Anterior cervical decompression and fusion on neck range of motion,pain, and function: a prospective analysis

Background contextIntractable cervical radiculopathy secondary to stenosis or herniated nucleus pulposus is commonly treated with an anterior cervical decompression and fusion (ACDF) procedure. However, there is little evidence in the literature that demonstrates the impact such surgery has on long-term range of motion (ROM) outcomes.PurposeThe objective of this study was to compare cervical ROM and patient-reported outcomes in patients before and after a 1, 2, or 3 level ACDF.Study designProspective, nonexperimental.Patient sampleForty-six patients.Outcome measuresThe following were measured preoperatively and also at 3 and 6 months after ACDF: active ROM (full and painfree) in three planes (ie, sagittal, coronal, and horizontal), pain visual analog scale, Neck Disability Index, and headache frequency.MethodsPatients undergoing an ACDF for cervical radiculopathy had their cervical ROM measured preoperatively and also at 3 and 6 months after the procedure. Neck Disability Index and pain visual analog scale values were also recorded at the same time.ResultsBoth painfree and full active ROM did not change significantly from the preoperative measurement to the 3-month postoperative measurement (ps>.05); however, painfree and full active ROM did increase significantly in all three planes of motion from the preoperative measurement to the 6-month postoperative measurement regardless of the number of levels fused (ps≤.023). Visual analog scale, Neck Disability Index, and headache frequency all improved significantly over time (ps≤.017).ConclusionsOur results suggest that patients who have had an ACDF for cervical radiculopathy will experience improved ROM 6 months postoperatively. In addition, patients can expect a decrease in pain, an improvement in neck function, and a decrease in headache frequency.     

Translation of the Neck Disability Index and validation of the Greek version in a sample of neck pain patients

Background  

Neck pain is a highly prevalent condition resulting in major disability. Standard scales for measuring disability in patients with neck pain have a pivotal role in research and clinical settings. The Neck Disability Index (NDI) is a valid and reliable tool, designed to measure disability in activities of daily living due to neck pain. The purpose of our study was the translation and validation of the NDI in a Greek primary care population with neck complaints.     

Neck and back pain specific outcome assessment questionnaires in the Spanish language: a systematic literature review

Background contextAccurate measurement of functional improvement in clinical practice is becoming increasingly recognized as essential in demonstrating whether patients are deriving meaningful benefit from care. Several simple questionnaires have been developed for this purpose. The majority of these have been developed in English. In North America, there is a growing need for clinical tools, including outcome assessment tools that are available in the Spanish language.PurposeThe purpose of this study was to systematically review the literature regarding spine-specific outcome assessment questionnaires that are available in Spanish and to examine the evidence on their clinical utility.Study designSystematic review.MethodsThe Medline, CINAHL, Embase, and MANTIS databases were searched for any studies on the topic of outcome assessment questionnaires in the Spanish language. Relevant articles were reviewed, and the data on reliability, validity, time to completion, and any other properties of the questionnaire was extracted.ResultsThe search strategy identified 287 articles, of which 10 were deemed relevant. With regard to neck pain, data were found regarding Spanish translations of the Northwick Park Neck Pain Questionnaire, Neck Disability Index (NDI), and Core Outcome Measure for neck pain. With regard to low back pain, data were found regarding Spanish translations of the Oswestry Low Back Pain Disability Index (ODI), Roland Morris Disability Questionnaire (RMQ), and the North American Spine Society—American Academy of Orthopedic Surgeons questionnaire.ConclusionsSeveral reliable and valid outcome assessment questionnaires are available in the Spanish language. All were originally developed in English. It appears from the data reviewed that the most useful instruments are the NDI for neck pain patients and the ODI and RMQ for low back pain patients. The current trend is for the development of culturally adapted versions of these questionnaires that are specific to a particular country or region.     

Cross-cultural adaptation of the Neck Disability Index and Copenhagen Neck Functional Disability Scale for patients with neck pain due to degenerative and discopathic disorders. Psychometric properties of the Polish versions

Background  

Even though there are several region-specific functional outcome questionnaires measuring neck disorders that have been developed in English-speaking countries, no Polish version has ever been validated. The purpose of our study was to translate, culturally adapt and validate the Neck Disability Index (NDI) and Copenhagen Neck Functional Disability Scale (CDS) for Polish-speaking patients with neck pain.     

Development of the Neck Pain and Disability Scale. Item analysis, face, and criterion-related validity.

STUDY DESIGN: The development and testing of a new comprehensive measure of neck pain and disability, the Neck Pain and Disability Scale. OBJECTIVES: To provide an initial evaluation of the Neck Pain and Disability Scale's reliability and validity. SUMMARY OF BACKGROUND DATA: Although several measures exist for generalized pain and disability, none is specific for neck pain. More specific measurements should improve assessment of treatments and clinical research aimed at cervical pain syndromes. METHODS: The Neck Pain and Disability Scale was designed using the Million Visual Analogue Scale as a template and consists of 20 items that assess neck pain. In this study, 100 patients with neck pain, 52 patients with lower back and leg pain, and 27 pain-free volunteers were rated by the Neck Pain and Disability Scale. In addition, a subset of the 47 patients with neck pain were rated by several other established psychometric instruments. RESULTS: An item analysis showed a high degree of internal consistency among the 20 items on the Neck Pain and Disability Scale (r = 0.93), and face validity was established by comparing patients who had neck pain as well as lower back and leg pain with a pain-free group. The Neck Pain and Disability Scale scores correlated with the Oswestry Disability Questionnaire, the Pain Disability Index, and psychological measures of depression and neuroticism. CONCLUSIONS: The results suggest a highly reliable instrument for evaluating neck pain with at least four underlying dimensions. Further work to address the predictive validity of this new tool are under way.     

Measurement of long-term outcome in patients with cervical spondylotic myelopathy treated surgically

Purpose

The Myelopathy Disability Index and the Neck Disability Index are widely used to assess outcome in cervical spine surgery. Short Form (SF) 36 is a generic measure of health which can be used to measure health gains across a wide variety of conditions. The aim of the current study is to assess long-term outcomes using these measures in a cohort of patients with cervical spondylotic myelopathy (CSM).

Methods

Cohort study with prospective data collection. Patients with CSM being offered decompressive surgery were asked to complete a set of generic and condition-specific outcome measures. This was repeated post-operatively at 3, 12, 24 and 60 months. SF-36 was used as a generic outcome measure and the Myelopathy Index, Neck Disability Score and visual analogue scores for arm, neck and hand pain, paraesthesia and dysthaesia were used as condition-specific outcome measures.

Results

Significant improvements in all outcome measures were seen in 70 % of the cohort. For SF-36, pre-operative scores were lower than age-matched controls in all domains and significant improvements were seen 3 months following surgery. This improvement in outcome was maintained at 5 years follow-up in approximately two-thirds of those with initial improvement.

Conclusion

We have used generic and condition-specific outcome measures of health and shown that in patients with CSM treated surgically, up to 70 % can expect improvement in their quality of life. These outcome measures are easy to collect and provide objective evidence of changes in quality of life and disability and can help quantify the potential health gains that can be achieved.     

The Tampa Scale of Kinesiophobia and neck pain, disability and range of motion: a narrative review of the literature

Background:

The Tampa Scale of Kinesiophobia (TSK) that was developed in 1990 is a 17 item scale originally developed to measure the fear of movement related to chronic lower back pain.

Objective:

To review the literature regarding TSK and neck pain, perceived disability and range of motion of the cervical spine.

Methods:

Medline, MANTIS, Index to Chiropractic Literature and CINAHL were searched.

Results:

A total of 16 related articles were found and divided into four categories: TSK and Neck Pain; TSK, Neck Pain and Disability; TSK, Neck Pain, Disability and Strength; and TSK, Neck Pain and Surface Electromyography.

Conclusion:

The fear avoidance model can be applied to neck pain sufferers and there is value from a psychometric perspective in using the TSK to assess kinesiophobia. Future research should investigate if, and to what extent, other measureable factors commonly associated with neck pain, such as decreased range of motion, correlate with kinesiophobia.     

Outcomes of cervical disc replacement in patients with neck pain greater than arm pain

BACKGROUND CONTEXTAlthough 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.PURPOSEPrimary: 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 DESIGNRetrospective review of prospectively collected data.PATIENT SAMPLEPatients 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 MEASURESPatient-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).METHODSChanges 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.RESULTSOne 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.CONCLUSIONSCDR 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.     

Normative score and cut-off value of the Neck Disability Index

BackgroundNeck pain is a common health problem that restricts activities of daily living. The Neck Disability Index (NDI) was developed to assess disability in patients with neck pain. The normative score and the cut-off value are mandatory to assess an individual patient or a certain patient group for clinically important neck pain with disability, by distinguishing it from nonsignificant pain. The objective of the present study was to determine the normative score and the cut-off value of the NDI.MethodsA total of 1,200 participants who registered with an internet research company were interviewed on the website about their episodes of neck pain during the previous 4 weeks, and completed the online NDI questionnaire. If the participants reported neck pain, they were also asked about the disability in activity of daily living it caused, and the presence of associated symptoms in upper limbs. Disability was defined according to the consensus study on the standardization of back pain definitions. The normative score was determined by calculating the mean in the participants, and the cut-off value was determined by the receiver-operating characteristic curve analysis.ResultsThe prevalence of neck pain was 37.8 %. Demographic data of the participants also indicated that they were representative of the normal population in Japan. The mean score was 6.98, and the median was 2. The NDI score was higher in middle age, and at its peak in the 50s age group (50–59 years of age). The female mean was significantly higher. The NDI score was higher in those with upper limb symptoms. We have determined the cut-off value of the NDI to detect neck pain associated with disability to be 15.ConclusionsThe normative score and the cut-off value of the NDI were determined. Our cut-off value is potentially useful in evaluating the therapeutic effectiveness of various interventions for neck pain.     

Impact of preoperative weakness and duration of symptoms on health-related quality-of-life outcomes following anterior cervical discectomy and fusion

BACKGROUND CONTEXTThe majority of patients with preoperative upper extremity weakness show improvements in motor function after anterior cervical discectomy and fusion (ACDF). Although numerous studies have examined both the extent and time course to which motor function can be expected to improve, few have shown that these improvements in motor function translate to improved health related quality of life (HRQOL) outcomes.PURPOSEThe purpose of this study was to examine the effect of preoperative weakness and duration of symptoms on HRQOL outcomes in patients who underwent ACDF.STUDY DESIGNRetrospective cohort study.PATIENT SAMPLEAdult patients who underwent an ACDF procedure at an academic hospital from January 2015 to December 2016 by a fellowship-trained spine surgeon.OUTCOME MEASURESThe primary outcomes of interest were HRQOL outcomes: Short Form-12 Physical/Mental Component Scores (SF-12 PCS/MCS), Neck Disability Index (NDI), and Visual Analog Scale Arm/Neck scores (VAS Arm/Neck).METHODSPatient demographics, surgical case characteristics, and motor strength exams were collected in patients who underwent ACDF over a 2-year period. Preoperative weakness was defined by a strength grade ≤3 (on a scale from 0 to 5) in at least one upper extremity muscle group. Multivariate linear regression analysis was performed to determine the effect of the preoperative weakness on HRQOL outcomes.RESULTSOf the 276 patients identified, 45 (16.3%) showed evidence of preoperative weakness, 44 (97.8%) of which showed subsequent postoperative motor improvements after ACDF. All patients reported significant improvements in all HRQOL outcome measures. Patients with preoperative weakness reported significantly worse preoperative VAS Arm (6.9 vs. 5.2; p=.01) and VAS Neck (6.1 vs. 4.8; p=.02) pain scores. Compared with patients without preoperative weakness, those with preoperative weakness reported significantly more improvement in NDI (β: −10.9; p=.001). Patients with symptoms greater than or equal to 12 months and preoperative weakness showed significantly less improvement in NDI (β: 14.8; p=.03).CONCLUSIONSPatients with preoperative weakness generally exhibited worse pain and HRQOL measures preoperatively, and showed greater potential for improvement after ACDF. Patients with a shorter duration of preoperative weakness had greater potential for improvement in HRQOL measures after ACDF compared with those with longer duration of symptoms. ACDF is an effective procedure to improve strength and HRQOL measures across all patient groups under appropriate indications.     

Prospective,multicenter clinical trial comparing M6-C compressible six degrees of freedom cervical disc with anterior cervical discectomy and fusion for the treatment of single-level degenerative cervical radiculopathy: 2-year results of an FDA investigational device exemption study

BACKGROUND CONTEXTVarious designs of total disc replacement (TDR) devices have been compared to anterior cervical discectomy and fusion (ACDF) with favorable outcomes in FDA-approved investigational device exemption trials. The design of M6-C with a compressible viscoelastic nuclear core and an annular structure is substantially different than prior designs and has previously demonstrated favorable kinematics and clinical outcomes in small case series.PURPOSETo evaluate the safety and effectiveness of the novel M6-C compressible artificial cervical disc compared with ACDF for subjects with single-level degenerative cervical radiculopathy.STUDY DESIGN/SETTINGProspective, multicenter, concurrently and historically controlled, FDA-approved investigational device exemption clinical trial.PATIENT SAMPLESubjects with one-level symptomatic degenerative cervical radiculopathy were enrolled and assigned to receive M6-C or ACDF.OUTCOME MEASURESPain and function (Neck Disability Index, VAS), quality of life (SF-36), safety, neurologic, and radiographic assessments of motion (both flexion extension and lateral bending) were performed. The primary clinical endpoint was composite clinical success (CCS) at 24 months.METHODSUsing propensity score subclassification to control for selection bias, 160 M6-C subjects were compared to a matched subset of 189 ACDF controls (46 concurrent and 143 historical controls).RESULTSBoth ACDF and M6-C subjects reported significant improvements in patient-reported outcomes at all time points over baseline. Overall SF-36 Physical Component Score and neck and arm pain scores were significantly improved for M6-C as compared to ACDF treatment. CCS and mean Neck Disability Index improvements were similar between M6-C and ACDF. Correspondingly, there were significantly fewer subjects that utilized pain medication or opioids following M6-C treatment at 24 months relative to baseline. Range of motion was maintained in subjects treated with M6-C. Subsequent surgical interventions, dysphagia rates, and serious adverse events were comparable between groups.CONCLUSIONSM6-C treatment demonstrated both safety and effectiveness for the treatment of degenerative cervical radiculopathy. Treatment with M6-C demonstrated noninferiority for the primary endpoint, indicating a similar ability to achieve CCS at 24 months. However, for the secondary endpoints, M6-C subjects demonstrated significantly improved pain and function compared to ACDF subjects, while maintaining range of motion, improving quality of life, and decreasing analgesic and opioid usage at 2 years postoperatively relative to baseline.     

Adaptation of Organ Donation Attitude Survey: Reliability and Validity Maintained as Demonstrated in a Turkish Population

BackgroundInadequate organ donation has become a major public health concern for society, particularly for patients with chronic organ failure. This study aims to regulate the validity and reliability of the Organ Donation Attitude Survey scale in the Turkish population, which was developed by Rumsey et al in 2003.MethodsThe study was conducted on 1088 students studying at the faculty of nursing and vocational school of health services. Data were analyzed using SPSS 26.0 and AMOS 24.0. After language adaptation, Exploratory Factor Analysis and Confirmatory Factor Analysis were made. The Composite Reliability and Cronbach α (CA) values were used to evaluate the reliability and structure reliability of the scales used in the study.ResultsThe mean age of the participants was 20.34 ± 1.48 years. Of the participants, 764 (70.2%) were female, and 324 (29.8%) were male. The Composite Reliability coefficients for Supporting Organ Donation, Positive Belief for Organ Donation, and all of the Organ Donation Attitude Survey scale were 0.916, 0.755, and 0.932, respectively. The Cronbach α coefficients were 0.913, 0.750, and 0.906, respectively. Analyses results revealed that the Turkish version of the scale had 2 subdimensions (Supporting Organ Donation and Positive Belief for Organ Donation) and 14 items (χ²/df = 3.111, Goodness of Fit Index= 0.985, Adjustment Goodness of Fit Index = 0.980, Normed Fit Index = 0.979, Relative Fit Index = 0.975).ConclusionsFit indices and reliability coefficients were acceptable. In conclusion, the Turkish version of the Organ Donation Attitude Survey is valid and reliable and can be used in future studies.     

Sensibilité au changement de trois questionnaires d’évaluation des cervicalgies

Objective. – To assess the sensitivity to change of three algo-functional scales for neck pain.Methods. – Observational, prospective study. Patients with neck disorders were included. Pain and patients’ perceived handicap were assessed on visual analog scales (VAS Pain, VAS Handicap), and functional disability measures (Neck Disability Index, Neck Pain and Disability Scale, Northwick Park Neck Pain Questionnaire) were recorded twice, at baseline and at an 11-months follow-up assessment. Sensitivity to change was assessed using the effect size (ES) and the standardised response mean (SRM), and the non parametric Spearman rank correlation coefficient (r) was used to assess the correlation between quantitative variable changes and patients’ overall opinion. Analysis of variance (ANOVA) followed by a Tukey test were performed to determine if the scales distinguished improved, stable, and deteriorated patients.Results. – Seventy-one patients (43 women, mean age 49 years) were included and evaluated twice at an interval of 11 ± 2 months. The three scales showed good sensitivity to change. The ANOVA showed a group effect, and individual changes in the scales scores were statistically different in two-by-two comparisons (improved, stable or deteriorated patients). Changes in NPDS scores had the highest correlation with patient’s overall assessment (r = 0.592).Conclusion. – The three scales can detect changes in patients with neck disorders. Changes in NPDS score had the best correlation with patients’ overall opinion concerning their neck disorder and this questionnaire should be given preference in clinical trials.     

Workers compensation patients experiencing depression report meaningful improvement in mental health scores after anterior cervical discectomy and fusion

BackgroundMental health has been demonstrated to affect postoperative outcomes. No prior literature has reported the relationship between preoperative mental health on outcomes following anterior cervical discectomy and fusion (ACDF) in the Workers Compensation (WC) population.MethodsWC claimants who underwent primary ACDF were identified from a single-surgeon retrospective database. Patients were separated by SF-12 MCS score into Depressed (<45.6) or Not Depressed (ND) (≥45.6) cohorts. Patient-reported Outcome Measurement Information System Physical Function (PROMIS PF), SF-12 Physical Component Score (SF-12 PCS), SF-12 MCS, visual analog scale (VAS) neck/arm pain, and Neck Disability Index (NDI) were collected and compared within and between groups. Minimum clinically important difference (MCID) achievement rates were compared between groups.ResultsDepressed patients had greater length of stay (p = 0.007) and postoperative narcotic consumption (p = 0.026). Depressed patients improved at 12-week to 2-year PROMIS PF, 6-month SF-12 PCS, 6-week to 6-month SF-12 MCS, 6-week to 6-month and 2-year VAS neck, all VAS arm, and 6-month NDI (p ≤ 0.045, all). ND patients improved at 12-week to 1-year PROMIS PF, 6-month to 2-year SF-12 PCS, 12-week to 1-year VAS neck, 6-week to 1-year VAS arm, and 12-week to 1-year NDI (p ≤ 0.044, all). Between groups, ND patients reported superior PROMIS PF, SF-12 MCS, VAS neck, VAS arm, and NDI scores at two or more periods (p ≤ 0.045, all). MCID achievement rate regarding SF-12 MCS was greater in the Depressed cohort at all postoperative points up to 1 year (p ≤ 0.020, all).ConclusionDepressed patients tended to have a greater length of stay and postoperative narcotic consumption immediately after surgery. Not depressed patients reported more favorable physical and mental function, pain, and disability scores preoperatively and postoperatively. Depressed patients reported greater MCID achievement in mental function following surgery. Depressed patients with WC have a greater likelihood of reporting tangible improvement in mental health scores following ACDF.     

Microwave diathermy for treating nonspecific chronic neck pain: a randomized controlled trial

Background contextAlthough the use of deep heat therapy is widespread, there is scant literature available on its effectiveness in treating back or neck pain.PurposeThe purpose of this study was to determine the efficacy of microwave diathermy to treat nonspecific chronic neck pain.DesignThe study was designed as a double-blind, randomized controlled trial.Patient sampleThe patient sample consisted of 149 patients with nonspecific chronic neck pain in a hospital of the Andalusian Public Health Care System, SpainOutcome measuresThe study outcome measures are as follows: at baseline, pain intensity (using a visual analogue scale), disability (Neck Disability Index), and health-related quality of life (36-item short form health survey [SF-36]); at 3 weeks, baseline measures and patients' perceived overall outcome and satisfaction with the treatment; and at 6 months, 3–week measures, therapeutic co-interventions, and adherence to exercises.MethodsPatients were allocated randomly to three groups. The first group received continuous microwave diathermy, the second group was administered pulsed microwaves, and the third group (the control group) received unplugged microwaves. All three groups received the same general treatment: range of motion, isometric exercises, and transcutaneous electrical nerve stimulation.ResultsThe three groups had reduced pain and disability, and improvement was seen in some dimensions of the SF-36. However, there were no differences found in any of the parameters measured among the three therapeutic groups.ConclusionsMicrowave diathermy does not provide additional benefit to a treatment regimen of chronic neck pain that already involves other treatment approaches.     

Is “fear of passive movement” a distinctive component of the Fear-Avoidance Model in whiplash?

Objectives:Modify the Tampa Scale for Kinesiophobia (TSK) for ‘fear of passive motion’ beliefs.Methods:With permission, a 14-item modification, the TSK-PM (passive movement), was created. Test-retest reliability was tested first. Construct validity was tested in chronic whiplash patients by comparing the TSK-PM with the TSK, the Neck Disability Index (NDI) and cervical ranges of motion.Results:The TSK-PM showed high test-retest reliability (r = 0.83) and high correlation with the original TSK (r = 0.84). Low, non-significant correlations were found with other variables. NDI scores were strongly correlated with ranges of motion.Conclusions:While having high test-retest reliability and a single factor structure, the TSK-PM failed to demonstrate distinctive construct validity vs the original TSK. The original TSK is likely to be sufficient to assess fear of being moved in neck pain patients in a clinical setting. Modifications to the current version of the TSK-PM might improve its construct validity in future studies.     

Responsiveness of the Neck Disability Index in patients with mechanical neck disorders

PurposeReport the test-retest reliability, construct validity, minimum clinically important difference (MCID), and minimal detectable change (MDC) for the Neck Disability Index (NDI).Study design/settingCohort study of patients presenting to outpatient physical therapy clinics.Patient sampleNinety-one subjects with a primary complaint of neck pain, with or without concomitant upper extremity (UE) symptoms, who were participants in a randomized clinical trial.Outcome MeasuresNDI and the 15-point Global Rating of Change (GRC) self-report measures.MethodsAll subjects completed the NDI at baseline and at a 3-week follow-up. Additionally, subjects completed the GRC scale, which was used to dichotomize patients into improved or stable groups. Changes in the NDI were used to assess test-retest reliability, construct validity, MCID, and MDC.ResultsTest-retest reliability was moderate for the NDI (intraclass correlation coefficient, 0.64; 95% confidence interval, 0.19–0.84). For the NDI, the MCID was 7.5 points and the MDC was 10.2 points.ConclusionsThe NDI appears to demonstrate adequate responsiveness based on statistical reference criteria when used in a sample that approximates the high percentage of patients with neck pain and concomitant UE referred symptoms. Because the MCID is within the bounds of measurement error, a 10-point change (the MDC) should be used as the MCID.     

How do C2 tilt and C2 slope correlate with patient reported outcomes in patients after anterior cervical discectomy and fusion?

BACKGROUND/CONTEXTC2 tilt and C2 slope are quick and easy measurements to obtain on lateral radiographs and may be used to determine overall cervical sagittal alignment; however, the influence of these measurements on patient outcomes has not been well established in literature.PURPOSETo determine if C2 tilt and/or C2 slope predict patient outcomes better compared with conventional radiographic measures after an anterior cervical discectomy and fusion (ACDF).STUDY DESIGN/SETTINGRetrospective cohort study.PATIENT SAMPLEA total of 249 patients who underwent 1 to 3 level ACDF to address radiculopathy and/or myelopathy at a single academic institution between 2011 and 2015 were identified. Patients with less than 1 year of follow-up were excluded.OUTCOME MEASURESPatient Reported Outcomes: Neck Disability Index (NDI), Physical Component Score-12 (PCS-12), and Mental Component Score (MCS-12), Visual Analog Score (VAS) Neck and Arm scoresCervical radiographic measurements: C2 tilt, C2 slope, C2–C7 lordosis, cervical SVA, T1 slope, T1 slope minus cervical lordosis (TS-CL), and C2–C7 ROMMETHODSPearson correlation tests were performed to assess for significant associations between radiographic measurements and patient outcomes. Multiple linear regression models were developed adjusting for demographics and radiographic parameters to determine which factors were predictive of patient outcomes.RESULTSC2 tilt and TS-CL correlated with all postoperative physical outcome scores (NDI, PCS-12, VAS Neck and ARM; p<.05), however no association was seen between C2 slope and postoperative outcomes. After accounting for the presence of subaxial deformity, C2 tilt and TS-CL remained strongly correlated to patient outcome scores. With multiple linear regression, C2 tilt was a significant predictor for NDI, whereas TS-CL was a significant predictor for PCS-12, VAS Neck and VAS Arm.CONCLUSIONSC2 tilt significantly correlated with well-described conventional cervical parameters as well as postoperative physical outcomes measures, especially NDI, on multivariate analysis. C2 tilt may provide an easy and practical tool for predicting physical outcomes after ACDF.     

The association between neck pain, the Neck Disability Index and cervical ranges of motion: a narrative review

Background:

The Neck Disability Index (NDI) and Cervical Ranges of Motion (CROM) are measurement tools that are used for neck pain patients.

Objective:

To review the literature to determine how the NDI is associated with neck pain and CROM outcomes.

Methods:

Computer based searches of 5 databases were performed and supplemented by internet and hand searching of article references and “related citations.”

Results:

The search yielded 23 studies that met the inclusion and exclusion criteria and these were summarized into four categories: NDI, NDI and other questionnaires, whiplash and NDI and cervical range of motion and NDI. The NDI was shown to be a well validated and reliable self-reported questionnaire, especially when compared to other questionnaires, in both neck pain and whiplash (WAD) patients. There are very few studies that discuss the NDI and cervical range of motion.

Conclusion:

This review outlines the strength of the NDI as a self-reported neck disability questionnaire, but also demonstrates a need for further research to explore the association between the NDI, neck pain and cervical ranges of motion.