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Bone & Joint Research
Vol. 12, Issue 6 | Pages 387 - 396
26 Jun 2023
Xu J Si H Zeng Y Wu Y Zhang S Shen B

Aims. Lumbar spinal stenosis (LSS) is a common skeletal system disease that has been partly attributed to genetic variation. However, the correlation between genetic variation and pathological changes in LSS is insufficient, and it is difficult to provide a reference for the early diagnosis and treatment of the disease. Methods. We conducted a transcriptome-wide association study (TWAS) of spinal canal stenosis by integrating genome-wide association study summary statistics (including 661 cases and 178,065 controls) derived from Biobank Japan, and pre-computed gene expression weights of skeletal muscle and whole blood implemented in FUSION software. To verify the TWAS results, the candidate genes were furthered compared with messenger RNA (mRNA) expression profiles of LSS to screen for common genes. Finally, Metascape software was used to perform enrichment analysis of the candidate genes and common genes. Results. TWAS identified 295 genes with permutation p-values < 0.05 for skeletal muscle and 79 genes associated for the whole blood, such as RCHY1 (PTWAS = 0.001). Those genes were enriched in 112 gene ontology (GO) terms and five Kyoto Encyclopedia of Genes and Genomes pathways, such as ‘chemical carcinogenesis - reactive oxygen species’ (LogP value = −2.139). Further comparing the TWAS significant genes with the differentially expressed genes identified by mRNA expression profiles of LSS found 18 overlapped genes, such as interleukin 15 receptor subunit alpha (IL15RA) (PTWAS = 0.040, PmRNA = 0.010). Moreover, 71 common GO terms were detected for the enrichment results of TWAS and mRNA expression profiles, such as negative regulation of cell differentiation (LogP value = −2.811). Conclusion. This study revealed the genetic mechanism behind the pathological changes in LSS, and may provide novel insights for the early diagnosis and intervention of LSS. Cite this article: Bone Joint Res 2023;12(6):387–396


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_15 | Pages 39 - 39
7 Aug 2024
Kimber D Husselbee R Brown L Ruffinato C
Full Access

Purpose/Background. Health inequalities are defined as unfair and avoidable differences in health across the population. People belonging to inclusion health groups are most at risk of experiencing these inequalities and tackling them is an NHS priority. Inclusion health groups include ‘people in contact with the justice system’ and BCHC NHS FT is commissioned to provide physiotherapy to prisoners at HMP Birmingham. The purpose of this study was to better understand the MSK health-status and MSK conditions affecting this minoritised patient population. Methods/Results. The MSK service at HMP Birmingham collects the MSK-HQ PROM for all prisoners attending physiotherapy. A retrospective analysis of the electronic patient record was performed using convenience sampling, with baseline MSK-HQ scores of prisoners seen between 01/04/2023 and 01/02/2024 captured alongside the primary presenting MSK condition. Simple descriptive statistics were used to evaluate the data. A total of 129 patients attended initial physiotherapy appointments within the time-period. Baseline MSK-HQ was collected for 62 patients (48%) with a mean (SD) score of 23.08(11.38). The most common MSK condition was Back pain with a count of 12(19.35%). The mean (SD) MSK-HQ score for prisoners with back pain was 22.08(9.98). Conclusion. This is the first known evaluation in the published literature of the baseline MSK health-status and primary MSK conditions affecting prisoners. A published evaluation of baseline MSK health-status for patients attending a community MSK service reported a mean (SD) MSK-HQ of 28.59(10.80) indicating that, a poorer MSK health-status is experienced by this minoritised group. Further work, co-produced with prisoners, is planned to explore further. Conflicts of interest. None. Sources of funding. None


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 4 - 4
1 Sep 2019
Gross D Steenstra I Shaw W Yousefi P Bellinger C Zaïane O
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Purposes and Background. Musculoskeletal disorders including as back and neck pain are leading causes of work disability. Effective interventions exist (i.e. functional restoration, multidisciplinary biopsychosocial rehabilitation, workplace-based interventions, etc.), but it is difficult to select the optimal intervention for specific patients. The Work Assessment Triage Tool (WATT) is a clinical decision support tool developed using machine learning to help select interventions. The WATT algorithm categorizes patients based on individual, occupational, and clinical characteristics according to likelihood of successful return-to-work following rehabilitation. Internal validation showed acceptable classification accuracy, but WATT has not been tested beyond the original development sample. Our purpose was to externally validate the WATT. Methods and Results. A population-based cohort design was used, with administrative and clinical data extracted from a Canadian provincial compensation database. Data were available on workers being considered for rehabilitation between January 2013 and December 2016. Data was obtained on patient characteristics (ie. age, sex, education level), clinical factors (ie. diagnosis, part of body affected, pain and disability ratings), occupational factors (ie. occupation, employment status, modified work availability), type of rehabilitation program undertaken, and return-to-work outcomes (receipt of wage replacement benefits 30 days after assessment). Analysis included classification accuracy statistics of WATT recommendations for selecting interventions that lead to successful RTW outcomes. The sample included 5296 workers of which 33% had spinal conditions. Sensitivity of the WATT was 0.35 while specificity was 0.83. Overall accuracy was 73%. Conclusion. Accuracy of the WATT for selecting successful rehabilitation programs was modest. Algorithm revision and further validation is needed. No conflicts of interest. Sources of funding: Funding was provided by the Workers' Compensation Board of Alberta


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 59 - 59
1 Sep 2019
Speijer L Soer R Reneman M Stegeman P Dutmer A
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Background. The aim of the Groningen Spine Center (GSC) is to provide personalized and effective interventions to patients with spine-related disorders. The GSC comprises a multidisciplinary team to triage and treat patients most optimally. Aim. To investigate the patient reported clinical results of the treatments of the GSC during seven years of its existence. Patients and methods. The basis of this study is a natural cohort of all patients admitted to the GSC. Treatments existed of rehabilitation, surgery, anesthesiology, medication, referral to else, advice and self-management, or any combination of the above. Baseline characteristics, pain (Numeric Rating Scale; NRS), disability (Pain Disability Index; PDI) and quality of life (Euroqol 5-D;EQ5D) were obtained at baseline and discharge. Per calendar year, effects will be presented. Descriptive statistics, effect sizes and t-tests were calculated. Results are compared to the minimal clinically important change (MCIC) of the corresponding scales. Results. In total, 9.897 patients (43% male, mean age 49.2±16.1 yrs) were analyzed on T0, of whom 1.373 filled in a discharge questionnaire. All measures showed statistically significant changes (p<0.01), but for pain and disability mean changes were not always higher than the clinical important change. Effect sizes (d) for pain ranged between 0.44 and 1.01, for disability between 0.40 and 0.80, and for quality of life between 0.41 and 0.76. Conclusion. The Groningen Spine Center provides positive patient reported results over the past 7 years Effect sizes are moderate to high. The results are considered to be clinically important to patients. Non-response and regression to the mean may be sources for bias and should be topic for further research. No conflicts of interest. No funding obtained


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 33 - 33
1 Sep 2019
Dutmer A Reneman M Wolff A Soer R Preuper HS
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Introduction. A minority of patients with chronic low back pain (CLBP) account for a majority of disability and costs. This subgroup has potentially most to gain from effective treatment. The Groningen Spine Cohort will provide a 10-year prospective insight into the burden of CLBP for patients referred to multispecialty tertiary spine care in the Netherlands. This study reports first baseline results. Objective. To study the personal and societal impact of CLBP in patients visiting the UMCG tertiary spine center. Patients. Adult patients with CLBP. Methods. Patient-reported baseline questionnaire and health insurance costs one year prior to visiting the Spine Center. Primary outcomes: NIH minimal dataset Impact Stratification score (range 8–50), functioning (Pain Disability Index, PDI; 0–70), quality of life (EuroQol-5D, EQ5D; -0.33–1.00), work ability (single-item Work Ability Score, WAS; 0–10), work participation (absenteeism, disability), and health insurance costs. Descriptive statistics were applied. Results. N=1503 patients (age m=46.3, sd=12.8 years, 57% female) were included. NIH Impact Stratification m=35.2±7.5; severe impact (≥35) for 58% of patients. PDI = 38.2±14.1; EQ5D = 0.44±0.30; WAS = 3.8±2.9. Absenteeism: 43% of workers. Permanent work disability: 17%. Health insurance costs: med= €2432, IQR €4739. Discussion And Conclusions. In patients seeking multispecialty tertiary spine care, the personal and societal impact of CLBP is very high. Costs are substantially higher than what is already known about the burden of the average patient with CLBP. Clinical Message. More effective personalized stepped and matched care is urgently needed to reduce the burden of CLBP in a subgroup of patients seeking multispecialty tertiary spine care. No conflicts of interest. Sources of Funding: Funding from the University Medical Center Groningen


Bone & Joint Research
Vol. 12, Issue 1 | Pages 80 - 90
20 Jan 2023
Xu J Si H Zeng Y Wu Y Zhang S Liu Y Li M Shen B

Aims

Degenerative cervical spondylosis (DCS) is a common musculoskeletal disease that encompasses a wide range of progressive degenerative changes and affects all components of the cervical spine. DCS imposes very large social and economic burdens. However, its genetic basis remains elusive.

Methods

Predicted whole-blood and skeletal muscle gene expression and genome-wide association study (GWAS) data from a DCS database were integrated, and functional summary-based imputation (FUSION) software was used on the integrated data. A transcriptome-wide association study (TWAS) was conducted using FUSION software to assess the association between predicted gene expression and DCS risk. The TWAS-identified genes were verified via comparison with differentially expressed genes (DEGs) in DCS RNA expression profiles in the Gene Expression Omnibus (GEO) (Accession Number: GSE153761). The Functional Mapping and Annotation (FUMA) tool for genome-wide association studies and Meta tools were used for gene functional enrichment and annotation analysis.


Bone & Joint Open
Vol. 5, Issue 7 | Pages 612 - 620
19 Jul 2024
Bada ES Gardner AC Ahuja S Beard DJ Window P Foster NE

Aims

People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians’ views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial).

Methods

An online cross-sectional survey was piloted by the multidisciplinary research team, then shared with clinical professional groups in the UK who are involved in the management of adults with severe, persistent LBP. The survey had seven sections that covered the demographic details of the clinician, five hypothetical case vignettes of patients with varying presentations, a series of questions regarding the preferred management, and whether or not each clinician would be willing to recruit the example patients into future clinical trials.


The Bone & Joint Journal
Vol. 106-B, Issue 11 | Pages 1333 - 1341
1 Nov 2024
Cheung PWH Leung JHM Lee VWY Cheung JPY

Aims

Developmental cervical spinal stenosis (DcSS) is a well-known predisposing factor for degenerative cervical myelopathy (DCM) but there is a lack of consensus on its definition. This study aims to define DcSS based on MRI, and its multilevel characteristics, to assess the prevalence of DcSS in the general population, and to evaluate the presence of DcSS in the prediction of developing DCM.

Methods

This cross-sectional study analyzed MRI spine morphological parameters at C3 to C7 (including anteroposterior (AP) diameter of spinal canal, spinal cord, and vertebral body) from DCM patients (n = 95) and individuals recruited from the general population (n = 2,019). Level-specific median AP spinal canal diameter from DCM patients was used to screen for stenotic levels in the population-based cohort. An individual with multilevel (≥ 3 vertebral levels) AP canal diameter smaller than the DCM median values was considered as having DcSS. The most optimal cut-off canal diameter per level for DcSS was determined by receiver operating characteristic analyses, and multivariable logistic regression was performed for the prediction of developing DCM that required surgery.


The Bone & Joint Journal
Vol. 104-B, Issue 11 | Pages 1249 - 1255
1 Nov 2022
Williamson TK Passfall L Ihejirika-Lomedico R Espinosa A Owusu-Sarpong S Lanre-Amos T Schoenfeld AJ Passias PG

Aims

Postoperative complication rates remain relatively high after adult spinal deformity (ASD) surgery. The extent to which modifiable patient-related factors influence complication rates in patients with ASD has not been effectively evaluated. The aim of this retrospective cohort study was to evaluate the association between modifiable patient-related factors and complications after corrective surgery for ASD.

Methods

ASD patients with two-year data were included. Complications were categorized as follows: any complication, major, medical, surgical, major mechanical, major radiological, and reoperation. Modifiable risk factors included smoking, obesity, osteoporosis, alcohol use, depression, psychiatric diagnosis, and hypertension. Patients were stratified by the degree of baseline deformity (low degree of deformity (LowDef)/high degree of deformity (HighDef): below or above 20°) and age (Older/Younger: above or below 65 years). Complication rates were compared for modifiable risk factors in each age/deformity group, using multivariable logistic regression analysis to adjust for confounders.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_15 | Pages 19 - 19
1 Oct 2014
Wickham N Bernard J Bishop T
Full Access

The exact prevalence of scoliosis remains unknown however it appears to be stable over time. In contrast the surgical management of spinal deformity has evolved considerably. In the UK this can be observed by examining recorded hospital statistics. Specifically the volume of procedures undertaken and preferred technique to correct deformity can be analysed and trends captured providing a comprehensive picture of changing UK practice. Annual data tables from 2000 to 2013 were downloaded from the health information and social care UK website which contains Hospital Episode Statistics (HES) data online. Numbers of completed consultant episodes for the four character primary procedure codes V41.1 (posterior attachment of correctional instrument to spine), V41.2 (anterior attachment of correctional instrument to spine), V41.4 (Anterior and posterior attachment of correctional instrument to spine), V41.8 and V41.9 (other specified and other non-specified instrumental correction of spinal deformity respectively) as main procedure where recorded. The total number of attachment of correctional instrument procedures listed as main procedure has increased significantly. The increase consists of higher numbers of posterior attachment procedures over this time from 352 in 2011–2012 to 1967 in 2012–2013 with data demonstrating a year on year increase to 2009–2010 before plateauing. Unspecified and other specified instrumental correctional spinal procedures have also contributed to the overall rise increasing from 206 in 2000–2001 to 447 in 2012–2013. Anterior attachment procedures listed as the main procedure are currently declining in number from a peak of 230 in 2005–2006 to 89 in 2012–2013. Combined posterior and anterior attachment procedures have also decreased marginally from 27 in 2009–2010 to 19 in 2012–2013. Unfortunately combined anterior and posterior procedures were not uniquely coded until 2009–2010. There is also some inherent variability in accuracy of coding which may distort HES data. Despite these limitations these results are likely to represent genuine changes in practice for the surgical correction of spinal deformity over the time period examined


The Bone & Joint Journal
Vol. 105-B, Issue 2 | Pages 166 - 171
1 Feb 2023
Ragborg LC Dragsted C Ohrt-Nissen S Andersen T Gehrchen M Dahl B

Aims

Only a few studies have investigated the long-term health-related quality of life (HRQoL) in patients with an idiopathic scoliosis. The aim of this study was to investigate the overall HRQoL and employment status of patients with an idiopathic scoliosis 40 years after diagnosis, to compare it with that of the normal population, and to identify possible predictors for a better long-term HRQoL.

Methods

We reviewed the full medical records and radiological reports of patients referred to our hospital with a scoliosis of childhood between April 1972 and April 1982. Of 129 eligible patients with a juvenile or adolescent idiopathic scoliosis, 91 took part in the study (71%). They were evaluated with full-spine radiographs and HRQoL questionnaires and compared with normative data. We compared the HRQoL between observation (n = 27), bracing (n = 46), and surgical treatment (n = 18), and between thoracic and thoracolumbar/lumbar (TL/L) curves.


Bone & Joint Open
Vol. 4, Issue 11 | Pages 832 - 838
3 Nov 2023
Pichler L Li Z Khakzad T Perka C Pumberger M Schömig F

Aims

Implant-related postoperative spondylodiscitis (IPOS) is a severe complication in spine surgery and is associated with high morbidity and mortality. With growing knowledge in the field of periprosthetic joint infection (PJI), equivalent investigations towards the management of implant-related infections of the spine are indispensable. To our knowledge, this study provides the largest description of cases of IPOS to date.

Methods

Patients treated for IPOS from January 2006 to December 2020 were included. Patient demographics, parameters upon admission and discharge, radiological imaging, and microbiological results were retrieved from medical records. CT and MRI were analyzed for epidural, paravertebral, and intervertebral abscess formation, vertebral destruction, and endplate involvement. Pathogens were identified by CT-guided or intraoperative biopsy, intraoperative tissue sampling, or implant sonication.


The Bone & Joint Journal
Vol. 106-B, Issue 1 | Pages 53 - 61
1 Jan 2024
Buckland AJ Huynh NV Menezes CM Cheng I Kwon B Protopsaltis T Braly BA Thomas JA

Aims

The aim of this study was to reassess the rate of neurological, psoas-related, and abdominal complications associated with L4-L5 lateral lumbar interbody fusion (LLIF) undertaken using a standardized preoperative assessment and surgical technique.

Methods

This was a multicentre retrospective study involving consecutively enrolled patients who underwent L4-L5 LLIF by seven surgeons at seven institutions in three countries over a five-year period. The demographic details of the patients and the details of the surgery, reoperations and complications, including femoral and non-femoral neuropraxia, thigh pain, weakness of hip flexion, and abdominal complications, were analyzed. Neurological and psoas-related complications attributed to LLIF or posterior instrumentation and persistent symptoms were recorded at one year postoperatively.


Bone & Joint Open
Vol. 4, Issue 11 | Pages 873 - 880
17 Nov 2023
Swaby L Perry DC Walker K Hind D Mills A Jayasuriya R Totton N Desoysa L Chatters R Young B Sherratt F Latimer N Keetharuth A Kenison L Walters S Gardner A Ahuja S Campbell L Greenwood S Cole A

Aims

Scoliosis is a lateral curvature of the spine with associated rotation, often causing distress due to appearance. For some curves, there is good evidence to support the use of a spinal brace, worn for 20 to 24 hours a day to minimize the curve, making it as straight as possible during growth, preventing progression. Compliance can be poor due to appearance and comfort. A night-time brace, worn for eight to 12 hours, can achieve higher levels of curve correction while patients are supine, and could be preferable for patients, but evidence of efficacy is limited. This is the protocol for a randomized controlled trial of ‘full-time bracing’ versus ‘night-time bracing’ in adolescent idiopathic scoliosis (AIS).

Methods

UK paediatric spine clinics will recruit 780 participants aged ten to 15 years-old with AIS, Risser stage 0, 1, or 2, and curve size (Cobb angle) 20° to 40° with apex at or below T7. Patients are randomly allocated 1:1, to either full-time or night-time bracing. A qualitative sub-study will explore communication and experiences of families in terms of bracing and research. Patient and Public Involvement & Engagement informed study design and will assist with aspects of trial delivery and dissemination.


The Bone & Joint Journal
Vol. 105-B, Issue 2 | Pages 172 - 179
1 Feb 2023
Shimizu T Kato S Demura S Shinmura K Yokogawa N Kurokawa Y Yoshioka K Murakami H Kawahara N Tsuchiya H

Aims

The aim of this study was to investigate the incidence and characteristics of instrumentation failure (IF) after total en bloc spondylectomy (TES), and to analyze risk factors for IF.

Methods

The medical records from 136 patients (65 male, 71 female) with a mean age of 52.7 years (14 to 80) who underwent TES were retrospectively reviewed. The mean follow-up period was 101 months (36 to 232). Analyzed factors included incidence of IF, age, sex, BMI, history of chemotherapy or radiotherapy, tumour histology (primary or metastasis; benign or malignant), surgical approach (posterior or combined), tumour location (thoracic or lumbar; junctional or non-junctional), number of resected vertebrae (single or multilevel), anterior resection line (disc-to-disc or intravertebra), type of bone graft (autograft or frozen autograft), cage subsidence (CS), and local alignment (LA). A survival analysis of the instrumentation was performed, and relationships between IF and other factors were investigated using the Cox regression model.


Bone & Joint Research
Vol. 12, Issue 4 | Pages 245 - 255
3 Apr 2023
Ryu S So J Ha Y Kuh S Chin D Kim K Cho Y Kim K

Aims

To determine the major risk factors for unplanned reoperations (UROs) following corrective surgery for adult spinal deformity (ASD) and their interactions, using machine learning-based prediction algorithms and game theory.

Methods

Patients who underwent surgery for ASD, with a minimum of two-year follow-up, were retrospectively reviewed. In total, 210 patients were included and randomly allocated into training (70% of the sample size) and test (the remaining 30%) sets to develop the machine learning algorithm. Risk factors were included in the analysis, along with clinical characteristics and parameters acquired through diagnostic radiology.


The Bone & Joint Journal
Vol. 105-B, Issue 8 | Pages 920 - 927
1 Aug 2023
Stanley AL Jones TJ Dasic D Kakarla S Kolli S Shanbhag S McCarthy MJH

Aims

Traumatic central cord syndrome (CCS) typically follows a hyperextension injury and results in motor impairment affecting the upper limbs more than the lower, with occasional sensory impairment and urinary retention. Current evidence on mortality and long-term outcomes is limited. The primary aim of this study was to assess the five-year mortality of CCS, and to determine any difference in mortality between management groups or age.

Methods

Patients aged ≥ 18 years with a traumatic CCS between January 2012 and December 2017 in Wales were identified. Patient demographics and data about injury, management, and outcome were collected. Statistical analysis was performed to assess mortality and between-group differences.


The Bone & Joint Journal
Vol. 104-B, Issue 6 | Pages 715 - 720
1 Jun 2022
Dunsmuir RA Nisar S Cruickshank JA Loughenbury PR

Aims

The aim of the study was to determine if there was a direct correlation between the pain and disability experienced by patients and size of their disc prolapse, measured by the disc’s cross-sectional area on T2 axial MRI scans.

Methods

Patients were asked to prospectively complete visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores on the day of their MRI scan. All patients with primary disc herniation were included. Exclusion criteria included recurrent disc herniation, cauda equina syndrome, or any other associated spinal pathology. T2 weighted MRI scans were reviewed on picture archiving and communications software. The T2 axial image showing the disc protrusion with the largest cross sectional area was used for measurements. The area of the disc and canal were measured at this level. The size of the disc was measured as a percentage of the cross-sectional area of the spinal canal on the chosen image. The VAS leg pain and ODI scores were each correlated with the size of the disc using the Pearson correlation coefficient (PCC). Intraobserver reliability for MRI measurement was assessed using the interclass correlation coefficient (ICC). We assessed if the position of the disc prolapse (central, lateral recess, or foraminal) altered the symptoms described by the patient. The VAS and ODI scores from central and lateral recess disc prolapses were compared.


The Bone & Joint Journal
Vol. 104-B, Issue 1 | Pages 120 - 126
1 Jan 2022
Kafle G Garg B Mehta N Sharma R Singh U Kandasamy D Das P Chowdhury B

Aims

The aims of this study were to determine the diagnostic yield of image-guided biopsy in providing a final diagnosis in patients with suspected infectious spondylodiscitis, to report the diagnostic accuracy of various microbiological tests and histological examinations in these patients, and to report the epidemiology of infectious spondylodiscitis from a country where tuberculosis (TB) is endemic, including the incidence of drug-resistant TB.

Methods

A total of 284 patients with clinically and radiologically suspected infectious spondylodiscitis were prospectively recruited into the study. Image-guided biopsy of the vertebral lesion was performed and specimens were sent for various microbiological tests and histological examinations. The final diagnosis was determined using a composite reference standard based on clinical, radiological, serological, microbiological, and histological findings. The overall diagnostic yield of the biopsy, and that for each test, was calculated in light of the final diagnosis.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_2 | Pages 7 - 7
1 Feb 2015
Zietsman B Heusch A McCarthy P
Full Access

Introduction. Research has suggested baby wearing results in happier healthier babies [1]. Various designs of carrier are available, is there one which has less impact on the biomechanics of the cervical spine?. Methods. 18 volunteers (9 male and female) performed a warm up procedure on the neck (movement through each range of motion), repeated thrice. Measurement of the active cervical range of motion (ACROM) in flexion and extension using a Cervical Range of Motion device, described in previous studies [2]. Volunteers were then allocated a baby carrier to wear including a specially designed “baby” mannequin (dimensions based on population average statistics for a 1yro). Volunteers continued with ADLs, returning after 2 hours. With the carrier removed, measurements were repeated (without warm-up). Volunteers were assessed at the same time of day, thrice (control, single carrier, double carrier) with at least 1 day between carrying. Results. ACROM measurements following the use of either single or double shoulder carrier, or no carrier showed through a paired t-test significance of <0.02, found a change from post-stretching to post-carrying in those wearing the single shoulder carrier, this was the only test period to result in a decrease in both extension and total ACROM for flexion-extension. Conclusions. Carrying an average 1 yro using a single shoulder carrier can lead to accelerated rate of change in extension of ACROM. These results may have an implication to healthy bodies, thus highly likely that choice of carrier in those with extant cervical spine dysfunction might lead to exacerbation of the problems and pain. Conflicts of interest: No conflicts of interest. Sources of funding: No funding obtained