scholarly journals Endoscopic Transcorporeal Approach and Channel Repair for Cervical Disc Herniation: 2-Year Follow-Up Study

2021 ◽  
Author(s):  
Qian Du ◽  
Wei-Jun Kong ◽  
Guang-Ru Cao ◽  
Zhi-Jun Xin ◽  
Jun Ao ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Japanese Orthopaedic Association ◽  
Operating Time ◽  
Neck Disability Index ◽  
Cervical Disc ◽  
Intervertebral Disc Herniation ◽  
X Rays ◽  
Radiographic Outcomes ◽  
Bone Plug

Abstract Objective To investigate the 2-year follow-up outcomes of patients with cervical intervertebral disc herniation (CIVDH) after percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) and channel repair. Methods From Oct. 2016 to Mar. 2017, 24 patients with central/mediolateral CIVDH was treated with PEATCD and channel repair. Of the 24 cases, five interventions were performed at C3-C4 level, 11 were performed at C4-C5 level, and 8 were performed at C5-C6 level. Clinical outcomes were evaluated by Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA), and Visual Analog Scale (VAS). Radiographic outcomes were measured with X-rays, computed tomography (CT) and magnetic resonance imaging.Results All the 24 procedures were completed successfully with an average operating time of 86.40±8.19min. Neck collar was advised for 3 weeks for all patients. No procedure-related complications were observed except for the swollen neck in 5 patients, which rehabilitated within 2 hours without sequela. The final scores of NDI, JOA, and VAS were improved significantly compared to those of preoperative assessments, 7.74±7.31 VS. 52.11±22.10, 16.04±0.68 VS. 9.08±1.31, and 0.52±0.65 VS. 6.73±1.45, respectively, P<0.05. Mean disc height was decreased from preoperative 5.43±0.52 mm to final 5.05±0.43 mm, without related-symptoms. No bone plug migration or channel collapse was measured during postoperative periods. All the channels were absent 12 months postoperative. Conclusion The most outstanding advantages of PEATCD with channel repair were “functional preservation” and “anatomical protection” for cervical spine, and which is a safe, feasible, effective, and minimally invasive surgery that offers an alternative for patients with CIVDH.

scholarly journals Pretic-I was a safe and effective artificial cervical disc prosthesis--a retrospective and comparative study with 5-year follow-up

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yingjun Guo ◽  
Hao Liu ◽  
Jianzhong Xu ◽  
Yuxiao Deng ◽  
Xiaoliang Tao ◽  
...  
Keyword(s):  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Operation Time ◽  
Cervical Disc ◽  
Adjacent Segment ◽  
Clinical Parameters ◽  
High Grade ◽  
Disc Prosthesis ◽  
Cervical Disc Prosthesis

Abstract Background The newly designed cervical disc prosthesis, Pretic-I, had been finished its limited clinical use for over 5 years. At a short-term follow-up of 2 years, we obtained satisfactory clinical results. The long-term clinical efficacy and safety of Pretic-I will now be analyzed. Methods Peri-operative parameters included intra-operative blood loss, operation time, off-bed time. Clinical parameters included visual analogue scale (VAS) for arm and neck, neck disability index (NDI), and Japanese Orthopaedic Association (JOA) score. Radiological parameters included C2–7 Cobb angle, Shell angle, and the range of motion (ROM) of C2–7, functional segment unit (FSU), and adjacent FSU. The CDA-related complications included adjacent segment degeneration (ASDeg), adjacent segment disease (ASDis), heterotopic ossification (HO), prosthesis subsidence, prosthesis displacement, and dysphagia. Results A total 64 patients from two independent centers received a single-level CDA with Discover (n = 32) and Pretic-I (n = 32), and all of patients finished a 5-year follow-up. There’re no significant differences between two groups in peri-operative parameters. The clinical parameters improved greatly in Pretic-I group (p<0.0001), and there’s no statistical difference from Discover group. Furthermore, Pretic-I could slightly improve the cervical curvature (15.08 ± 11.75 to 18.00 ± 10.61, p = 0.3079) and perfectly maintain the Shell angle (3.03 ± 3.68 to 2.23 ± 4.10, p = 0.1988), cervical ROM (52.48 ± 14.31 to 53.30 ± 11.71, p = 0.8062) and FSU ROM (12.20 ± 4.52 to 10.73 ± 4.45, p = 0.2002). The incidence of high-grade HO (Grade III-IV) at the final follow-up was significantly lower in Pretic-I group than in Discover group (12.50% vs. 34.38%, p = 0.0389, Statistical Power = 95.36%). The incidences of other CDA-related complications in Pretic-I group were also well-accepted, comparable to the Discover group, without significant differences. Conclusion CDA with Pretic-I demonstrated a well-accepted and sustained clinical outcome, with a significantly lower incidence of high-grade HO. This newly designed prosthesis is expected to become an alternative choice for cervical disc prosthesis in the future.

Long-term clinical results of microsurgical transdural discectomy with laminoplasty: follow-up results over 10 years

2013 ◽  
Vol 18 (6) ◽  
pp. 653-660 ◽  
Author(s):  
Nobuhiro Tanaka ◽  
Yoshinori Fujimoto ◽  
Tadayoshi Sumida ◽  
Hideki Manabe ◽  
Kazuyoshi Nakanishi ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Japanese Orthopaedic Association ◽  
Clinical Results ◽  
Intervertebral Discs ◽  
Cervical Disc ◽  
Age At Surgery ◽  
Long Term Follow Up ◽  
Surgical Treatments

Object In this retrospective analysis the authors describe the long-term clinical results of microsurgical transdural discectomy with laminoplasty (MTDL) in patients with cervical disc herniation (CDH). Methods Thirty patients (21 males, 9 females; mean age at surgery 55 years) with CDH had surgical treatments consisting of MTDL between 1990 and 1998. All patients demonstrated signs or symptoms of cervical myelopathy and/or radiculomyelopathy. Clinical outcomes were evaluated by the Japanese Orthopaedic Association (JOA) scoring system and by recovery rate (RR). The degenerative grades of the intervertebral discs were also evaluated based on preoperative, postoperative, and final follow-up MR images. The average follow-up period was 14.1 years (range 10–22 years). Results Twenty (67%) of the 30 patients completed the follow-up in this study. The preoperative JOA scores in these patients averaged 11.8, and the postoperative scores at the final follow-up averaged 15.5 (average RR 69.6%). None of these patients required reoperation after MTDL. Although disc degeneration progressed during the follow-up period, there were no cases of clinical deterioration, recurrence of disc herniation, or postoperative kyphotic deformity. Conclusions Sufficient clinical results were obtained after the MTDL for a long-term follow-up period exceeding 10 years. The MTDL may be an option for an alternative procedure if the patients are correctly selected and the procedure is safely performed.

Radiological and clinical outcomes of 3-level cervical disc arthroplasty

2020 ◽  
Vol 32 (2) ◽  
pp. 174-181 ◽  
Author(s):  
Hsuan-Kan Chang ◽  
Wen-Cheng Huang ◽  
Tsung-Hsi Tu ◽  
Li-Yu Fay ◽  
Chao-Hung Kuo ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Large Scale ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Disc Arthroplasty ◽  
Arm Pain ◽  
Estimated Blood Loss

OBJECTIVEOne- and two-level cervical disc arthroplasty (CDA) has been compared to anterior cervical discectomy and fusion (ACDF) in several large-scale, prospective, randomized trials that have demonstrated similar clinical outcomes. However, whether these results would be similar when treating 3-level disc herniation and/or spondylosis has remained unanswered. This study aimed to investigate the differences between 3-level CDA and ACDF.METHODSA series of 50 patients who underwent 3-level CDA at C3–7 was retrospectively reviewed and compared with another series of 50 patients (age- and sex-matched controls) who underwent ACDF at C3–7. Clinical outcomes were measured using the visual analog scale (VAS) for neck and arm pain, the modified Japanese Orthopaedic Association (mJOA) scale, and the Neck Disability Index (NDI). Radiological outcomes included range of motion (ROM) at the index levels. Every patient was evaluated by CT for the presence of fusion in the ACDF group. Also, complication profiles were investigated.RESULTSThe demographics and levels of distribution in both groups were very similar. During the follow-up period of 24 months, clinical outcomes improved (overall and respectively in each group) for both the CDA and ACDF patients when compared with the patients’ preoperative condition. There were essentially few differences between the two groups in terms of neck and arm pain VAS scores, mJOA scores, and NDI scores preoperatively and at 3, 6, 12, and 24 months postoperatively. After the 3-level surgery, the CDA group had an increased mean ROM of approximately 3.4°, at 25.2° ± 8.84°, compared to their preoperative ROM (21.8° ± 7.20°) (p = 0.001), whereas the ACDF group had little mobility (22.8° ± 5.90° before and 1.0° ± 1.28° after surgery; p < 0.001). The mean operative time, estimated blood loss, and complication profiles were similar for both groups.CONCLUSIONSIn this selectively matched retrospective study, clinical outcomes after 3-level CDA and ACDF were similar during the 2-year follow-up period. CDA not only successfully preserved but slightly increased the mobility at the 3 index levels. However, the safety and efficacy of 3-level CDA requires more long-term data for validatation.

scholarly journals Comparison of Pretic-I Versus Discover Disc Arthroplasty As Treatment for Single-level Cervical Disc Degenerative Disease With 5-year Follow-up

2021 ◽  
Author(s):  
Yingjun Guo ◽  
Hao Liu ◽  
Jianzhong Xu ◽  
Yuxiao Deng ◽  
Xiaoliang Tao ◽  
...  
Keyword(s):  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Cervical Disc ◽  
Adjacent Segment ◽  
Clinical Parameters ◽  
High Grade ◽  
Disc Prosthesis ◽  
Single Level ◽  
Cervical Disc Prosthesis

Abstract Background: The newly designed cervical disc prosthesis, Pretic-I, had been finished its limited clinical use for over 5 years. At a short-term follow-up of 2 years, we obtained satisfactory clinical results. The long-term clinical efficacy and safety of Pretic-I will now be analyzed. Methods: Peri-operative parameters included intra-operative blood loss, operation time, off-bed time. Clinical parameters included visual analogue scale (VAS) for arm and neck, neck disability index (NDI), and Japanese Orthopaedic Association (JOA) score. Radiological parameters included C2-7 Cobb angle, Shell angle, and the range of motion (ROM) of C2-7, functional segment unit (FSU), and adjacent FSU. The CDA-related complications included adjacent segment degeneration (ASDeg), adjacent segment disease (ASDis) , heterotopic ossification (HO), prosthesis subsidence, prosthesis displacement, and dysphagia.Results: A total 64 patients from two independent centers received a single-level CDA with Discover (n=32) and Pretic-I (n=32), and all of patients finished a 5-year follow-up. There’re no significant differences between two groups in peri-operative parameters. The clinical parameters improved greatly in Pretic-I group (p＜0.0001), and there’s no statistical difference from Discover group. Furthermore, Pretic-I could slightly improve the cervical curvature (15.08±11.75 to 18.00±10.61, p=0.3079) and perfectly maintain the Shell angle (3.03±3.68 to 2.23±4.10, p=0.1988), cervical ROM (52.48±14.31 to 53.30±11.71, p=0.8062) and FSU ROM (12.20±4.52 to 10.73±4.45, p=0.2002). The incidence of high-grade HO (Grade III-IV) at the final follow-up was significantly lower in Pretic-I group than in Discover group (12.50% vs. 34.38%, p=0.0389, Statistical Power=95.36%). The incidences of other CDA-related complications in Pretic-I group were also well-accepted, comparable to the Discover group, without significant differences.Conclusion: CDA with Pretic-I demonstrated a well-accepted and sustained clinical outcome, with a significantly lower incidence of high-grade HO. This newly designed prosthesis is expected to become an alternative choice for cervical disc prosthesis in the future.

scholarly journals Effects of smoking on cervical disc arthroplasty

2019 ◽  
Vol 30 (2) ◽  
pp. 168-174 ◽  
Author(s):  
Tsung-Hsi Tu ◽  
Chao-Hung Kuo ◽  
Wen-Cheng Huang ◽  
Li-Yu Fay ◽  
Henrich Cheng ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Smoking Status ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Disc Arthroplasty ◽  
Arm Pain ◽  
Smoking Group

OBJECTIVECigarette smoking can adversely affect bone fusion in patients who undergo anterior cervical discectomy and fusion. However, there is a paucity of data on smoking among patients who have undergone cervical disc arthroplasty (CDA). The present study aimed to compare the clinical and radiological outcomes of smokers to those of nonsmokers following CDA.METHODSThe authors retrospectively reviewed the records of consecutive patients who had undergone 1- or 2-level CDA for cervical disc herniation or spondylosis and had a minimum 2-year follow-up. All patients were grouped into a smoking group, which consisted of those who had consumed cigarettes within 6 months prior to the CDA surgery, or a nonsmoking group, which consisted of those who had not consumed cigarettes at all or within 6 months of the CDA. Clinical outcomes were evaluated according to the visual analog scale for neck and arm pain, Neck Disability Index, Japanese Orthopaedic Association Scale, and Nurick Scale at each time point of evaluation. Radiological outcomes were assessed using radiographs and CT for multiple parameters, including segmental range of motion (ROM), neutral lordotic curve, and presence of heterotopic ossification (HO).RESULTSA total of 109 patients completed at least 2 years of follow-up and were analyzed (mean follow-up 42.3 months). There were 89 patients in the nonsmoking group and 20 in the smoking group. The latter group was younger and predominantly male (both p < 0.05) compared to the nonsmoking group. The two groups had similar improvements in all clinical outcomes after CDA compared to preoperatively. Radiological evaluations were also very similar between the two groups, except for two factors. The smoking group had well-preserved segmental ROM after CDA at an average of 8.1° (both pre- and postoperation). However, while the nonsmoking group remained mobile, segmental ROM decreased significantly (8.2° to 6.9°, p < 0.05) after CDA. There was a trend toward more HO development in the nonsmoking group than in the smoking group, but the difference was without significance (59.6% vs 50.0%, p = 0.43).CONCLUSIONSDuring an average 3.5 years of follow-up after 1- and 2-level CDA, cigarette smokers and nonsmokers had similar improvements in clinical outcomes. Moreover, segmental mobility was slightly better preserved in smokers. Since smoking status did not negatively impact outcomes, CDA may be a reasonable option for selected patients who have smoked.

scholarly journals An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Ali Haghnegahdar ◽  
Mahsa Sedighi
Keyword(s):  
Disc Herniation ◽  
Treatment Success ◽  
Japanese Orthopaedic Association ◽  
Radicular Pain ◽  
Iranian Population ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Functional Score ◽  
Functional Scores

Background and Aim. First-line treatment strategy for managing cervical disc herniation is conservative measures. In some cases, surgery is indicated either due to signs/symptoms of severe/progressive neurological deficits, or because of persistence of radicular pain despite 12 weeks of conservative treatment. Success for treatment of cervical disc herniation using ACDF has been successfully reported in the literature. We aim to determine the outcome of ACDF in treatment of cervical disc herniation among Iranians. Methods and Materials/Patients. In a retrospective cohort study, we evaluated 68 patients who had undergone ACDF for cervical disc herniation from March 2006 to March 2011. Outcome tools were as follows: (1) study-designed questionnaire that addressed residual and/or new complaints and subjective satisfaction with the operation; (2) recent (one week prior to the interview) postoperative VAS for neck and upper extremity radicular pain; (3) Japanese Orthopaedic Association Myelopathy Evaluation Questionnaire (JOACMEQ) (standard Persian version); and (4) follow-up cervical Magnetic Resonance Imaging (MRI) and lateral X-ray. Results. With mean follow-up time of 52.93 (months) ± 31.89 SD (range: 13–131 months), we had success rates with regard to ΔVAS for neck and radicular pain of 88.2% and 89.7%, respectively. Except QOL functional score of JOAMEQ, 100% success rate for the other 4 functional scores of JOAMEQ was achieved. Conclusion. ACDF is a successful surgical technique for the management of cervical disc herniation among Iranian population.

Clinical Studies of Anterior Cervical Fusion with PEEK Cages: Comparing Iliac Graft and a Macroporous Biphasic Calcium Phosphate

2012 ◽  
Vol 529-530 ◽  
pp. 261-265
Author(s):  
G. Daculsi ◽  
H. Pascal-Moussellard
Keyword(s):  
Iliac Crest ◽  
Neck Disability Index ◽  
Cervical Disc ◽  
X Rays ◽  
Peek Cage ◽  
Disc Disease ◽  
Autologous Graft ◽  
Patients Satisfaction ◽  
Autograft Group

The objective of the study was to compare clinical efficiency of the fusion after reconstruction with an anatomically shaped PEEK cage associated with a iliac crest autograft or MBCP in the treatment of cervical disc disease in randomized clinical trial. A multicente randomized, comparative and prospective study on 58 patients, with a 12 months follow up are reported. They underwent anterior cervical decompression and fusion being randomized for autologous graft or MBCP. Patients presenting purely degenerative disc disease were implanted with a PEEK cage filled with iliac crest autograft or MBCP. Pain and functionality as well as patients satisfaction were assessed through VAS, Neck Disability Index (NDI) and Patient Satisfaction index were recorded until 24 month follow-up. Radiological evaluation included plain and dynamic short X-rays at each stage of the follow up. The patients satisfaction rates was of 82% in the autograft group versus 96% in the MBCP group. Pain at the donor site was significantly more important in the autograft group at 3 weeks, 3 months and 1 year follow-up. No implant failures were recorded. Previously goat preclinical study was performed. Micro CT, light microscopy and shistomorphometry were related to the high performance of the MBCP insert for filling cage fusion, completing the clinical assessment of our clinical study. The use of MBCP insert is safe and avoids potential graft site morbidity and pain in comparison with an autologous graft procedure.

scholarly journals The Midterm Surgical Outcome of Modified Expansive Open-Door Laminoplasty

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Kuang-Ting Yeh ◽  
Ru-Ping Lee ◽  
Ing-Ho Chen ◽  
Tzai-Chiu Yu ◽  
Cheng-Huan Peng ◽  
...  
Keyword(s):  
Neck Pain ◽  
Facet Joint ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Standard Technique ◽  
Invasive Technique ◽  
Open Door ◽  
Gradual Improvement ◽  
Less Invasive

Laminoplasty is a standard technique for treating patients with multilevel cervical spondylotic myelopathy. Modified expansive open-door laminoplasty (MEOLP) preserves the unilateral paraspinal musculature and nuchal ligament and prevents facet joint violation. The purpose of this study was to elucidate the midterm surgical outcomes of this less invasive technique. We retrospectively recruited 65 consecutive patients who underwent MEOLP at our institution in 2011 with at least 4 years of follow-up. Clinical conditions were evaluated by examining neck disability index, Japanese Orthopaedic Association (JOA), Nurick scale, and axial neck pain visual analog scale scores. Sagittal alignment of the cervical spine was assessed using serial lateral static and dynamic radiographs. Clinical and radiographic outcomes revealed significant recovery at the first postoperative year and still exhibited gradual improvement 1–4 years after surgery. The mean JOA recovery rate was 82.3% and 85% range of motion was observed at the final follow-up. None of the patients experienced aggravated or severe neck pain 1 year after surgery or showed complications of temporary C5 nerve palsy and lamina reclosure by the final follow-up. As a less invasive method for reducing surgical dissection by using various modifications, MEOLP yielded satisfactory midterm outcomes.

scholarly journals The Reconstruction Accuracy of the Hip Center of Rotation After Cementless Total Hip Arthroplasty for Failed Treatment of Acetabular Fractures. Does It Matter?

2021 ◽  
Author(s):  
Liang Zhang ◽  
Mingxue Chen ◽  
Zhuyi Ma ◽  
Tao Bian ◽  
Shaoliang Li ◽  
...  
Keyword(s):  
Harris Hip Score ◽  
Acetabular Fractures ◽  
X Rays ◽  
Reconstruction Accuracy ◽  
Center Of Rotation ◽  
Total Hip ◽  
Radiographic Outcomes ◽  
Negative Effect ◽  
Hip Arthroplasties

Abstract Background To assess the impaction of reconstruction accuracy of hip center of rotation (COR) on midterm clinical and radiographic results of cementless reconstruction of total hip arthroplasties (THAs) for patients after failed treatment of acetabular fractures. Methods One hundred and four patients (107 hips) who underwent THAs after failed treatment of acetabular fractures were retrospectively evaluated and cementless cups and stems were implanted in all hips. Clinical outcomes were assessed using the Harris hip score (HHS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scoring system. Radiographic results were analyzed by serial perioperative x-rays. Results At the latest follow-up examination, the median HHS increased from 52 (42-65) before surgery to 93 (90-97) (p < 0.001) and the median WOMAC decreased from 52 (36-65) before surgery to 5.8 (1.5-8) (p < 0.001). Compared with normal contralateral hip, 79 cups migrated superiorly (0.2-33.6mm) and 22 cups migrated inferiorly (0.2-16.1mm). The distance of superior migration of reconstructed COR was correlated with positive Trendelenburg sign at the latest follow-up examination (r=0.504; p < 0.001). The percentage of postoperative Trendelenburg sign was significantly higher in superior migration subgroup than that in subgroup with anatomical restoration of COR (P=0.015). Conclusions Cementless THAs in patients after failed treatment for acetabular fractures achieved predictable clinical and radiographic outcomes. A superiorly migrated hip COR appeared to exert a negative effect on abductor muscle function.

scholarly journals Physiotherapy after anterior cervical spine surgery for cervical disc disease: study protocol of a prospective randomised study to compare internet-based neck-specific exercise with prescribed physical activity

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e027387 ◽  
Author(s):  
Anneli Peolsson ◽  
Gunnel Peterson ◽  
Anna Hermansen ◽  
Maria Landén Ludvigsson ◽  
Åsa Dedering ◽  
...  
Keyword(s):  
Physical Activity ◽  
Disease Patient ◽  
Neck Disability Index ◽  
Cost Effective ◽  
Popular Science ◽  
Cervical Disc ◽  
Ethical Review ◽  
Cervical Disc Disease ◽  
Disc Disease

IntroductionPatients suffering from remaining disability after anterior cervical decompression and fusion (ACDF) surgery for cervical disc disease may be prescribed physical activity (PPA) or neck-specific exercises (NSEs). Currently, we lack data for the success of either approach. There is also a knowledge gap concerning the use of internet-based care for cervical disc disease. The scarcity of these data, and the high proportion of patients with various degrees of incapacity following ACDF, warrant increased efforts to investigate and improve cost-effective rehabilitation. The objective is to compare the effectiveness of a structured, internet-based NSE programme, versus PPA following ACDF surgery.Methods and analysisThis is a prospective, randomised, multicentre study that includes 140 patients with remaining disability (≥30% on the Neck Disability Index, NDI) following ACDF for radiculopathy due to cervical disc disease. Patient recruitment occurs following attendance at routine clinical appointments, scheduled at 3 months postsurgery. Patients are then randomised to one of two groups (70 patients/group) for a 3-month treatment programme/period of either internet-based NSE or PPA. Questionnaires on background data, pain and discomfort, physical and mental capacity, satisfaction with care, and health and workplace factors are completed, along with physical measures of neck-related function conducted by independent test leaders blinded to randomisation. Measures are collected at inclusion, after the 3-month treatments (end of treatment) and at a 2-year follow-up. Radiography will be completed at the 2-year follow-up. Preoperative data will be collected from the Swedish Spine Registry. Data on healthcare consumption, drug use and sick leave will be requested from the relevant national registers.Ethical considerationsThis study was approved by the Regional Ethical Review Board in Linköping Ref. 2016/283–31 and 2017/91– 32. The scientists are independent with no commercial ties. Patients are recruited after providing written informed consent. Patient data are presented at group level such that no connection to any individual can be made. All data are anonymised when reported, and subject to the Swedish Official Secrets Health Acts. The test leaders are independent and blinded for randomisation. Exercises, both general and neck-specific, have been used extensively in clinical practice and we anticipate no harm from their implementation other than a risk of muscle soreness. Both randomisation groups will receive care that is expected to relieve pain, although the group receiving NSE is expected to demonstrate a greater and more cost-effective improvement versu s the PPA group. Any significant harm or unintended effects in each group will be collected by the test leaders. All questionnaires and test materials are coded by the research group, with code lists stored in locked, fireproof file cabinets, housed at the university in a room with controlled (card-based) access. Only individuals in receipt of a unique website address posted by the researchers can access the programme; patients can neither communicate with each other nor with caregivers via the programme.Study participation might lead to improved rehabilitation versus non-participation, and might therefore be of benefit. The results of this study should also contribute to more effective and flexible rehabilitation, shorter waiting times, lower costs and the possibility to implement our findings on a wider level.DisseminationIf effective, the protocols used in this study can be implemented in existing healthcare structures. The results of the study will be presented in scientific journals and popular science magazines of relevance to health. The findings will also be presented at local, regional, national and international conferences and meetings, as well as in the education of university students and at public lectures. Information about the results will be communicated to the general population in cooperation with patient organisations and the media.Trial registrationNCT03036007.

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