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- Engquist, M., et al.
(author)
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A 5-to 8-year randomized study on the treatment of cervical radiculopathy: anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone
- 2017
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In: Journal of Neurosurgery-Spine. - : Journal of Neurosurgery Publishing Group (JNSPG). - 1547-5654. ; 26:1, s. 19-27
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Journal article (peer-reviewed)abstract
- OBJECTIVE The aim of this study was to evaluate the 5- to 8-year outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program as compared with that following the same physiotherapy program alone in patients with cervical radiculopathy. No previous prospective randomized studies with a follow-up of more than 2 years have compared outcomes of surgical versus nonsurgical intervention for cervical radiculopathy. METHODS Fifty-nine patients were randomized to ACDF surgery with postoperative physiotherapy (30 patients) or to structured physiotherapy alone (29 patients). The physiotherapy program included general and specific exercises as well as pain coping strategies. Outcome measures included neck disability (Neck Disability Index [NDI]), neck and arm pain intensity (visual analog scale [VAS]), health state (EQ-5D questionnaire), and a patient global assessment. Patients were followed up for 5-8 years. RESULTS After 5-8 years, the NDI was reduced by a mean score% of 21 (95% CI 14-28) in the surgical group and 11% (95% CI 4%-18%) in the nonsurgical group (p = 0.03). Neck pain was reduced by a mean score of 39 mm (95% CI 26-53 mm) compared with 19 mm (95% CI 7-30 mm; p = 0.01), and arm pain was reduced by a mean score of 33 mm (95% CI 18-49 mm) compared with 19 mm (95% CI 7-32 mm; p = 0.1), respectively. The EQ-5D had a mean respective increase of 0.29 (95% CI 0.13-0.45) compared with 0.14 (95% CI 0.01-0.27; p = 0.12). Ninety-three percent of patients in the surgical group rated their symptoms as "better" or "much better" compared with 62% in the nonsurgical group (p = 0.005). Both treatment groups experienced significant improvement over baseline for all outcome measures. CONCLUSIONS In this prospective randomized study of 5- to 8-year outcomes of surgical versus nonsurgical treatment in patients with cervical radiculopathy, ACDF combined with physiotherapy reduced neck disability and neck pain more effectively than physiotherapy alone. Self-rating by patients as regards treatment outcome was also superior in the surgery group. No significant differences were seen between the 2 patient groups as regards arm pain and health outcome.
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| 2. |
- Peolsson, A., et al.
(author)
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Altered mechanical deformation of the trapezius and multifidus muscles registered with ultrasonography in women with chronic whiplash-associated disorders
- 2016
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In: Manual Therapy. - : Elsevier BV. - 1356-689X .- 1532-2769. ; 25, s. e58-
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Journal article (peer-reviewed)abstract
- Background: The deformation and deformation rate of the dorsal neck muscle layers in individuals with chronic whiplash associated disorders (WAD) is rarely evaluated, and the mechanical behaviour during dynamic neck extension remains to be investigated.Purpose: To compare the deformation and deformation rate of dorsal neck muscles (trapezius, splenius capitis, semispinalis capitis and cervicis, and multifidus) in women with chronic WAD compared with healthy controls during a dynamic resisted neck extension.Methods: Nine women with chronic grade 2 and 3 WAD (mean age 38 years, standard deviation [SD] 11.3) and nine age- and gender-matched healthy controls (mean age 38 years, SD 11.6) participated in this cross-sectional, controlled study. Ultrasonography movies and post-process speckle tracking were used to investigate real-time mechanical dorsal neck muscle behaviour at the C4 segmental level during a low-loaded dynamic standardized neck extension. Deformation (longitudinal shortening and elongation) and deformation rate (speed of deformation) were calculated during the entire exercise sequence.Results: There were significant differences between the WAD and control groups in total deformation for the trapezius (p < 0.04) and multifidus (p < 0.03). The WAD group showed more shortening in the deformation pattern during the concentric contraction phase in the trapezius muscle, and during both the concentric and eccentric phase in the multifidus muscle compared to healthy controls. There were no other significant differences between groups either in deformation or deformation rate.Conclusion: There were altered mechanical deformations of the trapezius and multifidus muscles, with preliminary evidence for overuse in individuals with WAD compared to healthy controls. The findings must be interpreted with caution due to the small sample size.Implications: An ultrasound investigation made it possible to non-invasively capture multi-layered muscles in real time, adding new information of value for clinical practice of patients with WAD, which may impact future rehabilitation.
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