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Study Design: A retrospective cohort study.Objective: To determine if (1) preoperative marijuana use increased complications, readmission, or reoperation rates following anterior cervical discectomy and fusion (ACDF), (2) identify if preoperative marijuana use resulted in worse patient-reported outcome measures (PROMs), and (3) investigate if preoperative marijuana use affects the quantity of opioid prescriptions in the perioperative period.Summary Of Background Data: A growing number of states have legalized recreational and/or medical marijuana, thus increasing the number of patients who report preoperative marijuana use. The effects of marijuana on clinical outcomes and PROMs in the postoperative period are unknown.Methods: All patients 18 years of age and older who underwent primary one- to four-level ACDF with preoperative marijuana use at our academic institution were retrospectively identified. A 3:1 propensity match was conducted to compare patients who used marijuana versus those who did not. Patient demographics, surgical characteristics, clinical outcomes, and PROMs were compared between groups. Multivariate regression models measured the effect of marijuana use on the likelihood of requiring a reoperation and whether marijuana use predicted inferior PROM improvements at the one-year postoperative period.Results: Of the 240 patients included, 60 (25.0%) used marijuana preoperatively. Multivariate logistic regression analysis identified marijuana use (odds ratio=5.62, P <0.001) as a predictor of a cervical spine reoperation after ACDF. Patients who used marijuana preoperatively had worse one-year postoperative Physical Component Scores of the Short-Form 12 (PCS-12) ( P =0.001), Neck Disability Index ( P =0.003), Visual Analogue Scale (VAS) Arm ( P =0.044) and VAS Neck ( P =0.012). Multivariate linear regression found preoperative marijuana use did not independently predict improvement in PCS-12 (β=-4.62, P =0.096), Neck Disability Index (β=9.51, P =0.062), Mental Component Scores of the Short-Form 12 (MCS-12) (β=-1.16, P =0.694), VAS Arm (β=0.06, P =0.944), or VAS Neck (β=-0.44, P =0.617).Conclusion: Preoperative marijuana use increased the risk of a cervical spine reoperation after ACDF, but it did not significantly change the amount of postoperative opioids used or the magnitude of improvement in PROMs.Level Of Evidence: Levwl III. [ABSTRACT FROM AUTHOR]

Background: Depression and anxiety are common mental disorders among patients with chronic pain. It is hypothesised that patients suffering from these disorders benefit less from cervical spine surgery than mentally healthy patients. Therefore, this study aimed to quantify the effect of mental health status on functional outcome after anterior cervical discectomy in a post hoc analysis on RCT data. Methods: One hundred eight patients from the NECK trial, with radiculopathy due to a one-level herniated disc, underwent anterior cervical discectomy and were included into this analysis. Functional outcome was quantified using the Neck Disability Index (NDI), and mental health status was measured using the Hospital Anxiety and Depression Score (HADS) questionnaire. NDI differences were assessed using generalised estimated equations (GEE), crude means, a predictive linear mixed model (LMM) using baseline scores and over time with an explanatory LMM. Results: At baseline, 24% and 32% of patients were respectively depressed and anxious and had statistically significant and clinically relevant higher NDI scores during follow-up. However, in those patients in which the HADS returned to normal during follow-up, NDI values decreased comparably to the non-depression or non-anxiety cases. Those patients that demonstrated persisting high HADS values had convincingly worse NDI scores. A predictive LMM showed that combining baseline NDI and HADS scores was highly predictive of NDI during follow-up. The R shiny application enabled the effective, visual communication of results from the predictive LMM. Conclusion: This study shows that mental health status and disability are strongly associated and provides insight into the size of the effect, as well as a way to use this relation to improve preoperative patient counselling. These findings give rise to the suggestion that incorporating mental health screening in the preoperative assessment of patients could help to adequately manage patients' expectations for functional recovery. Trial registration: Dutch Trial Register Number: NTR1289 [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the risk factors associated with upper crossed syndrome (UCS) in females of age 25-50 years. METHODS: This population based case controlled study was conducted from May to August 2019. Total of 210 females including 105 cases (participants who had upper neck pain for at least one month) and 105 controls (participants who didn't had upper neck pain), aging 25-50 years were selected through non-probability convenient sampling technique from the population of Gujrat, Punjab Pakistan. Data was collected through a pre-tested questionnaire and analyzed through SPSS software (version 21.0). Universal goniometer used to assess cervical ranges. Neck disability index (NDI) was used for functional disability and visual analog scale (VAS) was applied to assess the degree of pain. RESULTS: Majority (n=88; 41.90%) of females were in age group of 25-30 years and were housewives (n=147; 70 %). Females who used handheld devices, unsupported back chairs, read, worked, travelled for more than 3 hours had 63.91, 9.127, 3.568, 3.301, 2.068 folds risk of developing UCS respectively as compared to those who did the same for less than 3 hours. Similarly, females who were fetal sleeper had 2.032 times more risk of than front sleeper. All risk factors were statistically significant (p< 0.005). CONCLUSION: Usage of handheld devices while reading, working, and travelling for >3 hours, sleeping with curved spine and in fetal position and unsupported back chair increase the risk of UCS.

Objective: To compare the effects of Mulligan manual traction and techniques in neural mobilization for managing pain in cervical radiculopathies. Methodology: It was a quasi-experimental study at physical therapy departments of Amin Welfare & Teaching Hospital and Allama Iqbal Memorial Teaching Hospital Sialkot for 6 months from December 2018 to May 2019 after Ethical approval. The sample of 34 participants was equally divided into group A & B. Patients were recruited on the basis of pre-defined inclusion and exclusion criteria. Group A was administered mulligan traction. Group B received neural mobilization of ulnar, median and radial nerve thrice a week. Hot pack and TENS were applied as baseline treatment to both the groups. Numeric pain rating scale (NPRS) and neck disability index (NDI) were used to measure the outcomes and data was recorded before 1st treatment session and after last treatment session. P value ≤ 0.005 was considered as significant. Results: Among the total of 34 sample size, 25 patients were females (73.52%) and 9 were males (26.47%). The mean Age±SD was 44.79±7.885 years. The mean NPRS score reduced from 8.18±0.809 to 3.12±1.269 (P=.000) in group A and from 7.47±1.007 to 2.76±1.147 (P=.004) in group B after treatment. Mean Score of NDI reduced to 4.78±1.23 from 16.00±1.71 (P=.000) in group A and 5.08±1.38 from 14.38±2.19 (P=.005). Conclusion: The study revealed that mulligan manual traction and neural mobilization were effective for the pain management and improvement of functional abilities in patients with cervical radiculopathies; but none of them is superior to other. Key words: Mulligan Manual Traction, Cervical Radiculopathy, neural mobilization, Numeric Pain Rating scale, Neck disability index.

Study Design: Retrospective cohort study.Objective: The present study is the first to assess the impact of paraspinal sarcopenia on patient-reported outcome measures (PROMs) following posterior cervical decompression and fusion (PCDF).Summary Of Background Data: While the impact of sarcopenia on PROMs following lumbar spine surgery is well-established, the impact of sarcopenia on PROMs following PCDF has not been investigated.Materials and Methods: We performed a retrospective review of patients undergoing PCDF from C2 to T2 at a single institution between the years 2017 and 2020. Two independent reviewers who were blinded to the clinical outcome scores utilized axial cuts of T2-weighted magnetic resonance imaging sequences to assess fatty infiltration of the bilateral multifidus muscles at the C5-C6 level and classify patients according to the Fuchs Modification of the Goutalier grading system. PROMs were then compared between subgroups.Results: We identified 99 patients for inclusion in this study, including 28 patients with mild sarcopenia, 45 patients with moderate sarcopenia, and 26 patients with severe sarcopenia. There was no difference in any preoperative PROM between the subgroups. Mean postoperative Neck Disability Index scores were lower in the mild and moderate sarcopenia subgroups (12.8 and 13.4, respectively) than in the severe sarcopenia subgroup (21.0, P <0.001). A higher percentage of patients with severe multifidus sarcopenia reported postoperative worsening of their Neck Disability Index (10 patients, 38.5%; P =0.003), Visual Analog Scale Neck scores (7 patients, 26.9%; P =0.02), Patient-Reported Outcome Measurement Information System Physical Component Scores (10 patients, 38.5%; P =0.02), and Patient-Reported Outcome Measurement Information System Mental Component Scores (14 patients, 53.8%; P =0.02).Conclusion: Patients with more severe paraspinal sarcopenia demonstrate less improvement in neck disability and physical function postoperatively and are substantially more likely to report worsening PROMs postoperatively.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background Context: Although anterior cervical discectomy and fusion is believed to positively impact a patient's radicular symptoms as well as axial neck pain, the outcomes of cervical disc replacement (CDR) with regards to neck pain specifically have not been established.Purpose: Primary: to assess clinical improvement following CDR in patients with neck pain greater than arm pain. Secondary: to compare the clinical outcomes between patients undergoing CDR for predominant neck pain (pNP), predominant arm pain (pAP), and equal neck and arm pain (ENAP).Study Design: Retrospective review of prospectively collected data.Patient Sample: Patients who had undergone one- or two-level CDR for the treatment of degenerative cervical pathology and had a minimum of 6-month follow-up were included and stratified into three cohorts based on their predominant location of pain: pNP, pAP, and ENAP.Outcome Measures: Patient-reported outcomes: Neck Disability Index (NDI), Visual Analog Scale (VAS) neck and arm, Short Form 12-Item Physical Health Score (SF12-PHS), Short Form 12-Item Mental Health Score (SF12-MHS), minimal clinically important difference (MCID).Methods: Changes in Patient-reported outcomes from preoperative values to early (<6 months) and late (≥6 months) postoperative timepoints were analyzed within each of the three groups. The percentage of patients achieving MCID was also evaluated.Results: One hundred twenty-five patients (52 pNP, 30 pAP, 43 ENAP) were included. The pNP cohort demonstrated significant improvements in early and late NDI and VAS-Neck, early SF-12 MCS, and late SF-12 PCS. The pAP and ENAP cohorts demonstrated significant improvements in all PROMs, including NDI, VAS-Neck, VAS-Arm, SF-12 PCS, and SF-12 MCS, at both the early and late timepoints. No statistically significant differences were found in the MCID achievement rates for NDI, VAS-Neck, SF-12 PCS, and SF-12 MCS at the late timepoint amongst the three groups.Conclusions: CDR leads to comparable improvement in neck pain and disability in patients presenting with neck pain greater than arm pain and meeting specific clinical and radiographic criteria. [ABSTRACT FROM AUTHOR]

A 42-year-old male patient presented with complaints of vertigo, neck pain, swallowing difficulties, and difficulty in maintaining an upright posture. The patient took allopathic consultation for the complaints and was advised to undergo MDCT scan of brain, hematological and audiological evaluations. No abnormalities were detected in the investigations and he was given some medications for symptomatic management. As no relief was noted, the patient took an Ayurveda consultation. After clinical evaluation, the patient was advised to perform an X-ray of the cervical spine and was diagnosed with congenital block vertebrae at C3 - C4 vertebral bodies and posterior appendages with hypoplastic intervening disc space. He was advised to take Ekangveerarasa 250 mg BD before food with honey, Trayodashang guggulu 1 gm BD after food, Vishatinduka vati 250 mg BD after food, Aswagandha churna 3 gm BD after food with milk.The patient was also advised to do light massage and mild hot fomentation in the neck region twice a day with Mahavishagarbha oil. Remarkable relief was observed with all signs and symptoms including a reduction of score in the Neck Disability Index (NDI) within a very short duration of treatment. Considerable improvements were noted in the quality of life of the patient as confirmed by the WHO QOL BREF score. This case report shows that Ayurveda can offer safer and more effective symptomatic treatment for conditions like congenitally fused vertebrae., Competing Interests: Declaration of competing interest Authors declares no conflict of interest. Declaration of Generative AI in scientitic writing None, (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: To ensure the validity and therapeutic utility of the Neck disability index (NDI) scale, translations, cultural adaptations and psychometric evidence is necessary. This study aimed to address the absence of a suitable and validated Hindi version of the NDI for the rural population. The specific objectives were to translate, adapt, and evaluate the psychometric properties of the newly developed Hindi version of the NDI., Methods: Following guidelines provided by the American Association of Orthopedic Surgeons, the original English NDI scale was cross-culturally adapted into Hindi. The adaptation process included translations (forward and backward), expert committee review, pre-testing and cognitive debriefing with 30 individuals experiencing chronic non-specific neck pain. The outcome of this process was the creation of the Hindi version of the NDI, termed NDI-Hi. Subsequently, NDI-Hi was administered to 211 participants with neck pain from multiple centers for psychometric testing. The evaluation involved test-retest reliability over a 48-hour interval, factor analysis, assessment of internal reliability measures, and criterion-related validity by comparing it with the NPAD-Hindi version., Results: The NDI-Hi version exhibited favorable psychometric properties, including good test-retest reliability with an intra-class correlation coefficient (ICC) of 0.87. Internal consistency of the scale was high, indicated by Cronbach's alpha coefficient (α) of 0.96. The standard error of measurement (SEM) was determined to be 2.58, and the minimal detectable change (MDC) was calculated to be 7.15. Furthermore, the NDI-Hi showed significant correlation with the NPAD-Hindi version, with a correlation coefficient (rho) of 0.86, and a p-value of less than 0.001., Conclusions: The NDI-Hi demonstrated validity and reliability as an outcome tool for assessing neck disability. It can be effectively utilized in clinical practice and research settings involving Hindi-speaking individuals with chronic non-specific neck pain. The adapted scale is particularly well-suited for the rural Northern Indian Hindi-speaking population., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Sidiq M et al.)

Background: Neck discomfort, arising from strained muscles, poor posture, accidents, or underlying medical conditions, significantly impacts daily activities and overall well-being, presenting a substantial healthcare challenge., Objective: This study aims to evaluate the efficacy of motor control therapeutic neck exercise and a Structured Exercise Program on neck pain and posture among automobile industrial workers., Methods: Using a lottery technique, 106 participants aged 20 to 45 were selected from the vicinity of Chennai's auto industries based on predetermined eligibility and exclusion criteria. Subsequently, participants were randomly assigned to either the motor control therapeutic neck exercise group or the structured exercise program group, each comprising 53 individuals. Participants received a comprehensive overview of the study and respective interventions, and their informed consent was obtained. Demographic details, Neck Injury and Disability scores, and Assessment of Postural and Ergonomic Characteristics data were then collected., Results: Statistical analysis revealed a significant difference between the groups, with the Motor Control Therapeutic Neck Exercise group demonstrating superior outcomes in reducing pain and improving posture, with p-values less than 0.001., Conclusions: This study highlights the efficacy of Motor Control Therapeutic Neck Exercise over Structured Exercise in improving neck pain and posture among automobile industrial workers. These findings contribute valuable insights for the development of targeted interventions in occupational health settings.

Background: Trigger points are palpable nodules or irritable spots present in the skeletal muscles, painful upon pressure. This study is concerned with the pain in the upper Trapezius muscle due to the formation of myofascial trigger points and to make a comparison of the effectiveness of dry needling with dry cupping for treating upper trapezius myofascial trigger points. Methodology: Myofascial trigger points were diagnosed in 30 individuals in the upper trapezius. Subjects were randomized into Group-A (n=15) and Group-B (n=15) using the coin toss method. Patients were evaluated at baseline and after the termination of intervention using the Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI) and cervical joint range of motions (ROM). Patients from both groups received three sessions of treatment on alternate days in one week. Results: Patients with both interventions resulted in significant improvement of NPRS (p=0.001), NDI (p=0.001), and cervical ranges of motion (p=0.001). However, between groups comparison of outcome measure showed no significant difference in NPRS (p=0.990), NDI (p=0.359), cervical flexion (p=0.457), cervical extension (p=0.382), right cervical lateral flexion (p=0.250), left cervical lateral flexion (p=0.792), right cervical rotation (p=0.336), and left cervical rotation (p=0.242) of motion. Conclusion: The pre-and post-intervention results have concluded that both treatment methods effectively treat myofascial trigger points. There was no significant difference between the two groups for numeric pain rating scale, neck disability index scoring and cervical range of motions.

الملخص: أهداف البحث: لا توجد دراسات متاحة حول آثار تحريك لوح الكتف مع حركة الرقبة على المرضى الذين يعانون من آلام الرقبة وخلل الحركة في لوح الكتف. هدف هذا البحث دراسة آثار إضافة تحريك لوح الكتف مع الرقبة إلى برنامج التمارين العلاجية والشريط اللاصق في المرضى الذين يعانون من آلام الرقبة ولديهم خلل في حركة لوح الكتف. طرق البحث: تم التعيين العشوائي لأربعين مشاركا يعانون من ألم الرقبة وخلل في حركة لوح الكتف في إحدى المجموعتين لمدة ثلاثة أسابيع: مجموعة التجربة (تحريك لوح الكتف مع الرقبة + تمارين علاجية + شريط لاصق علاجي) أو مجموعة المقارنة (تمارين علاجية + شريط لاصق علاجي). تم قياس شدة الألم، وعتبة الألم بالضغط، والمدى الحركي للرقبة ولوح الكتف، ومؤشر إعاقة الرقبة قبل أول جلسة وبعد الجلسة الثالثة وبعد الجلسة السادسة. النتائج: انخفض الألم بعد الجلسة السادسة في كلتا المجموعتين. لم يتغير مقدار عتبة الألم بالضغط أو المدى الحركي للوح الكتف، باستثناء حركة الدوران العلوي للوح الكتف حيث قلت هذه الحركة بشكل ملحوظ فقط في مجموعة المقارنة في الجلسة السادسة. تحسـَّن المدى الحركي للرقبة إحصائيا في عدة اتجاهات في كلا المجموعتين. مؤشر إعاقة الرقبة تحسـَّن في كلا المجموعتين. لم تكن هناك فروق ذات دلالة إحصائية بين المجموعات في أي من القياسات في أي جلسة. الاستنتاجات: لا يبدو أن إضافة تحريك لوح الكتف مع الرقبة إلى التمارين العلاجية والشريط اللاصق العلاجي على مدى ثلاثة أسابيع يضيف فائدة للألم والوظيفة في المرضى الذين يعانون من آلام الرقبة ولديهم خلل في حركة لوح الكتف. Abstract: Objectives: The perceived outcomes of scapulothoracic mobilisation with movement (MWM) in patients with neck pain and scapular dyskinesis remain unclear. This study aimed to examine the effects of adding scapulothoracic MWM to the corrective exercise and taping regimen in patients with neck pain and scapular dyskinesis. Methods: Forty participants with neck pain and scapular dyskinesis were randomly assigned to one of two 3-week regimens: experimental (scapulothoracic MWM + corrective exercises + tape) or comparison (corrective exercises + tape). The visual analogue scale, pressure pain threshold (PPT), cervical and scapular range of motion (ROM), and neck disability index (NDI) were measured at the start and after the third and sixth sessions. Results: Pain decreased after the sixth session in both experimental (mean difference: 3.1; 95% confidence interval [CI]: 2.1–4.1) and comparison (mean difference: 1.8; 95% CI: 0.81–2.8) groups. Although there was no change in PPT and scapular ROM, scapular upward rotation decreased significantly only in the comparison group in the sixth session (p = 0.014). The ROM for neck extension, right rotation, and right and left side bending improved significantly (p ≤ 0.031) in both groups. The NDI improved in both the experimental (mean difference: 7.2–10.6; 95% CI: 2.5–15.7) and comparison (mean difference: 5.9–10.3; 95% CI: 1.2–15.4) groups. There were no significant differences in outcomes between the groups. Conclusions: In this study, the addition of scapulothoracic MWM to the corrective exercise and taping regimen over a 3-week period did not increase pain or improve function in patients with neck pain and scapular dyskinesis.

Background: Health domains like pain, disability, and health-related quality of life are commonly used outcomes for musculoskeletal disorders. Most prognostic studies include only one outcome, and it is unknown if prognostic factors and models may be generic across different outcomes. The objectives of this study were to examine the correlation among commonly used outcomes for neck pain (pain intensity, disability, and health-related quality of life) and to explore how the predictive performance of a prognostic model differs across commonly used outcomes.Methods: We conducted an observational prospective cohort study with data from patients with neck pain aged 18-84 years consulting Norwegian chiropractors. We used three different outcomes: pain intensity (Numeric Pain Rating Scale), the Neck Disability Index (NDI), and health-related quality of Life (EQ-5D). We assessed associations between change in outcome scores at 12-weeks follow-up with Pearson's correlation coefficient. We used multivariable linear regression models to explore differences in explained variance and relationship between predictors and outcomes.Results: The study sample included 1313 patients and 941 (72%) completed follow-up at 12 weeks. The strongest correlation was between NDI and EQ-5D (r = 0.57) while the weakest correlation was between EQ-5D and pain intensity (r = 0.39). The correlation between NDI and pain intensity was moderate (r = 0.53) In the final regression models, the explained variance ranged from adjusted R2 of 0.26 to 0.60, highest with NDI and lowest with pain intensity as outcome. The predictive contributions of the included predictors were similar across outcomes. Among the investigated predictors, pain patterns and the baseline measure of the corresponding outcome measure contributed the most to explained variance across all outcomes.Conclusions: The highest correlation was found between NDI and EQ-5D and the lowest with pain intensity. The same prognostic model showed highest predictive performance with NDI as outcome and poorest with pain intensity as outcome. These results suggest that we need more knowledge on the reasons for the differences in predictive performance variation across outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Nonspecific neck pain is a common musculoskeletal disorder causing disability among the general population. Specific dynamic strength-endurance exercises may help maintain improved posture, which in turn can lessen or eliminate recurrent flare-ups of pain. The effect of exercise on patients with chronic nonspecific neck pain has been investigated in several studies. The efficacy is, however, questionable. AIM: The aim of the study is to find the effectiveness of dynamic strength-endurance training in reducing pain and improving function in nonspecific neck pain. DESIGN: This study was a pre- and postintervention design. SETTING: This study was conducted in tertiary care hospital in Mangaluru. MATERIALS AND METHODS: In this pre- and postexperimental study, dynamic strength-endurance training for cervical and scapular muscles was given to 24 adults fulfilling inclusion criteria for 4 weeks. The Neck Disability Index (NDI) was used for pain and disability assessment, and the Neck Bournemouth Questionnaire (NBQ) and the Northwick Park Neck Pain Questionnaire (NPNQ) were used for pain assessment. RESULTS: There was a significant reduction in NDI, NBQ, and NPNQ scores exceeding minimal clinically important difference (NDI >7.5 points, NBQ >5.5 points, and NPNQ >7.6 points) after 4 weeks of strength-endurance training of cervical and scapular muscles. There was significant improvement in hold time. Statistically, a significant difference was observed in pre- and posttreatment effect comparison of all outcome measures (P > 0.01). CONCLUSION: A dynamic strength-endurance training program is effective in reducing pain and disability in a patient with nonspecific neck pain. [ABSTRACT FROM AUTHOR]

Background & purpose: Volleyball is one of the most popular games in the world. The International Volleyball Federation represents about 150 million players in approximately 170 countries. Volleyball is a dynamic sport involving rapid and forceful movements of the body and of the arm and hand when spiking the ball. Injuries in volleyball are quite frequent. It is believed that an increase in the frequency, intensity and duration of training might lead to an increased rate of injury. Methods: A prevalence study was conducted in intercollegiate 50 volleyball players between age group 18-25 were selected from the list of players fulfilling the inclusion and exclusion criteria. Players were screened for prevalence of neck and upper limb injuries using Nordic Musculoskeletal Questionnaire (NMQ) and assessed for activity limitation using Disability of Arm, Shoulder and Hand (DASH), Neck Disability Index (NDI) and Shoulder Pain Disability Index (SPADI). Conclusion: The study was concluded that there is a more risk of upper limb injuries mainly wrist, fingers, shoulder is the more prone to Musculoskeletal disorder among volleyball players. Results: The result of the study was observed that due to wrist injury 10% players were prevented from carrying out their normal activities during last 12 months, followed by shoulder (4%), Elbow (4%) and Neck (2%) were prevented from doing normal activities during the last 12 months. [ABSTRACT FROM AUTHOR]

Background: We analyzed the clinical and radiological parameters influencing functional outcomes and neurological recovery in patients with cervicothoracic junctional tuberculosis (TB). Methods: This was a retrospective analysis of 16 cases of cervicothoracic junction (CTJ) spinal TB; 11 patients were managed operatively, while five were managed conservatively. Patients' outcomes were assessed at 1 month, 1 year, and yearly thereafter and included an analysis of multiple outcome scores, various radiographic parameters, and sensitivity or resistance to anti-tubercular therapy. Results: Patients averaged 25.94 years of age, and typically had three-level vertebral involvement. They were followed for a mean duration of 24 months, and the duration of anti-tubercular therapy averaged 17 months. Patients demonstrated clinical improvement on Japanese Orthopedic Association score and Neck disability index (P < 0.005) starting from 1 month following initiation of treatment which continued in subsequent followup, along with change in radiological parameters consisting of mean segmental kyphotic angle from 18.98° to 15.13°, C2-C7 SVA from 16.13 mm to 22.61 mm, T1 slope from 22.80° to 14.66°, thoracic inlet angle from 75.35° to 63.25°, neck tilt from 51.81° to 48.33°, and cervical lordosis from 4.66° to -0.44° (P > 0.05) at the end of 1 year. Conclusion: Tuberculous affection of the dynamic CTJ is a challenging scenario in clinical practice and its management involves consideration of disease extent, neurological status, and effort toward restoration of normal alignment of spine in sagittal and coronal plane to get favorable clinical outcomes. [ABSTRACT FROM AUTHOR]

To compare patient-reported outcomes measures (PROMs) following posterior cervical decompression and fusion (PCDF) based on changes in perioperative cervical sagittal alignment. We reviewed patients who underwent PCDF from C2 to T2 between the years 2015 and 2020. C2 sagittal vertical axis (SVA) and C2–C7 lordosis were assessed preoperatively and 1-year postoperatively. Neck Disability Index (NDI) and visual analog scale (VAS) Neck scores were collected preoperatively, 3 months' postoperatively, and 1-year postoperatively. PROMs were compared based on perioperative radiographic parameters. Eighty-five patients were included in this study. Patients with preoperative C2 SVA <40 mm had a larger improvement in VAS Neck pain scores at 3 months' postoperatively (–4.9 vs. –3.0, P = 0.03) and a larger decrease in NDI scores at 1-year postoperatively (7.2 vs. 3.1, P = 0.04) than patients with C2 SVA ≥40 mm. Patients with postoperative C2 SVA <40 mm demonstrated lower VAS Neck pain scores at 3 months' postoperatively (2.0 vs. 3.4, P = 0.049). The cohort of patients with a decrease of C2 SVA by ≥5 mm demonstrated lower NDI at 3 months' postoperatively but not at 1-year postoperatively in comparison with patients whose C2 SVA increased or remained unchanged (11.7 vs. 23.8 vs. 18.2; P < 0.001). Patients in whom both C2 SVA and C2–C7 lordosis improved demonstrated superior NDI (P < 0.001) and VAS Neck (P = 0.007) at 3 months' but not at 1-year postoperatively. In a uniform cohort of patients undergoing PCDF from C2 to T2, improvements in C2 SVA and C2–C7 lordosis were associated with improved early postoperative PROMs. [ABSTRACT FROM AUTHOR]

Objective Our study aims to evaluate the impact of severity of preoperative Neck Disability Index (NDI) on postoperative patient-reported outcome measures (PROMs). Methods A retrospective review of primary, elective, single or multilevel anterior cervical discectomy and fusion or cervical disc arthroplasty procedures between 2013 and 2019 was performed. Visual analogue scale (VAS) neck and arm, NDI, 12-item Short Form physical and mental composite score (SF-12 PCS and MCS), Patient-Reported Outcome Measurement Information System physical function, and 9-item Patient Health Questionnaire (PHQ-9) were collected preoperatively and postoperatively. Patients were categorized by preoperative NDI: none-to-mild disability (< 30); moderate disability (≥ 30 to < 50); severe disability (≥ 50 to < 70); complete disability (≥ 70). The impact of preoperative NDI on PROM scores and minimum clinically important difference (MCID) achievement rates were evaluated. Results The cohort included 74 patients with none-to-mild disability, 95 moderate, 76 severe, and 17 with complete disability. Patients with greater preoperative disability demonstrated significantly different scores for NDI, VAS neck, SF-12 MCS, and PHQ-9 at all timepoints (p < 0.001). Patients with more severe disability demonstrated different magnitudes of improvement for NDI (all p < 0.001), VAS neck (p ≤ 0.009), VAS arm (p = 0.025), and PHQ-9 (p ≤ 0.011). The effect of preoperative severity on MCID achievement was demonstrated for NDI and for PHQ-9 (p ≤ 0.007). Conclusion Patients with severe neck disability demonstrated differences in pain, disability, physical and mental health. MCID achievement also differed by preoperative symptoms severity. Patients with more severe neck disability may be limited to the degree of improvement in quality of life but perceive them as significant changes.

Background: Cognitive impairment (CI) is associated with prolonged hospital stays and increased complications; however, its role in symptom severity and health-related quality of life (HRQoL) among spine patients is unknown. We determined 1) prevalence of preoperative CI; 2) associations between CI and preoperative pain, disability, and HRQoL; and 3) association between CI and postoperative improvements in HRQoL. Methods: This is a prospective cohort study of 453 consecutive adult spine surgery patients between October 2019 and March 2021. We compared pain (Numeric Rating Scale, NRS), pain-related disability (Oswestry/Neck Disability Index, O/NDI), and HRQoL (PROMIS-29 profile, version 2.0) among participants having severe (PROMIS-29 Cognitive Abilities score ≤30), moderate (31–35), or mild CI (36–40) or who were unimpaired (score >40), using analysis of variance. Likelihood of clinical improvement given the presence of any CI was estimated using logistic regression. All comparisons were adjusted for age, gender, comorbidity, and use of opioid medication during the last 30 days. Alpha=.05. Results: Eighty-five respondents endorsed CI (38 mild; 27 moderate; 20 severe). Preoperatively, those with CI had more severe back pain (p=.005) and neck pain (p=.025) but no differences in leg or arm pain. Those with CI had greater disability on ODI (p

Study Design Cross-sectional population-based study. Purpose The study objective was to evaluate the coexistence of neck- and shoulder-disability, to establish normative scores for Neck Disability Index (NDI), Visual Analog Scale (VAS)-neck, VAS-arm, Quick Disability of Shoulder and Hand (Quick-DASH), and modified Constant score (mConstant score), and to determine the influence of psychological distress (Hospital Anxiety and Depression Scale [HADS]) on the disability measures. The authors also investigated the distribution of dysphagia across the population and its relation to the NDI scores. Overview of Literature Several factors can adversely influence the clinical outcomes after cervical surgeries. The interaction of neck and shoulder disability in the perspective of psychological distress is not well understood. Methods Prospective questionnaire-based assessment was performed for 1,000 participants. Questionnaires consisted of validated generic and disease-specific queries and specific questions. The survey included patients without pathologies of cervical spine/shoulders/upper extremities. Results Mean age of participants was 39 years. The average neck VAS score was 1.2, NDI% was 7.3, arm VAS score was 0.8, Quick-DASH was 6.2, mConstant score was 70.7, HADS-A score was 4.9, and HADS-D score was 3.2. The psychological scores showed a significant correlation with neck- and shoulder-disability (p35 kg/m2 influenced shoulder-disability (p

Objective Our study aims to evaluate the correlation of Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) with legacy patient-reported outcome measures (PROMs) among patients undergoing anterior cervical discectomy and fusion (ACDF). Methods A prospectively maintained database was retrospectively reviewed for ACDF surgeries performed between May 2015 and September 2017. Inclusion criteria were primary elective, single- or multilevel ACDFs for degenerative spinal pathology. Patients lacking preoperative or 2-year PROMIS PF surveys were excluded. Mean scores were calculated for visual analogue scale (VAS) neck, VAS arm, Neck Disability Index (NDI), 12-Item Short Form Physical Component Score (SF-12 PCS), and PROMIS PF at preoperative and 6-week, 12-week, 6-month, 1-year, and 2-year postoperative timepoints. A t-test and Pearson correlation coefficient were utilized to evaluate score improvement and PROM relationships respectively. Results The 50 subject cohort was 60.0% male, 50% obese (body mass index ≥ 30 kg/m2) and had an average age of 50.9 years. Significant improvements were demonstrated for VAS neck and NDI at all postoperative timepoints (p < 0.001) and for SF-12 and PROMIS PF at all timepoints except 6 weeks (p ≤ 0.025). VAS arm improvement was seen up to 1 year (p ≤ 0.016). PROMIS PF demonstrated strong correlations with NDI and SF-12 PCS at all evaluated timepoints and with VAS neck at all postoperative timepoints except 6 weeks (all p < 0.01). Conclusion PROMIS PF was strongly correlated with pain, disability, and physical function up to 2 years for patients undergoing ACDF. Our results support the long-term validity of PROMIS PF for measurement of patient-reported physical function among ACDF cohorts.

Surgery for cervical spondylotic myelopathy (CSM) may use anterior or posterior approaches. Our objective was to compare baseline differences and validated postoperative patient-reported outcome measures between anterior and posterior approaches. The NeuroPoint Quality Outcomes Database was queried retrospectively to identify patients with symptomatic CSM treated at 14 high-volume sites. Demographic, comorbidity, socioeconomic, and outcome measures were compared between treatment groups at baseline and 3 and 12 months postoperatively. Of the 1151 patients with CSM in the cervical registry, 791 (68.7%) underwent anterior surgery and 360 (31.3%) underwent posterior surgery. Significant baseline differences were observed in age, comorbidities, myelopathy severity, unemployment, and length of hospital stay. After adjusting for these differences, anterior surgery patients had significantly lower Neck Disability Index score (NDI) and a higher proportion reaching a minimal clinically important difference (MCID) in NDI (P = 0.005 at 3 months; P = 0.003 at 12 months). Although modified Japanese Orthopaedic Association scores were lower in anterior surgery patients at 3 and 12 months (P < 0.001 and P = 0.022, respectively), no differences were seen in MCID or change from baseline. Greater EuroQol-5D improvement at 3 months after anterior versus posterior surgery (P = 0.024) was not sustained at 12 months and was insignificant on multivariate analysis. In the largest analysis to date of CSM surgery data, significant baseline differences existed for patients undergoing anterior versus posterior surgery for CSM. After adjusting for these differences, patients undergoing anterior surgery were more likely to achieve clinically significant improvement in NDI at short- and long-term follow-up. [ABSTRACT FROM AUTHOR]

Introduction: Cervical radiculopathy is the clinical condition when a nerve root in the cervical spine becomes inflamed or damaged due to compression because of various reasons resulting in a change in neurological function. Kinesio taping is a treatment method used by physical therapists to improve symptoms associated with musculoskeletal disorders. It can be stretched to 140% of its original length before being applied to the skin. It subsequently provides a constant pulling (shear) force to the skin, unlike traditional athletic tape. Aim: To study the effect kinesio taping on pain, neck disability and physical function of upper limb in cervical radiculopathy. Materials and Methods: This longitudinal study was carried out at SGT Hospital Gurugram, Hrayana, India, between February 2018 to August 2018. Fifty subjects, aged 18-50 years with positive response for the 4 test item cluster described by Wainner RS et al., were included in the study and were given manual therapy treatment, cervical stabilisation exercises and kinesio taping. There were three sessions per week for a total of four weeks. Neck Disability Index (NDI), Numeric Pain Rating Scale (NPRS) and Disability of the Arm, Shoulder and Hand (DASH) questionnaire were the outcome measures. The readings were noted at prelevel (0 week), mid-levels (at 2 weeks weeks) and at post-levels (at 4 weeks weeks). Comparison of different values was done using paired t-test. Level of significance was taken at p-value <0.05. Results: The mean age of patients was 48.1±11.9 years. The NDI scores at 0 weeks, at 2 weeks, at 4 weeks were 46.00±4.96, 30.48±4.56, 14.84±3.94, respectively. The DASH scores at 0 weeks, at 2 weeks, at 4 weeks were 59.52±7.55, 34.49±8.70, 0.74±0.69, respectively. The NPRS scores at 0 weeks, at 2 weeks, at 4 weeks were 8.72±0.7, 5.10±1.07, 0.74±0.69. All the variables showed significant improvement between different intervals. Conclusion: Kinesio taping method along with manual therapy treatment, cervical stabilisation exercises was effective in treating patients with cervical radiculopathy. [ABSTRACT FROM AUTHOR]

Background: Neck pain is a common problem in the medical practice, and the limited movement of the neck muscles can result in impaired chest movement. This study aimed to investigate the relationship between neck pain and pulmonary function using spirometry. Methods: We included 75 patients with chronic neck pain and 75 age- and sex-matched healthy controls. We performed spirometry and recorded forced-vital capacity (FVC), forced expiratory volume in the first second of FVC (FEV1), forced expiratory flow at 25%–75% (FEF 25–75), and peak expiratory flow rate (PEFR). We also measured the neck active range of motion in all positions (flexion, extension, lateral flexion, and rotation) and administered the Neck Disability Index (NDI) and Visual Analog Scale (VAS) for pain. Results: Neck movements were significantly limited in all directions in patients with chronic neck pain. Pulmonary function (FVC, FEV1, FEF25–75, and PEFR) was significantly lower, and FEV1/ FVC was significantly higher in the neck pain group compared with the control group. In the neck pain group, restrictive pattern in spirometry was found in 39 participants (52%). The pulmonary function parameters (FVC, FEV1, FEF25–75, and PEFR) had a significant positive linear relationship with neck movement and a significant negative linear relationship with VAS and NDI scores. Conclusions: Patients with chronic neck pain had limited pulmonary function, which was related to a limited range of cervical movement.

Abstract Background To study the impact of changes in spino-cranial angle (SCA) on sagittal alignment and to investigate the relationship between SCA and Neck Disability Index (NDI) scores after laminoplasty (LP) Material and methods In total, 72 patients with multilevel cervical spondylotic myelopathy (MCSM) after laminoplasty (LP) were retrospectively enrolled. Based on the optimal cut-off values of preoperative SCA, patients were classified into low SCA and high SCA groups. Radiographic data were measured, including spino-cranial angle (SCA), T1-slope (T1s), C2–7 lordosis (CA), T1s minus CA (T1sCA), and C2–7 sagittal vertical axis (cSVA). JOA and NDI scores were both applied to assess postoperative and follow-up clinical efficacy. Pearson correlation coefficient and linear regression analysis were respectively calculated between radiographic data and between SCA and NDI. Results The preoperative SCA was significantly correlated with T1s (r = − 0.795), CA (r = − 0.857), and cSVA (r = 0.915). A receiver operating characteristic (ROC) curve model predicted a threshold of SCA (value of 85.2°). At the follow-up period, patients with lower SCA had a higher T1s and CA and a lower cSVA, simultaneously accompanied by greater △T1s, △CA, and △cSVA. The linear regression model demonstrated that SCA in the higher group was positively correlated with NDI, and patients with higher SCA had worse NDI scores (pre: p

Introduction: Cervical radiculopathy is the clinical condition when a nerve root in the cervical spine becomes inflamed or damaged due to compression because of various reasons resulting in a change in neurological function. Kinesio taping is a treatment method used by physical therapists to improve symptoms associated with musculoskeletal disorders. It can be stretched to 140% of its original length before being applied to the skin. It subsequently provides a constant pulling (shear) force to the skin, unlike traditional athletic tape. Aim: To study the effect of kinesio taping on pain, neck disability and physical function of upper limb in cervical radiculopathy. Materials and Methods: This longitudinal study was carried out at SGT Hospital Gurugram, Haryana, India, between February 2018 to August 2018. Fifty subjects, aged 18-50 years with positive response for the 4 test item cluster described by Wainner RS et al., were included in the study and were given manual therapy treatment, cervical stabilisation exercises and kinesio taping. There were three sessions per week for a total of four weeks. Neck Disability Index (NDI), Numeric Pain Rating Scale (NPRS) and Disability of the Arm, Shoulder and Hand (DASH) questionnaire were the outcome measures. The readings were noted at pre-level (0 week), mid-levels (at 2 weeks weeks) and at post-levels (at 4 weeks weeks). Comparison of different values was done using paired t-test. Level of significance was taken at p-value

ObjectivesTo investigate the characteristics of neck–shoulder pain (NSP) and explore the potentional relationship between the NSP and the individual and work organizational variables.MethodsA cross-sectional study was performed in the tertiary general hospitals in Hunan Province, China between May 2019 and July 2019. A total of 2,030 healthcare workers were enrolled randomly in this study based on a three-stage stratified sampling method. The Neck Disability Index (NDI) was used to measure disability in subjects with neck pain. A self-administered questionnaire was used to assess the characteristics of individual and work organizational variables. The Mann–Whitney U test and the Kruskal–Wallis H test were applied to analyze the prevalence of pain intensity among groups. Multivariate linear regression analysis was performed to explore the potentional relationship between NSP and individual and work organizational variables using the NDI score as the dependent variable.Results2,008 of 2,030 healthcare workers filled out the survey questionnaires online. In the past 12 months, 1,489 participants (74.2%) complained of pain in the cervical–shoulder region. NDI score increased by 0.10 for each year of age, with healthcare workers working in Obstetrics and Gynecology, and the Operating Room less likely to have NSP than those working in other departments. In contrast, female healthcare workers with a history of pregnancy were more likely to have NSP. In terms of organizational factors, workers who received concern from their supervisor about their health, who had the choice to change their shift status to off duty when they were not feeling well, or who were informed about WMSDs were less likely to have NSP.ConclusionThe prevalence of NSP within the previous year was high in this population. Individual factors including history of neck–shoulder diseases, age, and history of pregnancy and organizational factors including being adequately informed regarding WMSDs, concern from supervisors about workers' health, and the ability of workers to change their shift status to off duty when they were not feeling well were shown to induce significant effects to NSP.

Translating the Neck Disability Index (NDI) into the Malay language (NDI-M); evaluation of psychometric properties in patients with neck pain. The NDI-M was translated according to established guidelines. In the first visit, 120 participants completed the NDI-M, visual analogue scale (VAS) for pain and demographic details. 98 participants returned to complete similar questionnaires and the Global Rating of Change (GRoC) scale. The NDI-M was evaluated for internal consistency, test-retest reliability, content validity, construct validity and responsiveness. The NDI-M demonstrated excellent internal consistency (Cronbach's α = 0.84) and good test-retest reliability (ICC2,1 = 0.79). Content validity was confirmed with no floor or ceiling effects. Construct validity was established revealing three-factor subscales explaining 68% of the total variance. The NDI-M showed a moderate correlation with VAS (Rp = 0.49, p < 0.001). Regarding responsiveness, a moderate correlation between NDI-M change scores and VAS change scores was found (Rp = 0.40, p < 0.001). However, there was no significant correlation between NDI-M with GRoC (Rs = 0.11, p = 0.27). The NDI-M is a reliable and valid tool to measure functional outcomes in patients with neck pain. It is responsive in detecting changes in pain intensity during a patient's rehabilitation journey. The NDI was translated into the Malay language and culturally adapted for Malay-speaking patients with neck pain. The NDI-M demonstrated an excellent level of internal consistency and good test-retest reliability. It demonstrated content and construct validity, with three-factor subscales, and moderate responsiveness for pain intensity. The NDI-M is a reliable, valid and responsive instrument to measure functional limitations in patients with neck pain for rehabilitation. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective analysis was performed on data from 251 patients that were included in two randomized, double-blinded clinical trials comparing clinical results of anterior cervical discectomy and arthroplasty (ACDA) to anterior cervical discectomy and fusion (ACDF), and anterior cervical discectomy (ACD), for single-level disc herniation.Objective: This study aimed to investigate whether the ACDA procedure offers superior clinical results 2 years after surgery, to either ACDF or ACD without instrumentation, in the entire group of patients or in a particular subgroup of patients.Summary Of Background Data: The cervical disc prosthesis was introduced to provide superior clinical outcomes after ACD.Methods: Neck Disability Index (NDI), and subscales of the 36-item short-form health survey (SF-36) and McGill pain score were collected at baseline, 1 year and 2 years after surgery. Reoperations and complications were also evaluated. A preliminary subgroup analysis was performed for age, disc height, body mass index (BMI), smoking, and sex.Results: The NDI decreased comparably in all treatment arms to circa 50% of the baseline value and marginal mean NDI differences varied from 0.4 to 1.1 on a 100 point NDI scale, with confidence intervals never exceeding the 20-point minimal clinical important difference (MCID). Secondary outcome parameters showed comparable results. Preliminary subgroup analysis could not demonstrate clinically relevant differences in NDI between treatments after 2 years.Conclusion: After combining data from two Randomized Controlled Trials it can be concluded that there is no clinical benefit for ACDA, when compared with ACDF or ACD 2 years after surgery. Preliminary subgroup analysis indicated outcomes were similar between treatment groups, and that no subgroup could be appointed that benefited more from either ACD, ACDF, or ACDA.Level of Evidence: 1. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the risk factors associated with upper crossed syndrome (UCS) in females of age 25-50 years. METHODS: This population based case controlled study was conducted from May to August 2019. Total of 210 females including 105 cases (participants who had upper neck pain for at least one month) and 105 controls (participants who didn't had upper neck pain), aging 25-50 years were selected through nonprobability convenient sampling technique from the population of Gujrat, Punjab Pakistan. Data was collected through a pre-tested questionnaire and analyzed through SPSS software (version 21.0). Universal goniometer used to assess cervical ranges. Neck disability index (NDI) was used for functional disability and visual analog scale (VAS) was applied to assess the degree of pain. RESULTS: Majority (n=88; 41.90%) of females were in age group of 25-30 years and were housewives (n=147; 70 %). Females who used handheld devices, unsupported back chairs, read, worked, travelled for more than 3 hours had 63.91, 9.127, 3.568, 3.301, 2.068 folds risk of developing UCS respectively as compared to those who did the same for less than 3 hours. Similarly, females who were fetal sleeper had 2.032 times more risk of than front sleeper. All risk factors were statistically significant (p< 0.005). CONCLUSION: Usage of handheld devices while reading, working, and travelling for >3 hours, sleeping with curved spine and in fetal position and unsupported back chair increase the risk of UCS. [ABSTRACT FROM AUTHOR]

Study Design: Cross-sectional, epidemiological study.Objective: This study aims to describe the prevalence, risk factors, disability, and quality of life (QoL) burden of neck pain.Summary Of Background Data: Neck pain is an increasingly common symptom that results in significant disability and loss of QoL to the individual, and imposes a considerable economic burden to developed countries.Methods: A cross-sectional, questionnaire-based study was conducted via multistage random sampling of public households in Singapore on individuals aged 21 and older. Questionnaires were administered face-to-face by trained interviewers. Data analyzed included the prevalence and characteristics of neck pain, its relationship with sociodemographic factors, and its association on QoL and disability via validated questionnaires: EQ5D questionnaire and Neck Disability Index (NDI), respectively.Results: A total of 626 individuals with a median age of 52.0 years (interquartile range 37.0-67.0), and even sex distribution of males (54.0%) and females (46.0%) were included in this study. A total of 144 individuals reported neck pain over the past 6 months, giving a 6-month period prevalence of 23.0%. Among them, nine (6.3%) had chronic, whereas 12 (8.3%) had severe neck pain. Female sex was the only significant risk factor for neck pain on multivariate analysis, with a risk ratio of 1.34 (95% confidence interval [CI] 1.00-1.80, P = 0.049). Individuals with neck pain had mean raw NDI scores of 4.91 ± 6.25, with higher disability seen with increasing pain duration and intensity (P < 0.001 and P = 0.002 respectively). Compared to individuals without neck pain, those with neck pain had poorer QoL with lower EQ5D-Index scores (0.84 ± 0.25 vs. 0.93 ± 0.15; 95% CI 0.046-0.132, P < 0.001) and EQ5D-VAS scores (68.76 ± 14.59 vs. 73.86 ± 13.64; 95% CI 2.510-7.697, P < 0.001).Conclusion: Our findings show that neck pain is a prevalent condition with chronicity and severity of symptoms associated with reduced QoL and increased disability. Population sample health scores can serve as potential reference targets in disease management and aid national health care policy-making.Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Stomatologists present a high risk of musculoskeletal symptoms at the level neck level. Stomatology-specific manoeuvres require high precision, which calls for a flexed and rotated posture of the cervical spine. This position of the cervical spine leads to a high static load in the neck region which through high duration and repetitive neck movement can generate painful symptomatology in the cervical region, accompanied by muscle disequilibrium or cervical instability. Neck pain has become a serious health issue, especially amongst stomatologists. The evaluation of the neck disability index provides information about the way in which neck pain affects the capacity of managing everyday life.

Background and Aim: Neck pain is a typical disorder among people from diverse populations. Myofascial trigger points are located on upper trapezius with a high incidence. These trigger points are commonly found in individuals with mechanical neck pain. This study was conducted to compare the effectiveness of strain-counterstrain and digital ischemic compression on pain, range of cervical lateral flexion and the Neck Disability Index (NDI) score in individuals with Myofascial trigger points of upper trapezius. Materials and Methods: Fifty-five subjects between the age group of 25–45 years clinically diagnosed with neck pain associated with myofascial trigger points were enrolled after ethical approval. Subjects were randomly allocated into Group A (n = 28) (Strain-counterstrain) and Group B (n = 27) (Ischemic compression) for 5 sessions in a week. Outcomes were measured using numerical pain rating scale for pain, NDI for disability and cervical lateral range of motion (ROM) using a goniometer. Results: The intragroup comparison was done using Wilcoxon signed-rank test whereas the intergroup comparison was done using the Mann–Whitney test for data that were not normally distributed. The level of significance was determined by P < 0.05 at 95% confidence interval. Statistically significant improvements were seen in both groups (P < 0.001) whereas in between group analysis, there was no statistically significant difference found (P > 0.05). Conclusion: Both techniques were equally effective in reducing pain, improving ROM of cervical lateral flexion, and NDI score in individuals with myofascial trigger points of upper trapezius.

Context: No consensus about classification, treatment, and clinical relevance of occipital condyle fractures (OCFs) exists. Aims: The aim of the study was to determine radiological, clinical, and functional outcome of OCFs and thereby determine its clinical relevance. Settings and Design: This was a retrospective analysis of a prospective follow-up study. Materials and Methods: From May 2005 to May 2008, all OCFs were included from a Level-1 trauma center. Patient files were reviewed for patient and fracture characteristics. Fracture classification was done according to the Anderson criteria. Clinical outcome was assessed by completing two questionnaires, radiological outcome by computed tomography imaging, and functional outcome by measuring active cervical range of motion using a Cybex EDI-320. Statistical Analysis Used: A Fisher's exact Test was used in categorical variables and a one-sample t-test for comparing means of active cervical range of motion in occipital fracture patients with normal values. An independent samples t-test was carried out to compare the means of groups with and without accompanying cervical fractures for each motion. Results: Thirty-nine patients were included (4 type I, 16 type II, and 19 type III). Twenty-seven patients completed follow-up, of whom 26 were treated conservatively. Fracture healing was established in 25 of 28 fractures at a median follow-up of 19 months. Eleven patients had none to minimal pain or disability at follow-up, 12 had mild, and two had moderate pain or disability on questionnaires. No statistically significant difference in active cervical range of motion was identified comparing means stratified for accompanying cervical fractures. Conclusions: Conservatively treated patients with an OCF generally show favorable radiological and clinical outcome.

Objective: To investigate whether a combination of dry-needling treatments and upper extremity neuromuscular reeducation exercises can significantly improve neck pain and/or headache-related disability, joint position error, cervical range of motion, and pain pressure threshold in individuals suffering from cervicogenic headache (CGH)., Methods: This study is a quasi-experimental design. Seven participants met the inclusion criteria and received dry needling to three muscles that reproduced the participant's headache symptoms and completed the Neck Disability Index (NDI), Headache Disability Inventory (HDI), Visual Analog Scale (VAS), and Numeric Pain Rating Scale (NPRS). Participants performed an exercise regimen designed to address strength and mobility of cervical and scapulothoracic musculature., Results: There were significant improvements seen in cervical range of motion and neck pain-related disability (NDI) during the 4-week treatment period., Conclusion: Dry needling and neuromuscular re-education (NMR) exercises could be effective components of treatment for individuals suffering from CGH to reduce disability and pain.

Background Context: The Neck Disability Index (NDI), a common Patient-Reported Outcome Measure (PROM) for neck pain, lacks sufficient study on its psychometric properties in preoperative patients with cervical spondylotic myelopathy (CSM)., Purpose: This study aims to address these gaps by conducting an exploratory factor analysis of the Japanese NDI. The objectives are 2-fold: (1) to scrutinize the psychometric properties and internal consistency of the Japanese NDI, and (2) to explore the specific regions of pain and numbness influencing the NDI., Study Design/setting: A single-center observational study., Patient Sample: A total of 100 preoperative patients with CSM., Outcome Measures: The NDI and Numerical Rating Scale (NRS) were employed to assess preoperative neck disability and pain and numbness in various body regions., Methods: Demographic and clinical characteristics were collected, encompassing age, sex, body mass index, American Society of Anesthesiologists classification, smoking status, comorbidities, pain and numbness at various sites using the NRS, and NDI. For evaluating the psychometric properties and internal consistency of the NDI, exploratory factor analysis (EFA) and Cronbach's α coefficient were utilized. Furthermore, the impact of pain and numbness on NDI factors was examined through multivariable regression analysis., Results: EFA identified 2 factors-Physical and Mental-highlighting the dual nature of neck-related disability. Physical factors (std.β=0.724, p<.001) exerted a stronger impact on NDI scores compared to Mental factors (std.β=0.409, p<.001). Cronbach's α coefficient was 0.831 for physical factors and 0.723 for mental factors, indicating a high level of internal consistency. Numbness in the hand (std.β=0.338, p<.001) and pain in the neck (std.β=0.202, p=.035) were significant variables influencing Physical factor, while numbness in the hand (std.β=0.485, p<.001) and pain in the head (std.β=0.374, p<.001) impacted Mental factor., Conclusion: This study contributes valuable insights into the psychometric properties of the NDI in preoperative patients with CSM. The identified factors emphasize the importance of addressing both physical and sensory symptoms in preoperative care., Competing Interests: Declaration of competing interest No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. The manuscript submitted does not contain information about medical device (s)/drug (s)., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to investigate the influence of preoperatively assessed paraspinal muscle parameters on postoperative patient-reported outcomes and maintenance of cervical sagittal alignment after anterior cervical discectomy and fusion (ACDF)., Methods: Patients with preoperative and postoperative standing cervical spine lateral radiographs and preoperative cervical MRI who underwent an ACDF between 2015 and 2018 were reviewed. Muscles from C3 to C7 were segmented into 4 functional groups: anterior, posteromedial, posterolateral, and sternocleidomastoid. The functional cross-sectional area and also the percent fat infiltration (FI) were calculated for all groups. Radiographic alignment parameters collected preoperatively and postoperatively included C2-7 lordosis and C2-7 sagittal vertical axis (SVA). Neck Disability Index (NDI) scores were recorded preoperatively and at 2 and 4-6 months postoperatively. To investigate the relationship between muscle parameters and postoperative changes in sagittal alignment, multivariable linear mixed models were used. Multivariable linear regression models were used to analyze the correlations between the changes in NDI scores and the muscles' FI., Results: A total of 168 patients with NDI and 157 patients with sagittal alignment measurements with a median follow-up of 364 days were reviewed. The mixed models showed that a greater functional cross-sectional area of the posterolateral muscle group at each subaxial level and less FI at C4-6 were significantly associated with less progression of C2-7 SVA over time. Moreover, there was a significant correlation between greater FI of the posteromedial muscle group measured at the C7 level and less NDI improvement at 4-6 months after ACDF., Conclusions: The findings highlight the importance of preoperative assessment of the cervical paraspinal muscle morphology as a predictor for patient-reported outcomes and maintenance of C2-7 SVA after ACDF.

Objective: Use of bone morphogenetic protein (BMP)-an osteoinductive agent commonly used in lumbar arthrodesis-is off-label for cervical arthrodesis. This study aimed to identify the effect of BMP use on clinical and radiological outcomes in instrumented cervical arthrodesis., Methods: A comprehensive systematic review of the literature was performed to identify studies directly comparing outcomes between cervical arthrodeses with and without using BMP. Outcomes were analyzed separately for cases of anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF)., Results: A total of 20 studies with 5828 patients (1948 with BMP and 3880 without BMP) were included. In the ACDF cases, BMP use was associated with higher fusion rates (98.9% vs 93.6%, risk difference [RD] 8%; risk ratio [RR] 1.12, p = 0.02), lower reoperation rates (2.2% vs 3.1%, RD 3%; RR 0.48, p = 0.04), and higher risk of dysphagia (24.7% vs 8.1%, RD 11%; RR 1.93, p = 0.02). No significant differences in the Neck Disability Index, neck pain, or arm pain scores were associated with the use of BMP. On subgroup meta-analysis of ACDF cases, older age (≥ 50 years) and higher BMP dose (≥ 0.9 mg/level) were associated with significantly higher fusion rates and relatively lower risk for dysphagia, whereas arthrodesis of fewer segments (< 2 levels) showed significantly higher dysphagia rates without a significant increase in fusion rates. In the PCF cases, the use of BMP was not associated with significant differences in fusion (p = 0.38) or reoperation (p = 0.61) rates but was associated with significantly higher blood loss during surgery (mean difference 146.7 ml, p ≤ 0.01)., Conclusions: Use of BMP in ACDF offers higher rates of augmented fusion and lower rates of all-cause reoperation but with an increased risk of dysphagia. The benefit of fusion outweighs the risk of dysphagia with a higher BMP dose in older patients being operated on for < 2 levels. The use of BMP in PCF seems to have a less important effect on clinical and radiological outcomes.

Background: The erector spinae plane block (ESPB) is an interfascial plane block for managing neuropathic thoracic pain. Although the ESPB is applied widely in various clinical situations, no studies have evaluated the association between the analgesic outcomes of the ESPB and the numerical changes in the perfusion index (PI) and PI ratio., Objectives: The purpose of this study is to investigate the association between the clinical response following ESPB and other possible factors, including changes in the PI and PI ratio., Study Design: A prospective, nonrandomized, and open-label study., Setting: The pain clinic of a tertiary university hospital., Methods: This study included 92 patients with neck or arm pain who received T2 ESPB using 20 mL of 0.2% ropivacaine. To aid in the prediction of clinical outcomes, the PI was measured at the blocked side for 30 minutes as soon as the ESPB was finished. Various demographic data were also analyzed to predict the clinical outcomes., Results: Among 92 patients, 59 patients (64%) showed successful treatment outcomes (> 50% reduction in the numerical rating scale score or > 30% reduction in the neck disability index). The baseline PI of the responders was statistically higher than the nonresponders' (P < 0.05). Also, the responders' PI demonstrated statistically higher values than the nonresponders' at the time points of 4, 6, and 8 minutes after the ESPB. Multivariate logistic regression analysis revealed that a higher baseline PI (OR, 1.91; 95% CI, 1.27-2.86; P = 0.002) was an independent factor associated with a successful outcome., Limitations: Only a small number of patients with nonspinal diseases were included, except for those who had cervical radiculopathy. Therefore, it is hard to conclude that thoracic ESPB has any therapeutic benefits to patients with nonspinal diseases such as complex regional pain syndrome, adhesive capsulitis, or post-thoracotomy pain syndrome., Conclusion: A successful outcome at 4 weeks after T2 ESPB was achieved in 64% of patients with cervical radiculopathy. A higher baseline PI value was an independent factor associated with a successful response to T2 ESPB.

Background: Recurrent or persistent neck pain affects a vast number of people globally, leading to reduced quality of life and high societal costs. Clinically, it is a difficult condition to manage, and treatment effect sizes are often moderate at best. Activity and manual therapy are first-line treatment options in current guidelines. We aimed to investigate the combination of home stretching exercises and spinal manipulative therapy in a multicentre randomized controlled clinical trial, carried out in multidiscipline ary primary care clinics.Methods: The treatment modalities utilized were spinal manipulative therapy and home stretching exercises compared to home stretching exercises alone. Both groups received 4 treatments for 2 weeks. The primary outcome was pain, where the subjective pain experience was investigated by assessing pain intensity (NRS - 11) and the quality of pain (McGill Pain Questionnaire). Neck disability and health status were secondary outcomes, measured using the Neck Disability Indexthe EQ-5D, respectively. One hundred thirty-one adult subjects were randomized to one of the two treatment groups. All subjects had experienced persistent or recurrent neck pain the previous 6 months and were blinded to the other group intervention. The clinicians provided treatment for subjects in both group and could not be blinded. The researchers collecting data were blinded to treatment allocation, as was the statistician performing data analyses. An intention-to-treat analysis was used.Results: Sixty-six subjects were randomized to the intervention group, and sixty-five to the control group. For NRS - 11, a B-coefficient of - 0,01 was seen, indication a 0,01 improvement for the intervention group in relation to the control group at each time point with a p-value of 0,305. There were no statistically significant differences between groups for any of the outcome measures.Conclusion: Based on the current findings, there is no additional treatment effect from adding spinal manipulative therapy to neck stretching exercises over 2 weeks for patients with persistent or recurrent neck pain.Trial Registration: The trial was registered 03/07/2018 at ClinicalTrials.gov , registration number: NCT03576846. [ABSTRACT FROM AUTHOR]

Purpose: To transculturally adapt the Neck Disability Index to Mexican Spanish (NDI-Mx) and to evaluate its psychometric properties. Methods: Translation and transcultural adaptation of the NDI were conducted according to published guidelines. The test–retest reliability of the NDI-Mx was assessed with intraclass correlation coefficient (ICC3,1), the student t-test, standard error of measurement, minimal detectable change and Bland–Altman plot. Cronbach's α coefficient was used to evaluate internal consistency. Floor and ceiling effects were also evaluated. Convergent validity was assessed by comparison of the NDI-Mx with the Northwick Park Neck Pain Questionnaire (NPQ) through the Spearman correlation coefficient. Finally, a confirmatory factor analysis (CFA) was conducted. Results: The sample was composed of 113 subjects (38 men and 75 women) with a mean age of 30 (SD, 12.19) years. All items of the NDI-Mx showed good test–retest reliability (ICC3,1 = 0.86) and good internal consistency (Cronbach's α = 0.85). Floor and ceiling effects were not observed. There was good convergent validity with a high correlation between NDI-Mx and NPQ (ρ = 0.83). The CFA revealed that a one-factor solution fitted adequately the data (χ2(32) = 41.18, p =.13). Conclusion: The NDI-Mx seems to be a valid and reliable tool that can be used in clinical practice and research on Mexican populations with neck pain. [ABSTRACT FROM AUTHOR]

Background: Neck disability index (NDI) is one of the commonest patient-reported outcome measures used to evaluate disability related to neck pain. Its application to non-English-speaking Punjabi population is limited as a validated and cross-culturally adapted Punjabi version of NDI is not available. The purpose of the study was to analyze the psychometric properties of Punjabi version of neck disability index (NDI-P) in patients with neck pain. Materials and Methods: The translation and cross-cultural adaptation of Punjabi version of NDI was done according to well-recommended guidelines. The pre-final version was tested on a set of 15 patients and suitable modifications were made. The final version was administered to 100 patients with neck pain of more than 2 weeks duration. Psychometric properties comprising internal consistency, test–re-test reliability, construct validity and factorial structure of the questionnaire were determined. Results: The developed NDI-P showed excellent internal consistency (Chronbach alpha of NDI-P is 0.87), test–re-test reliability (ICC 0.840) and construct validity (Spearman correlation coefficient with VAS 0.547). Factor analysis proved the questionnaire to be having a 2-factor structure with a total variance of 56.58%. Conclusion: NDI (P) is a reliable and valid instrument for measurement of disability related to neck pain in Punjabi population. It can be used both in research and clinical care settings in future. [ABSTRACT FROM AUTHOR]

Background Context: Little is known about the effects of sleep disturbance (SD) on clinical outcomes after spine surgery.Purpose: To determine the (1) prevalence of SD among patients presenting for spine surgery at an academic medical center; (2) correlations between SD and health-related quality of life (HRQoL) scores; and (3) associations between postoperative SD resolution and short-term HRQoL.Study Design: Retrospective review of prospectively collected data.Patient Sample: We included 508 adults undergoing spine surgery at 1 academic center between December 2014 and January 2018.Outcome Measures: Participants completed the Oswestry Disability Index (ODI) or Neck Disability Index (NDI) and Patient Reported Outcome Measurement System (PROMIS-29) questionnaire preoperatively, during the immediate postoperative period (6-12 weeks), and at 6, 12, and 24 months after surgery.Methods: Using preoperative PROMIS SD scores, we grouped participants as having no sleep disturbance (score <55), mild disturbance (score, 55-60), moderate disturbance (score 60-70), or severe disturbance (score, 70). For the final analysis, we collapsed these categories into no/mild and moderate/severe. Pearson correlation tests were used to assess correlations between SD and HRQoL measures. Regression analysis (adjusting for age, sex, comorbidities, current opioid use, and occurrence of complications) was used to estimate the effect of postoperative resolved or continuing SD on HRQoL scores and the likelihood of achieving clinically meaningful improvements in HRQoL. Alpha = 0.05.Results: Preoperative SD was reported by 127 participants (25%). SD was significantly correlated with worse ODI and/or NDI values and worse scores in all PROMIS health domains (all, p<.001). At the immediate postoperative assessment, SD had resolved in 80 of 127 participants (63%). Compared with participants who reported no preoperative SD, those with ongoing SD were significantly less likely to achieve clinically meaningful improvements in Pain Interference (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.28, 0.84), Physical Function (OR, 0.32; 95% CI, 0.13, 0.82), and Satisfaction with Participation in Social Roles (OR, 0.57; 95% CI, 0.37, 0.80).Conclusion: One-quarter of spine surgery patients reported preoperative SD of at least moderate severity. Poor preoperative sleep quality and ongoing postoperative sleep disturbance were significantly associated with worse scores on several HRQoL measures. These results highlight the importance of addressing patients' sleep disturbance both before and after surgery. [ABSTRACT FROM AUTHOR]

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Background The purpose of this study was to determine the prevalence, symptoms of, and risk factors for spinal pain in physiotherapists, as well as to analyse the correlation between these factors and the nature of the work, anthropometric features of the respondents, and the level of their physical activity. Methods The study was conducted among 240 physiotherapists (71 male and 169 female) with a mean age of 38.7 years. They were divided into three groups: physical therapy (37), kinesitherapy (158) and massage (45). Physiotherapists were evaluated with a specially designed questionnaire, the postural discomfort chart, the Neck Disability Index (NDI) questionnaire, and the Oswestry Disability Index (ODI) questionnaire. Results The analysis showed a 91.7% incidence of spinal pain in physiotherapists (91.1% for kinesitherapy, 97.3% for physical therapy, and 88.9% for massage). The study revealed that 50.2% of physiotherapists indicated one to five pain episodes in their careers. Most respondents reported pain in the lumbosacral spine (82%) and the cervical spine (67%). Most respondents (58.5%) scored the pain as moderate (VAS scale). Carrying (62.6%) and torso bending (37.4%) were indicated as the causes of pain. Conclusions Physiotherapists demonstrate a high prevalence of spinal pain. Physical activity reduces the frequency of pain episodes.

Introduction: In the present era, the use of smartphones for teaching learning and communication in education in India has raised manyfold. The increasing use of smartphones in our daily life has brought about numerous musculoskeletal problems. Impairments in the neck is the most common when compared to other parts of the body. Aim: To find out the impact of smartphone addiction on neck pain and disability. Materials and Methods: This cross-sectional study was conducted on students from Garden City University aged between 18-25 years through non probability sampling technique. The data was collected from August to September 2019. The addiction level to a smartphone was measured using Smartphone Addiction Scale Short Version (SAS-SV) and the Neck disability was measured using the Neck Disability Index (NDI) and were circulated. The questionnaires were shared to the students through electronic media and 108 subjects participated in it. The data were analysed using IBM SPSS 20.0 statistical software to correlate smartphone addiction scale and NDI. Spearman’s correlation test was performed to analyse the relationship between smartphone assessment scale-short version and NDI Results: The Spearman correlation analysis clearly showed that there was a moderate positive correlation (r=0.682) between smartphone addiction and neck pain and neck disability in university students and the level of significance was (p

Cervical radiculopathy is a syndrome in which the patient complains of pain along with sensorimotor deficits. This syndrome commonly develops due to compression of the cervical nerve roots. This report describes the case of 52-year-old histopathology laboratory technician who developed cervical radiculopathy due to prolonged cervical forward flexion while working on his table. The patient also complained of pain on the right scapular border. Radiographic analysis showed cervical spondylosis having osteophyte formation on spinous process of C2, C3, C4, C5 and C6 vertebras. Neural tissue tension test was positive for median nerve. He was treated consecutively with strengthening for shoulder abductors, shoulder adductors, scapula elevators and scapular protractors along with thermotherapy. His right medial border scapular pain and symptoms of cervical radiculopathy decreased in severity after the seventh day of treatment. Although the authors cannot suggest a cause-and effect relationship, this report allows for initial hypothesis development that thermotherapy approach may have clinical merit. Future studies in the form of well-designed, randomised clinical trials should be performed to evaluate the effectiveness of this approach in patients with cervical radiculopathy.

Background Context: Postoperative dysphagia and dysphonia (PDD) are prevalent complications after anterior cervical discectomy and fusion (ACDF). Identification of risk factors for these complications is necessary for effective prevention. Recently, patient reported outcome measures (PROM) have been used to determine PDD after ACDF. The Hospital for Special Surgery Dysphagia and Dysphonia Inventory (HSS-DDI) is a validated PROM that specifically assesses dysphagia and dysphonia after anterior cervical spine surgery.Purpose: To identify the perioperative risk factors for PDD utilizing the HSS-DDI.Study Design/setting: Observational study of prospectively collected data at a single academic institution.Patient Sample: Patients undergoing anterior cervical discectomy and fusion from 2015 to 2019 who enrolled in the prospective data collection.Outcome Measure: The HSS-DDI administered 4 weeks, 8 weeks, and 4-6 months after surgery.Methods: As potential risk factors, the data on demographic factors, analgesic medications, history of psychiatric illness, preoperative sagittal alignment, surgical factors, preoperative diagnoses, and preoperative Neck Disability Index (NDI) scores were collected. Bivariate and multivariable regression analyses utilizing the Tobit model were conducted.Results: 291 patients were included in the final analysis. The median HSS-DDI at 4-weeks, 8 weeks, and 4-6 months postoperatively, were 80.7, 92.7, and 98.4, respectively. Multivariable analysis demonstrated that current smoking, previous cervical spine surgery, preoperative C2-7 angle, upper level surgery, multilevel surgery, opioid use, and a high preoperative NDI score, were independent contributing factors to a low HSS-DDI score at 4-weeks follow-up. Intraoperative topical steroid use was an independent protective factor for a low HSS-DDI score. Opioid use and high NDI score remained independent factors at 4-6 months. Sub-domain analysis demonstrated that prior cervical surgery, preoperative C2-7 angle, multilevel surgery, and intraoperative topical steroid use were significant for dysphagia only. Current smoking was significant for dysphonia only.Conclusions: Our results showed that preoperative opioid use and a high preoperative NDI score are novel independent risk factors for postoperative dysphagia and dysphonia in addition to other known factors. [ABSTRACT FROM AUTHOR]