopathy.” Anything that causes the spinal canal to narrow in size can cause this problem. Examples include arthritic changes, inflammation, trauma, or problems in the bone structure at birth.

Every bone in the spine has an opening for the spinal cord to pass through. This is called the spinal canal. Having a narrow spinal canal is the main reason people end up with cervical myelopathy.

Gender is also an important factor in cervical myelopathy. According to researchers, Japanese men have this problem more often than Japanese women. A third risk factor is large spine bones. Is there a relationship between these three risk factors?

To answer this question, researchers looked at X-rays of people newly hired by a large company in 1975. This company required a physical exam and spine X-ray of all its new employees. There were 107 men and 116 women in all.

Three measurements were taken from each X-ray: (1) the height of the individual neck bone, (2) the size of the neck bone from front to back (diameter), and (3) the size of the spinal canal opening.

The researchers found that the height of the neck bone had no connection to the size of the spinal canal. This was true for both men and women. However, in men only, the size of the neck bone from front to back made a difference in the size of the spinal canal.

Three risk factors for cervical myelopathy have been identified in the Japanese population. These are male sex, narrow spinal canal, and large bone size. For men, the size of the bone is linked to the size of the spinal canal. This is called the canal/body ratio. The canal/body ratio of the cervical spine is smaller in Japanese men than in women, which may be why cervical myelopathy shows up more in Japanese men.

If you have muscle pain in your neck and shoulders, you may wonder exactly where it comes from. Is it from doing the same tasks over and over at work? From job demands, or the amount of control and support you feel in the workplace? Or does neck pain come from personal factors such as your age, activity level, and personality?

These researchers collected information from over 3,000 workers in 19 industrial and service settings. The workers mostly did unskilled, blue-collar work.

Seven percent of the workers who did the same physical tasks over and over had neck and shoulder pain. Only four percent of workers who didn’t do repetitive tasks had pain.

The researchers looked at videotapes of people working to identify specific risk factors for neck and shoulder pain. In particular, they watched for repetitive work, use of physical force, neck posture (working with the neck bent forward), and lack of shoulder rest time. All of these were associated with neck and shoulder pain. Repetitive tasks that used force were especially related to pain.

High job demands and lack of job control were both linked to neck and shoulder pain. Lack of support from coworkers and supervisors was not linked to pain, however.

Women were more likely to have neck and shoulder pain than men. So were people who had lower tolerances for pain and those who were highly invested in their work. The strongest risk factor for neck and shoulder pain was previous neck or shoulder injury. Age, body size, and physical activities done outside of work were not related to neck and shoulder pain.

Neck and shoulder pain have a strong impact on workers’ lives. The more pain and muscle tenderness these workers had, the poorer their health-related quality of life. This research shows that a variety of factors, both personal and work-related, are important to neck and shoulder pain. All of these factors should be considered in prevention and treatment.

What happens to the neck during a whiplash injury? Researchers continue to study this question in hopes of finding ways to prevent long-term problems. If they can identify and measure the forces at the time of impact, maybe a restraint system could be made to reduce or prevent these forces.

Neck injuries from rear-end car accidents are common in the United States. This is true even with head restraints in all cars. One study showed that many head restraints are not adjusted properly, which contributes to neck injuries. The head and neck restraint should be adjusted so that it rests above ear level and within two inches of the back of the head.

Human volunteers are hard to come by for research of this kind. Understandably, not too many people want to suffer a rear-end impact for the sake of science. Crash dummies and cadavers (human bodies preserved for study) have stiff necks compared to live subjects and do not respond the same.

Computer simulation programs are providing new knowledge in this area. Information from these programs can be compared to previous data from cadavers, crash dummies, and humans. These comparisons help researchers see that the computer models are accurate. Now the forces of impact at different speeds and with different head positions can be tested with greater accuracy, and no one gets hurt in the process.

Such a study has shown that whiplash injury stretches the neck joints and the tissue around the joints. This has led doctors to try a new treatment. Injections were given into the neck joints of people with chronic neck pain. Sixty percent of patients got pain relief from this treatment.

Improvements for seat design have also been suggested. Keeping the head closer to the restraint seems to reduce the forces on the neck. This in turn reduces whiplash injuries.

Advanced computer technology has taken research on whiplash injuries to the next level. New information includes how neck injuries occur, the effects of different speeds on neck injuries, and the best type and placement of head restraints to prevent injuries. This information will help doctors find new treatments for whiplash injuries.

The use of manipulation or mobilization of the neck (sometimes called an “adjustment”) seems to help with some conditions. In fact, more and more studies have agreed that spine manipulation gives relief from pain and increases neck motion. This is especially true for people with neck pain, tension headaches, and whiplash injuries.

The increased use of this technique raises some questions. One concern is the possibility of a stroke after manipulation of the neck. How often does this really happen? Who is at risk? If risk factors can be determined, then patients can be screened ahead of time and advised of the possible dangers.

Risk factors may include age, gender, high blood pressure, diabetes, birth control pills, smoking, and migraine headaches. These are all thought to be risks, but no one has been able to clearly link them with stroke after manipulation. Likewise, patients are tested for problems with the neck arteries before manipulation, but no one has proven that this screening is accurate or effective.

One group of physicians and chiropractors reviewed 64 cases of strokes caused by neck manipulation. They were looking for common patterns among the patients that would point to one or more specific risk factors. Each of these cases was being investigated legally. For this reason, the medical and chiropractic records were thought to be very complete.

According to this study, strokes after neck manipulation are rare and unpredictable. No clear risk factors were found. Although most strokes occurred in patients between the ages of 30 and 50, this age group was more likely to go to a chiropractor for treatment in the first place. There was no evidence that older adults at risk for stroke from age or other medical conditions were more likely to have this problem after neck manipulation.

Right now, it isn’t possible to predict who might have a stroke after neck manipulation. The risk of complications from neck manipulation is not any higher than the risk that goes along with other common treatments for neck pain.

Do you wonder if you’re getting the best treatment for your injury or condition? Doctors and physical therapists wonder this, too. They work hard to keep up on the latest information for the many problems they treat.

One way to make sure all patients get the best care is to use clinical practice guidelines. These are helpful in giving health care workers information on a specific disease, illness, or injury. In turn, this leads to better treatment decisions and improved treatment results. Clinical practice guidelines go a long way in making sure everyone gets the same up-to-date care.

Unfortunately, not every health care problem has practice guidelines. Some illnesses and injuries are still being studied to find the best treatment. Such is the case with injury from whiplash. Many forms of treatment are currently offered for whiplash because there are no guidelines for the management of this problem.

A group of health care workers in the Netherlands wanted to set guidelines for treating whiplash. Since there are very few scientific answers about whiplash injury, some of the guidelines are based on opinion rather than research. Sometimes this is a necessary first step until more research can be done.

A panel of seven experts drafted the first clinical practice guidelines for whiplash. The panel included three different types of medical doctors, a psychologist, a surgeon, a medical advisor, and a member of the Whiplash Association (to represent patients). The first step was to consult available research. The panel studied reports of what works and what doesn’t in the treatment of whiplash.

Using this information, the panel laid out several steps:

• History Taking: Ask the patient about symptoms; difficulty doing tasks at home, work, or school; previous treatment for this problem; work history.


• Physical Examination: Perform a posture exam; measure motion, strength, and function; test for balance, sensation, and sense of position.


• Diagnosis: Combine the history and physical exam in making a diagnosis.


• Treatment Plan: The treatment plan is divided into five different phases based on the healing and recovery process. The goal is to return to normal activities quickly and prevent long-term problems.

Getting rear-ended can cause a painful neck injury that can result in long-lasting pain and disability. In fact, these types of whiplash injuries are still the most expensive for both patients and insurance companies.

Much has been done to find a way to reduce neck injuries that occur with rear-end collisions. In 1969, head restraints were placed in American cars to limit how far back the head could snap when a collision occurred. Unfortunately, there were still many drivers who reported neck injuries after rear-end impacts. This was probably because many of the head restraints were not properly adjusted. Most were down too low or back too far from the head.

When a driver is sitting in a stopped car and gets hit suddenly from behind, there is a fairly typical response of neck and head movement. The chest is thrust forward while the head flings back. Then the head is thrust forward as the chest stops moving. Throughout this process, the bones inside the upper neck move in an S-motion, like a wave. Researchers think it is this S-wave that causes most tissue damage in the neck.

The result is often neck soreness and stiffness that starts the next day and may last two or three days. For some people, pain, stiffness, and loss of motion become chronic problems lasting six months or more.

Engineers looked at results of low-impact rear-end crashes, comparing
cadavers (human bodies preserved for study) and live human volunteers. They measured the movement of the chest and head after a crash for two separate seat and head restraint units. The first group of volunteers sat on car seats with standard head restraints. The second group used an anti-whiplash head restraint with special modifications.

The modified restraint had a surface that could adjust to the driver’s head, neck, and upper back size and shape. It could also absorb some of the energy after impact, thus reducing how much the head moved forward and back. The seat and head restraint were closer together and gave as much support as possible at the same time.

The modified head restraint decreased the time it took for the chest to move forward and come back against the restraint. Likewise, the time before the head contacted the restraint was less than with the standard restraint. Overall chest-to-head forward motion was less, too.

Engineers have shown that it’s possible to reduce the forces of rear-end car collisions on the head and neck. They did this by creating a seat with more even contact between the upper body and the seat, and between the head and the head restraint. It’s not certain that reducing chest and head motion will prevent whiplash injuries. This is the first study in a series that will investigate this idea.

If you have whiplash from a car or other accident, your doctor may gauge the damage to your neck area by checking how much you can move your head. Amount of movement, also called range of motion (ROM), has long been used as a measure of physical impairment for patients with whiplash; however, the research on this issue has been inconclusive. Doctors aren’t sure whether neck ROM actually distinguishes patients who have whiplash from those who don’t.

Do people with whiplash have different ROM and patterns of movement in their necks than healthy subjects? These authors compared 89 healthy subjects to 114 people who had ongoing neck pain (two months to three years) from motor vehicle accidents. This second group was said to have “whiplash-associated disorders.” Participants’ ages ranged from 18 to 65, with an average of about 38. The healthy subjects were about half men, half women. In the whiplash group, there were a lot more women than men.

To measure neck ROM, participants sat in a chair in a comfortable position. They moved their heads forward and back, looked to the left and right, and tipped their heads side to side (ear to shoulder). They wore special sensors to track how far they could move in each direction.

Participants with persistent whiplash had moderate pain and disability at the time of the study. They also had much less ROM than the other group in all directions. Moving the head forward (chin to chest) and back was the most difficult movement for people with whiplash.

Age also made a difference in neck ROM in all directions. The authors found that when taken together, ROM, age, and gender correctly distinguished people with whiplash from those without 90 percent of the time.

Though whiplash reduced neck ROM, it did not change the actual patterns of movement seen in this study. In other words, people with whiplash did not show abnormal kinds of movement compared to healthy subjects.

More research is needed to see whether ROM is related to the degree of whiplash. And researchers have yet to determine exactly how whiplash affects neck movement, be it through changes in tissues, pain, or some other factor.

Serious neck problems are sometimes treated with surgery to fuse together one or more bones. Fusion may be the best treatment for some patients with disc protrusion. It’s also used for patients with a narrow opening for the spinal cord. These conditions can put pressure on the spinal cord or the nerves as they leave the spinal cord.

Doctors know that worker’s compensation (WC) patients with low back problems typically don’t do as well as those who aren’t receiving WC, for various reasons. A group of doctors at St. Luke’s Medical Center in Chicago wanted to know if this difference was also true for neck pain patients.

Would someone on WC have a worse result after neck fusion? The authors compared two groups of patients. There were 30 patients in the WC group and 50 patients in the non-WC group. Both groups had similar neck problems and were treated with the same fusion operation.

There was no difference in the results for these two groups. Patients returned to work about the same time. The strength of the fusion was equal between the two groups. Pain relief and use of pain medication was also the same.

There was one difference in these two groups. The patients who used tobacco had poorer results. They were more likely to have a weak fusion or places where false joints (called pseudoarthroses) formed.

As much as 40 percent of the population experiences neck pain in a given year. There are a number of risk factors for neck pain. Among them, the type of work you do and the “personality” of your workplace may play a big part.

How might work lead to neck pain? Things like deadlines, dealing with difficult coworkers, and trying to move up the corporate ladder can cause stress. If the stress exceeds your coping skills or the support provided by the workplace, you may wind up with added muscle tension, and possibly a pain in your neck.

These authors wanted to see which “psychosocial” characteristics of the workplace were linked to neck pain. In particular, they wondered whether job demands, authority to make decisions, freedom to use one’s skills, support of supervisors and coworkers, and job security were risk factors for neck pain.

Workers from 34 industrial and service companies in the Netherlands filled out questionnaires once a year for three years. Nine hundred seventy-seven workers participated. Three-quarters of them were men. Their average age was 35. They had been at their jobs for about 10 years and worked roughly 38 hours a week. None of them had experienced neck pain the year before the study began.

One hundred forty-one workers (14 percent) had neck pain at least once during the three years. The authors felt this number was relatively low. Because workers who’d had neck pain in the previous year were excluded from the study, this sample of workers may not have been very prone to neck pain.

Participants who worked under a lot of time pressure (seven percent) were more likely to have neck pain. So were those who didn’t feel supported by their coworkers (10 percent). Workers with little decision-making authority were somewhat more likely to have neck pain, but this relationship was felt to be slight.

None of the other psychosocial factors was related to neck pain. Notably, physical factors such as sitting or bending your neck on the job were just as likely as the psychosocial factors to lead to neck pain.

The authors think that reducing deadlines and time pressure may help prevent some cases of neck pain. More support among coworkers may also be beneficial. Finally, workers given more opportunities to make decisions about their own work may be less susceptible to neck problems.

If you have neck pain from a herniated or degenerating disc, your doctor may eventually recommend surgery. Surgeons usually get to the problem disc by operating through the front of the neck. They take out the damaged part of the disc and replace it with bone from elsewhere in the patient’s body or from another source. The goal of this type of surgery is for the bones to grow back together, forming one solid bone.

There is considerable variation in the success of this surgery, particularly when fusion is attempted at more than one vertebral level in the neck. Some researchers have estimated that surgeons operating on multiple levels achieve successful fusion in just under half of the cases.

This author’s surgical group reports better results when using bone from the patient’s lower leg (fibula) to fuse the spine. This study documents the success rate of this procedure when more than one vertebral level is fused.

One hundred forty-five patients had neck fusion surgery. All of the patients tried conservative treatment for a long period before resorting to surgery. There were about an equal number of men and women with an average age of 49 years old. Most of the patients (112) had surgery at two levels. Thirty-two had surgery at three levels, and one had surgery at four levels. After surgery, patients wore soft collars for at least three months.

Neck X-rays were taken no less than two years after surgery. All but 14 patients had solid fusions at that time. That means 90 percent of patients had good results from surgery. For each level of fusion attempted, there was a 94 percent success rate.

The number of vertebral levels involved in the surgery didn’t affect patients’ results in any major way. The rate for successful fusion was 92 percent for two levels and 84 percent for three levels.

The majority of patients who didn’t achieve solid fusion were women. However, the difference in success rates between men and women was not felt to be significant. Also, six of the patients who didn’t have solid fusions were smokers at the time of surgery. It is well known that smoking interferes with healing and lowers the chance fusion will occur.

Ten patients had complications from surgery. The author attributes the overall success of this procedure to the fact that the fibula grafts used in neck fusion have a large surface area. The larger surface area improves the body’s ability to heal the graft and bones together into one solid bone. Still, the variation in reported success rates among surgeons suggests that more research is needed.

The authors are confident that fusing more than one level in the neck using bone graft from the fibula offers acceptable success rates.

In the right circumstances, neck surgery can provide relief of pain and other symptoms. Sometimes surgery may be the only option. This is often the case when a disc herniation in the neck puts pressure against the spinal cord, causing a condition called myelopathy. Myelopathy can lead to problems with the bowels and bladder. It can change the way a person walks and affect the ability to use the fingers and hands. Doctors take this condition very seriously because if left untreated, severe pressure on the spinal cord can cause permanent damage to the nerve tissues.

But what if symptoms from the pressure are only mild? Is conservative treatment–treatment without surgery–an equally good option, with fewer risks? Unfortunately, these questions are often left unanswered. Due to their doctors’ concerns about irreversible nerve damage, patients with cervical myelopathy typically have surgery. Yet these questions have merit because studies have shown that some disc herniations shrink with time.

In this study, the authors looked at patients with cervical disc herniations. A cervical disc herniation (CDH) occurs when a disc ruptures out of its normal space in the neck. In this study, CDH caused mild symptoms in patients from the pressure against the spinal cord. The authors wanted to learn whether conservative treatment alone would provide good results for the patients.

Twenty-seven patients participated in the study, which took place in Japan. The patients were mostly male. Their average age was 44. At the time of treatment, they didn’t require canes to walk as is sometimes the case with cervical myelopathy. However, they had numbness in both hands and couldn’t stretch their legs out completely. 

Treatment involved wearing a neck brace for at least eight hours a day. This lasted for three months. After that, patients wore their braces as needed. They were also told not to do activities that were hard on their necks.

Seventeen of the patients (63 percent) improved or stayed the same when they followed this regimen. In fact, ruptured discs healed on their own in 10 of these patients. The other 10 patients either did not improve or got worse over a six-month period. These patients had surgery to remove pressure from their spinal cords.

At follow-up, both groups (the patients who had surgery and those who didn’t) had the same level of function. They also functioned just as well as an additional group of surgery patients who hadn’t started with conservative treatment.

Both groups were satisfied with their treatment. Seventy-seven percent of patients who had only conservative treatment were satisfied with their results. Ninety percent of those who had conservative treatment plus surgery were satisfied. Yet the difference in satisfaction between the groups was only slight.

MRI scans showed that certain kinds of disc herniations were related to how well patients did with conservative treatment. Patients who benefited from conservative treatment tended to have discs that herniated toward the front of the spinal cord. In the neck, the spinal canal is bigger in the center, so the spinal cord isn’t squeezed as easily by a disc that herniates into the front of the spinal cord. Herniations that press into the spinal cord from the side tend to cause bigger problems, as the spinal canal is narrower at this point.

Also, “diffuse” herniations that spread out were more likely to improve without surgery. These herniations tend to get smaller with time. As they shrink, the pressure against the spinal cord is relieved. But a rupture that is focused in a confined area may not trigger the body’s corrective responses. As a result, this form of herniation often continues to cause problems and usually requires surgery.

In conclusion, the authors feel that conservative treatment has good results for patients with mild symptoms of myelopathy from CDH. Also, MRI scans can be helpful in predicting whether patients will benefit from this kind of treatment. If patients get worse after three months of conservative treatment, surgery should be considered.

Headaches related to head impact in football are common. Often, these headaches go unreported. Researchers gave out questionnaires to high school and collegiate football players. Of 433 completed surveys returned, 85 percent of the players reported having a headache related to playing football. Most (81 percent) said they had a headache in at least one-fourth of their games. Yet only 16 percent alerted sideline personnel. 

Trainers and team physicians face split-decisions about players with headaches. Complaints of a headache may have resulted from a minor impact. But it may signal a serious problem, such as a concussion or more severe head injury. Making a decision to sideline a player with a headache isn’t easy. Often the symptoms are vague and don’t point to more serious problems.

A blow to the head may accompany symptoms of nausea and vomiting from a problem called post-concussion symptom, which happens in about 25 percent of people who’ve had a concussion. Most feared is an often-fatal condition called second-impact syndrome (SIS). This is thought to occur when a player has a first-time injury to the head, leading to post-concussion syndrome. Then the player has another seemingly minor head injury, walks off the field, and collapses within five minutes. Most players who have SIS end up with severe problems or even death. Notably, the only symptom leading up to the final blow is a persistent headache.

The biggest challenge is knowing what to do–and when. Some guidelines state that any player with ongoing headache symptoms shouldn’t go back out on the field. The authors suggest that if these guidelines were strictly enforced, more than 20 percent of players, according to their research findings, would have to sit out. They insist that players reporting a headache should have a neurological examination. If they pass the examination and their headache symptoms aren’t getting worse, it should be okay for them to return to play. 

The authors’ concern is that strictly following the guidelines might lead to even less reporting of headaches. Instead, they believe sideline personnel need to use clinical judgment when making decisions about returning players with headaches to the playing field.

Magnetic resonance imaging–more commonly known as MRI–provides doctors with computerized pictures of tissues inside the body. This machine creates images that look like slices of the area your doctor is interested in. If a person has neck pain, for example, doctors can use MRI to determine exactly where the problem is and where to operate. But can the MRI give an accurate picture of whether the surgery will be a success?

Seventy-three patients requiring surgery for spinal stenosis were studied. Spinal stenosis develops when the tube surrounding the spinal cord narrows. The resulting pressure on the spinal cord causes “myelopathy,” a condition that can cause problems with the bowels and bladder, change the way a person walks, and affect a person’s ability to use his or her fingers and hands.

Fifty of the patients were men; 23 were women. Their ages ranged from 43 to 81 years old. The average age was 64.

The authors studied MRI scans taken of each patient before surgery. The authors wanted to compare whether certain qualities of the MRI were common in patients who didn’t do well after surgery. If patients with a particular finding on the MRI didn’t get good results from surgery, doctors might know not to suggest surgery for these kinds of patients.

The results showed that, for the most part, MRIs don’t predict how well a patient will do after surgery. The findings of one type of MRI pattern suggested there was greater damage to the spinal cord tissues. Patients with this MRI pattern tended to do poorly after surgery. But since only four of these patients were in the study, the results weren’t conclusive.

A combination of the patients’ ages, certain MRI patterns, and duration of symptoms seemed to be good predictors of how well the participants would do after surgery. Younger patients whose MRI scans didn’t suggest a lot of damage and whose symptoms hadn’t lasted as long were more likely to get good results from surgery.

MRIs can give lots of information about the spine. However, doctors don’t yet know how to use this information to predict how well people will do after surgery. The authors hope future research will expand doctors’ knowledge in this area.

If you have a degenerative neck condition, your doctor may recommend surgery. In most cases, the surgeon removes a damaged intervertebral disc and replaces it with a chunk of bone. Think of the results as a bone sandwich, with the new bone–or graft–as the filling. The hope is that the graft will attach to the other bones, fusing solidly.

Unfortunately, neck surgery doesn’t always have the desired outcome. If the graft doesn’t take, problems arise. Grafts can collapse, stick out, or be absorbed. Special devices (instrumentation) have been created to hold grafts in place and stabilize the surrounding bones while the graft heals. These devices are implanted during surgery and remain in the spinal column. Though they often have good results, many of these devices have proven to be faulty or result in complications.

In this article, the authors report on a new instrumentation system. The device they used was developed in France. Like other devices of its kind, this one–called the PCB–is made of titanium. Its simple design consists of a “cage” where chips of bone graft are held. The cage keeps the graft material (mentioned above) from falling out and improves the chances the graft will begin fusing the two neck bones together.

The PCB is specially angled to restore the natural curve of the neck. The screws that hold it in place are simple to fit and insert. And the device is designed to work on more than one vertebral level when multilevel fusion is performed. The procedure to implant the PCB creates enough stability in the neck that patients don’t need to wear neck collars after surgery.

The PCB was tried out on 29 patients. The patients were mostly male. Their average age was 49. Most of them had surgery at one level (or location) in their neck. Seven had surgery at two levels, and two had surgery at three levels.

The authors followed up five months to two years after surgery. They took X-rays to see whether the bones had fused successfully. In 27 cases, there was noticeable improvement. One patient had gotten worse, and one patient had no change. 

There were no complications or infections from surgery. The PCB stayed solidly positioned, with none of the screw breakage that sometimes happens with other types of instrumentation. None of the patients had abnormally high levels of pain after surgery.

These early results were very positive. The PCB seemed to reduce neck pain by immediately stabilizing the bones in the neck. What’s more, the device was successful in maintaining the space between vertebrae and correcting the curve of the neck. The authors would like to see more research on this device. They are especially interested in a new version of the PCB that shows up more clearly on X-rays.

By now it comes as no surprise that smoking is a far from healthy habit. Smoking is hard on the heart, lungs, and immune system. It also poorly affects the success of certain surgeries, such as low back surgery. Does smoking also have a negative impact on the results after neck surgery?

Fifty-five smokers and 135 nonsmokers had surgery to fuse the vertebrae in their necks. Fusion surgery is used to get two or more bones to grow together into one solid bone. One type of surgery used in this study, called interbody grafting, involved placing bone grafts between the vertebral bodies. Another type, strut grafting, involved removing several vertebral bodies and putting in a long column of bone to replace the vertebral bodies.

Two years after surgery, nonsmokers showed better neck fusion than smokers. Nonsmokers also reported less neck pain. The only exception to this was in the case of strut grafting, which had the same results for smokers and nonsmokers. This may be because the interbody procedure involved putting bone in at multiple points in the neck. So at least four separate surfaces had to heal. Strut grafting, by contrast, involved only two surfaces.

Not surprisingly, patients whose necks healed properly also felt better. With this in mind, the authors want to find ways to improve the rate of neck fusion for smokers. The best way, of course, is to get patients to quit smoking. In the meantime, the authors prefer the strut-graft method for smokers who need to have a longer section of their neck bones fused.

If your car is rear-ended, your neck may pay the price. Whiplash happens when your neck snaps back and forth during a collision. It often results in neck stiffness. How long does this stiffness usually last?

One hundred forty-one people with whiplash from rear-end collisions participated in this study. On average, there was a 40 kilometers per hour difference in the speeds of the colliding vehicles. The accidents were generally described as “minor.” Patients with whiplash symptoms (headache and neck pain) were included in the study if they didn’t become unconscious during the accident or have amnesia afterward. Most of the subjects were using headrests and seat belts at the time of impact.

Subjects were matched with people of the same age and sex who were being treated for an entirely different problem, ankle sprain. This set of subjects gave the researchers a “normal” comparison group. Scientists match subjects in a research study to get a clearer idea of how factors (like whiplash) impact participants.

The subjects with whiplash showed less neck movement than the comparison group on the day of their accidents. Of the movements they were asked to perform, they had the most trouble moving their necks up and down. Three months later, however, there were no differences between the two groups in amount of neck movement. This suggests that people with whiplash may get “normal” neck movement back within three months of injury.

The severity of the accident didn’t seem to affect patients’ whiplash. The speeds of the colliding cars and extent of car damage were not related to patients’ amount of neck movement, either right after the accident or three months later.

For subjects with whiplash, less neck movement was often accompanied by neck pain and headaches. But unlike the costs of car repair, these symptoms went away quickly, and without lasting effects.

If you have a neck injury in your sport, the decision to head back to the track or field may be a tough one. Many athletes rely on doctors and other health providers for advice. But how consistent is their advice, and what is it based on?

In this study, 113 orthopedic doctors reviewed the cases of 10 athletes who had sustained neck injuries. The doctors were asked to select which types of sport they would feel comfortable recommending to each athlete based on the injury. Types of sport ranged from collision sports (football, hockey) to contact sports (lacrosse, basketball) to various noncontact sports (skiing, gymnastics, golf).

Doctors generally agreed that collision and contact sports were riskier than noncontact sports. However, they had different opinions about which levels of sport were safe for the athletes in question.

Although half of the doctors reported using published medical guidelines to form their opinions, their advice didn’t always match these guidelines. More often, their recommendations related to the length of their careers and their areas of specialty. Doctors who had been practicing medicine longer tended to okay lower risk sports than those who were newer to medicine. Specialists in sports medicine tended to suggest lower risk sports than doctors who specialized in treatment of the spine.

This study suggests that if you go for a second opinion, that’s probably what you’ll get. The wide range of opinions can be confusing. Researchers hope that further study of the risks involved with returning to sport after a neck injury will clear up some of the guesswork for athletes.

Doctors sometimes suggest surgery to take out a herniated disc in the cervical spine (the neck). Most times, a graft of bone is placed between the two vertebrae where the disc was removed. The graft connects–or fuses–both vertebrae into one solid bone, a procedure called arthrodesis. This often takes away pain and other symptoms caused by the injured disc. However, the fused part of the neck can no longer move. In addition, doctors fear that the vertebral joints above and below the fused section tend to degenerate quicker.

These complications have launched the medical quest for an artificial disc. An artificial disc (also called a disc prosthesis) could be used in place of a herniated disc that has been removed, and there would no longer be any need to fuse the neck bones together. The idea is that the artificial disc would take the place of the disc without a loss of joint movement.

This author reported on his use of a new type of artificial disc in 10 patients. All patients had been having pain and other symptoms for at least three months before surgery. They each had a herniated cervical disc taken out and replaced with an artificial disc.

Of the 10 patients, two developed intense neck pain after the surgery. Follow-up X-rays were done with the neck bent down. The images of both these patients showed movement around the artificial disc. In one patient, the implant actually caused the neck joint to tilt too far forward–the joint worked like a see-saw.

The other eight patients had no pain after the initial operation. However, their X-ray tests showed that they had lost mobility in the area of the artificial disc. The bones ended up fusing together around the prosthesis.

The author rates this particular artificial disc a “total failure.” If the neck could move afterward, pain was not relieved; if the pain went away, so did neck mobility. The prosthesis simply didn’t do what it was designed to do–take away symptoms while keeping the vertebrae mobile.

Despite these disappointing results, the author “remains convinced of the need for a cervical disc prosthesis that is easy to implant.” He suggests ways to design an artificial disc that will be more successful. So the quest for an effective artificial disc goes on.

Much of the testing done by physical therapists for their neck patients is based on common sense. Hard scientific evidence to support the tests’ conclusions is sometimes lacking. These authors looked at specific tests done for people with neck problems, also called cervical spine disorders (CSD). The authors wanted to see whether tests to measure anatomical problems, functional limitations, and disability had consistent results.

The authors tested 80 people with CSD using eight specific measures that are commonly used by physical therapists. Subjects were tested for basic anatomical problems using measures of pain, neck range of motion, and neck strength. They were tested for functional limitations using measures of spinal motion and a lift test. Disability was tested using two surveys, one of neck health and one of general health and quality of life.

As clinicians have long assumed, these results confirm that each of the three measures were related in patients with CSD–anatomical problems, functional limitations, and disability. Problems with neck movement or strength make it harder to do needed activities. This–in turn–affects whether and how much people feel their neck problem is disabling them.

The authors also checked to see if payment method (insurance or self-pay) or length of time since symptoms started were related to the test results. They found no relationship between the tests and these variables.

This study gives a starting point for designing future research on ways to develop effective therapy programs and to help forecast how well patients with CSD might fare with treatment.

Whiplash–now that’s a diagnosis that’s easy to understand, right? Wrong. Very, very wrong. As the authors of this article point out, medical professionals don’t even agree on the exact definition of whiplash. Everyone agrees that it happens most often in car crashes. But nobody knows exactly what happens in the body to cause prolonged pain and disability. Doctors and therapists don’t even know which treatments work best to get whiplash patients back to full function–there aren’t enough good studies.

These authors searched the medical literature to find clinical studies using conservative treatment for whiplash. Conservative treatments for whiplash include heat and ice packs, ultrasound, exercise, traction, and massage, among other therapies. The authors located only three studies that were good enough to be considered in detail in this review. The three studies looked at pulsed electromagnetic therapy, a combination of conservative treatments, and encouraging normal activity.

Overall, the authors found the studies of low quality and not very useful. The strongest conclusion from the three studies is that activity is probably better than rest and strict immobilization for whiplash patients. The authors’ main conclusion is that there is a glaring need to better understand treatment for whiplash. Based on their review, they suggest that future clinical trials should follow patients for a year and measure social and psychological outcomes as well as physical outcomes. Until better research is done, doctors and therapists have a limited understanding about the best way to treat whiplash.