Cervical Spinal Cord Stimulation: A Review.

PURPOSE OF REVIEW: This literature review critically examines existing studies on cervical spinal cord stimulation (cSCS) for the treatment of chronic pain. The objective is to evaluate the current evidence, identify knowledge gaps, and collate data to inform clinical decision-making and suggest future research avenues. The review covers indications, contraindications, surgical and anesthetic approaches, trials, efficacy, and complications of cSCS. RECENT FINDINGS: Recent advancements highlight the evolving role of cSCS in chronic pain management. New neuromodulation techniques involve optimal placement of leads based on the pain's innervation level, maximizing therapeutic outcomes. Contemporary studies underscore the broadening benefits of cSCS, including enhanced functional abilities and sleep quality. However, alongside these innovations come challenges; emerging data bring attention to complications such as hardware issues and infections. Significantly, modern research emphasizes the crucial role of accurate patient selection, factoring in prior therapy responses and comprehensive evaluations. cSCS emerges as a promising tool for chronic pain management, with benefits beyond mere pain relief. As surgical techniques, patient selection criteria, and postoperative care refine, the potential of cSCS expands to benefit a broader patient demographic. However, further comprehensive research is necessary to enhance its application, validate its role earlier in treatment, and ultimately ameliorate the lives of those with chronic pain.

Pulsed Radiofrequency of the Auriculotemporal Nerve to Reduce the Intensity of Tinnitus.

INTRODUCTION: Stimulation of the nonauditory nervous systems via the trigeminal nerve pathways can be a promising intervention for patients with tinnitus refractory to medical, conservative, and other treatment options. Therapy of the mandibular division of the trigeminal nerve through the auriculotemporal nerve has been reported as useful for patients with tinnitus. OBJECTIVES: The objective of our study was to study the long-term effects of pulsed radiofrequency of the auriculotemporal nerve in a large group of tinnitus sufferers and to find predictors for a prosperous result. DESIGN: A monocenter backward-looking group study. RESULTS: In a two-year period, 67 tinnitus patients had pulsed radiofrequency of the auriculotemporal nerve. Twentythree (35%) reported reduced tinnitus loudness at the 7-week post-treatment follow-up. These patients valued the improvements as: 61% good, 22% moderate, and 17% slight. In 3% of patients, tinnitus magnified after the treatment. The odds of permanent tinnitus relief after successful pulsed radiofrequency of the auriculotemporal nerve are 68% at 1 year postoperative. In tinnitus patients without cervical pain 62% had an improvement following pulsed radiofrequency of the auriculotemporal nerve compared to 28% in those not fulfilling this criterion (p=0.024). CONCLUSIONS: Neuromodulation of the auriculotemporal nerve is an uncomplicated remedy for tinnitus. In a select group of tinnitus patients this treatment can a good relief of their tinnitus for a long period. Especially, tinnitus sufferers without cervical pain will benefit of this therapy.

Radiofrequency for chronic lumbosacral and cervical pain: Results of a consensus study using the RAND/UCLA appropriateness method.

BACKGROUND: Despite the routine use of radiofrequency (RF) for the treatment of chronic pain in the lumbosacral and cervical region, there remains uncertainty on the most appropriate patient selection criteria. This study aimed to develop appropriateness criteria for RF in relation to relevant patient characteristics, considering RF ablation (RFA) for the treatment of chronic axial pain and pulsed RF (PRF) for the treatment of chronic radicular pain. METHODS: The RAND/UCLA Appropriateness Method (RUAM) was used to explore the opinions of a multidisciplinary European panel on the appropriateness of RFA and PRF for a variety of clinical scenarios. Depending on the type of pain (axial or radicular), the expert panel rated the appropriateness of RFA and PRF for a total of 219 clinical scenarios. RESULTS: For axial pain in the lumbosacral or cervical region, appropriateness of RFA was determined by the dominant pain trigger and location of tenderness on palpation with higher appropriateness scores if these variables were suggestive of the diagnosis of facet or sacroiliac joint pain. Although the opinions on the appropriateness of PRF for lumbosacral and cervical radicular pain were fairly dispersed, there was agreement that PRF is an appropriate option for well-selected patients with radicular pain due to herniated disc or foraminal stenosis, particularly in the absence of motor deficits. The panel outcomes were embedded in an educational e-health tool that also covers the psychosocial aspects of chronic pain, providing integrated recommendations on the appropriate use of (P)RF interventions for the treatment of chronic axial and radicular pain in the lumbosacral and cervical region. CONCLUSIONS: A multidisciplinary European expert panel established patient-specific recommendations that may support the (pre)selection of patients with chronic axial and radicular pain in the lumbosacral and cervical region for either RFA or PRF (accessible via https://rftool.org). Future studies should validate these recommendations by determining their predictive value for the outcomes of (P)RF interventions.

The relationship between cervical spine range of motion and postural sway in mechanical neck pain: A cross-sectional study.

Background: Impairments in postural sway have been identified in people with mechanical neck pain. The influence of cervical spine range of motion (ROM) on postural sway is unclear in mechanical neck pain (MNP). Objective: This study investigated the relationship between cervical spine range of motion (ROM) and postural sway in MNP. Methods: The cervical ROM was measured using the Cervical Range of Motion (CROM) device. Standing postural sway characterised by mean centre of pressure (COP) measurements in the anterior posterior (AP) and medio-lateral direction with eyes closed and feet together condition was recorded on a posturography platform. Pearson product moment correlation coefficient was used to identify the relationship between cervical ROM and postural sway. Results: Seventy-two MNP individuals (Mean age: 29.9±11.7) of either sex (Male: Female=23:49) were recruited. Overall, no statistically significant correlations were identified between cervical spine ROM in sagittal and frontal plane and postural sway (r values ranging from 0.00 to -0.38; p-values >0.05). However, a weak negative correlation was present between the cervical rotation and AP (r-value=-0.23; p-value=0.04) and mediolateral (r-value=-0.38; p-value=0.01) COP excursion. Conclusion: The cervical spine ROM was found to have a weak relationship with postural sway in individuals with MNP. This suggests the investigation of other mechanisms especially muscle tension which might be responsible for altered postural sway in MNP.

Dry Needling Versus Trigger Point Injection for Neck Pain Symptoms Associated with Myofascial Trigger Points: A Systematic Review and Meta-Analysis.

OBJECTIVE: To examine the effects of dry needling against trigger point (TrP) injections (wet needling) applied to TrPs associated with neck pain. METHODS: Electronic databases were searched for randomized clinical trials in which dry needling was compared with TrP injections (wet needling) applied to neck muscles and in which outcomes on pain or pain-related disability were collected. Secondary outcomes consisted of pressure pain thresholds, cervical mobility, and psychological factors. The Cochrane Risk of Bias tool, the Physiotherapy Evidence Database score, and the Grading of Recommendations Assessment, Development, and Evaluation approach were used. RESULTS: Six trials were included. TrP injection reduced pain intensity (mean difference [MD ] -2.13, 95% confidence interval [CI] -3.22 to -1.03) with a large effect size (standardized mean difference [SMD] -1.46, 95% CI -2.27 to -0.65) as compared with dry needling. No differences between TrP injection and dry needling were found for pain-related disability (MD 0.9, 95% CI -3.09 to 4.89), pressure pain thresholds (MD 25.78 kPa, 95% CI -6.43 to 57.99 kPa), cervical lateral-flexion (MD 2.02°, 95% CI -0.19° to 4.24°), or depression (SMD -0.22, 95% CI -0.85 to 0.41). The risk of bias was low, but the heterogenicity and imprecision of results downgraded the evidence level. CONCLUSION: Low evidence suggests a superior effect of TrP injection (wet needling) for decreasing pain of cervical muscle TrPs in the short term as compared with dry needling. No significant effects on other outcomes (very low-quality evidence) were observed. LEVEL OF EVIDENCE: Therapy, level 1a.

Alterations in kinematics of temporomandibular joint associated with chronic neck pain.

BACKGROUND: Temporomandibular disorder (TMD) is an umbrella term for pain and dysfunction of the temporomandibular joint (TMJ) and its associated structures. Patients with TMD show changes in TMJ kinematics and masticatory muscle activation. TMD is commonly comorbid with non-specific chronic neck pain (NCNP), which may be one of the risk factors for TMD. OBJECTIVES: This study aimed to investigate whether patients with NCNP have altered TMJ kinematics and masticatory muscle activity. METHODS: This was a cross-sectional exploratory study including 19 healthy participants and 20 patients with NCNP but without TMD symptoms. TMJ kinematics was measured during mouth opening and closing, jaw protrusion and jaw lateral deviation. Surface electromyography was used to record the muscle activity of the anterior temporalis, masseter, sternocleidomastoid and upper trapezius while clenching. Furthermore, cervical posture, cervical range of motion (ROM) and pressure-pain threshold of the neck and masticatory muscles were measured. RESULTS: Compared with the healthy group, the NCNP group showed significantly reduced upper cervical rotation ROM (p = .041) and increased condylar path length (p = .02), condylar translation (opening p = .034, closing p = .011) and mechanical pain sensitivity of the upper trapezius (p = .018). Increased condylar translation was significantly correlated with reduced upper cervical mobility and poor cervical posture (r = -0.322 to -0.397; p = .012-.046). CONCLUSION: Increased condylar translation and path length in patients with NCNP may indicate poor control of TMJ articular movement, which may result from neck pain or may be a compensation for limited neck mobility. Evaluation of excessive TMJ translation may be considered in patients with NCNP.

Pain in relationship to Tinnitus and Hearing Loss.

INTRODUCTION: Cervical and lower back pain are noteworthy in the manner of development of tinnitus. OBJECTIVES: The focus of this research was to indicate the consequence of the severity of neck pain and pain of the lower back and/or lower limbs in tinnitus patients. DESIGN: A retrospective analysis of 61 patients with tinnitus as main complaint during a three month period. RESULTS: In this study, we found two groups of tinnitus patients defined by the existence of postural instability. Patients with tinnitus and postural unsteadiness were characterized by predominant female, self-perceived hearing loss, a higher intensity of tinnitus, cervical pain, and pain of the lower back and/or of the lower limbs, and more hearing deficit from 250 Hz to 4 kHz. CONCLUSIONS: In patients with tinnitus one should be aware that hearing loss can be a consequence of high intensity cervical pain. Stimulation of the proprioceptive input pathways due to cervical pain can result in a higher intensity of tinnitus and a hearing loss in the range of 250 Hz to 4 kHz.

Is Pain Harder To Withstand Than Tinnitus?

OBJECTIVES: The object of the study was to compare the perception of tinnitus with the perception of pain and to find specific factors that could influence the perception of both pain and tinnitus. DESIGN: A retrospective analysis of 124 patients with tinnitus as main complaint and 300 patients with cervical pain as main complaint who visited our clinic in a two-year period. RESULTS: This study indicates that it is harder to withstand cervical pain than tinnitus with a higher prevalence of fatigue and impaired work performance in cervical pain patients. Our analyses highlight the importance of fatigue as a potential mediator of the deleterious effects of pain and tinnitus on individual functioning. Female gender and the presence of cervical pain makes patients more accessible for fatigue. Tolerance against tinnitus depends on the perceived maximal intensity of tinnitus, but also of the presence of cervical pain. Cervical pain may reinforce the irritating awareness of tinnitus. CONCLUSION: Tinnitus and chronic pain are related to structural and functional brain changes that show a striking overlap between both conditions. The tolerance, the ability to withstand the "unpleasantness" of the percept, for tinnitus and pain depends on the perceived intensity of the sensation. However, the perceived intensity of pain provoked annoyance earlier compared to the perceived intensity of tinnitus. Cervical pain may reinforce and maintain the negative awareness of tinnitus. For a better withstanding of tinnitus, we advise to reduce the perceived maximal intensity of tinnitus and to treat cervical pain and fatigue.

The Diagnostic Value of an X-ray-based Scoring System for Degeneration of the Cervical Spine: A Reproducibility and Validation Study.

BACKGROUND: In interventional pain medicine, cervical facet joint (CFJ) pain is commonly treated with CFJ denervation techniques, almost automatically assuming degeneration of the CFJs as an important cause of CFJ pain. A standard cervical X-ray is still commonly used in the clinical evaluation of patients suspected for CFJ degeneration. Although degenerative features can be visualized by different radiological imaging techniques, the relation between radiological degenerative features of the cervical spine and pain remains controversial. Paramount in order to estimate the clinical usefulness of a radiological imaging is to establish the reproducibility of the radiological scoring system. A reproducible and clinically feasible diagnostic scoring system was developed to estimate cervical degeneration on standard cervical X-rays. MATERIALS AND METHODS: A reproducibility study for the interpretation of degenerative abnormalities on standard cervical X-rays was performed, using a dichotomous outcome (degenerative abnormalities present Yes/No). The estimation of intervertebral disc height loss on standard cervical X-rays was validated with computed tomography (CT) scan measurements. RESULTS: Five radiological degenerative features on standard cervical X-rays (disc height loss, anterior vertebral osteophytes, posterior vertebral osteophytes, vertebral end plate sclerosis, and uncovertebral osteoarthritis) showed a substantial to excellent reproducibility (kappa value ≥ 0.60). The qualitative definition of disc height loss used in the reproducibility study showed a substantial agreement with the actual measurements of disc height loss on CT scan (kappa value = 0.69). CONCLUSION: Subjective judgment of a cervical standard X-ray is a reproducible method to demonstrate degenerative abnormalities of the cervical spine.

Relationship between specific temporomandibular disorders and impaired upper neck performance.

Upper neck impairments are more prevalent in patients with temporomandibular disorders (TMDs) but the differences between specific types of TMDs are unclear. This study evaluated the distribution of such impairments among different forms of TMD. In total, 116 participants (86 women and 30 men, age range 21-75 yr) were investigated. Forty-two individuals had no TMDs and were assigned to the control group. The remaining 74 patients were assigned to one of three groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) findings: pain-related (n = 37); intra-articular (n = 17); or mixed (combined pain-related and intra-articular) (n = 20). Analyses of impairments included between-group comparisons of key parameters of upper neck performance (active/passive mobility and muscular capabilities) and pain (subjective neck disability and pain sensitivity). Patients in the pain-related and mixed TMD groups were found to have decreased upper neck mobility in the cervical flexion-rotation test compared with patients in intra-articular and control groups, as well as poorer capabilities of the deep neck flexor muscles in the cranio-cervical flexion test compared to the control group. It was concluded that patients with pain-related TMD diagnoses are more likely to experience significant upper-neck hypomobility and poor muscular capabilities than patients with intra-articular diagnoses of TMD.

Cervical Spinal Cord Stimulation Using Monophasic Burst Waveform for Axial Neck and Upper Extremity Radicular Pain: A Preliminary Observational Study.

BACKGROUND: Cervical spinal cord stimulation (cSCS) is an accepted therapeutic option for radicular upper extremity pain and less commonly for cervical axial pain despite less available literature in comparison with lumbar and lower extremity applications. METHODS: This preliminary observational pilot study evaluated the efficacy of cSCS using the monophasic burst pattern in the treatment of both upper extremity radicular pain and axial neck pain. Primary outcome measures were reduction in pain scores, global pain scale (GPS) indices, and neck Oswestry disability index (nODI). RESULTS: Of the 23 subjects trialed, 15 went to implantation of cSCS using burst and were followed for 1 year prospectively. Pre- and postprimary outcome measures suggested a statistically (p < 0.05) and clinically significant 12.40 point differential in the nODI, a statistically significant reduction of the GPS from 74.60 to 56.37 (p < 0.05), and a reduction in the pain rating score from 8.13 +/- 1.0 prior to trial to 3.85 +/- 1.1 at 1 year for axial neck and with and without radicular pain (p < 0.05). CONCLUSIONS: This preliminary study suggests that the use of the burst waveform applied to cSCS results in improved function and decreased pain scores in subjects with axial neck pain with and without radicular symptomatology and cervicogenic headache.

Efficacy of Kinesio Taping and Postural Correction Exercises on Levator Scapula Electromyographic Activities in Mechanical Cervical Dysfunction: A Randomized Blinded Clinical Trial.

OBJECTIVE: Mechanical neck dysfunction (MND) is a major health burden. Although postural correction exercises (PCEs) are commonly used for its treatment, efficacy of Kinesio Taping (KT) has received considerable attention. This study was conducted to determine the effect of KT and PCEs on levator scapula (LS) electromyography. METHODS: Ninety-one patients with MND were randomly assigned into 1 of 3 groups that received 4 weeks' treatment: group A, KT; group B, PCE; and group C, both interventions. Neck pain, LS root mean square (RMS), and median frequency (MDF) were measured pretreatment and post-treatment with the Numerical Pain Rating Scale and surface electromyography, respectively, by an assessor blinded to the patients' allocation. RESULTS: Multivariate analysis of variance indicates a statistically significant group-by-time interaction (P = .000). Pain intensity was significantly reduced in group C more than in group B (P = .001). Mean values of RMS were significantly reduced in group C compared to both group A (P = .001) and group B (P = .022), whereas MDF was significantly increased in group C compared to either group A (P = .00) or group B (P = .026), and in group B compared to group A (P = 0.26). A paired t test revealed that there was a significant decrease in pain and RMS, and a significant increase in MDF in all groups (P < .01). CONCLUSION: Application of both KT and PCE combined can significantly reduce neck pain and normalize LS activities in patients with MND more than the application of either intervention.

Interactive Association Between Mechanical and Sensorimotor Aspects of Cervical Extensor Muscles: Implications for Chronic Neck Pain.

While proprioceptive functioning of the cervical extensor muscles has been proposed to be associated with chronic neck pain (NP), the mechanism by which such impairment might contribute to NP is not clear. The aim of this cross-sectional study was to investigate the relevance of proprioception, extensor muscles size, and endurance to chronic NP. A total of 60 participants with (n = 30) or without (n = 30) chronic NP participated in this cross-sectional study. Joint repositioning error (JRE), ultrasonographic parameters of the cervical extensors, and clinical extensor endurance were assessed. Multivariate analysis of variance and logistic regression tests were used to compare the groups and test the predictive value of the dependent variables for chronic NP, respectively. Patients showed comparable JRE scores but smaller multifidus size and lower extensor endurance (Cohen d = 0.66 for both). JRE in the transverse plane (ß = 1.20), multifidus muscle size (ß = 0.02), and endurance (ß = 0.99) were significant predictors for chronic NP odds ratio. The results found multifidus size as the most relevant factor to NP by showing both between-groups difference and considerable odds ratio. As JRE in transverse plane was not different between the groups and extensor endurance demonstrated minimal odds ratio, these 2 factors may be considered as less relevant to NP comparing multifidus muscle size.

Comparison of Cyriax manipulation with traditional physical therapy for the management of cervical discogenic problems. A randomized control trial.

OBJECTIVE: To determine and compare the clinical outcome of Cyriax manipulation and traditional physical therapy for the treatment of cervical discogenic problems in terms of pain, range of motion and disability. METHODS: The randomised controlled trial was conducted at Benazir Bhutto Hospital, Rawalpindi, Pakistan, from January to June, 2018, and comprised patients having prolapsed intervertebral disc with neck or arm pain who were then randomly allocated into control and experimental groups using the sealed envelope method. The control group received cervical isometrics 10 repetitions ×1 set, 4 days/week and targeted muscle strechings 10 repetition × 1 set/day for 4 days/week. The experimental group received 10 min pre-manipulative massage and Cyriax manipulation protocol. Data was analysed using SPSS 20. RESULTS: Of the 40 subjects, there were 20(50%) in each of the two groups. The experimental group showed significance difference in terms of numeric pain rating scale, range of motion and the neck disability index (p<0.05 each). CONCLUSIONS: Cyriax manipulation was found to be significantly better than the traditional treatment of physiotherapy for cervical discogenic pain.

The Effectiveness of Virtual Reality in Patients With Spinal Pain: A Systematic Review and Meta-Analysis.

BACKGROUND: Virtual reality (VR) technologies have been shown to be beneficial in various areas of health care; to date, there are no systematic reviews examining the effectiveness of VR technology for the treatment of spinal pain. PURPOSE: To investigate the effectiveness of VR technology in the management of individuals with acute, subacute, and chronic spinal pain. METHODS: Six electronic databases were searched until November 2019. Randomized controlled trials (RCTs) assessing the effectiveness of VR were eligible for inclusion. Two independent reviewers extracted the data and assessed the risk of bias for each study and the overall quality of evidence. Mean differences of outcomes were pooled as appropriate using random-effects models. RESULTS: Seven RCTs with high risk of bias met review criteria. Quality of evidence ranged from very low to low quality. In patients with chronic neck pain, VR improved global perceived effect (GPE), satisfaction, and general health at short-term follow-up, as well as general health and balance at intermediate-term follow-up compared to kinematic training. VR improved pain intensity and disability at short-term and long-term follow-up compared to conventional proprioceptive training in patients with chronic neck pain. In patients with either subacute or chronic low back pain (LBP), VR improved pain, disability, and fear of movement compared to lumbar stabilization exercises and improved pain compared to conventional physical therapy (at short-term follow-up). In patients with chronic LBP, VR improved pain compared to lumbar stabilization exercises and improved fear of movement compared to conventional physical therapy (at short-term follow-up). CONCLUSION: VR's potential for improvement in outcomes for spinal pain that demonstrated statistical and/or clinical significance (pain intensity, disability, fear of movement, GPE, patient satisfaction, general health status, and balance) highlights the need for more focused, higher-quality research on the efficacy and effectiveness of VR for treatment of patients with spinal pain.

When cervical pain is actually migraine: An observational study in 207 patients.

Introduction A large proportion of migraine patients remain undiagnosed or misdiagnosed in Italy. In our experience, many migraineurs self-diagnose their condition as "cervical pain attack" or "cervical pain syndrome" (CP), assuming cervical spine pathology as the cause. We aimed to phenotype and classify the headache of patients with self-diagnosed CP, and to describe this sample of patients. Methods Consecutive patients aged 18 to 75 years, referred to the Headache Center of the Mondino Institute (Pavia, Italy) for a first visit for headache, completed a questionnaire about CP and were subsequently examined by an experienced clinician. Results Out of 207 patients, 132 (64%) believed they suffered from CP. According to ICHD-IIIß criteria, these patients suffered from migraine or probable migraine in 91% of cases. The great majority of patients who believed that they suffered from CP underwent unnecessary medical exams (including radiation exposure in 40% of cases) and used treatments that were inadequate for their real diagnosis. Conclusion The majority of patients with CP suffer from typical migraine. The misdiagnosis produces an economic burden (for patients and the health care system) and leads to impaired quality of life of patients.

Text neck and neck pain in 18-21-year-old young adults.

PURPOSE: The aim of this study was to investigate whether there is an association between text neck and neck pain in young adults. METHODS: Observational cross-sectional study with 150 18-21-year-old young adults from a public high school in the state of Rio de Janeiro was performed. In the self-report questionnaire, the participants answered questions on sociodemographic factors, anthropometric factors, time spent texting or playing on a mobile phone, visual impairments, and concern with the body posture. The neck posture was assessed by participants' self-perception and physiotherapists' judgment during a mobile phone texting message task. The Young Spine Questionnaire was used to evaluate the neck pain. Four multivariate logistic regression models were fitted to investigate the association between neck posture during mobile phone texting and neck pain, considering potential confounding factors. RESULTS: There is no association between neck posture, assessed by self-perception, and neck pain (OR = 1.66, p = 0.29), nor between neck posture, assessed by physiotherapists' judgment, and neck pain (OR = 1.23, p = 0.61). There was also no association between neck posture, assessed by self-perception, and frequency of neck pain (OR = 2.19, p = 0.09), nor between neck posture, assessed by physiotherapists' judgment, and frequency of neck pain (OR = 1.17, p = 0.68). CONCLUSION: This study did not show an association between text neck and neck pain in 18-21-year-old young adults. The findings challenge the belief that neck posture during mobile phone texting is associated to the growing prevalence of neck pain.

Does improvement towards a normal cervical sagittal configuration aid in the management of cervical myofascial pain syndrome: a 1- year randomized controlled trial.

BACKGROUND: There is a growing interest concerning the understanding of and rehabilitation of the sagittal configuration of the cervical spine as a clinical outcome. However, the literature on the topic specific to conservative treatment outcomes of patients with chronic myofascial cervical pain syndrome (CMCPS) has not adequately addressed the relationship between cervical sagittal alignment and improved pain, disability and range of motion. METHODS: A randomized controlled study with a 1-year follow-up. Here, 120 (76 males) patients with chronic CMCPS and defined cervical sagittal posture abnormalities were randomly assigned to the control or an intervention group. Both groups received the Integrated neuromuscular inhibition technique (INIT); additionally, the intervention group received the denneroll cervical traction device. Alignment outcomes included two measures of sagittal posture: cervical angle (CV), and shoulder angle (SH). Patient relevant outcome measures included: neck pain intensity (NRS), neck disability (NDI), pressure pain thresholds (PPT), cervical range of motion using the CROM. Measures were assessed at three intervals: baseline, 10 weeks, and 1 year after the 10 week follow up. RESULTS: After 10 weeks of treatment, between group statistical analysis, showed equal improvements for both the intervention and control groups in NRS (p = 0.36) and NDI (p = 0.09). However, at 10 weeks, there were significant differences between groups favoring the intervention group for PPT (p<0.001) and all measures of CROM (p<0.001). Additionally, at 10 weeks the sagittal alignment variables showed significant differences favoring the intervention group for CV p<0.001 and SH (p<0.001) indicating improved CSA. Importantly, at the 1-year follow-up, between group analysis identified a regression back to baseline values for the control group for the non-significant group differences (NRS and NDI) at the 10-week mark. Thus, all variables were significantly different between groups favoring the intervention group at 1-year follow up: NRS (p<0.001), NDI (p<0.001), PPT p<0.001), CROM (p<0.001), CV (p<0.001), SH (p<0.001). CONCLUSION: The addition of the denneroll cervical orthotic to a multimodal program positively affected CMCPS outcomes at long term follow up. We speculate the improved sagittal cervical posture alignment outcomes contributed to our findings. TRIAL REGISTRATION: Pan African Clinical Trial Registry Clinical Trial Registry: PACTR201801002968301 , registered 11 January 2018 (retrospectively registered).

Retrograde Placement of High Cervical Electrodes: A Technical Refinement and Case Series.

INTRODUCTION: Cervical cord stimulation is used in the treatment of chronic (neuropathic) pain syndromes refractory to conservative treatments. Several authors describe different techniques for the placement of cervical electrodes. Electrodes can be placed retrogade [Correction added on 03 April 2018 after first online publication: the word "plased" has been changed to "placed".]. In this article, we describe a refinement on how to dissect the dorsal meningo-vertebral ligaments to decrease the risk of complications. PATIENTS AND METHODS: Twenty-eight patients received a permanent cervical spinal cord stimulator. A C0-C1 retrograde insertion was performed with careful dissection of the meningo-vertebral ligaments. Complications were registered during the follow-up (mean 44.6 months [SD = 43, range 1-162 months]). RESULTS: Six complications were observed 93% of the patients reported a significant reduction in pain. CONCLUSIONS: We describe an additional surgical detail for the known procedure for retrograde placement of high cervical plate electrodes. This surgical detail might result in a lower risk of complications. We present a case series of 28 patients to support this hypothesis.

Spinal Cord Stimulation for the Treatment of Failed Neck Surgery Syndrome: Outcome of a Prospective Case Series.

OBJECTIVES: Spinal cord stimulation (SCS) is an accepted, cost-effective treatment option for a variety of chronic pain syndromes, including failed back surgery syndrome (FBSS). The application of SCS in the cervical spine, particularly for pain after cervical spine surgery, has been drawn into question in recent years by payers due to a purported lack of clinical evidence. To challenge this claim, we analyzed data from a prospective registry to support the use of SCS in the cervical spine for pain after spine surgery. MATERIALS AND METHODS: Data from the EMPOWER and PAIN registries were analyzed on patients diagnosed with pain after neck surgery (C-FBSS) for the following outcomes: patient reported percent pain relief (PRPR), pain disability index (PDI), quality of life (QoL), and satisfaction at 3-, 6-, and 12-month post-implantation. Statistical analysis was provided for all measures. RESULTS: Fifteen patients with C-FBSS were successfully implanted with SCS leads in the cervical spine. PRPR was 65.2%, 62.4%, and 71.9% at 3-, 6-, and 12-month post-implantation, respectively. PDI scores were significantly reduced from baseline (51.21-23.70 at 12 months, p = 0.001). At one-year post-implantation, the average overall QoL was reported to be improved/greatly improved and patient satisfaction was rated satisfied/greatly satisfied. CONCLUSIONS: For many, the application of SCS in the neck for pain after surgery is based on the obvious similarities to FBSS or anecdotal experience rather than published data. The data contained herein suggest SCS for C-FBSS is an effective therapy that improves QoL and patient satisfaction, as well as decreasing pain and PDI. The use of successful application of neurostimulation as a therapy has largely been predicated on the principles of patient selection, implantation technique, and stimulation parameters. As such, SCS would appear to be an appropriate and valid treatment for C-FBSS that requires further study and investigation to make additional recommendations.