Do key measurement parameters derived from specific cervical vertebral segments differ between lordotic and non-lordotic cervical spine alignments? A study of asymptomatic young adults.

BACKGROUND: Measurement parameters derived from specific cervical vertebral segments (e.g., C2 slope) can provide clinicians with important information on cervical sagittal balance and guide pre- and post-surgical decision-making processes. It is unclear however, what constitutes typical values for these types of measurements in an asymptomatic population of young adults, whether values change depending upon the classification of the cervical spine's global alignment, and if any non-lordotic cervical subtypes display values that are comparable to those reported for pre-surgery patients. METHODS: Neutral lateral cervical radiographs of 150 asymptomatic participants (18-30 years) were taken. Global cervical alignment was classified as lordotic or one of four non-lordotic subtypes using a multi-method subtyping protocol. Four key measurement parameters - the anterior translation of the head measure (ATHM), C0-C2 angle, C2 slope, and C7 slope - were derived from specific cervical segments. Independent samples t-tests were used to compare lordotic and non-lordotic groups. RESULTS: There was considerable variation in the four key measurement parameters amongst this asymptomatic population of young adults. Thirty-four percent of the sample were classified as lordotic and 66% were classified as non-lordotic. There was a significant difference (p ≤ 0.0125) between lordotic and non-lordotic groups for the C0-C2 angle, C2 slope and C7 slope. There was no difference between groups for the ATHM (p ≥ 0.0125). Within the non-lordotic group, the global-kyphotic (GK) subtype had the largest mean C2 slope, largest mean C0-C2 angle, and smallest mean C7 slope. CONCLUSIONS: Long term prospective investigations are required to determine whether possible biomarkers (alignment parameters/radiological measurements) for spinal degenerative changes can be identified so that early interventions can be put in place to try and reduce the impact of neck pain on society.

Long-term Return to Sports After Anterior Cruciate Ligament Injury: Reconstruction vs No Reconstruction-A Comparison of 2 Case Series.

BACKGROUND: Reconstruction is considered to provide the best opportunity for return to sports (RTS) after anterior cruciate ligament (ACL) rupture. However, recent studies report that <50% of athletes return to preinjury sporting levels and that RTS rates at 1 year after injury are the same for athletes undergoing reconstruction and nonoperative management. Long-term studies are essential to confirm these findings and guide decisions regarding surgery. PURPOSE: First, to compare long-term sports participation after ACL reconstruction and nonreconstruction and, second, to relate RTS level to strength and stability. STUDY DESIGN: Cohort study; Level of evidence, 3. METHOD: Patients with ACL deficiency (n = 101) who were referred for physical therapy at the time of diagnosis were followed long term: 56 were treated surgically 2.5 years (interquartile range [IQR], 1-4) after injury and 45 were treated nonoperatively. At long-term follow-up, the reconstructed group was at 9 years (IQR, 7-11) after injury and aged 33.3 ± 6.2 years (mean ± SD, 70% male; 61% meniscal injury), and the nonreconstructed group was at 11 years (IQR, 7-14) after injury and aged 38.7 ± 8.3 years (67% male; 58% meniscal injury). Measures of objective stability, subjective stability, and quadriceps/hamstring strength were compared between groups using independent-samples t tests. Current RTS level, scored on a 6-point scale, was compared between groups using chi-square tests. Spearman rho correlated RTS with outcome measures. RESULTS: Of the total group of patients, 96% with reconstruction and 93% without continued to play sports. In the reconstructed and nonreconstructed groups, 4% and 7% did not RTS, and 8% and 17% returned to safe sports, respectively: 13% and 12% to running, 20% and 26% to sports involving limited twisting, 12% and 24% to recreational pivoting sports, and 43% and 14% to competitive pivoting sports. The only significant difference was in return to competitive pivoting sports (P = .003). Five patients with reconstruction ruptured the contralateral ACL, and 1 ruptured his graft. Most patients treated nonoperatively modified their sports participation. Their RTS levels correlated significantly with quadriceps strength (r = 0.65; P < .001), hamstring strength (r = 0.721; P < .001), and subjective stability (r = 0.405; P = .01). CONCLUSION: Surgically treated patients returned to competitive pivoting sports at 3 times the rate of those managed nonoperatively, confirming that reconstruction provides the best opportunity for continued participation in competitive pivoting sports. Regardless of grouping, RTS correlated with modifiable factors, including strength and stability. Higher rates of subsequent injuries observed after reconstruction may result from increased participation in competitive pivoting sports.