News Category: Cervical Spine

If you’re feeling dizzy after having your hair shampooed and styled, there might be an explanation–other than your dazzling new looks. The problem could have to do with a shortage of blood to the brain from having your neck tilted back while getting a hair shampoo, a position commonly used in hairdressing salons.

The vertebral basilar arteries carry blood to the back part of the brain, the cerebellum. In some people, one or both of these arteries can start to get squeezed when the head is tilted back and turned to the side. This squeezing effect can cause a shortage of blood to the brain, leading to dizziness and possibly even a “brain attack,” or stroke. Usually, the symptoms only last a short time. There haven’t been a lot of reports of this problem, but it is common enough that scientists have given it a name–“beauty parlor stroke syndrome.”

In this study, researchers reported the case of a 62-year-old woman who’d had problems with dizziness after shampoo treatments at a hair salon. Along with her feelings of dizziness, she noticed pain in the back of her head and had problems walking. Test results using MRI angiography showed a problem with the blood flow through the left vertebral artery. The doctors also saw markings on MRI scans that showed where a stroke had happened in the tissues of the cerebellum. 

People placed in the head-back position for hair treatments at the salon may end up getting more cut off than just their hair. The authors encourage public education in hopes that hairdressers will place their customers in safer neck postures when doing hair treatments and shampoos.

Health providers rely on results of carefully designed research studies to know which types of treatments will best help their patients. Researchers pursuing this quest recently compared the benefits of three types of programs for patients with chronic neck pain.

Three groups of patients were randomly assigned to receive different forms of treatment. One group received active treatments twice each week for 12 weeks with direct help from a physical therapist. They also received relaxation training and neck posture and coordination exercises. They were  encouraged to work through fears of pain that might otherwise keep them from doing normal activity. A second group was given two separate lectures about neck pain, got a handout of exercises to do at home, and kept an exercise diary of their progress. Participants in the third group attended one lecture about neck problems. They then took home information about neck exercises to do on their own.

Before starting their treatment programs, all the patients completed a survey with basic physical information and information about their pain levels, use of medications, and ability to do daily activities. The patients answered questions about work, including how much and how often they had to lift and whether they got adequate breaks or felt rushed. Patients also reported their feelings and attitudes about their pain, and whether it was keeping them from their normal activities. The researchers then measured how well each person’s neck moved and how much pain patients had when pressure was place on certain neck muscles. The surveys, motion measurements, and pressure scores were rechecked after three months and then again at 12 months.

People seen for active treatments with a physical therapist showed the best results. They had fewer neck symptoms, reported better general health, and even showed better moods and feelings of well-being. They reported doing better at work, a finding the authors feel may “have an affect on absenteeism and costs due to neck pain.” All these benefits were reported at three months and 12 months.

The measurements of neck motion and pressure responses didn’t change much in any of the groups. However, individual reports of benefits were highest in the active group. People in the active group had better results than those in the home-exercise group, who in turn had better results than people who only got a lecture and information about exercise.

More research is needed. But this study indicates the benefits of an active program. It is noteworthy that people who are monitored in their exercise program do better than patients who merely get a recommendation for exercise.

When operating on the spine through the front of the neck, surgeons have to decide whether to make the incision on the right or left side of the neck. It used to be that they went in through the left to avoid hurting the recurrent laryngeal nerve, or RLN.

The RLN hooks up with the voice box (larynx). The nerve takes a windier path getting there on the right side of the neck. Some doctors think this puts the nerve at risk for injury when surgery is done through the right side. Damage to this nerve can cause hoarseness or even loss of speech if the vocal cord is paralyzed.

To determine whether surgery on the right or left side was more likely to lead to RLN injury, the authors examined the cases of 328 patients who had surgery to fuse the spine through the front of their necks. One hundred eighty-six of the patients were men; 142 were women. Their ages ranged from 7 to 82 years old. Four different surgeons performed the operations. One hundred seventy-three surgeries were from the right; 155 were from the left.

Patients were said to have RLN injury if they had hoarseness lasting at least two weeks after surgery. Out of 328 patients, nine (2.9 percent) had RLN injuries. Seven patients’ symptoms went away within three months. The other two patients had ongoing symptoms that were identified as vocal cord paralysis. These two patients had been operated on from the left.

Overall, though, whether the surgery was on the right or left side didn’t make much difference for RLN injuries. The percentage of patients with injuries was 2.3 percent for those operated on from the right and 3.2 percent for those operated on from the left. In other words, the level of risk was nearly the same for both sides.

Patients’ chance of RLN injury didn’t depend on the type of procedure they had or whether special medical instruments were used. Chances of RLN injury didn’t change if patients were having more than two discs fused. However, patients who were on their second operation of this type were more prone to RLN injury than those who hadn’t had this kind of procedure before. For patients having their second surgery, the risk of RLN injury rose to 9.5 percent.

In general, this study suggests that surgeons can safely operate from whichever side of the neck they choose. In the case of repeat surgeries, surgeons should make their choice based on a thorough patient evaluation to reduce risk of injury.

Many football players and wrestlers are familiar with the terms burner and stinger. They describe how nerve pain can “zing” down one arm from a hard hit to the head and neck. This intense sensation of burning pain is thought to be from a pinching of the nerve root where it comes out of the spinal column of the neck.

The area between the bones of the spine where the nerve comes out is called the foramen. When the head is bent back and then compressed, as can happen in a football tackle, the foramen becomes narrower, and the nerve can get pinched. The authors wanted to see if athletes who had problems with burners tended to have a smaller foramen, a condition called stenosis. Researchers came up with a formula to quickly and accurately size the foramen by measuring the height of the foramen and the spinal bone below it on an X-ray image.

Researchers looked at neck X-rays of 64 athletes between the ages of 15 and 18 who reported having had a burner. Comparisons were made to another group of athletes in the same age range who reported having a neck injury in the past but no burner.

Two calculations were used. The first measured the spinal canal. The second was the formula designed by the authors for measuring the size of the foramen. They discovered that athletes who had a burner in the past had smaller spinal canals and smaller foramen. It is likely these athletes were at risk for a burner because a hit to the head and neck, especially with the head tilted back, tends to close the foramen down and pinch the nerve root.

Athletes who keep having problems with burners or who show signs of stenosis on X-ray might benefit from safety features to keep their necks from bending into unsafe positions and from being compressed from impact. These measures, according to the authors, could include neck rolls, special collars, and tips on how to tackle without putting the neck at risk.