Posterior Laminectomy and Lateral Mass Screw Fixation for the Treatment of Severe Cervical Spondylotic Myelopathy

Background Severe and complex cervical spondylotic myelopathy(CSM) requires surgical treatment. The common methods of posterior cervical spine surgery are laminoplasty and laminectomy with lateral mass screw internal fixation. However, the operative effect of this surgical approach is unclear owing to the complexity and severity of CSM in patients who undergo this surgical treatment.Therefore, we aimed to evaluate the clinical effects of posterior cervical laminectomy and lateral mass screw internal fixation in patients with severe and complex CSM. Methods We retrospectively analysed 60patients (48men,12women; mean age59.7 years) with severe and complex CSM who underwent posterior cervical laminectomy and lateral mass screw internal fixation from May 2013 to June 2020. Forty-eight patients underwent laminectomy and lateral mass screw internal fixation;12 patients underwent laminectomy and lateral mass screw internal fixation with 1–2 segmental laminoplasty. C-spine radiographs, computed tomography (CT) scans, and magnetic resonance imaging (MRI) were used to detect any curvature and fusion of the cervical spine, restenosis, and loose/broken internal fixation screws.Clinical efficacy was evaluated using Japanese Orthopaedic Association (JOA)scores, neck disability index(NDI), Odom’s classification, and the visual analogue scale(VAS) for pain. Results Overall effect was satisfactory at the last follow-up (average, 3.6 years [range, 6 months–6 years]), with no restenosis or loosened, slipped, or broken internal fixations. The anterior curvature angle of lordosis (n=46)was not significantly different from baseline at the last follow-up(P>0.05). The cervical kyphosis angle (n=14)was significantly improved at the last follow-up compared with the baseline value (P<0.05), as were the JOA, NDI, and VAS scores(all P<0.05). Odom’s classifications at the last follow-up were excellent, good, and fair in 45, 12, and three patients, respectively. Conclusions Posterior cervical laminectomy and lateral mass screw internal fixation achieved satisfactory clinical results in severe and complex CSM cases.Combining this surgical method with laminoplasty of 1–2 spinal segments stabilised the cervical spine and provided spinal decompression while preventing excessive backward drift of the cervical spinal cord, resulting in fewer complications.

Early Management of Cervical Impairments and the Incidence of Delayed Recovery in Adolescents With Acute Concussion

ObjectiveTo determine if concussed adolescents with positive cervical findings on examination provided with early cervical treatment demonstrate recovery time and incidence of persistent post-concussive symptoms (PPCS, recovery = 30 days) comparable to those without cervical findings.BackgroundCervical impairments resulting from concussive injury are historically associated with longer recovery times. Concomitant cervical injuries may result in symptoms that overlap with concussion, including headache, dizziness, tinnitus, sleep disturbances, and blurred vision. Current recommendations include assessment of the cervical spine; however, there is limited evidence for the effect of immediate cervical intervention on recovery.Design/MethodsRetrospective case-controlled study. Patients included adolescents with acute concussion presenting with (n = 132, 14.99 ± 1.9 years, 58% male, 5.70 ± 3.3 days since injury) and without (n = 138, 14.85 ± 1.8 years, 65% male, 6.13 ± 3.4 days since injury) cervical findings on physical exam. Patients were assessed with the Buffalo Concussion Physical Examination (BCPE), Neck Disability Index (NDI) and Post-Concussion Symptom Scale (PCSS) instruments. Groups were separated based on positive or negative cervical findings on the BCPE. Cervical impairments were addressed by physicians specializing in concussion management using a clinical algorithm. Mild impairments were managed conservatively (over-the-counter analgesics, warm/cold compresses, and/or neck stretching exercises). Patients with moderate or greater impairments were assessed by a physical therapist at the initial clinic encounter and given specific cervical interventions.ResultsPhysician-observed cervical findings had moderate agreement with self-reported function on the NDI (? = 0.414, p < 0.001). Patients with cervical findings reported greater symptom severity on the PCSS (37.9 ± 22.1 vs 30.8 ± 20.2, p = 0.011); however, there was no significant difference in recovery time (34.44 ± 33.2 vs 34.81 ± 39.0 days, p = 0.933) or incidence of persistent symptoms (39% vs 35%, p = 0.511).ConclusionsIn this group of adolescents, cervical impairment managed early after concussion was not associated with prolonged recovery. Early management of cervical impairments may reduce the development of PPCS. Prospective evaluation is warranted.

Effectiveness of Myofascial Release vs High Frequency TENS for Pain Relief and Functional Improvement in College Students with Trapezius Myalgia: A Comparative Study

Background: Trapezius Myalgia is characterized by pain in the trapezius muscle. The patient suffering from myalgia usually complaints of pain, stiffness and tightness of the upper trapezius muscle. Acute or chronic neck-shoulder pain is the hallmark of this condition. The pain in the muscle usually lasts for few days or it can be even longer. The presence of spasm in upper trapezius muscle is shown by neck pain in the back of the neck and between the bases of the neck and the shoulder. This protocol has been created that describes the design of experimental study to evaluate and compare the effect of Myofascial Release (MFR) versus High-Frequency TENS for pain relief and functional improvement in subjects with Trapezius Myalgia. Methods: The participants (n=45) will be recruited in the study suffering from Trapezius Myalgia and meeting the inclusion criteria. Two groups will be formed such that group A will be treated with Myofascial Release technique and group B will be treated with High Frequency TENS modality. The protocol will cover 4 weeks of treatment. Regular assessment will be carried out on 1st and 4th week of the rehabilitation period. During the rehabilitation period, we will evaluate pain status and functional improvement and range of motion of the neck in the subject at regular intervals. Our outcome measures will be – Numerical Pain Rating Scale (NPRS) and Neck Disability Index (NDI). Discussion: The efficacy of the intervention will be evaluated by analyzing pain relief using Numerical Pain Rating Scale (NPRS) and functional improvement by using Neck Disability Index (NDI). The result of the study will significantly provide affirmation on using these modalities for treating myalgia patients.

Effectiveness of Progressive Resisted Exercise along with Conventional Exercise and Conventional Exercise Program alone in Subjects with Text Neck Syndrome

Background: "Text neck" is a term coined to describe the posture created by leaning forward for lengthy periods of time, such as when reading and texting on a cellphone which has been linked to stress injuries. Neck pain, upper back discomfort, shoulder pain, frequent headaches, and greater curvature of the spine are all dangerous indications of text neck. According to a survey, 35% of smartphone users suffer from text neck syndrome. People between the ages of 15 and 18 are more likely to have neck pain. This protocol has been created that describes the design of comparative study to evaluate effectiveness of progressive resisted exercise along with conventional exercise and conventional exercise program alone in text neck syndrome. Methods: The participants (n=80) will be recruited in the study suffering from text neck syndrome and meeting the inclusion criteria. Two groups will be formed such that patients in group A will be treated with conventional therapy and group B will be treated with progressive resisted exercise (PRE) along with conventional therapy. The protocol will cover 4 weeks of treatment. In the rehabilitation period, we will evaluate the pain intensity, strength of neck muscles and functional activity. Our outcome measures will be- Numerical pain rating scale (NPRS) and Neck disability index (NDI). Discussion: Efficacy of the intervention will be evaluated by analyzing the pain intensity by using Numerical pain rating scale (NPRS) and level of functional disability by using Neck disability index (NDI). The result of the study will significantly provide affirmation on either using combination therapy of PRE with conventional exercise or conventional exercise alone.

Is the Severity of Cervical Foraminal Stenosis Related to the Severity and Sidedness of Symptoms?

(1) Background: Cervical foraminal stenosis (CFS) is a common cause of axial neck and arm pain. The aim of this study was to determine the relationship between the severity of CFS and clinical symptoms in terms of severity and sidedness. (2) Methods: We retrospectively reviewed 75 consecutive patients with degenerative CFS. We graded 900 foramina from C3–4 to T1–2 using Park’s grading system. We collected visual analogue scale (VAS) and neck disability index (NDI) values from the neck and both arms. We analyzed the relationships with CFS grades and total number. We defined four types of left/right dominance of CFS (none, left-dominant, right-dominant, and both) by comparing left and right sides using total counts and maximal grade of CFS, respectively. We compared arm pain sidedness (no arm pain, left-only, right only, and bilateral) among different left and right CFS dominance types. (3) Results: Mean neck and left and right arm VAS scores were 4.4 ± 2.5, 4.9 ± 1.6, and 4.6 ± 2.0, respectively. The mean total NDI was 16.0 ± 8.0. The CFS grade at C3–4 and total count were correlated with neck VAS. Arm VAS was also correlated with CFS grade and total counts. Total NDI score was not correlated with radiological parameters. The presence and sidedness of arm pain were significantly different between left and right CFS dominance groups divided by total count of grade 2 and 3 CFS. (4) Conclusions: The CFS grade and total count were correlated with neck and arm VAS. Arm pain occurred more frequently on the side with more grade 2 and 3 CFS.

Anterior Corpectomy and Plating with Carbon-PEEK Instrumentation for Cervical Spinal Metastases: Clinical and Radiological Outcomes

Background: Anterior cervical corpectomy and plating has been recognized as a valuable approach for the surgical treatment of cervical spinal metastases. This study aimed to report the surgical, clinical and radiological outcomes of anterior carbon-PEEK instrumentations for cervical spinal metastases. Methods: Demographical, clinical, surgical and radiological data were collected from 2017 to 2020. The Neck Disability Index (NDI) questionnaire for neck pain, EORTC QLQ-C30 questionnaire for quality of life, Nurick scale for myelopathy and radiological parameters (segmental Cobb angle and cervical lordosis) were collected before surgery, at 6 weeks postoperatively and follow-up. Results: Seventeen patients met inclusion criteria. Mean age was 60.9 ± 7.6 years and mean follow-up was 12.9 ± 4.0 months. The NDI (55.4 ± 11.7 to 25.1 ± 5.4, p < 0.001) scores and the EORTC QLQ-C30 global health/QoL significantly improved postoperatively and at the last follow-up. The segmental Cobb angle (10.7° ± 5.6 to 3.1° ± 2.2, p < 0.001) and cervical lordosis (0.9° ± 6.7 to −6.2 ± 7.8, p = 0.002) significantly improved postoperatively. Only one minor complication (5.9%) was recorded. Conclusions: Carbon/PEEK implants represent a safe alternative to commonly used titanium ones and should be considered in cervical spinal metastases management due to their lower artifacts in postoperative imaging and radiation planning. Further larger comparative and cost-effectiveness studies are needed to confirm these results.

Prevalence of Musculo-skeletal Discomfort and Level of Functional Limitations among Physiotherapists in Karachi City

Introduction: Musculoskeletal discomfort is one of the most prevalent muscular pain condition hindering normal activities reported by physical therapists and health care professionals generally engaged in handling and mobilizing patients. The study was conducted to find the prevalence of musculoskeletal discomfort and level of functional limitations in physiotherapists. Method: This research was questionnaire based cross sectional study conducted in Karachi city from January to April 2019.Data collection was completed from registered physical therapists employed in different institutions. Two questionnaires were filled by the physiotherapists. Questionnaire 01, including thirteen questions on functional activities of daily life which are potentially related to functional areas of Neck Disability Index (NDI). Questionnaire 02 was based on 1987 version of Nordic musculoskeletal questionnaire. Results: Participation of 80 physical therapists in the study.75% was directly involved with patient handling and 25% were teachers. A total of 35% therapists reported 7 days symptoms prevalence with a higher prevalence in cervical (77.1%), lower back (68.6%) and upper back (51.4%).Similarly 65% workers showed previous 12 month symptoms with higher prevalence in neck (72.3%). Gender prevalence of 7days and 12 months was high in female therapist. Conclusion: It has been concluded that 12 month prevalence of musculoskeletal discomfort was 65%, whereas 7 days was 35% and level of functional limitation from activities was insignificant. Keywords: Epidemiology, musculoskeletal discomfort, Severity, Physical therapy,

Scapular Dyskinesis in Elite Boxers with Neck Disability and Shoulder Malfunction

Background and Objectives: Neck and shoulder injuries commonly occur during boxing, and scapular dyskinesis is related to those injuries. This study investigated scapular dyskinesis with neck disability and shoulder malfunction in elite boxers. Materials and Methods: Seventy-two elite boxers participated in this study. Scapular dyskinesis was evaluated as normal, subtle, and obvious. Neck disability index (NDI), shoulder internal (IR), and external (ER) range of motion (ROM), isometric strength of IR and ER, and pectoralis minor length were measured and compared with the severity of scapular dyskinesis. Results: Thirty-eight boxers (52.7%) showed scapular dyskinesis. NDI score was significantly different (normal = 3.89 ± 3.08, obvious = 7.36 ± 4.95, p = 0.025). Isometric IR strength was significantly different (normal = 10.48 ± 2.86, obvious = 8.46 ± 1.74, p = 0.01). The length of the pectoralis minor was significantly different (normal = 10.17 ± 0.67, subtle = 9.87 ± 0.79, obvious = 9.47 ± 0.85; p = 0.001), and the dominant and non-dominant arm IR ROM was significantly different (dominant = 57.43 ± 11.98, non-dominant = 64.62 ± 10.3, p = 0.001). Conclusions: The prevalence of scapular dyskinesis is high among elite boxers. Boxers with scapular dyskinesis presented shoulder malfunction as well as neck disability. Further investigation is necessary to examine the relationship between scapular dyskinesis and neck disability in boxers.

Management of fresh odontoid fractures using posterior C1–2 fixation without fusion: a long-term clinical follow-up study

OBJECTIVE Posterior C1–2 fixation without fusion makes it possible to restore atlantoaxial motion after removing the implant, and it has been used as an alternative technique for odontoid fractures; however, the long-term efficacy of this technique remains uncertain. The purpose of the present study was to explore the long-term follow-up outcomes of patients with odontoid fractures who underwent posterior C1–2 fixation without fusion. METHODS A retrospective study was performed on 62 patients with type II/III fresh odontoid fractures who underwent posterior C1–2 fixation without fusion and were followed up for more than 5 years. The patients were divided into group A (23 patients with implant removal) and group B (39 patients without implant removal) based on whether they underwent a second surgery to remove the implant. The clinical outcomes were recorded and compared between the two groups. In group A, the range of motion (ROM) of C1–2 was calculated, and correlation analysis was performed to explore the factors that influence the ROM of C1–2. RESULTS A solid fracture fusion was found in all patients. At the final follow-up, no significant difference was found in visual analog scale score or American Spinal Injury Association Impairment Scale score between the two groups (p > 0.05), but patients in group A had a lower Neck Disability Index score and milder neck stiffness than did patients in group B (p < 0.05). In group A, 87.0% (20/23) of the patients had atlantoodontoid joint osteoarthritis at the final follow-up. In group A, the C1–2 ROM in rotation was 6.1° ± 4.5° at the final follow-up, whereas the C1–2 ROM in flexion-extension was 1.8° ± 1.2°. A negative correlation was found between the C1–2 ROM in rotation and the severity of tissue injury in the atlantoaxial region (r = –0.403, p = 0.024) and the degeneration of the atlantoodontoid joint (r = –0.586, p = 0.001). CONCLUSIONS Posterior C1–2 fixation without fusion can be used effectively for the management of fresh odontoid fractures. The removal of the implant can further improve the clinical efficacy, but satisfactory atlantoaxial motion cannot be maintained for a long time after implant removal. A surgeon should reconsider the contribution of posterior C1–2 fixation without fusion and secondary implant removal in preserving atlantoaxial mobility for patients with fresh odontoid fractures.

Prevalence of Cervical Spondylitis in Dentists of Lahore

Aim: To analyze prevalence of cervical spondylitis among dentists practicing in Lahore. Methods: A cross sectional survey of 6 months was conducted on 110 dentists practicing in dental clinics of Lahore were examined using neck disability index performa. SPSS Version 24 used for entering/analyzing the data. Results: In 110 individuals, 22% dentists including males (n=19%) and females (n=24.2%) were suffering from cervical spondylitis. According to neck disability index 34.5% had no disability, 47.2% had mild, 10.9% had moderate, 5.4% had severe disability and only 1.9% had complete disability. The major number (30%) was among 41-50years, and also statistically significant difference was observed (p-value = 0.02). Similarly maximum number of cervical spondylitis was found among females, 15(24.2%) but statistically insignificant difference was observed with respect to gender (p-value = 0.493). Longer practicing experience had also significant impact on the occurrence of spondylitis (p-value <0.001). Conclusion: Dentists are likely to have neck pain prevalent in them and very few had cervical spondylitis (22%) but the damage could be reduced if postural changes and regular exercises could be adapted. Keywords: Cervical Spondylitis, Neck Disability Index, Postural Changes