The Efficacy of Cervical Lordosis Rehabilitation for Nerve Root Function and Pain in Cervical Spondylotic Radiculopathy: A Randomized Trial with 2-Year Follow-Up

Abstract

Sagittal cervical alignment is a clinically related feature in patients suffering from chronic cervical spondylotic radiculopathy (CSR). We designed this randomized trial to explore the effects of cervical lordosis (CL) correction in thirty chronic lower CSR patients with CL < 20°. Patients were assigned randomly into two equal groups, study (SG) and control (CG). Both groups received neck stretching and exercises and infrared radiation; additionally, the SG received cervical extension traction. Treatments were applied 3× per week for 10 weeks after which groups were followed for 3 months and 2 years. The amplitude of dermatomal somatosensory evoked potentials (DSSEPS), CL C2–C7, and pain scales (NRS) were measured. The SG had an increase in CL post-treatment (p < 0.0001), this was maintained at 3 months and 2 years. No statistical improvement in CL was found for the CG. A significant reduction in NRS for SG after 10 weeks of treatment with non-significant loss of change at 3 months and continued improvement at 2 years was found. CG had less significant improvement in post-treatment NRS; the 3-month and 2-year measures revealed significant worsening in NRS. An inverse linear correlation between increased CL and NRS was found (r = −0.49; p = 0.005) for both groups initially and maintained in SG at the final 2-year follow-up (r = −0.6; p = 0.01). At 10 weeks, we found significant improvements in DSSEPS for both groups (p < 0.0001). We identified a linear correlation between initial DSSEPs and CL for both groups (p < 0.0001), maintained only in the SG at the final follow-up for all levels (p < 0.0001). Improved CL in the SG correlated with significant improvements in nerve root function and pain rating in patients with CSR at short and long-term follow-up. These observed effects indicate that clinicians involved in the treatment of patients with symptoms of cervical degenerative disorders should add sagittal curve correction to their armamentarium of rehabilitation procedures for relevant patient populations.

A Comparison of Two Forward Head Posture Corrective Approaches in Elderly with Chronic Non-Specific Neck Pain: A Randomized Controlled Study

“…The patient lies flat on their back (supine) on the ground with their legs extended and arms by their sides. The patient is encouraged to relax while lying on the Denneroll [ 15 , 16 ]. The denneroll was placed on the ground and positioned in the posterior aspect of the neck depending on the area to be addressed, as shown in Figure 1 .…”

“…The technique utilizes both mirror image ® adjusting/manipulation, exercises, and the unique extension traction procedures [ 11 , 12 , 13 ]. Meanwhile, the mirror image refers to the reversal of the spine and posture in the opposite direction of the present malalignment during the performance of rehabilitative procedures; the unique extension traction methods are for restoring normal lordosis and reducing forward head posture [ 11 , 14 , 15 , 16 , 17 ].…”

“…It was determined that there were “several high-quality controlled clinical trials substantiating that increasing cervical lordosis by extension traction as part of a spinal rehabilitation program reduces pain and disability and improves functional measures and that these improvements are maintained long-term” [ 14 ]. Since this review (Oct., 2021), additional trials have emerged, further supporting the clinical importance of increasing the cervical curve and reducing forward head posture using the CBP cervical extension traction methods, but none of these trials have specifically investigated an elderly population [ 15 , 16 ].…”

Abnormal Static Sagittal Cervical Curvatures following Motor Vehicle Collisions: A Retrospective Case Series of 41 Patients before and after a Crash Exposure

“…There have been numerous studies demonstrating the chronic effect of abnormalities of the cervical lordosis both in cervical spine trauma scenarios and degenerative spine disorders. The consequences for long-term increases in pain, loss of function, and increased risk for disability have been detailed in the surgical [50], MVC [18][19][20][21], and conservative care rehabilitation literature [51,52]. Further, studies have shown that both non-surgical and surgical improvement in cervical lordosis is a desirable clinical goal of care, with significant short-and long-term improved outcomes [50][51][52].…”

Pediatric Text Neck Syndrome

“…If not adequately addressed, the pain and other symptoms of the cervical spine can progressively worsen, leading to a range of physical health issues such as spinal disc degeneration, musculoskeletal pain, and reversed cervical lordosis [ 2 ]. Cervical spine disorders include cervicogenic headaches [ 3 ], cervicogenic dizziness [ 2 ], cervicogenic angina and dyspnea [ 4 , 5 ], facial pain [ 6 ], fibromyalgia [ 7 ], visual disturbance [ 8 , 9 ], and cervical radiculopathy [ 10 , 11 ], which often present with a combination of painful symptoms and spinal dysfunction.…”