Neck muscle activity during loaded arm lifts 2 Practice of applications• Evaluating potential impairments in individuals with persistent disorders following cervical surgery will permit a more structured approach to rehabilitative exercise for this understudied group.• Greater muscle mechanical activity levels were observed in the ventral muscles and dorsal multifidus muscle of patients with persistent symptoms following anterior cervical decompression and fusion.• The differences may indicate an altered motor strategy in this group when performing the upper limb task.• The altered motor strategy need to be considered when prescribing exercise for their rehabilitation.Neck muscle activity during loaded arm lifts 3 ABSTRACT Objective: To compare the mechanical activity of the neck muscles during loaded arm lifting tasks in individuals with longstanding disability after anterior cervical decompression and fusion (ACDF) to that of healthy controls.Methods: Ten individuals (mean age 60 years; SD 7.1) who underwent ACDF (10-13 years previously) for cervical disc disease and 10 healthy age-and gender-matched controls participated in the study. Ultrasonography were used to investigate the degree of deformation and deformation rate of ventral and dorsal neck muscles at the C4-segmental level during a single (1 x arm flexion to 120°) and repeated (10 x arm flexion to 90°) loaded arm elevation condition. Results:The ACDF group demonstrated greater deformation and deformation rate of the longus capitis (p=0.02) as well as deformation rate of the sternocleidomastoid (p=0.04) during the 120° arm lift. For repeated 90° arm lift, there was a significant effect of group with higher deformation rate values observed in the longus capitis (p=0.005-0.01) and multifidus (p=0.03) muscles in the ACDF group. Muscle behavior did not change the repeated arm lifts (no group x time interactions) for either the ventral or dorsal muscles. Conclusions:Greater muscle mechanical activity levels were observed in the ventral muscles as well as the multifidus muscle, of patients with persistent symptoms following ACDF.These differences may be indicative of an altered motor strategy in this patient group when performing the upper limb task and may need to be considered when prescribing exercise for their rehabilitation.

No abstract

We evaluated by in situ nick end labeling the presence of apoptotic glial cells in the spinal cord of rats which have sustained a moderate and severe compression injury at the level of T8-9, resulting in a severe but reversible paraparesis and irreversible paraplegia, respectively. In a previous investigation we found apoptotic glial cells (oligodendrocytes) in the immediate vicinity of the primary lesion (T7 and T10). The present study was designed to evaluate the extent of such cells in the spinal cord even at long distances away from the primary injury. Rats sustaining a moderate and severe compression injury and surviving 4 and 9 days showed a significant increase in the number of apoptotic glial cells at the T1, T5, T7, T12 and L2 levels. At the T10 level the elevation was significant only after day 9. There was no significant increase in the number of these cells at 4 h and 1 day after moderate and severe compression. In general, the apoptotic cells were most often seen in segments adjacent to the compression. They were randomly located in the ventral, lateral and dorsal tracts but were rarely present in the gray matter of the cord. In conclusion, compression trauma to rat spinal cord induces signs of apoptosis in glial cells, presumably oligodendrocytes of the long tracts. This newly discovered type of secondary injury is widely distributed in the damaged spinal cord and occurs even at long distances remote from the initial compression injury. Apoptotic cell death of oligodendrocytes will induce myelin degeneration and cause additional disturbances of axonal function. This cell damage may be a target for future therapy since it occurs after a delay and chemical compounds are now available by which apoptotic cell death can be modified.

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.

Study DesignProspective randomized controlled trial. ObjectiveTo study the outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program compared to the same physiotherapy program alone for patients with cervical radiculopathy. Summary of Background DataKnowledge concerning the effects of interventions for patients with cervical radiculopathy is scarce due to a lack of randomized studies. Methods63 patients were randomized to surgery with postoperative physiotherapy (n=31) or physiotherapy alone (n=32). The surgical group was treated with ACDF. The physiotherapy program included general/specific exercises and pain coping strategies. The outcome measures were disability (Neck Disability Index, NDI), neck-and arm-pain intensity (VAS) and the patient's global assessment. Patients were followed for 24 months. ResultsThe result from the repeated-measures ANOVA showed no significant between group difference for NDI (p=0.23).For neck-pain intensity, the repeated-measures ANOVA showed a significant between group difference over the study period in favor of the surgical group (p=0.039).For arm-pain intensity, no significant between group differences was found according to the repeated-measures ANOVA (p=0.580).Radiculopathy, surgery vs non-surgical treatment 4 87% of the patients in the surgical group rated their symptoms as "better/much better" at the 12-month follow-up, compared to 62% in the non-surgical group (p<0.05). At 24 months the corresponding figures were 81% and 69% (p=0.28). The difference was significant only at the 12-month follow-up in favor of the surgical group.Significant reduction in NDI, neck-pain and arm-pain compared to baseline was seen in both groups (p<0.001). ConclusionsIn this prospective, randomized study of patients with cervical radiculopathy, it was shown that surgery with physiotherapy resulted in a more rapid improvement during the first postoperative year, with significantly greater improvement in neck pain and the patient's global assessment compared to physiotherapy alone, but the differences between the groups decreased after two years. Structured physiotherapy should be tried before surgery is chosen. Radiculopathy, surgery vs non-surgical treatment 5 Mini Abstract/ PrécisA prospective, randomized study comparing surgery plus physiotherapy with physiotherapy alone for patients with cervical radiculopathy was conducted. Surgery resulted in a more rapid improvement during the first postoperative year, with significantly greater improvement in neck pain and the patient's global assessment compared to physiotherapy alone, but the differences between the groups decreased after two years. Key PointsPatients with cervical radiculopathy were randomized to ACDF with physiotherapy or physiotherapy alone.Significant improvement was found with regard to disability, neck-and arm-pain intensity, and global assessment in both groups at the 1 and 2 year follow-ups.A significantly better result was seen after ACDF regarding neck pain and glo...