Background. BANDAIDE aka Back and Neck Discomfort relief with Altered behaviour, Intelligent Postures, Dynamic movement and Exercises (ISBN - 0995676933) is a concise self-help booklet containing strengthening exercises and illustrated information to enable patients self-manage their back and neck pain. The aim of this preliminary audit was to determine patient opinion on BANDAIDE. Institutional audit approval was obtained – No. 8429. Methods and Results. BANDAIDE was distributed to 40 patients, who were asked to evaluate the booklet using the Usefulness Scale for Patient Information Material (USE). USE consists of nine positive statements which are subdivided into three sub-domains; cognition, emotional and behavioural. The cognition sub-domain assesses the knowledge obtained from the material, the emotional sub-domain evaluates the effects of the material on an individual's ability to cope with the illness and the behavioural sub-domain assesses ability to self-manage. Responders were required to rate the extent to which they agreed with each of the nine statements on a scale of 0 to 10, where 0 denotes ‘completely disagree’ and 10 denotes ‘completely agree’. Each subsection is on a scale of 0–30, with a higher score suggesting better usefulness. 23 participants provided their opinions of BANDAIDE through the USE. For the three sub-domains, the mean ratings for cognition, emotional and behavioural were 27.2, 24.7, and 26.4 respectively. Conclusions. This preliminary audit suggests that BANDAIDE provides coherent advice that enables a patient to self-manage their back and neck pain. Nevertheless, the opinions of a larger cohort should be pursued to obtain more robust conclusions. Conflict of Interest: George Ampat sells the BANDAIDE booklet online through Amazon and other platforms. S Rhodes and J Sims are employed by Talita Cumi Ltd, of which Bandaide is a trading name. Shantanu Kundu is a medical student and has no conflict of interest. Sources of funding: No funding was obtained

Purpose. Even though various factors have been associated with neck pain, skeletal muscle mechanical properties have been cited among the leading causes of neck pain. Changes in skeletal muscle stiffness may be related to chronic neck pain and these changes may be associated with the severity of pain and disability in patients with chronic neck pain. The purpose of the present study was to investigate differences in neck muscle stiffness between patients with chronic neck pain and asymptomatic control group. Another purpose of the study was to investigate the relationship of muscle stiffness with the severity of physical disability and pain in patients with chronic neck pain. Methods. A cross-sectional case-control study with 86 participants (43 patients with chronic neck pain and 43 age-matched asymptomatic controls) was designed. The present study included patients with a pain intensity level of 20 or more based on the Numerical Rating Scale (NRS) and a total disability level of 10 or more based on the Neck Disability Index (NDI). Ultrasonic evaluation of upper trapezius, splenius capitis, and sternocleidomastoid muscle performed with the ACUSON S3000 Ultrasonography Device using Siemens 9L4 (4–9 MHz) linear-array ultrasound probe. Shear Wave Velocity (SWV) of selected muscles was obtained using customized software, Virtual Touch Imaging and Quantification® (Siemens Medical Solution, Mountain View, CA, USA). Results. SWV of splenius capitis was similar in both groups (p=0.979); however, SWV of upper trapezius (p<0.001) and sternocleidomastoid (p=0.003) of the patients with chronic neck pain were higher compared to the asymptomatic controls groups. NRS score did not correlate with SWV of upper trapezius (r=−0.27, p=0.085), sternocleidomastoid (r=−0.02, p=0.879) and splenius capitis (r=0.01, p= 0.990). Similarly, NDI score did not correlate with SWV of upper trapezius (r=−0,09 p=0.567), sternocleidomastoid (r=0.15, p=0.345) and splenius capitis (r=0.18, p= 0.274). Conclusions. SWV of splenius capitis muscle stiffness was found similar in both groups, but SWV of upper trapezius and sternocleidomastoid muscle were found increased in patients with neck pain compared to asymptomatic controls groups. In addition, severity of pain and disability did not relate to stiffness of these muscles in patient with chronic neck pain

Introduction The aim of the study was to determine the prevalence of different causes of neck pain in a private practice clinic by a retrospective audit of records. Methods The study included all consecutive patients attending a private spine pain clinic in the state of Washington, USA, seen between January 2003 and January 2005, in whom a diagnosis of neck pain was made. The records of all patients were examined to determine the prevalence of various diagnostic entities determined by history, examination, and invasive tests such as controlled diagnostic blocks and provocation discography. Using different denominators, the prevalence of various conditions was determined in all patients who presented with neck pain, in patients in whom investigations were undertaken, and in patients who completed investigations. Results A large proportion of patients (35%) did not pursue investigations, which diluted the crude prevalence of various conditions. A further 17% deferred completing investigations. Amongst the 48% of patients who completed investigations, the prevalence of zygapophysial joint pain was 55%, discogenic pain was 16%, and lateral atlanto-axial joint pain was 9%. A diagnosis remained elusive in only 17% of those patients who completed investigations. Discussion In a private practice setting, a patho-anatomic diagnosis for chronic neck pain can be established in over 80% of patients, provided that appropriate investigations are undertaken. The prevalence of cervical zygapophysial joint pain encountered in the present study corroborates the prevalence rates established in academic studies. The observed prevalence of discogenic pain is probably an underestimate because not all eligible patients underwent discography

Purpose: Neck disorders, including both neck pain and injuries, are significant and increasing problem worldwide. The purpose of this study was to assess progression and current condition of patients with neck pain five years after initial treatment in the Back Pain Screening Clinic. Study design: This study was a randomised cohort Level I study. We randomly selected and reassessed one hundred patients with the neck pain who were treated conservatively out of the first one thousand of patients seen in our clinic five years ago. Outcome measures included SF36 (PCS and MCS), ODI, VAS, HA and DS scores. Methods and results: One hundred randomly selected patients were interviewed and assessed for initial complaint, progression of symptoms, time out of work, litigation, other treatments and BPSC treatment satisfaction. BPSC treatment consisted of the patient assessment, advice, education, reassurance or course of physiotherapy. All of the patients were treated conservatively. 46 male and 54 female patients with mean male age 44.85 years (SD=14.43) and mean female age 48.56 (SD=15.39) were included in the study. In 72 patients pain started spontaneously. 15 patients had pain related to industrial injury/RTA. 6 patients were excluded from the study (4 with no data available, 1 child, 1 death). Mean time out of work for patients with spontaneous onset pain was 3 weeks (SD 1.12) and for patients with industrial injury/RTA 29.24 weeks (SD 20.92) (p=0.003). Analyzing outcome measures first vs 5y showed: SF36 PCS mean 30.04 vs 51.24 (SD 7.18 vs 6.38) (p< 0.001), MCS mean 30.63 vs 53.0 (SD 11 vs 6.10) (p< 0.001), ODI 41.72 vs 13.22 (SD 19.65 vs 8.41) (p< 0.001), HA mean 8.72 vs 2.37 (SD 4.54 vs 1.32) (p< 0.001), DS mean 6.71 vs 2.01 (SD 4.12 vs 1.20) (p< 0.001) and VAS mean 4.32 vs 0.84 (SD 2.18 vs 1.03) (p< 0.001). Using the patient satisfaction questionnaire, 93% of patients found BPSC treatment useful. Conclusion: Significant symptomatic improvement is found in this cohort group of patients five years after initial treatment in BPSC. Time out of work is significantly increased in patients pursuing litigation compared with patients with spontaneous onset of neck pain (3/52 vs 29.24/52, p=0.003)

Background: The purpose of this study was to investigate the relationship between neck pain and upper limb disability. Methodology: This was a secondary analysis of neck pain patients participating in an RCT comparing usual physiotherapy with graded exercise treatment, to investigate the correlation between baseline neck pain and baseline upper limb disability. 151 neck pain patients from High Wycombe, Nottingham, Grimsby and Hull participated in the study. The measure used to assess baseline neck pain/disability was the Northwick Park Neck Pain Questionnaire (NPQ). The measure of baseline upper limb disability was the Disabilities of Arm, Shoulder, Hand (DASH). A range of variables were also measured at baseline as potential confounding variables. These included pain self efficacy, anxiety, depression, fear avoidance beliefs, coping strategies, age, gender, current smoking status, material and social deprivation and activity level. The measures were validated self administered questionnaires. Results: Pair wise analysis revealed a strong positive correlation between NPQ score and DASH score (Pearsons’ r=0.799, p< 0.001 (2 tailed), n=142). Stepwise linear regression indicated that increased severity of upper limb disability was predicted by two baseline variables: higher NPQ scores (B=0.743) and lower pain self efficacy scores (B= – 0.489) {Adjusted R2=0.708; n=100, p< 0.001}. After adjusting for potential confounding variables there remains a strong positive association between NPQ score and DASH score. Conclusions: Patients presenting with high levels of neck pain may also have high levels of upper limb disability. Upper limb disability may need to be assessed and addressed as part of the neck management process

Background: Sensorimotor mechanisms that control activation of neck and trunk muscles are important in preventing injury to spinal tissues. People with back pain often show delayed reflex activation of trunk muscles, and such impairment increases the risk of future back pain. The aim of this study was to investigate whether sensorimotor impairment is evident in patients with neck pain. Methods: Measures of sensorimotor function were assessed in fourteen patients with chronic, non-traumatic neck pain and forty healthy controls. Position sense was evaluated using the Fastrak electromagnetic tracking device to assess angular errors during head repositioning tasks. Movement sense was assessed using a KinCom dynamometer to determine the time taken to detect head motion at 1°s-1 and 10°s-1. Reflex responses were assessed using surface electromyography to determine the onset of muscle activation (reflex latency) in trapezius and sternocleidomastoid muscles, following perturbations of the head. Results: Neck pain patients showed increased angular errors in reproducing upright postures, compared to controls (2.24±1.21° vs 1.85±1.06° respectively; p=0.01), and faster movement detection times (385±98ms vs 540±182ms respectively; p=0.0052). Reflex activation of trapezius was delayed in patients, indicated by a 20ms increase in reflex latency (89±19ms vs 69±21ms in controls; p=0.0039). Conclusions: Sensorimotor function is altered in patients with neck pain. Enhanced movement detection suggests some afferents become hypersensitive in response to pain. However, impaired position sense and reflex activation suggest that some proprioceptors, including muscle spindles, develop a reduced sensitivity to mechanical stimuli. These changes may impair reflexive muscle protection and expose the cervical spine to repetitive minor injuries. Conflicts of Interest: None. Source of Funding: BBSRC (Biotechnology and Biological Sciences Research Council, U.K.)

Background and aims. The EU-funded Back-UP project aims to develop a cloud computer platform to guide the treatment of low back and neck pain (LBNP) in first contact care and early rehabilitation. In order to identify evidence-based treatment options that can be recommended and are accessible to people with LBNP across Europe, we conducted a systematic review of recently published guidelines. Methods. Electronic databases, including Medline, Embase, CINAHL, PsycINFO, HMIC, Epistemonikos, PEDro, TRIP, NICE, SIGN, WHO, Guidelines International Network (G-I-N) and DynaMed Plus were searched. We searched for guidelines published by European health professional or guideline development organisations since 2013, focusing on the primary care management of adult patients presenting with back or neck pain (including whiplash associated symptoms, radicular pain, and pregnancy-related LBP). The AGREE-II tool was used to assess the quality of guideline development and reporting. Results. Searches generated 3098 unique citations that were screened for eligibility. A total of 189 full-texts were retrieved, and 18 guidelines were included in the review (from the UK, Germany, France, Italy, Denmark, Poland, Belgium, and the Netherlands). Data extraction showed considerable variation in guideline development processes, especially regarding the methods used for identifying, appraising, and synthesising evidence, and for formulating, agreeing, and grading recommendations. Conclusions. Recommendations for the management of LBNP cover a wide range of treatment options, with self-management advice, analgesics, and exercise proposed as core treatments by most guidelines. A narrative synthesis, taking into account consistency, strength, and quality of guideline recommendations, will be presented. No conflicts of interest. Funding: This abstract presents independent research within the Back-UP project, which has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No. 777090. This document reflects only the views of the authors, and the European Commission is not liable for any use that may be made of its contents. The information in this document is provided “as is”, without warranty of any kind, and accept no liability for loss or damage suffered by any person using this information

Background and objectives. Numerous approaches are recommended for the management of non-specific neck pain (NS-NP). However, the extent to which approaches are used is unclear. This survey investigated current UK physiotherapists' measurement and management of patients with NS-NP. Methods and results. Physiotherapists were invited to participate in an online survey if they were practicing in the UK and had experience of managing NS-NP. 2101 responses were received. Analysis of the results indicated the overall popularity of active treatment approaches with 84% and 61% of respondents employing exercise and patient education respectively. 48% of respondents reported using a multimodal approach (that is, combination of exercise and manual therapy with/without patient education). Over a third of respondents reported not using outcome measures (OMs) for NS-NP. Of the two-thirds who reported using OMs, the majority reported using pain and range of motion measures. Physical and functional limitations, psychological distress, and quality of life constructs, which are frequently associated with NS-NP, were rarely measured. Conclusion. The active interventions most frequently used in the management of NS-NP were supported by moderate to strong evidence but a variety of other commonly used approaches have limited, unclear or no evidence of efficacy. Multimodal treatment approaches that are supported by strong evidence of efficacy are less commonly used. Physiotherapists in the UK are inadequately evaluating NS-NP. Research and guidelines are needed to reduce the use of ineffective interventions, promote the use of multimodal care and develop high quality outcome measures that are relevant and feasible for use in clinical practice. Keywords. Health, survey, neck pain, non-specific, rehabilitation. Conflicts of interest: None. Sources of funding: None

Chronic pain and psychosocial distress are generally thought to be associated in chronic musculoskeletal disorders such as non-specific neck pain. However, it is unclear whether a raised level of anxiety is necessarily a feature of longstanding, intense pain amongst patient and general population sub-groups. Post-hoc analysis. In a cohort of 70 self-selected female, non-specific neck pain sufferers, we observed relatively high levels of self-reported pain of 4.46 (measured on the 11 point numerical pain rating scale (NRS-101)) and a longstanding duration of symptoms (156 days/year). However, the mean anxiety scores observed (5.49), fell well below the clinically relevant threshold of 21 required by the Beck Anxiety Inventory. The cohort was stratified to further distinguish individuals with higher pain intensity (NRS>6) and longer symptom duration (>90 days). Although a highly statistically significant difference (p=0.000) was subsequently observed with respect to pain intensity, in the resulting sub-groups, none such a difference was noted with respect to anxiety levels. Our results indicate that chronic, intense pain and anxiety do not always appear to be related. Explanations for these findings may include that anxiety is not triggered in socially functional individuals, that individual coping strategies have come into play or in some instances that a psychological disorder like alexithymia could be a confounder. More studies are needed to clarify the specific role of anxiety in chronic non-specific musculoskeletal pain before general evidence-driven clinical extrapolations can be made

Purpose: Currently, there is limited research on the effectiveness of rehabilitative exercises for neck pain patients generally, and chronic neck pain patients in particular. Interestingly, recent evidence suggests that dysfunction of cervicocephalic kinaesthesia, as measured by head repositioning accuracy (HRA), is present in many chronic patients, and that active eye-head-neck co-ordination exercises may be useful in terms of patients’ rehabilitation. The purpose of this study was twofold: i) to determine if there was a difference in HRA in chronic neck pain subjects versus controls; ii) to assess the effect of a rehabilitative exercise programme on chronic neck pain subjects’ HRA and reported levels of pain. Method: A prospective, intervention study on a convenience sample of chronic neck pain subjects (> 3 months duration) versus age- and gender-matched, asymptomatic control subjects was conducted. Exclusion criteria included any form of active treatment (> 1 per month) for musculoskeletal complaints, including medication, as well as any arthritic, orthopaedic, or neurological disorder. Both symptomatic and asymptomatic subjects were assigned, via stratified, random allocation, to either a rehabilitative exercise or non-exercise group. This gave rise to 4 groups. Symptomatic and asymptomatic exercise subjects were given a training session as well as written and verbal instructions on how to perform the eye-head-neck co-ordination exercises. Subjects were asked to perform the exercises twice daily over a 4-week period, and to keep a diary of exercise compliance and any associated symptomatology. Outcomes included HRA for all active cervical range-of-motion, measured by a helmet-mounted laser pointer on a paper target, and pain intensity as measured by a 100 mm visual analogue scale (VAS). Outcomes were measured in all subjects at baseline, end of week 2, and end of week 4. Results: 63 subjects were recruited, of which 56 completed the 4-week study. 28 chronic neck pain subjects (14 males and 14 females; mean age 22.6 years, range 19–30 years), and 28 asymptomatic controls (14 males and 14 females; mean age 23.9 years, range 19–31 years) were assigned via stratified random allocation, to an exercise or non-exercise group. Each of the 4 groups contained 14 subjects. Active HRA was found to be significantly reduced in neck pain subjects compared to control subjects (ANOVA, p< 0.001). Whiplash patients (N=17) in particular, were significantly less precise (ANOVA, p< 0.001). A significant reduction in reported pain was experienced by the symptomatic exercise versus symptomatic non-exercise group (ANOVA, p< 0.001). At 4-weeks, the symptomatic exercise group demonstrated significantly improved HRA in all active movements compared to the other groups (ANOVA, p< 0.001). Conclusions: This study provides evidence that simple, eye-head-neck co-ordination exercises may be helpful in reducing functional impairment in terms of cervicocephalic kinaesthesia as well as reported levels of pain in chronic neck pain subjects

Background: Neck pain is a common problem accounting for up to 22% of the workload of physiotherapists. Many different approaches are used and the evidence for these is unclear. Purpose: To evaluate the effectiveness of a brief physiotherapy intervention (1–3 sessions) for patients with neck pain in the primary care setting, taking preferences into account. Method: A Randomised controlled trial (n=268) compared a brief physiotherapy intervention based on cognitive-behavioural principles with ‘usual’ physiotherapy. Patients from physiotherapy waiting lists aged 18 – 87 years with neck pain of musculoskeletal origin of more than 2 weeks duration were invited to participate. Their preferences for type of treatment were elicited independently of randomisation. The brief intervention aimed to facilitate problem-solving, encourage self-management and early return to normal function. Physiotherapists undertook a one-day training programme in communication skills and cognitive-behavioural approaches. In the ‘Usual’ physiotherapy intervention treatment was provided at the discretion of the individual physiotherapist. The main outcome measures were the Neck Pain Questionnaire, a specific measure of functional disability due to neck pain, the SF-36 a generic health-related quality of life measure, the Tampa Scale for Kinesophobia, a measure of fear- and-avoidance of movement and the use of healthcare services. Data was collected at baseline, at 3 months and at 12 months. Results: Patients randomised to the ‘Usual’ physiotherapy group were significantly improved compared with the Brief Intervention group, 12 months after randomisation. However, the differences were small and patients randomised to the Brief Intervention who preferred that arm of the study also improved to a similar degree. In contrast, patients who wanted ‘Usual’ physiotherapy but got the brief Intervention did not improve. Conclusions: The Brief intervention may be effective for patients who prefer the option of a one-off treatment of advice. It is also cheaper and should therefore be offered as an option.ot

This case report describes a patient with thoracic plasmacytoma, an uncommon haematological malignancy, who presented with neck pain. Plasmacytoma is a neoplastic proliferation of B cell lineage but is much less common than multiple myeloma. The histological examination of multiple myeloma and plasmacytoma is identical however in plasmacytoma there is a solitary lesion with negative skeletal survey, negative bone marrow aspirate and little or no myeloma protein detected in the blood. This makes it more challenging to diagnose and a high index of suspicion is required

Introduction Although manual therapists believe that they can diagnose symptomatic joints in the neck by manual examination, that conviction is based on only one study. That study claimed that manual examination of the neck had 100% sensitivity and 100% specificity for diagnosing painful zygapophysial joints. However, the study indicated that its results should be reproduced before they could be generalized. The present study was undertaken to answer the call for replication studies. The objective was to determine the sensitivity, specificity, and likelihood ratio of manual examination for the diagnosis of cervical zygapophysial joint pain. The study was conducted in a private practice located in a rural town. The practice specialised in musculoskeletal pain problems. Methods Patients who exhibited the putatively diagnostic physical signs of cervical zygapophysial joint pain were referred to a radiologist who performed controlled, diagnostic blocks of the suspected joint, and other joints if indicated. The results of the blocks constituted the criterion standard, against which the clinical diagnosis was compared, by creating contingency tables. The validity of manual diagnosis was determined by calculating its sensitivity, specificity, and positive likelihood ratio. Results The study sample was 173 patients with neck pain in whom cervical zygapophysial joint pain was suspected on clinical examination, and who were willing to undergo controlled diagnostic blocks of the suspected joint or joints. Manual examination had a high sensitivity for cervical zygapophysial joint pain, at the segmental levels commonly symptomatic, but its specificity was poor. Likelihood ratios barely greater than 1.0 indicated that manual examination lacked validity. Although the results obtained were less favourable than those of the previous study, paradoxically they were statistically not different. Discussion The present study found manual examination of the cervical spine to lack validity for the diagnosis of cervical zygapophysial joint pain. It refutes the conclusion of the one previous study. The paradoxical lack of statistical difference between the two studies is accounted for by the small sample size of the previous study

Summary. Each patient received Cognitive Reassurance appropriate for and proportionate to his/her capacity through evidence informed explanation/education to enhance effective self-care and realistic self-management. Background and pathway. Changes to back and neck pain commissioning by our CCG required GPs not to refer to manual therapy until six weeks and upgrade GP care beyond that previous. 100 consecutive patients requesting GP appointment reporting back/neck pain were directed to a pragmatic service provided by an experienced manual therapy practitioner. Cognitive Reassurance reflecting evidenced informed biopsychosocial and salutogenic thinking was given at initial consultation/assessment. Patients were contacted at 10 and 20 days to ascertain their status. One sub-group suggested an opportunity for long-term follow-up. Pilot Objectives. Providing Cognitive Reassurance for achieving greater levels of patient engagement with self-management. Demonstrate full clinical triage by primary care providers is effective/practical. Demonstrate a need for appropriate contracting models. ————————–. Outcomes 100 patients. Wait time. 2d. Inappropriate self-referral directed to GPs. 25%. DNAs. 7%. Referral for medication –. 28%. Prescribed AQP manual therapy. 35%. Outcomes 36 patients decided at 20 days no further treatment needed . Treatments averaged. 1.8/pt (Range 0–4). Patients deciding no treatment needed beyond initial consultation. 4%. Patients requesting further consultation during the 12 months following:. 4%. Conclusion. Patient experience measured by an external moderator showed 94% highly satisfied or satisfied. Clinical triage was acceptable to patients and GPs. Adapting to the needs of each patient requires a more pragmatic model of contracting to be created. The opportunity for a further pilot are considered

Aims. Surgical approaches to cervical ossification of the posterior longitudinal ligament (OPLL) remain controversial. The purpose of the present study was to analyze and compare the long-term neurological recovery following anterior decompression with fusion (ADF) and posterior laminectomy and fusion with bone graft and internal fixation (PLF) based on > ten-year follow-up outcomes in a single centre. Methods. Included in this retrospective cohort study were 48 patients (12 females; mean age 55.79 years (SD 8.94)) who were diagnosed with cervical OPLL, received treatment in our centre, and were followed up for 10.22 to 15.25 years. Of them, 24 patients (six females; mean age 52.88 years (SD 8.79)) received ADF, and the other 24 patients (five females; mean age 56.25 years (SD 9.44)) received PLF. Clinical data including age, sex, and the OPLL canal-occupying ratio were analyzed and compared. The primary outcome was Japanese Orthopaedic Association (JOA) score, and the secondary outcome was visual analogue scale neck pain. Results. Compared with the baseline, neurological function improved significantly after surgery in all patients of both groups (p < 0.001). The JOA recovery rate in the ADF group was significantly higher than that in the PLF group (p < 0.001). There was no significant difference in postoperative cervical pain between the two groups (p = 0.387). The operating time was longer and intraoperative blood loss was greater in the PLF group than the ADF group. More complications were observed in the ADF group than in the PLF group, although the difference was not statistically significant. Conclusion. Long-term neurological function improved significantly after surgery in both groups, with the improvement more pronounced in the ADF group. There was no significant difference in postoperative neck pain between the two groups. The operating time was shorter and intraoperative blood loss was lower in the ADF group; however, the incidence of perioperative complications was higher. Cite this article: Bone Jt Open 2024;5(9):768–775

Mental disorders in particular depression and anxiety have been reported to be prevalent among patients with spinal pathologies. Goal of the current study was to analyze the relationship of Zung pre- and post-op score to other PROs and length of stay. Secondary outcomes included revision surgery and post-operative infections. Data from the international multicenter prospective spine degenerative surgery data repository, DegenPRO v1.1 (AO Spine Knowledge Forum Degenerative) were utilized. Patients undergoing cervical or lumbar procedure were included. Patient's demographics, Charlson Comorbidity Index, surgical information, Zung score, NDI, pain related PROs and EQ-5D, and complications at surgery and at various post-op time periods. Except for hospital duration, data were analyzed, using multivariable mixed linear models. A robust linear regression model was used to assess the association between Zung score and hospital duration. All models were adjusted for gender and age. 42 patients had Zung score administered. Among those patients 22 (52%) were within normal range, 18 (43%) were mildly and 2 (5%) severely depressed. 62% of the patients had a lumbar pathology with fusion procedures being the most common. Median EQ-5D (3L) score at surgery was significantly higher (0.7, IQR: 0.4-0.7) for patients within normal range than for those with mild (0.4, IGR: 0.3-0.7) or severe depression (0.3, IQR: 0.3-0.3, p-value: 0.05). Compared to patients within normal Zung range, mixed models, indicated lower EQ-5D (3L) score values and higher values for neck and arm pain at surgery with both PROs and EQ-5D (3L) improving in patients with depression over the follow-up time. No association was found between Zung score and hospital length of stay. The initial analysis showed that 43% of the patients were mildly depressed and mainly male patients. Zung score was correlated with post-operative improvements in EQ-5D and arm and neck pain PROs

Purpose and background. To evaluate the clinical and cost-effectiveness of a physical and psychological group intervention (BOOST programme) compared to physiotherapy assessment and advice (best practice advice [BPA]) for older adults with neurogenic claudication (NC) which is a debilitating spinal condition. Methods and results. A randomised controlled trial of 438 participants. The primary outcome was the Oswestry Disability Index (ODI) at 12 months. Data was also collected at 6 months. Other outcomes included Swiss Spinal Stenosis Questionnaire (symptoms), ODI walking item, 6-minute walk test (6MWT) and falls. The analysis was intention-to-treat. We collected the EQ5D and health and social care use to estimate cost-effectiveness. Participants were, on average, 74.9 years old (SD 6.0). There was no significant difference in ODI scores between groups at 12 months (adjusted mean difference (MD): −1.4 [95% Confidence Intervals (CI) −4.03,1.17]), but, at 6 months, ODI scores favoured the BOOST programme (adjusted MD: −3.7 [95% CI −6.27, −1.06]). Symptoms followed a similar pattern. The BOOST programme resulted in greater improvements in walking capacity (6MWT MD 21.7m [95% CI 5.96, 37.38]) and ODI walking item (MD −0.2 [95% CI −0.45, −0.01]) and reduced falls risk (odds ratio 0.6 [95% CI 0.40, 0.98]) compared to BPA at 12 months. Probability that the BOOST programme is cost-effective ranged from 67%–89% across cost-effectiveness thresholds. Conclusions. The BOOST programme improves mobility and reduces falls in older adults with NC compared to BPA at 12 months follow-up. It is good value for the NHS. Future iterations of the programme will consider ways to reduce symptoms and disability long-term. Conflicts of interest: No conflicts of interest. Sources of funding: National Institute of Health Research – Programme for Applied Research NIHR - PTC-RP-PG-0213-20002: Better Outcomes for Older people with Spinal Trouble (BOOST). Publication and presentations: The clinical effectiveness paper has just been accepted for publication in the Journal of Gerontology Series A. The health economic analysis is not yet published. It was presented at the Physiotherapy UK conference and the International Back and Neck Pain Forum in 2021

Introduction. Studies have addressed the issue of increasing prevalence of work-related musculoskeletal (MSK) pain among different occupations. However, contributing factors to MSK pain have not been fully investigated among orthopaedic surgeons. Thus, this study aimed to approximate the prevalence and predictors of MSK pain among Saudi orthopaedic surgeons working in Riyadh, Saudi Arabia. Methods. A cross-sectional study using an electronic survey was conducted in Riyadh. The questionnaire was distributed through email among orthopaedic surgeons in Riyadh hospitals. Standardized Nordic questionnaires for the analysis of musculoskeletal symptoms were used. Descriptive measures for categorical and numerical variables were presented. Student’s t-test and Pearson’s χ2 test were used. The level of statistical significance was set at p ≤ 0.05. Results. The response rate was 80.3%, with a total number of 179 of Saudi orthopaedic surgeons (173 males and six females). Of our sample, 67.0% of the respondents complained of having MSK pain. The most commonly reported MSK pain was lower back (74.0%), followed by neck (58.2%). Age and body mass index were implicated in the development of more than one type of MSK pain. Increased years of experience (≥ 6 years) was linked to shoulder/elbow, lower back, and hip/thigh pain. Smoking is widely associated with lower back pain development, whereas physicians who do not smoke and exercise regularly reported fewer pain incidences. Excessive bending and twisting during daily practice have been correlated with increased neck pain. Conclusion. MSK pain was found to be common among Saudi orthopaedic surgeons. Further extensive research should be conducted to understand and analyze the risk factors involved and search for possible improvements to avoid further complications. However, ergonomics education during surgical training could be effective at modifying behaviors and reducing MSK pain manifestations

Background and objectives. The Alexander Technique (AT) is a self-care method usually taught in one-to-one lessons. AT lessons have been shown to be helpful in managing long-term health-related conditions (Int J Clin Pract 2012;66:98−112). This systematic review aims to draw together evidence of the effectiveness of AT lessons in managing musculoskeletal (MSK) conditions, with empirically based evidence of physiological changes following AT training, to provide a putative theoretical explanation for the observed benefits of Alexander lessons. Methods and results. Systematic searches of a range of databases were undertaken to identify prospective studies evaluating AT instruction for any musculoskeletal condition, using PICO criteria, and for studies assessing the physiological effects of AT training. Citations (N=332) were assessed and seven MSK intervention studies were included for further analysis. In two large well-designed randomised controlled trials, AT lessons led to significant long-term (1 year) reductions in pain and incapacity caused by chronic back or neck pain (usual GP-led care comparator). Three smaller RCTs in chronic back and neck pain, respectively, and a pain clinic service evaluation broadly supported these findings. A pilot study reported preliminary evidence for pain reduction in knee osteoarthritis patients. Further studies showed significant improvements in general coordination, walking gait, motor control and balance, possibly resulting from improved postural muscle tone regulation and adaptability, in people with extensive AT training. Conclusion. Available evidence supports the effectiveness of AT lessons for people with chronic back or neck pain. Studies suggest some of the observed benefit may be due to improvements in movement coordination, balance and postural tone. Conflicts of interest: None. Authors are practising Alexander Technique teachers. Funding: None

Cervical total disc replacement has been in practice for years now as a viable alternative to cervical fusion in suitable cases, aspiring to preserve spinal motion and prevent adjacent segment disease. Reports are rife that neck pain emerges as an annoying feature in the early postoperative period. The facet joint appears to be the most likely source of pain. 50 patients were prospectively followed up through 5 years after having received disc replacement surgery, indicated for symptomatic soft disc herniation of the cervical spine presenting with radiculopathy. • All were skeletally mature and aged between 22 to 50. • All had failed a minimum of 6 months conservative therapy. • Up to 2 disc levels were addressed. C3 till C7 levels. • Single surgeon (first author). • NDI > 30% (15/50). • Deteriorating radicular neurology. We excluded those with degenerative trophic changes of the cervical spine, focal instability, trauma, osteoporosis, previous cervical spine surgery, previous infection, ossifying axial skeletal disease and inflammatory spondyloarthritides. The device used was an unconstrained implant with stabilizing teeth. Over the 5 years, we studied their postoperative comfort level via the Neck Disability Index (NDI) and Visual Analogue Score (VAS). Pre-operative and post-operative analysis of the sagittal axis and of involved facet joints were done. 22 patients suffered postoperative neck pain as reflected by the NDI and VAS scores. Of these, 10 reported of neck pain even 24 months after surgery. However, none were neurologically worse and all patients returned to their pre-morbid functions and were relieved of pain by 28 months. All 22 patients reported of rapid dissolution of neckache after peri-facetal injections of steroids were done under image guidance. We draw attention to the facet joint as the pain generator, triggered by inappropriate implant height, eccentric stresses via hybrid constructs, eccentric loading due to unconstrained devices and unaddressed Luschka joint degeneration. Such factors require careful selection of patients for surgery, necessitate proper pre-operative templating and call for appropriate technical solutions during surgery