Functional analysis of the cervical spine : Reliability, reference data and outcome after anterior cervical decompression and fusion

• The aim of the thesis was to investigate the reliability of the test procedure, and to obtain reference values for active range of motion (AROM) of the neck, neck-, and hand strength. Another aim was to perform a broad assessment of outcome in patients with cervical disc disease operated on by anterior cervical decompression and fusion (ACDF) and to identify predictive factors for a good outcome. For a broad assessment it is important to have reliable objective and subjective variables, and reference values obtained in healthy people.Three studies concern reliability and reference values for neck AROM, neck strength, and hand strength of healthy individuals. One study concerns the outcome of 34 consecutively included patients six months and one year after ACDF, and any remaining deficits afterwards. One study is a prospective randomised study of 103 patients concerning prognostic factors (mean follow-up 19 months, SD 6, range 12-24 months) for a good outcome of ACDF, and any remaining deficits afterwards.The intra-, and inter-tester reliability of neck AROM, neck strength, and hand strength obtained from 30-32 healthy volunteers were considered substantial to almost perfect (ICC-values 0.61-0.98) and can be used for comparisons between or within groups. The reference values obtained in 101 asymptomatic men and women aged 25-64 years showed that age was the most important factor to take into consideration when measuring neck AROM, and gender was most important for neck and hand strength measurements. The patients showed benefits from ACDF at the one-year follow-up in neck strength in lateral flexion, neck muscle endurance in flexion, pain, numbness, ADL, Neck Disability Index (NDI), sick leave, change in general health, and symptom satisfaction. Except for a deterioration in general health there were no significant differences between the six-month and the one-year followup. The most important predictor for low postoperative pain intensity was greater preoperative kyphosis.The predictive value of segmental kyphosis is noteworthy and of potential clinical interest. Low preoperative pain intensity was the most important predictor for improved NDI. Non-smoking males with a greater segmental kyphosis at the level of surgical intervention, with less severe pain experience and better initial function, had the best prognosis for a successful outcome of ACDF. Although the patients experienced benefits from surgery in many of the variables, a large number still had remaining deficits. These studies support the need for improvements in the selection for and the treatment techniques in both surgery and physiotherapy in degenerative cervical disorders.

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