Validity of a measure of the frequency of headaches with overt neck involvement, and reliability of measurement of cervical spine anthropometric and muscle performance factors

OBJECTIVE: To test the validity of a questionnaire to measure frequency of headaches related to the neck. A secondary goal was to test the reliability of field measurement of associated cervical spine anthropometric and muscle performance factors. DESIGN: Intermethod and test-retest comparisons. SETTING: Two municipalities in a rural area of Tasmania, Australia. PARTICIPANTS: One hundred subjects were selected as a representative sample of never-injured adults from a comprehensive listing of the source population, and 93 participated. MAIN OUTCOME MEASURES: Subjects distinguished headaches matching three criteria for overt neck involvement, reported past-month frequency by questionnaire, and recorded in a diary occurrences during the next month. Measurements of height, weight, neck column length and circumference, lateral flexion and extension range of movement, cervical short flexor muscle endurance, and cervical long flexor and extensor strength were taken at the start and end of the month. RESULTS: Headache frequency was associated with neck stiffness and neck ache. There was moderate agreement (weighted K = .66) between questionnaire and diary, but better agreement (K = .72) for subjects who maintained their usual patterns of recreational sport. For this group, the correlation with "true" frequency was r(u) = .87. The anthropometric and muscle performance factors were reliably measured (intraclass correlations .96 to 1.00, kappa .78 to .86) despite minor improvement in muscle performance on retest. CONCLUSIONS: The questionnaire measure has construct validity. Neck-related headaches are a temporally stable presentation in never-injured subjects who maintain customary sporting activity. Measurement error was consequential, but less so for this group than for the study subjects generally. The anthropometric and muscle performance measurements were reliable, but slight improvements on retest suggest the need for multiple measurements.     

Clinical factors associated with unexpected critical care management and prolonged hospitalization after elective cervical spine surgery

OBJECTIVES: To determine preoperative and operative factors associated with the need for unanticipated critical care management and prolonged hospitalization after cervical spine surgery. DESIGN: Retrospective, case controlled study with data collection over 5 yrs. SETTING: Intensive care unit at a Veterans Affairs hospital. PATIENTS: A total of 109 patients who underwent elective cervical decompression for degenerative disease. INTERVENTIONS: Anterior or posterior cervical spine surgery. MEASUREMENTS AND MAIN RESULTS: Data were recorded with regard to pre- and postoperative neurologic function, extent of surgery, length and cost of hospitalization and critical care, and preoperative co-morbidities. Of 109 patients, 16 (15%) required critical care management in the early postoperative phase (group I). The remainder (n = 93) represented group II. Group I had an average hospital stay of 18.5 days as compared with 6.1 days for group II (p <.001) and a cost difference of approximately $26,000. The incidence of preexisting myelopathy (69%) and the extent of decompression (2.38 levels) were greater in group I than group II (27%, p <.005; 1.67 levels, p <.01). The presence of pulmonary disease (p <.03), hypertension (p <.02), cardiovascular disease (p <.05), and diabetes mellitus (p <.002) all were associated with the need for critical care management and longer hospitalization. CONCLUSIONS: In those patients undergoing decompressive cervical surgery for degenerative disease, the following factors were linked to the need for unanticipated, postoperative critical care and longer hospitalization: multilevel decompression, preexisting myelopathy, pulmonary disease, cardiovascular disease, hypertension, and diabetes mellitus.     

Frequency,associated factors,and associated outcomes of dysphagia following sepsis

BackgroundIdentifying dysphagia as a potential complication of sepsis may improve swallowing function and survival while decreasing hospital length of stay.ObjectivesOur goal was to determine the frequency of dysphagia in sepsis survivors on the 7th day after admission, as well as their associated factors and outcomes.MethodsThis single-centre, retrospective, observational study analysed data from sepsis survivors admitted to Okayama Saiseikai General Hospital from 2018 to 2019. Participants with sepsis were assigned to one of two study groups based on the presence or absence of dysphagia using the criterion of Functional Oral Intake Scale score <5 on the 7th day after admission. We used multivariate logistic regression to determine factors independently associated with dysphagia on the 7th day after admission. Multivariate logistic regression was also used to determine associations between groups and outcomes, including dysphagia on hospital discharge, direct discharge home (discharge of patients directly to their home), and total dependency (Barthel Index score ≤20) on hospital discharge.ResultsOne hundred one patients met the study inclusion criteria, 55 with dysphagia and 46 without dysphagia. Fasting period (adjusted odds ratio [AOR]: 1.31, 95% confidence interval [CI]: 1.07–1.59) and enteral tube feeding (AOR: 8.56, 95% CI: 1.95–37.5) were independently associated with the presence of dysphagia on the 7th day after admission. Dysphagia on the 7th day after admission was associated with dysphagia on hospital discharge (AOR: 46.0, 95%, CI: 7.90–268.3), a lower chance of direct discharge home (AOR: 0.03, 95% CI: 0.01–0.15), and a higher incidence of total dependency (AOR: 9.30, 95% CI: 2.68–32.2).ConclusionsWe found that dysphagia was commonly encountered post sepsis. Fasting period and enteral tube feeding were independently associated with dysphagia on the 7th day after admission. Dysphagia on the 7th day after admission was also associated with dysphagia on hospital discharge, nondirect discharge home, and dependency in activities of daily living at the time of hospital discharge.     

Fibrosarcoma of the cervical spine.

The clinical and radiographic presentation of fibrosarcoma of the third cervical segment is presented. Conventional radiographic examination and advanced imaging in this case revealed destruction of the C3 vertebral body and neural arch with extension into the spinal canal and paravertebral soft tissues. Surgical pathology revealed a pre- and postoperative diagnosis of fibrosarcoma.     

Multiple muscle force simulation in axial rotation of the cervical spine

OBJECTIVE: To produce axial rotation of the cervical spine in vitro by coordinated application of eight simulated muscle forces. DESIGN: Biomechanical testing of the cervical spine by controlled pneumatics. BACKGROUND: Some muscle simulation experiments have been performed in vitro in the lumbar spine but data generally are lacking for this testing mode in the cervical spine. Thus, physiological biomechanical behavior in this region remains poorly understood. METHODS: Six human donor cervical spines were loaded by a set of computer-controlled pneumatic cylinders representing pairs of trapezius, splenius and sternocleiodmastoid muscles, plus longus and splenius colli left. Muscle functions were derived from a previously-developed mathematical optimization model. Muscle forces generally were achievable within 2 N of the intended values provided by the model. RESULTS: Rotation of the head followed fairly closely that predicted by the model. The resulting force components to produce 37 degrees were dominated by axial compression of about--100 N and the resulting moments were similar in all planes at about 2 Nm. Coupled motions were larger than primary motions in some intersegmental behavior. CONCLUSIONS: Slow, physiologic axial rotation of the head may be simulated by a complex and representative series of controlled pneumatics. Controlled rotation results in a relatively high compressive force and occurs through fairly balanced and small moments. RELEVANCE: Experimental approaches in biomechanics are generally limited to one or two simplified muscle forces whose representation of in vivo loading conditions can only be presumed. Improvements in the application of pneumatic technology are a promising approach to more thoroughly duplicating the physiological loading environment.     

Prevalence of hyperplastic articular pillars in the cervical spine and relationship with cervical lordosis.

BACKGROUND: Cervical lordosis is often used as an indicator for a number of clinical conditions ranging from traumatic to degenerative. Previous research has indicated that a number of factors may change the lordosis. However, the link between hyperplastic articular pillars and cervical lordosis measurements has never been studied. OBJECTIVE: To investigate the reliability of determining articular pillar hyperplasia, to determine its prevalence, and to compare lordosis measurements between persons with and without hyperplasia of the cervical articular pillars. METHODS: Twelve normal neutral lateral cervical radiographs were chosen for the reliability study. Two chiropractors independently evaluated the articular pillars of C3 through C6 by drawing lines along the planes of the superior and inferior articular surfaces of each pillar. Each pillar was categorized as "normal" or "hyperplastic" depending on the convergence or divergence of these lines. One examiner repeated this procedure after a 1-month interval. Percent agreement and kappa statistics were calculated for interexaminer and intraexaminer agreement. Forty-eight normal neutral lateral cervical radiographs with a horizontal Chamberlain's line were evaluated for the presence or absence of pillar hyperplasia. Two measurement techniques were used to assess the cervical lordosis: the method of Jochumsen and the "angle of the cervical lordosis." The unpaired t test was used to compare the angle of cervical lordosis measurements between the two groups. The Mann-Whitney U test was used to analyze data obtained with the method of Jochumsen. The prevalence of pillarhyperplasia was calculated on 100 normal lateral cervical radiographs. RESULTS: Interexaminer and intraexaminer reliability of determining pillar hyperplasia was fair to substantial (kappa = 0.4 to 0.61; 75% to 92%). Forty-six percent of the patients demonstrated pillar hyperplasia of at least one cervical level. Patients with pillar hyperplasia had a mean cervical curve of 31.52 degrees, whereas the curve in patients without pillar hyperplasia was 44.76 degrees (P = .0001). The method of Jochumsen also detected a significant difference in the curve measurements between the two patient groups (P = .0127). CONCLUSION: Articular pillar hyperplasia is common and significantly reduces the cervical lordosis measurements. Accepted normal values for lordosis evaluation need to be reassessed and articular pillar configuration considered when treatment plans include attempts to restore a "normal" cervical lordosis. Previous studies attempting to link lordosis measurements with pathologic conditions or symptoms may need to be reevaluated.     

Use of cervical spine manipulation under anesthesia for management of cervical disk herniation, cervical radiculopathy, and associated cervicogenic headache syndrome

OBJECTIVE: To demonstrate the benefits of cervical spine manipulation with the patient under anesthesia as an approach to treating a patient with chronic cervical disk herniation, associated cervical radiculopathy, and cervicogenic headache syndrome. CLINICAL FEATURES: The patient had neck pain with radiating paresthesia into the right upper extremity and incapacitating headaches and had no response to 6 months of conservative therapy. Treatment included spinal manipulative therapy, physical therapy, anti-inflammatory medication, and acupuncture. Magnetic resonance imaging, electromyography, and somatosensory evoked potential examination all revealed positive diagnostic findings. INTERVENTION AND OUTCOME: Treatment included 3 successive days of cervical spine manipulation with the patient under anesthesia. The patient had immediate relief after the first procedure. Her neck and arm pain were reported to be 50% better after the first trial, and her headaches were better by 80% after the third trial. Four months after the last procedure the patient reported a 95% improvement in her overall condition. CONCLUSION: Cervical spine manipulation with the patient under anesthesia has a place in the chiropractic arena. It is a useful tool for treating chronic discopathic disease complicated by cervical radiculopathy and cervicogenic headache syndrome. The beneficial results of this procedure are contingent on careful patient selection and proper training of qualified chiropractic physicians.     

Age-dependent relationships among pain, depressive symptoms, and functional disability in youth with recurrent headaches

OBJECTIVE: To assess age differences associated with depressive symptoms and functional disability in children and adolescents with recurrent headache. BACKGROUND: Research has indicated that psychological factors, especially depression, are related to the extent and nature of functional disability experienced from headaches. There is a lack of research examining how age impacts the relationship between pain, psychological factors, and activity restriction in children and adolescents with recurrent headache. METHODS: Seventy-seven participants from a pediatric neurology clinic completed self-report measures of pain intensity, depressive symptoms, and functional disability. RESULTS: Findings demonstrated a significant positive correlation between pain and functional disability, and depressive symptoms and functional disability for children. Correlations for adolescents failed to reach significance. Functional disability emerged as a mediator between headache pain and depressive symptoms for children but not for adolescents. CONCLUSIONS: Results indicate potentially important age differences when examining the impact of functional disability on depressive symptoms in this sample. Findings suggest that functional disability may contribute to depressive symptoms differently for children versus adolescents with recurrent headache. Age-specific interventions that differentially focus on the specific roles that pain, depressive symptoms, and disability have for children and adolescents with recurrent headache may be warranted.     

A subject-specific biomechanical control model for the prediction of cervical spine muscle forces

BackgroundThe aim of the present study is to propose a subject-specific biomechanical control model for the estimation of active cervical spine muscle forces.MethodsThe proprioception-based regulation model developed by Pomero et al. (2004) for the lumbar spine was adapted to the cervical spine. The model assumption is that the control strategy drives muscular activation to maintain the spinal joint load below the physiological threshold, thus avoiding excessive intervertebral displacements. Model evaluation was based on the comparison with the results of two reference studies. The effect of the uncertainty on the main model input parameters on the predicted force pattern was assessed. The feasibility of building this subject-specific model was illustrated with a case study of one subject.FindingsThe model muscle force predictions, although independent from EMG recordings, were consistent with the available literature, with mean differences of 20%. Spinal loads generally remained below the physiological thresholds. Moreover, the model behavior was found robust against the uncertainty on the muscle orientation, with a maximum coefficient of variation (CV) of 10%.InterpretationAfter full validation, this model should offer a relevant and efficient tool for the biomechanical and clinical study of the cervical spine, which might improve the understanding of cervical spine disorders.     

Cervicocephalic kinesthetic sensibility in patients with chronic, nontraumatic cervical spine pain.

OBJECTIVE: To investigate cervicocephalic kinesthetic sensibility (head repositioning accuracy to subjective straight ahead) in patients with chronic, nontraumatic cervical spine pain. DESIGN: A prospective, 2-group, observational design. SETTING: An outpatient chiropractic clinic in the United Kingdom. PARTICIPANTS: Eleven patients (6 men, 5 women; mean age +/- standard deviation, 41.1 +/- 13.3 yr; range, 18-55 yr) with chronic, nontraumatic cervical spine pain (mean duration, 24 +/- 18 mo), with no evidence of cervical radiculopathy and/or myelopathy or any other neurologic disorder. Eleven asymptomatic, unimpaired volunteers (5 men, 6 women; mean age, 39.3 +/- 10.3 yr; range, 28-54 yr) with no history of whiplash or other cervical spine injury or pain served as controls. MAIN OUTCOME MEASURES: Cervicocephalic kinesthetic sensibility was investigated by testing the ability of blindfolded participants to relocate accurately the head on the trunk, to a subjective straight-ahead position, after a near-maximal active movement of the head in the horizontal or vertical plane. The active cervical range of motion and the duration and intensity of neck pain were also recorded. RESULTS: Mann-Whitney U testing indicated that the patient (P) group was no less accurate in head repositioning than the control (C) group for all movement directions except flexion (median global positioning error [95% confidence interval], P = 5.7 degrees [5.03-9.10], C = 4.2 degrees [3.17-5.32]; p <.05). CONCLUSIONS: Nontraumatic neck pain patients show little evidence of impaired cervicocephalic kinesthetic sensibility. These results contrast with studies of chronic cervical pain patients in which the origin was not controlled or involved a cervical whiplash injury.     

Personal influencing factors associated with pap smear testing and cervical cancer

Pap smear is a screening test that detects abnormal cells before they advance to cancer. Unfortunately, not all women obtain routine screening. The method used was a qualitative study exploring personal influences regarding Pap smears. Face-to-face interviews with 7 low-income African American women who do and do not obtain Pap smears (between 21 and 37 years of age) were conducted at a health department about their social influence, previous health care experience, and cognitive appraisal regarding Pap smears and cervical cancer. Women were found to be socially influenced by their family and their physician. Previous health care experience with the Pap and pelvic was perceived as negative. Cognitively, Pap smears were believed to test for sexually transmitted diseases, including HIV, and the women also felt that if one took good care of oneself it reduced the risk for cervical cancer. It was concluded that exploring beliefs associated with Pap smears and perceptions of vulnerability to cervical cancer and giving correct information and counseling may increase Pap smear screening in women.     

Experiences with the internal fixation of the cervical spine

During the period 1994-1999, 141 surgeries were performed cervical vertebra in the Department of Neurosurgery at the Copernicus Hospital in ?ód?; 62 of these were posttraumatic injuries. In cases of injury to the C1-C2 complex, anterior or posterior fixation was applied, ora a combination of both. In injuries involving the segment from C3 to Th1, fixation was done with the anterior approach, using autogenic or allogenic implants. We present here the treatment outcome for posttraumatic injuries treated surgically with the use of implants.     

Unsuspected upper cervical spine fractures associated with significant head trauma: role of CT

Several recent studies report the sensitivity of computed tomography (CT) to be far greater than that of traditional plain film radiographic studies for evaluation of cervical spine fractures and spinal cord pathology. Nevertheless, plain films continue to be the standard screening examination. CT is used only if fractures are demonstrated or suspected on plain film survey. Recently, three patients with significant head and neck trauma (all three patients had intracranial hemorrhage) had cervical spine evaluation by computed tomography and standard plain film views. CT demonstrated significant C1-C2 fractures, while plain films were completely normal in all three cases. Prospectively studying the next 50 patients with significant head trauma, we added a few more slices to the routine head scan protocol to cover the first three cervical vertebrae. This added very little time or cost to the procedure. The additional CT images demonstrated four upper cervical fractures that could not be seen on plain films, even in retrospect. Our findings suggest that routine inclusion of the upper cervical spine with head CT is appropriate in the evaluation of patients with significant head trauma as defined by intracranial hemorrhage or skull fracture.     

Self-reported sinus headaches are associated with neck pain and cervical musculoskeletal dysfunction: a preliminary observational case control study

Objectives: Headaches can be associated with rhinosinusitis and may present a diagnostic challenge because of symptomatic overlap with other recurring headaches. Neck pain has received extensive attention in migraine, tension-type and cervicogenic headache but not as a comorbid feature of headache in those with rhinosinusitis. This study investigated the occurrence of neck pain and cervical musculoskeletal dysfunction in individuals with self-reported sinus headaches (SRSH).

Methods: Participants with and without SRSH attended a single data collection session. Participants completed the Headache Impact Test (HIT)-6 and the Sino-Nasal Outcome Test (SNOT)-22. Cervical range of motion (ROM), segmental examination, muscle endurance and pressure-pain threshold (PPT) were measured .

Results: Participants included 31 with SRSH (77.4% female; age 43.7 (9.9) years) and 30 without headache. Average symptom duration was 89.7 (±85.6) months. Mean SNOT-22 and HIT-6 scores were 36.2 (15.3) and 56.7 (7.1), respectively. In the SRSH group, 83.9% (n = 26) reported neck pain. There was a significant difference between groups for cervical sagittal (14.3° [5.3°, 23.3°], p = 0.002) and transverse plane ROM (21.5° [12.4°, 30.6°], p < 0.001), but no difference in frontal plane motion (p = 0.017). There were significant between groups difference in neck flexor endurance (19.5 s [10.1 s, 28.9 s], <0.001), segmental dysfunction O-C4 (p < 0.001) but not in PPT (p = 0.04).

Discussion: Neck pain and cervical musculoskeletal dysfunction are common among persons with SRSH and may be a comorbid feature or contributing factor to headaches attributed to rhinosinusitis. Further research is needed to understand these associations.