scholarly journals Posterior Ligamentous Complex Reconstruction for Cervical Dislocation and Instability in Patients without Vertebral Fracture with Artificial Ligaments: A Technical Note

2020 ◽  
Author(s):  
Chengyi Huang ◽  
Beiyu Wang ◽  
Hao Liu ◽  
Tingkui Wu ◽  
Kangkang Huang ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Vertebral Fracture ◽  
Neck Pain ◽  
Facet Joint ◽  
Spinous Process ◽  
Posterior Ligamentous Complex ◽  
Reconstruction Surgery ◽  
Artificial Ligaments ◽  
Cervical Surgery ◽  
Patient Reported

Abstract Introduction: The posterior ligamentous complex (PLC) offers restraints to deformation in a complex and interconnected manner. The stability and range of motion (ROM) of the posterior cervical spine is greatly restricted when the PLC is damaged, even without bone disruptions. We describe a novel surgical technique, its advantages, and the postoperative condition of the first patient to use artificial ligament in a reconstruction surgery of PLC injuries in patients without lower cervical vertebral fracture. This technique aimed to fully retain the mobility of the injured segment based on spinal stability and apply dynamic reconstruction in patients’ treatment.Method: We present a detailed description of the reconstruction surgery with artificial ligaments performed on C4-6 PLC injuries in a 27-year-old male presented with neck pain and restricted movement following a high fall injury accompanied by impaired movement of limbs. Results: Immediately postsurgery, the patient’s neck pain and quadriparesis had been improved. The spinal canal decompression and cervical spine sequence results were satisfactory, the facet joint face was in a good position, and the spinous process spacing returned to normal. After three months of rehabilitation, the patient reported improvement of symptoms and the physical and imaging examination showed a significant improvement in the patient’s condition. The patient’s neck mobility motor function had improved further.Conclusion: The present data demonstrate that the novel technique for reconstruction of PLC injury is feasible and safe. However, familiarity with cervical anatomy and adequate experience in lateral mass screws placement during surgery is crucial for this procedure. Therefore, a highly experienced cervical surgery team is recommended to perform the surgery.

scholarly journals Fluoroscopically-Guided Cervical Zygapophyseal Therapeutic Joint Injections May Reduce the Need for Radiofrequency Neurotomy

2018 ◽  
Vol 1 (21;1) ◽  
pp. E661-E665
Author(s):  
Christopher Huston
Keyword(s):  
Observational Study ◽  
Neck Pain ◽  
Prospective Observational Study ◽  
Facet Joint ◽  
Zygapophyseal Joint ◽  
Radiofrequency Neurotomy ◽  
Case Series Study ◽  
Patient Reported ◽  
Joint Injections

Background: There is a paucity of literature studying therapeutic intraarticular zygapophyseal (commonly referred to as facet) joint injections in the atraumatic patient population. As a result of this, intraarticular injections have been dismissed as a possible treatment for cervical zygapophyseal joint-mediated pain. Radiofrequency neurotomy (RFN) is currently the accepted treatment for facet joint neck pain. Objective: This prospective observational study investigated injection response in an atraumatic population to determine treatment viability and whether injections reduce the need for RFN in neck pain patients. Study Design: Observational case series study. Setting: This study took place in the outpatient clinic of a private practice. Methods: The double-block paradigm (DBP) was used to determine if symptoms were zygapophyseal joint-mediated. Lidocaine and bupivacaine diagnostic injections were used. Participants passing the DBP underwent fluoroscopically-guided cervical zygapophyseal joint injections (betamethasone and 1% lidocaine) and 1 year of follow-up. Outcomes were a Verbal Numeric Scale score (VNS) > 2, 50% decrease in VNS, patient-reported improvement, and opioid use at the 1-year follow-up. Results: One hundred and eighteen patients were enrolled; 51 passed the DBP. These 51 patients underwent injections. Forty-four patients (59 joints) were surveyed 1 year later with 7 follow-up losses. Thirty-four of 59 joints showed ≥ 2-point VNS reductions or ≥ 50% overall symptomatic improvement after 1 year. Twenty-four of 44 ceased narcotics use. Limitations: The limitations of this research included the lack of randomization and blinding, smaller sample size, and reliance on subjective reporting from the participants both immediately after the procedures and at follow-up. As this was a prospective observational study, there is the possibility of unintended bias by both patients as well as the authors. Conclusion: Cervical zygapophyseal joint injections may reduce the need for RFN; additional studies are required. Key words: Neck pain, facet joint, cervical zygapophyseal joint injections, radiofrequency neurotomy

The Benefit of Therapeutic Medial Branch Blocks after Cervical Operations

2010 ◽  
Vol 6;13 (6;12) ◽  
pp. 527-534
Author(s):  
Stephan Klessinger
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Joint Pain ◽  
Facet Joint ◽  
Medial Branch ◽  
Level Of Evidence ◽  
Nerve Blocks ◽  
Medial Branch Block ◽  
Cervical Facet ◽  
Cervical Facet Joint

Background: Persistent neck pain is a common problem after surgery of the cervical spine. No therapy recommendation exists for these patients. Objectives: The objective of this study was to determine if a therapeutic medial branch block is a rational treatment for patients with postoperative neck pain after cervical spine operations. Study Design: Retrospective practice audit. Setting: Review of charts of all patients who underwent cervical spine operations for degenerative reasons during a time period of 3 years. Methods: Patients with persistent postsurgical pain were treated with therapeutic medial branch blocks (local anesthetic and steroid). A positive treatment response was defined if at least 80% reduction of pain could be achieved or if the patient was sufficiently satisfied with the relief. All patients with a minimum follow up time of 6 month were included. Results: Of the 312 operations performed, 128 were artificial disc operations, 125 were stand alone cages, and 59 were fusions with cage and plate. Persistent neck pain occurred in 33.3 % of the patients. There was no difference between the patients with neck pain and the whole group of patients. More than half of the patients with neck pain—52.9%—were treated successfully with therapeutic medial branch blocks. Since no further treatment was necessary, the initial treatment was considered successful. Nearly a third—32.2%—of the patients were initially treated successfully, but their pain recurred and further diagnostics and treatments were necessary. In this group of patients, significantly more with double level operations were found (P = 0.003). Patients not responding to the medial branch block were 14.9%. Limitations: This audit is retrospective and observational, and therefore does not represent a high level of evidence. However, to our knowledge, since this information has not been previously reported and no recommendation for the treatment of post-operative zygapophysial joint pain exists, it appears to be the best available research upon which to recommend treatment and to plan higher quality studies. Conclusions: For persistent postsurgical neck pain only limited therapy recommendations exist. This study suggests treating these patients in a first instance with therapeutic medial branch blocks. The success rate is 52.9 %. Key words: Chronic neck pain, cervical zygapophysial pain, cervical facet joint pain, medial branch blocks, therapeutical cervical facet joint nerve blocks, postsurgery syndrome, pain therapy Pain Physician

scholarly journals Bilateral facet effusion is a risk factor for segmental instability with cervical injury without vertebral fracture

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shinji Tanishima ◽  
Tokumitsu Mihara ◽  
Shinya Ogawa ◽  
Chikako Takeda ◽  
Satoshi Fujiwara ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Vertebral Fracture ◽  
Cervical Spine Injury ◽  
Facet Joint ◽  
Joint Effusion ◽  
Spine Injury ◽  
Cervical Injury ◽  
Segmental Instability ◽  
Group A ◽  
Group B

AbstractMagnetic resonance imaging (MRI) is effective in identifying cervical spine injury after trauma. However, cervical instability without major bone injury or dislocation is challenging to assess. Hence, the current study aimed to investigate and compare the MRI and radiography findings of segmental instability in patients with cervical spine injury. We investigated 34 participants with cervical spine injury without vertebral fracture. Based on the radiography findings, the participants were categorized into two: group A with segmental instability (n = 11) and group B without segmental instability (n = 23). Both groups were compared in terms of the presence of segmental instability on radiography and MRI. Anterior longitudinal ligament (ALL) injury, disc injury, and bilateral facet effusion were observed in 6/11, 5/11, and 7/11 patients in group A and in 5/23, 2/23 and 7/23 patients in group B, respectively. The results showed significant differences (p < 0.05). Moreover, 2 and 10 of 11 patients in group A and 16 and 7 of 23 patients in group B presented with hemi lateral facet effusion and paravertebral muscle injury, respectively. However, the results did not significantly differ. According to a logistic regression analysis, bilateral facet effusion after trauma was associated with cervical segmental instability (odd ratio: 10.6, 95% confidence interval: 1.31–84.7). Facet joint effusion might be caused by capsule injury during trauma. Most participants with segmental instability had ALL, disc, and flavum injury and bilateral facet effusion. Therefore, we need to consider bilateral facet effusion with other soft tissue damage of the cervical spine as an association factor to show the instability.

PROMIS-29 Validity and Conversion Equation to Neck Disability Index (NDI) using a National Sample of Cervical Spine Surgery Patients

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Inamullah Khan ◽  
Jacquelyn S Pennings ◽  
Claudia Davidson ◽  
Mohamad Bydon ◽  
Anthony L Asher ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Neck Disability Index ◽  
Reliability And Validity ◽  
National Registry ◽  
Good Reliability ◽  
Cervical Spine Surgery ◽  
Cervical Surgery ◽  
Patient Reported ◽  
Conversion Equation

Abstract INTRODUCTION Patient Reported Outcomes Measures (PROMs) have become a vital tool for evaluating success of spine surgery. The purpose was to examine the validity of the PROMIS-29 to better understand it's use for cervical spine surgery patients. A secondary objective was to calculate a conversion equation between PROMIS-29 and NDI, to allow researchers and clinicians to determine a predicted NDI. METHODS We conducted a retrospective analysis of prospectively collected national registry data, the Quality Outcomes Database (QOD), which is designed to evaluate risk-adjusted outcomes for the most commonly performed spinal surgical procedures. We queried the QOD registry for patients with PROMIS-29 and NDI responses. Of 619 patients, 41% were female, 87% Caucasian, and 13% had revision surgery. The mean age was 58 yr (SD = 12). Validity of the PROMIS-29 was assessed using Cronbach's a, ceiling/floor effects, and principle axis factoring. Multivariable regression predicting NDI scores from PROMIS-29 domains used data from all three timepoints. Predicted NDI scores, derived from PROMIS-29 domains, were plotted against NDI scores to determine how well PROMIS-29 domains predicted NDI. A conversion equation was created from PROMIS regression coefficients. RESULTS Results showed good reliability (Cronbach's a >0.80) and validity of PROMIS-29 in patients undergoing cervical surgery: convergent (r > 0.65) and discriminant (r = 0.49-0.63) validity, low/high floor/ceiling effects (=2%), and unidimensional domains (factor loading >0.64). The conversion equation used 6 PROMIS-29 domains (NDIpercent = 7.928-0.527*[PFraw] + 1.570*[PAINraw] +0.995*[SDraw] + 1.101[PIraw] + 0.392[Fatigueraw] 0.409 [SRraw]). Correlations between predicted and actual NDI scores at each timepoint were: r = 0.84 at baseline, r = 0.76 at 3 mo, and r = 0.84 at 12 mo, suggesting that the equation predicted NDI-scores that are strongly correlated with actual NDI-scores. CONCLUSION Good reliability and validity support the use of PROMIS-29 in cervical surgery patients. Findings suggest accurate NDI score can be derived from PROMIS-29 domains. These results support the idea that PROMIS-29 domains have the potential to replace disease-specific traditional PROMs like NDI.

The utility of radionucleotide imaging in the surgical management of axial neck pain from cervical facet joint arthropathy

2020 ◽  
Vol 32 (2) ◽  
pp. 168-173
Author(s):  
Christopher D. Witiw ◽  
Nataliya Tsapenko ◽  
Vincent C. Traynelis
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Facet Joint ◽  
Case Series ◽  
Tracer Uptake ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Axial Neck Pain ◽  
Cervical Facet ◽  
Facet Arthropathy

OBJECTIVEAxial neck pain is common and often debilitating. Diagnosis of the specific pain source can be a challenge, and this confounds effective treatment. Cervical facet arthropathy is implicated in many of these cases. The diagnosis is readily made on conventional cross-sectional imaging modalities, particularly CT imaging. However, this modality falls short in determining if an osteoarthritic facet joint is truly the source of symptoms. Radionucleotide imaging presents a noninvasive radiological adjunct to conventional cross-sectional imaging in the workup of patients with suspected facetogenic pain. Herein, the authors present the patient-reported outcomes (PROs) following posterior instrumented arthrodesis of the subaxial cervical spine from a consecutive case series of patients with a diagnosis of cervical facet joint arthropathy and a concordant positive radionucleotide tracer uptake.METHODSThe clinical case series of patients treated by the senior author at a single tertiary care institution between September 2014 and April 2018 was reviewed. Patients were selected for inclusion if their primary symptom at presentation was axial neck pain without neurological deficits and if CT imaging revealed facet arthropathy of the cervical spine. These patients underwent radionucleotide imaging in the form of a planar 99mTc methylene diphosphonate (99mTc MDP) bone scintigraphy study. Those with a finding of radionucleotide tracer uptake at a location concordant with the facet arthropathy were selected to undergo posterior cervical instrumented arthrodesis of the affected levels. PROs were recorded at the time of surgical consultation (i.e., after nonoperative treatment) and at 6 weeks, 3 months, 6 months, and 1 year following surgery. These included neck and arm pain, the Neck Disability Index (NDI) and the 12-Item Short Form Health Survey responses.RESULTSA total of 11 patients were included in this retrospective case series. The average reported neck pain and NDI scores were high at baseline; 7.6 ± 2.3 and 37.1 ± 13.9 respectively. Twelve months after surgical intervention, a significant decrease in reported neck pain of −4.5 (95% CI −6.9, −2.1; p = 0.015) and a significant decrease in NDI of −20.0 (95% CI −29.4, −10.6; p = 0.014) was observed.CONCLUSIONSThis case series represents the largest to date of patients undergoing surgical arthrodesis following a finding of facet arthropathy with a concordant positive radioisotope image study. These observations add support to a growing body of evidence that suggests the utility of radioisotope imaging for identification of a facetogenic pain generator in patients with primary axial neck pain and a finding of cervical facet arthropathy. These preliminary data should serve to promote future prospective, controlled studies on the incorporation of radionucleotide imaging into the workup of patients with suspected facetogenic pain of the cervical spine.

scholarly journals Response to Cervical Medial Branch Blocks In Patients with Cervicogenic Vertigo

2018 ◽  
Vol 1 (21;1) ◽  
pp. 285-293
Author(s):  
Stephan Klessinger
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Diagnostic Tool ◽  
Facet Joint ◽  
Electronic Medical Record System ◽  
Clinical Impression ◽  
Medial Branch ◽  
Case Scenario ◽  
Record System ◽  
Worst Case

Background: Among the various causes of vertigo, the so-called cervicogenic vertigo (CV) has been the most controversial. However, perturbations of proprioceptive signals and abnormal activity of the cervical afferents can induce vertigo. Medial branch blocks (MBBs) are a diagnostic tool designed to test whether a patient’s neck pain is mediated by one or more of the medial branches of the dorsal rami of the spinal nerve. It is unknown whether MBBs are also suitable for testing symptoms other than pain. Objectives: The purpose of this study was to test whether MBBs of the cervical spine can be used as a diagnostic tool to identify patients with CV. Study Design: A retrospective practice audit (clinical observation). Setting: An interventional pain management and spine practice. Methods: An electronic medical record system was used to identify patients in a single spine center. Included were consecutive patients with neck pain and vertigo, who had received cervical MBBs in a period from July 2001 to April 2016. The patients were tested with a MBB of about 1 mL of bupivacaine (0.25%) and 20 mg triamcinolone. Injections were performed with fluoroscopic visualization using established techniques in 2 or 3 levels on one or both sides. Vertigo was analyzed through the global clinical impression of the patient (i.e., “gone,” “better,” “the same,” or “worse”). Results: One-hundred seventy-eight patients met the inclusion criteria. One-hundred eleven patients (62.4%) experienced a significant improvement of the vertigo. In 47 patients (26.4%), no information about the vertigo was available at follow-up; these patients were assumed to have no improvement (worst-case scenario). Hence, altogether 67 patients (37.6%) had a negative result. The median relief of the vertigo was 2 months. Differences in age, gender, level of treatment, or pain duration between patients with relief of the vertigo and without relief were not found. Nine patients with a whiplash injury in their medical history were also tested. They experienced a lower success rate and had longer duration of pain before the treatment; however, these differences are not statistically significant. Limitations: It was the primary intention to treat neck pain; the assessment of vertigo was an additional aim. Therefore, the history taken and the clinical examination were not targeted specifically to vertigo. A placebo effect cannot be excluded. Further studies with the primary focus on CV are necessary to prove the significance of MBBs. Conclusions: This is the first study to demonstrate that MBBs of the cervical spine can be a useful tool for the diagnosis of CV, because they temporarily block cervical afferents. In 63.4% of patients with neck pain and suspected CV, the vertigo was significantly improved. Further placebo-controlled studies with the primary intention on CV are necessary to prove the significance of MBBs. Key words: Cervicogenic vertigo, medial branch block, facet joint, zygapophysial joint, neck pain, differential diagnosis

Residual numbness of the upper extremity after cervical surgery in patients with cervical spondylotic myelopathy

2020 ◽  
Vol 33 (6) ◽  
pp. 734-741
Author(s):  
Masayoshi Iwamae ◽  
Akinobu Suzuki ◽  
Koji Tamai ◽  
Hidetomi Terai ◽  
Masatoshi Hoshino ◽  
...  
Keyword(s):  
Neck Pain ◽  
Upper Extremity ◽  
Cervical Spondylotic Myelopathy ◽  
Multivariate Linear Regression Analysis ◽  
Vas Score ◽  
Radiographic Parameters ◽  
Clinical Scores ◽  
Sf 36 ◽  
Cervical Surgery ◽  
Preoperative Factors

OBJECTIVEAlthough numbness is one of the chief complaints of patients with cervical spondylotic myelopathy (CSM), preoperative factors relating to residual numbness of the upper extremity (UE) and impact of the outcomes on cervical surgery are not well established. The authors hypothesized that severe preoperative UE numbness could be a risk factor for residual UE numbness after surgery and that the residual UE numbness could have a negative impact on postoperative outcomes. Therefore, this study aimed to identify the preoperative factors that are predictive of residual UE numbness after cervical surgery and demonstrate the effects of residual UE numbness on clinical scores and radiographic parameters.METHODSThe study design was a retrospective cohort study. The authors analyzed data of 103 patients who underwent cervical laminoplasty from January 2012 to December 2014 and were followed up for more than 2 years postoperatively. The patients were divided into two groups: the severe residual-numbness group (postoperative visual analog scale [VAS] score for UE numbness > 40 mm) and the no/mild residual-numbness group (VAS score ≤ 40 mm). The outcome measures were VAS score, Japanese Orthopaedic Association scores for cervical myelopathy, physical and mental component summaries of the 36-Item Short-Form Health Survey (SF-36), radiographic film parameters (C2–7 sagittal vertical axis, range of motion, C2–7 lordotic angle, and C7 slope), and MRI findings (severity of cervical canal stenosis, snake-eye appearance, severity of foraminal stenosis). Following univariate analysis, which compared the preoperative factors between groups, the variables with p values < 0.1 were included in the multivariate linear regression analysis. Additionally, the changes in clinical scores and radiographic parameters after 2 years of surgery were compared using a mixed-effects model.RESULTSAmong 103 patients, 42 (40.8%) had residual UE numbness. In the multivariate analysis, sex and preoperative UE pain were found to be independent variables correlating with residual UE numbness (p = 0.017 and 0.046, respectively). The severity of preoperative UE numbness did not relate to the residual UE numbness (p = 0.153). The improvement in neck pain VAS score and physical component summary of the SF-36 was significantly low in the severe residual-numbness group (p < 0.001 and 0.040, respectively).CONCLUSIONSForty-one percent of the CSM patients experienced residual UE numbness for at least 2 years after cervical posterior decompression surgery. Female sex and preoperative severe UE pain were the predictive factors for residual UE numbness. The patients with residual UE numbness showed less improvement of neck pain and lower physical status compared to the patients without numbness.

scholarly journals Cervicovestibular rehabilitation in adult with mild traumatic brain injury: a randomised controlled trial protocol

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Pierre Langevin ◽  
Philippe Fait ◽  
Pierre Frémont ◽  
Jean-Sébastien Roy
Keyword(s):  
Traumatic Brain Injury ◽  
Cervical Spine ◽  
Brain Injury ◽  
Neck Pain ◽  
Mild Traumatic Brain Injury ◽  
Controlled Trial ◽  
Rehabilitation Program ◽  
Conventional Approach ◽  
Persistent Symptoms ◽  
Link Type

Abstract Background Mild traumatic brain injury (mTBI) is an acknowledged public health problem. Up to 25% of adult with mTBI present persistent symptoms. Headache, dizziness, nausea and neck pain are the most commonly reported symptoms and are frequently associated with cervical spine and vestibular impairments. The most recent international consensus statement (2017 Berlin consensus) recommends the addition of an individualized rehabilitation approach for mTBI with persistent symptoms. The addition of an individualized rehabilitation approach including the evaluation and treatment of cervical and vestibular impairments leading to symptoms such as neck pain, headache and dizziness is, however, recommended based only on limited scientific evidence. The benefit of such intervention should therefore be further investigated. Objective To compare the addition of a 6-week individualized cervicovestibular rehabilitation program to a conventional approach of gradual sub-threshold physical activation (SPA) alone in adults with persistent headache, neck pain and/or dizziness-related following a mTBI on the severity of symptoms and on other indicators of clinical recovery. We hypothesize that such a program will improve all outcomes faster than a conventional approach (between-group differences at 6-week and 12-week). Methods In this single-blind, parallel-group randomized controlled trial, 46 adults with subacute (3 to12 weeks post-injury) persistent mTBI symptoms will be randomly assigned to: 1) a 6-week SPA program or 2) SPA combined with a cervicovestibular rehabilitation program. The cervicovestibular rehabilitation program will include education, cervical spine manual therapy and exercises, vestibular rehabilitation and home exercises. All participants will take part in 4 evaluation sessions (baseline, week 6, 12 and 26) performed by a blinded evaluator. The primary outcome will be the Post-Concussion Symptoms Scale. The secondary outcomes will be time to clearance to return to function, number of recurrent episodes, Global Rating of Change, Numerical Pain Rating Scale, Neck Disability Index, Headache Disability Inventory and Dizziness Handicap Inventory. A 2-way ANOVA and an intention-to-treat analysis will be used. Discussion Controlled trials are needed to determine the best rehabilitation approach for mTBI with persistent symptoms such as neck pain, headache and dizziness. This RCT will be crucial to guide future clinical management recommendations. Trial registration ClinicalTrials.gov Identifier - NCT03677661, Registered on September, 15th 2018.

Immediate effects of static and proprioceptive neuromuscular facilitation stretching of hamstring muscles on straight leg raise, craniovertebral angle, and cervical spine range of motion in neck pain patients with hamstring tightness: A prospective randomized controlled trial

2021 ◽  
pp. 1-10
Author(s):  
Eun-Dong Jeong ◽  
Chang-Yong Kim ◽  
Nack-Hwan Kim ◽  
Hyeong-Dong Kim
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Range Of Motion ◽  
T Test ◽  
Static Stretching ◽  
Proprioceptive Neuromuscular Facilitation ◽  
Before And After ◽  
Straight Leg Raise ◽  
Pain Patients ◽  
Group Effects

BACKGROUND: The cranio-cervical flexion exercise and sub-occipital muscle inhibition technique have been used to improve a forward head posture among neck pain patients with straight leg raise (SLR) limitation. However, little is known about the cranio-vertebral angle (CVA) and cervical spine range of motion (CROM) after applying stretching methods to the hamstring muscle. OBJECTIVE: To compare the immediate effects of static stretching and proprioceptive neuromuscular facilitation stretching on SLR, CVA, and CROM in neck pain patients with hamstring tightness. METHODS: 64 subjects were randomly allocated to the static stretching (n1= 32) or proprioceptive neuromuscular facilitation (n2= 32) stretching group. The SLR test was performed to measure the hamstring muscle’s flexibility and tightness between the two groups, with CROM and CVA also being measured. The paired t-test was used to compare all the variables within each group before and after the intervention. The independent t-test was used to compare the two groups before and after the stretching exercise. RESULTS: There were no between-group effects for any outcome variables (P> 0.05). However, all SLR, CVA, and CROM outcome variables were significantly improved within-group (P< 0.05). CONCLUSIONS: There were no between-group effects for any outcome variable; however, SLR, CVA, and CROM significantly improved within-group after the one-session intervention in neck pain patients with hamstring tightness.

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