Postoperative Rigid Cervical Collar Leads to Less Axial Neck Pain in the Early Stage After Open-Door Laminoplasty-A Single-Blinded Randomized Controlled Trial.

BACKGROUND: Cervical collars are used after laminoplasty to protect the hinge opening, reduce risks of hinge fractures, and avoid spring-back phenomena. However, their use may lead to reduced range of motion and worse neck pain. OBJECTIVE: To investigate the clinical, radiological, and functional outcomes of patients undergoing single-door laminoplasty with or without collar immobilization. METHODS: This was a prospective, parallel, single-blinded randomized controlled trial. Patients underwent standardized single-door laminoplasty with mini-plates for cervical myelopathy and were randomly allocated into 2 groups based on the use of collar postoperatively. Clinical assessments included cervical range of motion, axial neck pain (VAS [visual analogue scale]), and objective scores (short-form 36-item, neck disability index, and modified Japanese Orthopaedic Association). All assessments were performed preoperatively and at postoperative 1, 2, 3, and 6 wk, and 3, 6, and 12 mo. Comparative analysis was performed via analysis of variance adjusted by baseline scores, sex, and age as covariates. RESULTS: A total of 35 patients were recruited and randomized to collar use (n = 16) and without (n = 19). There were no dropouts or complications. There were no differences between groups at baseline. Subjects had comparable objective scores and range of motion at postoperative time-points. Patients without collar use had higher VAS at postoperative 1 wk (5.4 vs 3.5; P = .038) and 2 wk (3.5 vs 1.5; P = .028) but subsequently follow-up revealed no differences between the 2 groups. CONCLUSION: The use of a rigid collar after laminoplasty leads to less axial neck pain in the first 2 wk after surgery. However, there is no additional benefit with regards to range of motion, quality of life, and complication risk.

Effectiveness of Schroth exercises during bracing in adolescent idiopathic scoliosis: results from a preliminary study-SOSORT Award 2017 Winner.

BACKGROUND: Bracing has been shown to decrease significantly the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis (AIS), but the treatment failure rate remains high. There is evidence to suggest that Schroth scoliosis-specific exercises can slow progression in mild scoliosis. The aim of this study was to evaluate the efficacy of Schroth exercises in AIS patients with high-risk curves during bracing. METHODS: A prospective, historical cohort-matched study was carried out. Patients diagnosed with AIS who fulfilled the Scoliosis Research Society (SRS) criteria for bracing were recruited to receive Schroth exercises during bracing. An outpatient-based Schroth program was given. Data for these patients were compared with a 1:1 matched historical control group who were treated with bracing alone. The assessor and statistician were blinded. Radiographic progression, truncal shift, and SRS-22r scores were compared between cases and controls. RESULTS: Twenty-four patients (5 males and 19 females, mean age 12.3 ± 1.4 years) were included in the exercise group, and 24 patients (mean age 11.8 ± 1.1 years) were matched in the control group. The mean follow-up period for the exercise group was 18.1 ± 6.2 months. In the exercise group, spinal deformity improved in 17% of patients (Cobb angle improvement of ≥ 6°), worsened in 21% (Cobb angle increases of ≥ 6°), and remained stable in 62%. In the control group, 4% improved, 50% worsened, and 46% remained stable. In the subgroup analysis, 31% of patients who were compliant (13 cases) improved, 69% remained static, and none had worsened, while in the non-compliant group (11 cases), none had improved, 46% worsened, and 46% remained stable. Analysis of the secondary outcomes showed improvement of the truncal shift, angle of trunk rotation, the SRS function domain, and total scores in favor of the exercise group. CONCLUSION: This is the first study to investigate the effects of Schroth exercises on AIS patients during bracing. Our findings from this preliminary study showed that Schroth exercise during bracing was superior to bracing alone in improving Cobb angles, trunk rotation, and QOL scores. Furthermore, those who were compliant with the exercise program had a higher rate of Cobb angle improvement. The results of this study form the basis for a randomized controlled trial to evaluate the effect of Schroth exercises during bracing in AIS. TRIAL REGISTRATION: HKUCTR-2226. Registered 22 June 2017 (retrospectively registered).

A multidisciplinary rehabilitation programme for patients with chronic low back pain: a prospective study.

PURPOSE: To examine the effectiveness of a multidisciplinary rehabilitation programme for patients with chronic low back pain in Hong Kong, and to identify factors associated with work resumption. METHODS: 57 men and 8 women aged 20 to 56 (mean, 39) years who had a more than 3-month history of low back pain and were unresponsive to more than 6 months of conventional treatment participated in a 14-week multidisciplinary rehabilitation programme involving physical conditioning, work conditioning, and work readiness. Training protocols entailed flexibility and endurance training, hydrotherapy, weight lifting, and work stimulation. Patients were assessed at baseline (week 1), week 7, week 14, and month 6 with regard to the intensity of low back pain, self-perceived disability, range of lumbar motion, isoinertial performance of the trunk muscles, and depression level. Patient demographics that influenced work resumption were identified using a prediction model. Patients who did and did not return to work were compared. RESULTS: Of the 54 patients who completed all follow-up assessments, 28 returned to work and 26 did not. The latter was significantly older (37 vs. 42 years, p=0.038) and absent from work longer (11 vs. 22 months, p=0.029) than the former. The rehabilitation programme helped patients regain physical function and the ability to work. Patients who returned to work showed greater improvement in self-perceived disability and physical function. CONCLUSION: This rehabilitation programme facilitated regain of physical functioning and the ability to return to work. The pre-programme employment status, duration of absence from work, and patient age were the most important predictors for work resumption.

Flexion-relaxation ratio in sitting: application in low back pain rehabilitation.

STUDY DESIGN: A multiple-comparative study between normal and low back pain (LBP) patients before and after rehabilitation. OBJECTIVE: To examine whether there is a change in flexion-relaxation phenomenon in sitting in LBP patient following a rehabilitation treatment. SUMMARY OF BACKGROUND DATA: There is an association between LBP and seated spine posture. Previous study has reported an absence of flexion-relaxation phenomenon in LBP patients during sitting. However, it is unknown whether there is a difference in flexion-relaxation phenomenon in sitting in LBP patients before and after rehabilitation treatment. METHODS: A total of 20 normal subjects and 25 chronic LBP patients who underwent a 12 weeks rehabilitation program were recruited. Surface electromyography recordings during upright sitting and flexed sitting were taken from the paraspinal muscles (L3) bilaterally from the normal subjects, and in the LBP patients before and after the rehabilitation treatment. The main outcome measures for patients include the visual analogue scale, Oswestry disability index, subjective tolerance for sitting, standing and walking, trunk muscle endurance, lifting capacity, and range of trunk motion in the sagittal plane. Flexion-relaxation phenomenon in sitting, expressed as a ratio between the average surface electromyography activity during upright and flexed sitting, was compared between normal and patients; and in LBP patients before and after rehabilitation. RESULTS: Flexion-relaxation ratio in sitting in normal subjects (Left: 6.83 +/- 3.79; Right: 3.45 +/- 2.2) presented a significantly higher (Left: P < 0.001; Right: P < 0.05) value than LBP patients (Left: 3.04 +/- 2.36; Right: 2.02 +/- 1.49). An increase in flexion-relaxation ratio in sitting was observed in LBP patients after rehabilitation (Left: 4.69 +/- 3.94, P < 0.05; Right: 3.58 +/- 2.97, P < 0.001), together with a significant improvement (P < 0.05) in subjective tolerance in sitting and standing, abdominal and back muscle endurance, lifting capacity, and range of motion. There were no significant changes in disability and pain scores, and subjective tolerance in walking. CONCLUSION: Flexion-relaxation ratio in sitting has demonstrated its ability to discriminate LBP patients from normal subjects, and to identify changes in pattern of muscular activity during postural control after rehabilitation.

The effects of release height on center of pressure and trunk muscle response following sudden release of stoop lifting tasks.

BACKGROUND AND OBJECTIVES: Sudden release of load during lifting threatens postural stability and is countered by trunk muscle response, which can generate high loads on the spine, and may be a cause of tissue injury. The postural threat following sudden release and the consequent muscular response are likely to depend on the posture at the time of release. This study investigates the effects of sudden release of load at two release heights of one- and three-quarters of the knee to shoulder distance during stoop lifting. METHODS: Ten normal southern Chinese male volunteers were subject to sudden release of 20, 40, 60 and 80 N loads during stoop lifting trials. The release was randomly selected to be on the third, fourth or fifth cycle of a trial and was triggered at heights of one- and three-quarters of the total knee to shoulder lifting distance. The subjects stood on a force platform to allow the postural disturbance to be recorded by monitoring the center of pressure (COP), and electromyographic (EMG) data were collected from the rectus abdominus, internal oblique, external oblique, erector spinae and latissimus dorsi muscle groups. RESULTS: The COP excursion moved closer to the posterior limit of stability with increasing release load, and this effect was significantly more marked for release from the lower of the two heights. The minimum posterior COP separation from the posterior limit of stability was significantly less for the lower release height at all loads (p<0.001 in all cases). EMG data showed that the agonist-antagonist co-contraction durations were higher for the lower release height, and unlike sudden release from the higher level, showed a significant increase with increasing load. CONCLUSIONS: Sudden release at lower release height during stoop lifting results in significantly greater postural disturbance and spinal loading. The mean load predicted to result in fall or stumble at the lower release height (133 N) is significantly less than that predicted at the higher of the two release heights (245 N). A more marked effect of release load is also seen in the postural disturbance and trunk muscle co-contraction time for the lower release height, and particular care should therefore be taken when handling potentially unstable loads under these conditions. If the security of the load cannot be guaranteed, storage at a higher level may reduce the risk of injury due to sudden release of the load.