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Lack of endogenous pain inhibition during exercise in people with chronic whiplash associated disorders: an experimental study. Van Oosterwijck J, Nijs J, Meeus M, Van Loo M, Paul L. J Pain 2012;13(3):242–54. Epub 2012 Jan 24.
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Journal Reports / The Spine Journal 12 (2012) 451–453
Perioperative pregabalin for postoperative pain control and quality of life after major spinal surgery. Gianesello L, Pavoni V, Barboni E, Galeotti I, Nella A. J Neurosurg Anesthesiol 2012;24(2):121–6. BACKGROUND: Adequate management of postoperative pain after major spine surgery is often difficult to achieve. We investigated the efficacy of an antineuropathic pain drug, pregabalin (PG), on postoperative pain control and on improvement of quality of life (QoL). METHODS: Sixty patients scheduled for elective decompressive spine surgery were enrolled. One hour before surgery patients received 300 mg of either oral PG or placebo (PL) and 150 mg of PG or PL twice a day for 48 hours postoperatively. During the first 48 postoperative hours, a continuous infusion of morphine 0.01 mg/kg/h and ketorolac tromethamine 2.5 mg/h was administered. Intravenous morphine in 2-mg aliquots up to a maximum of 10 mg was used as rescue therapy. Pain was measured at rest and during movement using a visual analog scale (VAS score), and side effects were recorded in the first hour and at 4, 8, 12, 24, and 48 hours. Three months and 1 year after discharge, patients were contacted by telephone by 1 of the authors to obtain follow-up information using the EuroQoL questionnaire. RESULTS: During the first 8 postoperative hours, VAS scores at rest were significantly lower in the PG group than in the PL group (P!0.05), whereas VAS scores on movement were significantly lower up to 12 hours after the operation in the PG group (P!0.05). The morphine consumption in the PG group was 362 mg, whereas in the PL group it was 9.562.5 mg (P!0.05). Postoperative incidence of constipation and nausea/vomiting was higher in the PL group than in the PG group. No significant differences between the 2 groups were observed with regard to other adverse effects. QoL measures revealed an improvement in outcome, especially in movement and in pain dimensions in both groups; however, at 3 months, subjective qualification of overall QoL was better in the PG group than in the PL group. There were no differences in QoL after the 1-year follow-up period. CONCLUSIONS: Perioperative PG administration reduces early postsurgical pain at rest and particularly during movement after major spine surgery with less opioid consumption, and it seems to influence the improvement of overall QoL 3 months after surgery. PMID: 22045156 [PubMed - in process. Available at: http://www.ncbi. nlm.nih.gov/pubmed/22045156] Reprinted with permission from: Gianesello L, Pavoni V, Barboni E, Galeotti I, Nella A. Perioperative pregabalin for postoperative pain control and quality of life after major spinal surgery. J Neurosurg Anesthesiol 2012;24(2):121–6. doi: 10.1016/j.spinee.2012.05.021
The analysis of segmental mobility with different lumbar radiographs in symptomatic patients with a spondylolisthesis. Cabraja M, Mohamed E, Koeppen D, Kroppenstedt S. Eur Spine J 2012;21(2):256–61. Epub 2011 Jun 14. PURPOSE: Lumbar flexion-extension radiographs in standing position (SFE) are the most commonly used imaging method to evaluate segmental mobility. Many surgeons use SFE to disclose abnormal vertebral motion and base their decision for surgical fusion on its results. We tested the hypothesis that imaging in standing and recumbent position (SRP) reveals a higher sagittal translation (ST) and sagittal rotation (SR) in symptomatic patients than with SFE. MATERIALS AND METHODS: We analysed images of 100 symptomatic patients with a low-grade spondylolisthesis that underwent surgical fusion. To determine the ST and SR in SRP, we compared the images taken in the recumbent position in the CT with images taken in the standing position during the routine plain radiography. RESULTS: The measurement of ST revealed an absolute value of 2.361.5 mm in SFE and 4.062.0 mm in SRP and differed significantly (P50.001). The analysis of the relative value showed an ST of 5.963.9% in SFE and 7.865.4% in SRP (p50.008). The assessment of ST in flexion and in a recumbent position (FRP) revealed the highest ST
(4.662.5 mm or 9.265.7%). Comparison of SR showed the highest rotation in SFE (6.1 63.8 ), however, compared to SRP (5.4 63.3 ), it missed the level of significance (P50.051). CONCLUSIONS: For evaluation of ST in symptomatic patients with spondylolisthesis SRP appears to be more suitable than SFE, while a pathological SR is better revealed in SFE. The analysis of SRP might offer a complementary method to detect or exclude pathological mobility in more cases. PMID: 21670945 [PubMed - indexed for MEDLINE. Available at: http:// www.ncbi.nlm.nih.gov/pubmed/21670945] Reprinted with permission from: Cabraja M, Mohamed E, Koeppen D, Kroppenstedt S. The analysis of segmental mobility with different lumbar radiographs in symptomatic patients with a spondylolisthesis. Eur Spine J 2012; 21(2):256–61. Epub 2011 Jun 14. Available at: http://www.springerlink.com/ content/t7860w2072281r4x/. doi: 10.1016/j.spinee.2012.05.022
Decision-making in lumbar spinal stenosis: a survey on the influence of the morphology of the dural sac. Schizas C, Kulik G. J Bone Joint Surg Br 2012;94(1):98–101. Surgical decision-making in lumbar spinal stenosis involves assessment of clinical parameters and the severity of the radiological stenosis. We suspected that surgeons based surgical decisions more on dural sac cross-sectional area (DSCA) than on the morphology of the dural sac. We carried out a survey among members of three European spine societies. The axial T2-weighted MR images from ten patients with varying degrees of DSCA and morphological grades according to the recently described morphological classification of lumbar spinal stenosis, with DSCA values disclosed in half the assessed images, were used for evaluation. We provided a clinical scenario to accompany the images, which were shown to 142 responding physicians, mainly orthopaedic surgeons but also some neurosurgeons and others directly involved in treating patients with spinal disorders. As the primary outcome we used the number of respondents who would proceed to surgery for a given DSCA or morphological grade. Substantial agreement among the respondents was observed, with severe or extreme stenosis as defined by the morphological grade leading to surgery. This decision was not dependent on the number of years in practice, medical density or specialty. Disclosing the DSCA did not alter operative decision-making. In all, 40 respondents (29%) had prior knowledge of the morphological grading system, but their responses showed no difference from those who had not. This study suggests that the participants were less influenced by DSCA than by the morphological appearance of the dural sac. Classifying lumbar spinal stenosis according to morphology rather than surface measurements appears to be consistent with current clinical practice. PMID: 22219255 [PubMed - indexed for MEDLINE. Available at: http:// www.ncbi.nlm.nih.gov/pubmed?term522219255] Reproduced from: Schizas C, Kulik G. Decision-making in lumbar spinal stenosis: a survey on the influence of the morphology of the dural sac. J Bone Joint Surg Br. 2012;94(1):98–101, with permission and copyright of the British Editorial Society of Bone and Joint Surgery. doi: 10.1016/j.spinee.2012.05.023
Lack of endogenous pain inhibition during exercise in people with chronic whiplash associated disorders: an experimental study. Van Oosterwijck J, Nijs J, Meeus M, Van Loo M, Paul L. J Pain 2012;13(3):242–54. Epub 2012 Jan 24. A controlled experimental study was performed to examine the efficacy of the endogenous pain inhibitory systems and whether this (mal)functioning is associated with symptom increases following exercise in patients with chronic whiplash-associated disorders (WAD). In addition, 2 types of exercise were compared. Twenty-two women with chronic WAD and 22 healthy
Journal Reports / The Spine Journal 12 (2012) 451–453 controls performed a submaximal and a self-paced, physiologically limited exercise test on a cycle ergometer with cardiorespiratory monitoring on 2 separate occasions. Pain pressure thresholds (PPT), health status, and activity levels were assessed in response to the 2 exercise bouts. In chronic WAD, PPT decreased following submaximal exercise, whereas they increased in healthy subjects. The same effect was established in response to the selfpaced, physiologically limited exercise, with exception of the PPT at the calf which increased. A worsening of the chronic WAD symptom complex was reported post-exercise. Fewer symptoms were reported in response to the self-paced, physiologically limited exercise. These observations suggest abnormal central pain processing during exercise in patients with chronic WAD. Submaximal exercise triggers post-exertional malaise, while a selfpaced and physiologically limited exercise will trigger less severe symptoms, and therefore seems more appropriate for chronic WAD patients. PERSPECTIVE: The results from this exercise study suggest impaired endogenous pain inhibition during exercise in people with chronic WAD. This finding highlights the fact that one should be cautious when evaluating and recommending exercise in people with chronic WAD, and that the use of more individual, targeted exercise therapies is recommended. Copyright Ó 2012 American Pain Society. Published by Elsevier Inc. All rights reserved. PMID: 22277322 [PubMed - in process. Available at: http://www.ncbi. nlm.nih.gov/pubmed/22277322] Reprinted from: Van Oosterwijck J, Nijs J, Meeus M, Van Loo M, Paul L. Lack of endogenous pain inhibition during exercise in people with chronic whiplash associated disorders: an experimental study. J Pain 2012;13(3):242–54. Epub 2012 Jan 24, with permission from the American Pain Society. doi: 10.1016/j.spinee.2012.05.024
Early development and progression of heterotopic ossification in cervical total disc replacement. Lee SE, Chung CK, Jahng TA. J Neurosurg Spine 2012;16(1):31–6. Epub 2011 Oct 14. OBJECT: The purpose of cervical total disc replacement (TDR) is to decrease the incidence of adjacent segment disease through motion preservation. Heterotopic ossification (HO) is a well-known complication after hip and knee arthroplasties. There are few reports regarding HO in patients undergoing cervical TDR, however; and the occurrence of HO and its effects on cervical motion have rarely been reported. Moreover, temporal progression of HO has not been fully addressed. One goal of this study involved determining the incidence of HO following cervical TDR, as identified from plain radiographs, and demonstrating the progression of HO during the follow-up period. A second goal consisted of determining whether segmental motion could be preserved and identifying the relationship between HO and clinical outcomes. METHODS: The authors conducted a retrospective clinical and radiological study of 28 consecutive patients who underwent cervical TDR with Mobi-C prostheses (LDR Medical) between September 2006 and October 2008. Radiological outcomes were evaluated using lateral dynamic radiographs obtained preoperatively and at 1, 3, 6, 12, and 24 months postoperatively. The occurrence of HO was interpreted on lateral radiographs using the McAfee classification. Cervical range of motion (ROM) was also measured. The visual analog scale (VAS) and Neck Disability Index (NDI) were used to evaluate clinical outcome. RESULTS: The mean follow-up period was 21.667.0 months, and the mean occurrence of HO was at 8.066.6 months postoperatively. At the last followup, 18 (64.3%) of 28 patients had HO: Grade I, 6 patients; Grade II, 8 patients; Grade III, 3 patients; and Grade IV, 1 patient. Heterotopic ossification progression was proportional to the duration of follow-up; HO was present in 3 (10.7%) of 28 patients at 1 month; 7 (25.0%) of 28 patients at 3 months; 11 (42.3%) of 26 patients at 6 months; 15 (62.5%) of 24 patients at 12 months; and 17 (77.3%) of 22 patients at 24 months. Cervical ROM was preserved in Grades I and II HO but was restricted in Grades III and IV HO.
453
Clinical improvement according to the VAS and NDI was not significantly correlated with the occurrence of HO. CONCLUSIONS: The overall incidence of HO after cervical TDR was relatively high. Moreover, HO began unexpectedly to appear early after surgery. Heterotopic ossification progression was proportional to the time that had elapsed postoperatively. Grade III or IV HO can restrict the cervical ROM and may lead to spontaneous fusion; however, the occurrence of HO did not affect clinical outcome. The results of this study indicate that a high incidence of HO with the possibility of spontaneous fusion is to be expected during longterm follow-up and should be considered before performing cervical TDR. PMID: 21999390 [PubMed - indexed for MEDLINE: Available at: http:// www.ncbi.nlm.nih.gov/pubmed/21999390] Reprinted with permission from: Lee SE, Chung CK, Jahng TA. Early development and progression of heterotopic ossification in cervical total disc replacement. J Neurosurg Spine. 2012;16(1):31–6. Epub 2011 Oct 14. Available at: www.thejns.org. doi: 10.1016/j.spinee.2012.05.025
Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Ann Intern Med 2012;156(1 Pt 1):1–10. BACKGROUND: Mechanical neck pain is a common condition that affects an estimated 70% of persons at some point in their lives. Little research exists to guide the choice of therapy for acute and subacute neck pain. OBJECTIVE: To determine the relative efficacy of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain in both the short and long term. DESIGN: Randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00029770) SETTING: 1 university research center and 1 pain management clinic in Minnesota. PARTICIPANTS: 272 persons aged 18 to 65 years who had nonspecific neck pain for 2 to 12 weeks. INTERVENTION: 12 weeks of SMT, medication, or HEA. MEASUREMENTS: The primary outcome was participant-rated pain, measured at 2, 4, 8, 12, 26, and 52 weeks after randomization. Secondary measures were self-reported disability, global improvement, medication use, satisfaction, general health status (Short Form-36 Health Survey physical and mental health scales), and adverse events. Blinded evaluation of neck motion was performed at 4 and 12 weeks. RESULTS: For pain, SMT had a statistically significant advantage over medication after 8, 12, 26, and 52 weeks (P#0.010), and HEA was superior to medication at 26 weeks (P50.02). No important differences in pain were found between SMT and HEA at any time point. Results for most of the secondary outcomes were similar to those of the primary outcome. LIMITATIONS: Participants and providers could not be blinded. No specific criteria for defining clinically important group differences were prespecified or available from the literature. CONCLUSION: For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points. PRIMARY FUNDING SOURCE: National Center for Complementary and Alternative Medicine, National Institutes of Health. PMID: 22213489 [PubMed - indexed for MEDLINE. Available at: http:// www.ncbi.nlm.nih.gov/pubmed?term522213489] Reprinted with permission from: Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med 2012;156(1 Pt 1):1–10. doi: 10.1016/j.spinee.2012.05.026
Journal Reports / The Spine Journal 12 (2012) 451–453
Perioperative pregabalin for postoperative pain control and quality of life after major spinal surgery. Gianesello L, Pavoni V, Barboni E, Galeotti I, Nella A. J Neurosurg Anesthesiol 2012;24(2):121–6. BACKGROUND: Adequate management of postoperative pain after major spine surgery is often difficult to achieve. We investigated the efficacy of an antineuropathic pain drug, pregabalin (PG), on postoperative pain control and on improvement of quality of life (QoL). METHODS: Sixty patients scheduled for elective decompressive spine surgery were enrolled. One hour before surgery patients received 300 mg of either oral PG or placebo (PL) and 150 mg of PG or PL twice a day for 48 hours postoperatively. During the first 48 postoperative hours, a continuous infusion of morphine 0.01 mg/kg/h and ketorolac tromethamine 2.5 mg/h was administered. Intravenous morphine in 2-mg aliquots up to a maximum of 10 mg was used as rescue therapy. Pain was measured at rest and during movement using a visual analog scale (VAS score), and side effects were recorded in the first hour and at 4, 8, 12, 24, and 48 hours. Three months and 1 year after discharge, patients were contacted by telephone by 1 of the authors to obtain follow-up information using the EuroQoL questionnaire. RESULTS: During the first 8 postoperative hours, VAS scores at rest were significantly lower in the PG group than in the PL group (P!0.05), whereas VAS scores on movement were significantly lower up to 12 hours after the operation in the PG group (P!0.05). The morphine consumption in the PG group was 362 mg, whereas in the PL group it was 9.562.5 mg (P!0.05). Postoperative incidence of constipation and nausea/vomiting was higher in the PL group than in the PG group. No significant differences between the 2 groups were observed with regard to other adverse effects. QoL measures revealed an improvement in outcome, especially in movement and in pain dimensions in both groups; however, at 3 months, subjective qualification of overall QoL was better in the PG group than in the PL group. There were no differences in QoL after the 1-year follow-up period. CONCLUSIONS: Perioperative PG administration reduces early postsurgical pain at rest and particularly during movement after major spine surgery with less opioid consumption, and it seems to influence the improvement of overall QoL 3 months after surgery. PMID: 22045156 [PubMed - in process. Available at: http://www.ncbi. nlm.nih.gov/pubmed/22045156] Reprinted with permission from: Gianesello L, Pavoni V, Barboni E, Galeotti I, Nella A. Perioperative pregabalin for postoperative pain control and quality of life after major spinal surgery. J Neurosurg Anesthesiol 2012;24(2):121–6. doi: 10.1016/j.spinee.2012.05.021
The analysis of segmental mobility with different lumbar radiographs in symptomatic patients with a spondylolisthesis. Cabraja M, Mohamed E, Koeppen D, Kroppenstedt S. Eur Spine J 2012;21(2):256–61. Epub 2011 Jun 14. PURPOSE: Lumbar flexion-extension radiographs in standing position (SFE) are the most commonly used imaging method to evaluate segmental mobility. Many surgeons use SFE to disclose abnormal vertebral motion and base their decision for surgical fusion on its results. We tested the hypothesis that imaging in standing and recumbent position (SRP) reveals a higher sagittal translation (ST) and sagittal rotation (SR) in symptomatic patients than with SFE. MATERIALS AND METHODS: We analysed images of 100 symptomatic patients with a low-grade spondylolisthesis that underwent surgical fusion. To determine the ST and SR in SRP, we compared the images taken in the recumbent position in the CT with images taken in the standing position during the routine plain radiography. RESULTS: The measurement of ST revealed an absolute value of 2.361.5 mm in SFE and 4.062.0 mm in SRP and differed significantly (P50.001). The analysis of the relative value showed an ST of 5.963.9% in SFE and 7.865.4% in SRP (p50.008). The assessment of ST in flexion and in a recumbent position (FRP) revealed the highest ST
(4.662.5 mm or 9.265.7%). Comparison of SR showed the highest rotation in SFE (6.1 63.8 ), however, compared to SRP (5.4 63.3 ), it missed the level of significance (P50.051). CONCLUSIONS: For evaluation of ST in symptomatic patients with spondylolisthesis SRP appears to be more suitable than SFE, while a pathological SR is better revealed in SFE. The analysis of SRP might offer a complementary method to detect or exclude pathological mobility in more cases. PMID: 21670945 [PubMed - indexed for MEDLINE. Available at: http:// www.ncbi.nlm.nih.gov/pubmed/21670945] Reprinted with permission from: Cabraja M, Mohamed E, Koeppen D, Kroppenstedt S. The analysis of segmental mobility with different lumbar radiographs in symptomatic patients with a spondylolisthesis. Eur Spine J 2012; 21(2):256–61. Epub 2011 Jun 14. Available at: http://www.springerlink.com/ content/t7860w2072281r4x/. doi: 10.1016/j.spinee.2012.05.022
Decision-making in lumbar spinal stenosis: a survey on the influence of the morphology of the dural sac. Schizas C, Kulik G. J Bone Joint Surg Br 2012;94(1):98–101. Surgical decision-making in lumbar spinal stenosis involves assessment of clinical parameters and the severity of the radiological stenosis. We suspected that surgeons based surgical decisions more on dural sac cross-sectional area (DSCA) than on the morphology of the dural sac. We carried out a survey among members of three European spine societies. The axial T2-weighted MR images from ten patients with varying degrees of DSCA and morphological grades according to the recently described morphological classification of lumbar spinal stenosis, with DSCA values disclosed in half the assessed images, were used for evaluation. We provided a clinical scenario to accompany the images, which were shown to 142 responding physicians, mainly orthopaedic surgeons but also some neurosurgeons and others directly involved in treating patients with spinal disorders. As the primary outcome we used the number of respondents who would proceed to surgery for a given DSCA or morphological grade. Substantial agreement among the respondents was observed, with severe or extreme stenosis as defined by the morphological grade leading to surgery. This decision was not dependent on the number of years in practice, medical density or specialty. Disclosing the DSCA did not alter operative decision-making. In all, 40 respondents (29%) had prior knowledge of the morphological grading system, but their responses showed no difference from those who had not. This study suggests that the participants were less influenced by DSCA than by the morphological appearance of the dural sac. Classifying lumbar spinal stenosis according to morphology rather than surface measurements appears to be consistent with current clinical practice. PMID: 22219255 [PubMed - indexed for MEDLINE. Available at: http:// www.ncbi.nlm.nih.gov/pubmed?term522219255] Reproduced from: Schizas C, Kulik G. Decision-making in lumbar spinal stenosis: a survey on the influence of the morphology of the dural sac. J Bone Joint Surg Br. 2012;94(1):98–101, with permission and copyright of the British Editorial Society of Bone and Joint Surgery. doi: 10.1016/j.spinee.2012.05.023
Lack of endogenous pain inhibition during exercise in people with chronic whiplash associated disorders: an experimental study. Van Oosterwijck J, Nijs J, Meeus M, Van Loo M, Paul L. J Pain 2012;13(3):242–54. Epub 2012 Jan 24. A controlled experimental study was performed to examine the efficacy of the endogenous pain inhibitory systems and whether this (mal)functioning is associated with symptom increases following exercise in patients with chronic whiplash-associated disorders (WAD). In addition, 2 types of exercise were compared. Twenty-two women with chronic WAD and 22 healthy
Journal Reports / The Spine Journal 12 (2012) 451–453 controls performed a submaximal and a self-paced, physiologically limited exercise test on a cycle ergometer with cardiorespiratory monitoring on 2 separate occasions. Pain pressure thresholds (PPT), health status, and activity levels were assessed in response to the 2 exercise bouts. In chronic WAD, PPT decreased following submaximal exercise, whereas they increased in healthy subjects. The same effect was established in response to the selfpaced, physiologically limited exercise, with exception of the PPT at the calf which increased. A worsening of the chronic WAD symptom complex was reported post-exercise. Fewer symptoms were reported in response to the self-paced, physiologically limited exercise. These observations suggest abnormal central pain processing during exercise in patients with chronic WAD. Submaximal exercise triggers post-exertional malaise, while a selfpaced and physiologically limited exercise will trigger less severe symptoms, and therefore seems more appropriate for chronic WAD patients. PERSPECTIVE: The results from this exercise study suggest impaired endogenous pain inhibition during exercise in people with chronic WAD. This finding highlights the fact that one should be cautious when evaluating and recommending exercise in people with chronic WAD, and that the use of more individual, targeted exercise therapies is recommended. Copyright Ó 2012 American Pain Society. Published by Elsevier Inc. All rights reserved. PMID: 22277322 [PubMed - in process. Available at: http://www.ncbi. nlm.nih.gov/pubmed/22277322] Reprinted from: Van Oosterwijck J, Nijs J, Meeus M, Van Loo M, Paul L. Lack of endogenous pain inhibition during exercise in people with chronic whiplash associated disorders: an experimental study. J Pain 2012;13(3):242–54. Epub 2012 Jan 24, with permission from the American Pain Society. doi: 10.1016/j.spinee.2012.05.024
Early development and progression of heterotopic ossification in cervical total disc replacement. Lee SE, Chung CK, Jahng TA. J Neurosurg Spine 2012;16(1):31–6. Epub 2011 Oct 14. OBJECT: The purpose of cervical total disc replacement (TDR) is to decrease the incidence of adjacent segment disease through motion preservation. Heterotopic ossification (HO) is a well-known complication after hip and knee arthroplasties. There are few reports regarding HO in patients undergoing cervical TDR, however; and the occurrence of HO and its effects on cervical motion have rarely been reported. Moreover, temporal progression of HO has not been fully addressed. One goal of this study involved determining the incidence of HO following cervical TDR, as identified from plain radiographs, and demonstrating the progression of HO during the follow-up period. A second goal consisted of determining whether segmental motion could be preserved and identifying the relationship between HO and clinical outcomes. METHODS: The authors conducted a retrospective clinical and radiological study of 28 consecutive patients who underwent cervical TDR with Mobi-C prostheses (LDR Medical) between September 2006 and October 2008. Radiological outcomes were evaluated using lateral dynamic radiographs obtained preoperatively and at 1, 3, 6, 12, and 24 months postoperatively. The occurrence of HO was interpreted on lateral radiographs using the McAfee classification. Cervical range of motion (ROM) was also measured. The visual analog scale (VAS) and Neck Disability Index (NDI) were used to evaluate clinical outcome. RESULTS: The mean follow-up period was 21.667.0 months, and the mean occurrence of HO was at 8.066.6 months postoperatively. At the last followup, 18 (64.3%) of 28 patients had HO: Grade I, 6 patients; Grade II, 8 patients; Grade III, 3 patients; and Grade IV, 1 patient. Heterotopic ossification progression was proportional to the duration of follow-up; HO was present in 3 (10.7%) of 28 patients at 1 month; 7 (25.0%) of 28 patients at 3 months; 11 (42.3%) of 26 patients at 6 months; 15 (62.5%) of 24 patients at 12 months; and 17 (77.3%) of 22 patients at 24 months. Cervical ROM was preserved in Grades I and II HO but was restricted in Grades III and IV HO.
453
Clinical improvement according to the VAS and NDI was not significantly correlated with the occurrence of HO. CONCLUSIONS: The overall incidence of HO after cervical TDR was relatively high. Moreover, HO began unexpectedly to appear early after surgery. Heterotopic ossification progression was proportional to the time that had elapsed postoperatively. Grade III or IV HO can restrict the cervical ROM and may lead to spontaneous fusion; however, the occurrence of HO did not affect clinical outcome. The results of this study indicate that a high incidence of HO with the possibility of spontaneous fusion is to be expected during longterm follow-up and should be considered before performing cervical TDR. PMID: 21999390 [PubMed - indexed for MEDLINE: Available at: http:// www.ncbi.nlm.nih.gov/pubmed/21999390] Reprinted with permission from: Lee SE, Chung CK, Jahng TA. Early development and progression of heterotopic ossification in cervical total disc replacement. J Neurosurg Spine. 2012;16(1):31–6. Epub 2011 Oct 14. Available at: www.thejns.org. doi: 10.1016/j.spinee.2012.05.025
Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Ann Intern Med 2012;156(1 Pt 1):1–10. BACKGROUND: Mechanical neck pain is a common condition that affects an estimated 70% of persons at some point in their lives. Little research exists to guide the choice of therapy for acute and subacute neck pain. OBJECTIVE: To determine the relative efficacy of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain in both the short and long term. DESIGN: Randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00029770) SETTING: 1 university research center and 1 pain management clinic in Minnesota. PARTICIPANTS: 272 persons aged 18 to 65 years who had nonspecific neck pain for 2 to 12 weeks. INTERVENTION: 12 weeks of SMT, medication, or HEA. MEASUREMENTS: The primary outcome was participant-rated pain, measured at 2, 4, 8, 12, 26, and 52 weeks after randomization. Secondary measures were self-reported disability, global improvement, medication use, satisfaction, general health status (Short Form-36 Health Survey physical and mental health scales), and adverse events. Blinded evaluation of neck motion was performed at 4 and 12 weeks. RESULTS: For pain, SMT had a statistically significant advantage over medication after 8, 12, 26, and 52 weeks (P#0.010), and HEA was superior to medication at 26 weeks (P50.02). No important differences in pain were found between SMT and HEA at any time point. Results for most of the secondary outcomes were similar to those of the primary outcome. LIMITATIONS: Participants and providers could not be blinded. No specific criteria for defining clinically important group differences were prespecified or available from the literature. CONCLUSION: For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points. PRIMARY FUNDING SOURCE: National Center for Complementary and Alternative Medicine, National Institutes of Health. PMID: 22213489 [PubMed - indexed for MEDLINE. Available at: http:// www.ncbi.nlm.nih.gov/pubmed?term522213489] Reprinted with permission from: Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med 2012;156(1 Pt 1):1–10. doi: 10.1016/j.spinee.2012.05.026