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The efficacy of Cervical Lordosis rehabilitation for nerve root function, pain, and segmental motion in Cervical Spondylotic Radiculopathy

PUBLISHED: PhysioTherapy 2011; 97 Supplement: 846-847. https://www.researchgate.net/publication/258226733

AUTHORS: Moustafa IM, Diab AM, Ahmed A, Harrison DE.

BACKGROUND: This study was conducted to test the hypothesis that improvement of cervical lordosis in Cervical Spondylotic Radiculopathy, using 3-point bending traction, will improve the clinical features in a sample population of patients suffering from Cervical Spondylotic Radiculopathy (CSR)with defined cervical hypo-lordosis.

RELEVANCE: This study assists in the understanding of the association between sagittal curve alignment and lasting improved function providing physiotherapists with a guidelines for proper rehabilitation of CSR.

PARTICIPANTS:  Thirty patients with lower CSR and with a cervical hypo-lordosis were included in the study.

The patients were assigned randomly into two groups of equal number, study and control groups.

METHODS: Both groups received stretching exercises and infrared radiation; additionally the study group received 3 point bending cervical traction.

Treatments were applied 3 x per week for 10 weeks after which a 12 week follow up was performed. The peak to peak amplitude of dermatomal somatosensory evoked potentials (DSSEPS), absolute rotation angle (ARA C2-C7), cervical flexion-extension kinematics analysis, and visual analogue scale (VAS) were measured for all patients at three intervals (initial, after 10 weeks of treatment, and at follow up of 3 months).

ANALYSIS: The outcome measure of ARA, pain, peak to peak DSSEPS, and kinematics analysis of cervical spine were measured using repeated measures one-way ANOVA to compare measurements made at three intervals.

RESULTS: In the study group, an increase in cervical lordosis (ARA C2-C7) was found (p< 0.0001, F=49.81) and maintained at follow up. No statistically significant improvement in lordosis was found for the control group.

A significant reduction in VAS for study group after 10 weeks of treatment and at 12 weeks follow up was found.

In contrast, there was a less significant decrease in post treatment VAS and the follow up measures revealed a significant increase in the VAS score towards initial baseline values.

An inverse linear correlation between increased lordosis and VAS was found (r=-.49; p=0.0059) for both groups initially and maintained in the study group post treatment (r=-.6; p=0.0138).

At 10-week follow up, we found statistically significant improvements in DSSEPS for both groups (one way ANNOV, p< 0.0001).

However, at 12 week post treatment follow up, only the study group showed statistically significant improvement compared to initial (p < 0.006) whereas the control group values returned to baseline measurement (p<0.153).

We identified a linear correlation between initial DSSEPs and ARA for both groups (r=.65; p<0.0001), where as this relationship was only maintained in the study group at final follow-up (r=.55; p=0.033).

CONCLUSIONS: Improved lordosis in the study group was associated with significant improvements in nerve root function, VAS rating, and translational and rotational motions of the lower cervical spine.

Only in the study group were the results maintained at long-term follow up.

IMPLICATIONS: Appropriate physical rehabilitation for Cervical Spondylotic Radiculopathy should include cervical sagittal curve correction, as it is may to lead greater and longer lasting improved function.

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