News Category: Cervical Spine

Disc herniation in the cervical spine (neck) can require surgery. The disc is removed and the vertebrae at that level are fused together. When the operation is done from the front of the neck it’s called an anterior cervical decompression (ACD).

In this study, neurosurgeons report on problems that can occur after the ACD. Nerve damage and swelling in the soft tissues often cause difficulty swallowing and talking. Although these problems are temporary and usually clear up, permanent nerve damage is not rare.

Three groups of patients were included. Two groups had ACD with follow-up at different times. The first (early group was examined before and after surgery. Then they filled out a survey three-months later.

The second group had the surgery and then was invited for a postoperative visit three to nine months later. The third group was the control group. They were seen at the Department of Head and Neck Surgery for other problems.

Information was collected about voice quality and difficulty with swallowing. Everyone was also asked about quality of life (QOL). Vocal cord paralysis on the operated side was common (12 per cent).

Difficulty speaking and talking occurred during the first week after surgery. Most patients had recovered completely by the end of three months. They were generally satisfied with the results. There were fewer satisfied patients in the group who had lasting pain, hoarseness, numbness, and weakness.

The authors concluded that although problems talking and swallowing are common after ACD, in most cases, they are temporary. Symptoms can last months after the surgery. When symptoms last longer than expected, patients should be seen by an ear, nose, and throat specialist.

One method of treating cervical (neck) disc injuries is with a surgical procedure called anterior cervical microdiscectomy, or ACD. In this surgery, the vertebrae (bones) can be fused together, depending on the procedure. However, there is some debate among surgeons as to wheter this is a good idea.

In this study, researchers conducted a randomized trial to see how patients responded immediately after ACD, without fusion, and then how they were 1 year later. Twenty patients who had not had cervical surgery before and who urgently needed surgery or were not responding to non-surgical treatment participated. Eleven patients (7 women) were in group A and did not have a fusion. Group B had 9 patients (7 men) and they did have fusions. Groups A’s ages ranged from 21 to 58 years, with the average being 39.9; group B’s ages ranged from 30 to 50 years, with the average being 40.2 years. The patients’ major complaint was arm pain.

After the surgery, all patients were told to wear soft collars for 2 weeks. They participated in physical therapy and rehabilitation. Their progress was monitored by the specialists and pain was rated using the Visual Analog Scale (VAS). X-rays were taken before surgery, 1 day after, and again 1 year later.

The researchers found that the scores for group A, from the VAS for arm pain before surgery, was an average of 8.18 and it decreased to 3.27 1 year later. Group B reported VAS of 8 before surgery and 3.11 after a year. The neck pain scored 3.18 before surgery and 2.81 a year later in group A, 3.22 before and 2 after in group B. The authors didn’t consider the difference significant for group A, but it was significant for group B. No differences were seen in any of the other aspects studied.

The authors concluded that the ACD technique was safe and effective whether fusion was performed or not. They did suggest, however, that another study with larger numbers of patients may result in different findings.

MRIs are often used to see what’s going on inside the spine. Neck pain and other symptoms from pressure on the spinal cord shows up well on an MRI. This condition is called cervical myelopathy.

Studies show that signal changes occur on MRI for patients with cervical myelopathy who have significant stenosis. Stenosis is a narrowing of the spinal canal, the opening where the spinal cord is located.

But the question is: are there other factors that are just as important as the MRI in making the decision to have surgery? Are there other factors that are more important such as age or duration of symptoms? Can we just rely on the MRI results?

In this study, researchers look to see if the signal intensity on MRIs was linked with severity of symptoms and the results of surgery for cervical myelopathy. Severity of myelopathy and improvement in symptoms were analyzed and compared to results of MRIs taken before surgery. Other factors included in the analysis were age and duration of disease. Function before and after surgery and recovery rate were also measured.

Increased MRI signal intensity (SI) is often seen in cases of myelopathy. Of the 104 patients tested, 83 per cent had increased SI. This group was older and had their symptoms longer than the other patients. They also had poor results after surgery and a slow recovery rate.

In the future, the timing of surgery for myelopathy may be based just on MRI results. Surgery for stenosis had the best results when done early before the patients developed neurologic symptoms and disability.

Disc herniation in the neck can cause pressure on the spinal cord. The result is a problem called cervical compression myelopathy (CCM). Patients with this condition can have neck and arm pain. As CCM gets worse, numbness and tingling down the arm with weakness and muscle atrophy (wasting) can occur.

The treatment for CCM remains under question. Removing the disc and fusing the spine is often done. It would be helpful if doctors could tell which patients need this kind of treatment. Some studies show that younger patients get better faster than older adults with this type of operation. But other studies don’t show age as a predictive factor of success at all.

There is some thought that symptom duration makes a difference. It may be that the longer the patient has symptoms before the surgery, the worse the results will be after surgery. And it’s been suggested that patients with worse symptoms before surgery tend to have less pain relief and less improvement in function when compared to patients who had milder symptoms before the operation.

In this study, 20 patients with CCM were tested before and after surgery. Surgery included disc removal and anterior fusion of the spine. Preoperative age, duration of symptoms, and severity of symptoms were compared to postoperative results. Curvature of the spine and MRI findings were also compared.

The authors found that it was really the fusion itself that made the difference. Everyone got better, even those patients whose MRIs still showed signs of significant compression. The fact that they couldn’t move their spine at the affected level (due to the fusion) seemed to make the most difference. Age and symptom duration didn’t seem to make any difference for this group.

People who experience whiplash are rated on a grading system called the Whiplash-Associated Disorders (WADs) system. Using the symptoms and physical findings, patients are rated as grade I (neck pain but no other physical findings), II (pain and some findings, such as difficulty moving neck from side to side), III (neurologic, or nerve, injury), and IV (major injury like a fracture). Most patients who sustain a whiplash from a car accident, about 90 percent, fall into grades I and II.

Physicians have found that many patients who are WADs grade I or II end up having some cognitive (thinking) problems, such as difficulty with memory or concentration. The authors of this study noted that there is some evidence that patients with WADs do show some decrease in testing regarding attention and memory, but findings of previous tests haven’t been consistent. The investigators in this study wanted to evaluate the findings of testing these patients to see if they could predict who would experience cognitive difficulties.

There were 203 patients who were WADs, grades I or II, in the study. The patients had to have had neck pain as a result of a car accident within two or three months of the study, had not been admitted to the hospital following the accident, had not lost consciousness as a result of the accident, and had no substance abuse.

The patients were asked to check off a list of symptoms and complete questionnaires that evaluated their pain and mental status, such as anxiety or depression. The physicians used the Wechsler Memory Scale – Third Edition (WSC-III) to check for hearing, sight, recognition, and memory. The Trail-Making Test (TST) checked to see the ability of people to connect numbers and letters as directed.

The investigators found that 32 percent of the patients complained of memory problems and 41 percent complained of problems concentrating. However, 54 percent denied either problem. Most patients had either both problems (called group CS+) or neither (called CS-).

The CS+ group had a higher incidence of pain severity, depression, catostrophizing (thinking things are worse than they are), fear of specific movements, and perceived disability. However, there were no differences in the test results, either the WSC-III or the TMT, between either the CS+ or the CS- groups.

In conclusion, the authors stated that the 46 percent finding of patients reporting memory and concentration problems was in line with other study findings. The investigators’ search to find if testing could predict the outcome of these complaints was not met. They recommended that watchful waiting, with reassurance and educating the patients about potential problems following whiplash may be enough for patients with WADs grades I and II.

Twenty-one chronic whiplash patients from the Spinal Care Unit in Tel Aviv were included in this study. The goal was to see if tests of pain and pressure threshold could measure small changes in patient symptoms and disability.

The idea is that tests should not be used unless they can be used to judge the status of the patient. Test results don’t mean anything if they aren’t truly measuring changes that have taken place as a result of treatment. And treatment should be proven effective before using it on patients routinely.

Three tests were used with each patient: the visual analogue scale (VAS), the Neck Disability Index (NDI), and the Pain Pressure Threshold (PPT). The VAS is a simple way to show how much pain the patient is experiencing. The NDI is a self-rated disability test. And the PPT measures the amount of pressure used to cause pain at six specific sites in the neck.

The tests were given to all 21 patients by three different people. The researchers then compared the results to see if the three testers had the same responses. This is a measure of intertester reliability. Tests must be reliable enough so that no matter who uses them, so long as the test is given properly, each tester gets the same response from the patient.

Analysis of the results found that the VAS should only be used with patients who rate their pain as a four (centimeters) or higher on the scale. PPT can be used for measuring changes in chronic whiplash patients so long as the same tester gives the test each time.

In the United States alone, it’s estimated that as many as 1 million new cases of whiplash are diagnosed each year. Whiplash is not only painful and debilitating, it also exacts an economic cost through loss of work and personal injury claims.

Whiplash is traditionally associated with rear-end vehicle impacts, including low-speed impacts. When undertaking this retrospective study, the researchers wanted to learn if higher impact injuries would result in a higher incidence of whiplash.

This study involved 101 consecutive patients who had experienced multiple injuries from a high-impact accident (a fall from more than two meters or a road traffic accident at more than 30 km/hr) that could result in whiplash. After examination, 13 of the patients, all of whom had been in traffic accidents, complained of whiplash injury and they became the study group. Eighty-eight did not complain of whiplash pain and became the control group. During initial triage, 69 percent of the patients in the study group complained of neck pain, while only 20 percent in the study group complained of similar pain. Injury severity, which included head, facial, and chest injuries, and skull, spine, and arm fractures, were higher in the study group.

The researchers collected data on patient demographics, how the injury occurred, where the patient was in the vehicle if involved in a road traffic accident, treatment, and length of hospital stay, among other details. After discharge, the patients were followed monthly, with a mean follow-up of 17 months.

According to the study’s findings, a relatively low number of patients, only 13 percent, developed whiplash following the high-impact trauma. There were no statistical differences found between the study and control groups regarding the length of stay in intensive care, overall hospital stay, injury distribution (other than tibial, foot, and ankle fractures [P<0.001], neck physiotherapy received, and any litigation.

The authors concluded that their hypothesis of increased whiplash with high-impact injury was not correct and that there was no direct correlation between the impact of the trauma and the incidence of whiplash.

Researchers have been investigating ways to determine how neck muscles are affected when someone is injured in a rear-end motor vehicle crash, resulting in whiplash. Using human subjects and cadaveric necks have given some clues, but a biomechanical neck was needed for more in-depth study.

The researchers in this study used human subject data gleaned from subjects who were exposed to low-impact rear-end motor vehicle collision and then integrated the data into a biomechanical neck model. Using electromyographic data from the sternocleidomastoid (SCM) and the posterior cervical muscles, the researchers determined which muscles were being contracted in an unnatural fashion during and after the impact. This allowed the researchers to quantify the magnitude and rate of muscles strain resulting from the forced neck action.

The results showed that the SCM muscle lengthened at impact and then shortened in the rebounding motion. The posterior muscles, the spelius capitis (SPL), semispinalis capitis and the trapezius, did the opposite, shortening upon impact and forward motion, and lengthening on rebound.

Electromyography data showed that the muscle strains on both anterior and posterior muscles were most active during imposed muscle lengthening. The researchers noted that the peak lengthening fascicle strains were significantly greater in the posterior muscles, specifically the SPL. The findings suggest that this is the point when there is most activity in the posterior muscles, during the imposed lengthening, when there is the greatest potential for muscle injury.

Although these tests were done at low velocity impact (less than 8 km/hr), it’s likely that a higher velocity impact would result in a more severe muscle reaction and injury. This type of study is important in order for researchers to understand the factors that are important in the development of whiplash.

The authors concluded that the rate of strain in the neck muscles, following a rear-end collision, is highest among the posterior muscles and that this indicates that they are more likely to be injured.

In this study researchers compare tests used to measure change in pain and disability before and after treatment for chronic whiplash. Most patients do improve over time. Measuring how soon and how much they improve helps guide treatment. Finding the tool that measures these changes most accurately would be helpful.

Four tests commonly used to measure disability were included. These were the Neck Disability Index, the Functional Rating Scale, the Copenhagen Scale, and the Patient-Specific Functional Scale.

Tests used to measure change in pain included the Visual Analog Scale, Bothersome Numerical Rating Scale, and Pain Numerical Rating Scale. The well-known test SF-36 was used as an overall measure of health status.

All of these tools are known to be reliable. This study looks at how responsive they are to changes over a specific period of time. All four tests were used on the same group of whiplash patients. The patients were tested before treatment began and again after six weeks of treatment.

The authors report that the Patient-Specific Functional Scale (PSFS) was the most responsive test measure for disability. The other three tests were equally responsive compared to each other. This means that any of those tests could be used and get the same results but the PSFS gave the best results.

The PSFS is quick and easy to give. It is recommended as the best measure of changes in disability for patients with chronic whiplash. The numerical pain rating scale of pain bothersome was the most responsive measure of pain.

Recovery after whiplash varies among patients with whiplash associated disorder (WAD). A good tool that can be used for patients across all studies is needed to measure results of treatment. Such a measurement device would make it possible to compare various kinds of treatment for all WAD patients (early or late, mild to severe).

In this study, researchers used a five-item version of the Core Outcome Measure (COM) with whiplash patients. The original seven-item COM was designed for use with low back pain patients. They called the adapted version the Core Whiplash Outcome Measure (CWOM).

In order to be useful, the CWOM must be able to measure short-term and long-term results for private insurance and primary care patients. The five items on the CWOM measured symptoms, function, well-being, and disability.

Three groups of patients were tested with the CWOM. All were adults with a whiplash injury caused by an accident. The first group of 99 patients had an acute whiplash. They were seen within the first six weeks of their injury.

The second group (250 patients) were insurance patients classified as early chronic whiplash. The third group were the late chronic whiplash. These 134 patients came for treatment three to 12 months after injury.

The results of this study show that the shorter CWOM is a good tool to use with various groups of whiplash patients. Although it’s a good measure of physical health, it does not measure emotional status.

Statistical analysis of the CWOM showed that it is a responsive and valid measure of neck disability. It can be used to measure pain, physical, and social functioning for all WAD patients.

rh-BMP-2 (BMP) is a protein that helps bone heal. It has been used with good results in spinal fusion of the lumbar spine. BMP helps speed up the recovery rate after lumbar spinal fusion. It has not been approved by the FDA yet for use in the cervical (neck) spine.

Doctors at the Institute for Spinal Disorders in Los Angeles report on the case of one patient who had a bad reaction to BMP. A 54-year old man had an anterior cervical discectomy and fusion (ACDF). Several discs were removed and a metal plate attached to fuse the neck.

A bioresorbable implant called a cage was put in place of the disc to help hold the vertebrae until healing took place. Bone graft containing BMP was put inside the cage to stimulate bone growth and help speed up fusion.

Three days later, the patient started having neck swelling and trouble swallowing. On day five after surgery, he arrived at the emergency room with massive neck swelling. Neurologic signs were normal. The patient was able to breathe okay. Lab values were all normal.

MRIs showed the trachea was pushed over to the side and flattened by severe soft-tissue swelling. Several pockets of air (gas) could be seen on a CT scan. The gas appeared to be inside the track of fluid (swelling). The patient was treated in the ICU for three days and stabilized enough to go home again.

This is the first report describing an adverse response to rh-BMP-2 when used in the cervical spine. The authors suggest that the sponge used to hold the BMP may have released too much of the protein too fast.

BMP is designed to promote bone formation by setting up an inflammatory reaction. It’s likely that reducing the amount of BMP used could tone down the inflammatory response and avoid the swelling seen in this case. This report is meant to alert other surgeons of the possible dose/carrier problems with BMP.

Does acupuncture work to relieve neck pain? Canadian researchers reviewed the results of 10 studies on the effects of acupuncture for cervical (neck) pain patients.

Acupuncture is the insertion of tiny needles along pathways called meridians. Certain points are stimulated to alter pain messages to the brain. In each of these studies, acupuncture was used in one group of patients.

A second (control or comparison) group was treated with pretend acupuncture or some other form of real or mock treatment. Some patients were on a waiting list and did not get any treatment. All patients had chronic mechanical neck disorders. This included whiplash disorders, degenerative changes, and muscular pain.

Results were measured in terms of pain levels, activity level, and patient satisfaction. The authors report the following:

Hospital records are kept nationally in the United States every year. They keep track of the age, sex, diagnosis, and treatment of each patient. The Nationwide Inpatient Sample is one of those databases. The information collected is available for research purposes.

In this study, researchers used information collected over a 10-year period from 1992 to 2001. They looked at treatment and outcomes of patients with degenerative disease of the cervical spine (neck). Over 900,000 records met the criteria for the study and were included.

All patients in the study had cervical spine surgery. More than half were for a herniated disc. Another 20 per cent had a diagnosis of cervical spondylosis with myelopathy.

Spondylosis is the degeneration of the vertebral joints with the development of bone spurs. It occurs most often with aging. The joint changes cause the space between the two adjacent vertebrae to narrow. This puts pressure on the spinal nerves. Painful symptoms and changes in sensation or weakness from this condition are called myelopathy.

Problems after surgery were classified into one of four groups: 1) no complications, 2) total number of complications, 3) heart, lung, or blood vessel problems, and 4) local complications. Local complications included hematomas, accidental cuts, infection, or blood vessel problems.

Analysis of the data showed an overall complication rate of about four per cent. Older adults (at least 74-years old) had the greatest risk of complications during their hospital stay. There were more deaths in the group who had higher rates of complications.

More deaths occurred in patients who had a posterior fusion. And patients with cervical spondylosis and myelopathy had more problems after surgery compared to patients with a herniated disc.

The authors conclude that older age and a diagnosis of cervical myelopathy puts people at increased risk for complications and death. Fortunately the rates of complication are low for this procedure.

Disc disease causing neck and arm pain may be treated with disc removal called a discectomy. Most often after the disc is taken out, the surgeon fills the gap with a mesh cage filled with bone graft. For the best results, the graft is taken from the patient’s own bone. This is called an autograft.

The most common donor site is the pelvic bone. But painful symptoms after bone removal have led doctors to look for alternative donor sites. In this study, bone from the manubrium (the sternum or breast bone) was used with good results.

Ten patients were treated with anterior cervical discectomy and fusion (ACDF) at one level in the cervical spine (neck). A titanium, mesh cage, manubrium graft, and metal plate were used to fuse the spine.

Everyone had immediate relief of pain. X-rays at three months showed signs of a solid fusion. There were no complaints of donor site pain, a common problem with pelvic bone grafts. Only one patient was unhappy with how the scar looked.

This is the first report of manibrium autograft used in ACDF surgery. The authors conclude manibrium autografts are safe and effective. Fusion rates were very high when used in single-level fusions. Fututre studies are needed to test the use of this alternative bone graft site for fusion at multilevel (two or more) segments.

Osteoblastoma is a typically benign bone cancer most common in adults younger than 30 years old. It affects the spine in about 40 per cent of all cases. In this article, surgeons review surgical treatment for this problem in the cervical spine (neck).

Even with careful removal of the tumor, they often grow back. Their presence so close to vital blood vessels and the spinal cord make treatment of this problem very complex.

The exact type of surgery depends on the tumor size and location. In this study, one surgeon performed a surgical procedure in each of nine patients with cervical osteoblastoma. Embolization (either partial or complete) was done first before surgery.

Embolization is a non-surgical, minimally-invasive procedure using metal sponges or other devices to purposefully block blood flow. Surgery to remove the tumor was then done within 24 hours of the embolization.

In each case, the tumor and a small margin of normal tissue around each tumor was removed. This is called marginal resection. Fusion of the bones was done when necessary. Methods of fusion used were described. In one case a larger amount of tissue was removed due to the location of the tumor.

Results of surgery were measured by assessing pain, neurologic symptoms, and whether or not the tumor came back. X-rays, CT scans, and MRI were used to diagnose and follow each case closely.

There was no recurrence of tumor in any of these patients. The authors suggest that preoperative embolization helps make removal of tumors easier. The small number of patients in the study prevented them from recommending this preoperative treatment routinely. But their work so far supports the use of preoperative embolization combined with tumor-free margin resection to prevent tumor recurrence.

Are the extra aches and pains from exercise worth it when you already have chronic pain from a whiplash injury? Patients in this study said, Yes. Improvements in overall pain and function were enough to put up with muscle pain and increased headache pain.

Pain and disability from whiplash-associated disorders (WAD) is a common problem without a good solution. No treatment has been successful in helping these patients. In this study, exercise and advice were compared to advice alone as a possible treatment method.

The advice-only group was given information by a physical therapist about the nature of whiplash injuries. They were told that physical activity causing pain was not going to further damage their necks. They were encouraged to keep moving despite the pain. Follow-up contact was made by phone with each advice-only participant two more times during the study.

The exercise group did a six-week program of exercises supervised by a physical therapist. Exercises were designed for each person individually. There was an aerobic component such as walking or biking and stretching and strength training exercises. Patients in the exercise and advice group were also given a home program to continue after the study was over.

The authors report two main findings in this study. First, exercise and advice worked better than just advice early on. Pain was less intense and less bothersome and function improved. However, there was no difference between the two groups at the end of 12 months, so the effect was short-term.

Secondly, patients with high levels of pain and disability were helped the most both at six weeks and at 12 months. Exercise and advice is helpful in the short-term, but especially for more severe patients.

This information may help doctors and physical therapists guide patients with WAD. Preventing chronic pain and the associated social and economic costs may be a final outcome of this study.

There aren’t very many reports on the treatment and results for cancerous tumors of the cervical spine (neck). In this study, 35 cases of rare cervical spine tumors are treated surgically.

Pain, neurologic symptoms, and cancer recurrence are used to track results. The authors were hoping to find out which factors affect results the most. Patients were followed anywhere from six months up to 15 years.

Surgery was done on all 35 patients to remove some or all of the tumor. Removing all of the tumor is best. But some tumors were more difficult to remove because of their location. The anatomy in this area is complex. It’s possible to damage vital blood vessels or nerves. Fusion to stabilize the spine was necessary more than half the time. Some patients with malignant tumors received radiation therapy or chemotherapy before and/or after surgery.

MRIs were used to look for signs of any cancer recurrence. Patients were asked about pain and other symptoms either by phone or during follow-up visits. Surgery was successful for most of the patients. Neurologic symptoms and pain were decreased or eliminated.

Tumor regrowth was common with chordoma tumors. Chordomas are malignant, and they tend to develop in the upper cervical region where total removal is difficult, if not impossible.

Type of tumor and location were the two most important factors in the final outcome. Some patients with malignant tumors were still alive and free of painful symptoms up to eight years after surgery was done to remove the tumor.

There isn’t a good way to assess results of treatment for all medical conditions. The Short Form-36 (SF-36) survey is probably used the most. The SF-36 measures physical and mental health. It also looks at limitations on work and play. Play includes recreational and social activities.

In this study, a tool called the Cervical Spine Outcomes Questionnaire (CSOQ) is tested on a group of over 500 patients with cervical spine disorders. The results were compared to the SF-36 and one other instrument called the Neck Disability Index (NDI). The NDI measures the effect of spinal disorders on 10 daily activities such as bathing or personal care.

The SF-36 gives a big picture view of a person’s overall health. The NDI is more disease-specific. Previous studies showed that the CSOQ is reliable (it measures what it says it will measure). But how does the CSOQ compare to the SF-36 or the NDI? Does the CSOQ register small changes in symptoms?

Patients at 23 different clinics were included. Everyone was at least 18 years old and had a neck fusion. Specifically, all patients had a procedure called an anterior cervical discectomy and fusion (ACDF). The surgery was done from the front (anterior) of the neck (cervical). Bone graft material was used to hold or stabilize the spine until healing occurred (fusion).

Scores for all sections of these three tests were very similar. This is called a high concurrent validity. It means that the tests measure the same things and get similar results.

For these tests, that means a patient’s neck or shoulder/arm pain tested the same regardless of which test was used. The same was true for function, disability, and psychologic distress. One thing the CSOQ measures that isn’t reported by the SF-36 or NDI is health-care use. Use of narcotic medications andnumber of physician visits in the past six months are measured by the CSOQ.

The authors conclude the CSOQ is a good tool to use with patients who have cervical spine problems. It is both valid and reliable. It measures equally well all the test items in the SF-36 and NDI. It also provides some additional information about job-related tasks that may be helpful.

What’s the best treatment for whiplash injury? Is there any benefit to attending a fitness group over having individual therapy? Canadian researchers compared two group of patients with whiplash injuries to answer these questions.

The Canadian Government Insurance has a no-fault policy with rehab benefits for patients with traffic injuries. Multidisciplinary treatment teams of healthcare professionals provide rehab. Group fitness training is offered at local health clubs. Outpatient rehab is available at private clinics. Hospital inpatient rehab is a third option.

Individual care is also funded. The patient can see a physician, physical therapist, chiropractor, or massage therapist for whiplash injury. The treatment and methods offered in these programs varied in content, frequency, and length. The authors described each group and listed which healthcare professionals were on each team.

Recovery was measured by self-report using a computer-assisted telephone interview. Each patient was contacted at six, 12, 24, 36, and 52 weeks after their injury. Areas assessed included pain and other symptoms, disability, exercise levels, and activity limitations. Quality of life and work status were also included.

The authors report there was no evidence that patients attending the fitness or rehab programs were helped in their recovery. Complete recovery was defined as feeling cured or at least much improved. It could be that the rehab programs were started too late. Or perhaps there was too much variation from program to program to show a difference.

The results of this study need to be confirmed in future follow-up research. For now, individual care is recommended over whiplash rehab or group programs.

In this case report, surgeons from the Department of Neurosurgery at Kinki University School of Medicine (Japan) present a rare case of dropped head syndrome. The patient was a 68-year old woman with her head hanging forward.

Her symptoms came on gradually and got worse over a month’s time. There were no neurologic problems at first. Gradually, she developed weakness in her arms and legs. She could no longer walk. Other neurologic signs and symptoms developed.

Treatment with steroids for inflammation made no difference in her symptoms. An X-ray showed an area of instability at the C34 cervical spine level. A year after her symptoms first started, she tried using a cervical collar. There was no change in her symptoms.

Surgery to fuse her spine was successful. She was able to resume all activities including walking. The authors say this is the first report of dropped head syndrome with spinal cord compression. Pressure on the spinal cord was caused by cervical spine instability and muscular weakness of the neck.

Since the cause of the problem was not a neuromuscular disease, direct treatment with surgery was successful.