Thursday, July 12, 2007

Range of Neck Motion

I've been doing some research into the type of surgery I plan to have. One question that comes up about having vertebrae fused is whether I'll still be able to move my neck all around, or how compromised I will be. (After all, having two vertebrae become one piece of bone is obviously not how the spine is designed to work; the discs are there to let the thing flex.)

Alan Hilibrand has an article in the journal Spine (Jul2006, Vol. 31 Issue 15, p1688-1692, 5p) with this abstract (emphases mine):

STUDY DESIGN.: Prospective cohort study.

OBJECTIVE.: To precisely measure the effect of anterior cervical fusion on neck motion.

SUMMARY OF BACKGROUND DATA.: Anterior cervical decompression and stabilization procedures are successful in treating recalcitrant cervical radiculopathy and cervical myelopathy. Most assume that these “fusion” procedures result in a loss of neck motion, although changes in overall motion following anterior cervical fusion have never been precisely quantified.

METHODS.: Twenty-five consecutive patients undergoing anterior cervical fusion of ne to four levels underwent cervical range of motion testing in three planes using an unconstrained instrumented linkage before surgery and more than 3 months after surgery. These data were compared with that of 10 volunteers with no prior history of neck complaints. Motion data were compared between patients and volunteers, and between the patients before surgery and at last follow-up, using RMANOVA and Fisher’s PLSD post hoc test.

RESULTS.: Before surgery, the patients had significantly less motion than the volunteers in all directions. Following surgical fusion, patients gained a statistically significant amount of motion in all planes, although they did not achieve the motion seen among the volunteers. Gains in motion were seen among all patients, including those undergoing four-level fusions, and there was no correlation between postoperative motion and the number of levels fused.

CONCLUSIONS.: Patients undergoing anterior cervical fusion have diminished neck motion compared with normal volunteers. Following surgery, they may be expected to gain motion, even when undergoing multilevel fusions. However, these patients are unlikely to regain the neck motion seen among normal individuals without neck complaints

This is fairly reassuring. My range of neck motion right now is indeed pretty minimal. I can't look up very far, can't look sideways nearly as far as normal people, and both directions (especially in combination, which is really bad) hurt me. For instance, if I'm in the driver's seat of my car, parked, and talk to someone in the passenger seat for more than a couple of minutes I get a lot of pain.


Sally said...

Interesting that the assumption was that "fusion procedures result in a loss of neck motion" -- relative to what? Did they mean compared to normal people or to how the same individuals were pre-surgery?

In any event, it's good to know that you can expect improvement in motion after the surgery.

rvman said...

I assume they mean relative to normal. It may also be that, strictly speaking, some people have a smaller range of motion post-surgery than pre-surgery, it is just that much of that 'range of motion' presurgery hurts. A lot. Post surgery the 'pain-free'/low pain range of motion is better, but the absolute max flex is smaller.

"Twenty-five consecutive patients undergoing anterior..."

Nice to know they didn't skip anyone. Is this supposed to be some sort of guarantee of random sampling?

Tam said...

I assume that "fusion procedures result in a loss of neck motion" relative to having a normal, healthy spine, since they remove one flexible part and replace it with a solid part. But yeah, I think that's relative to normal people, so kind of the attitude of the research (as I see it) is, "OK, but we're talking about people who are already fucked up."

I think the "consecutive" is meant to suggest that they didn't cherry-pick which surgical patients to use in the study (based on, you know, which ones they guessed would recover more range of motion).

My range of motion, as I mentioned, is pretty bad, and becomes pathetic once my fears come into play (which they always do).

biobot said...

"Consecutive patients" is not even close to "random samples" so the study results are in lay terms very lame. The whole idea of sampling in a study is to get a cross section of subjects. Consecutive sampling does not even attempt to be random and therefore it is not representative of anything.

Now to your point. I had posterior fusion from the occiput (base of skull) to C5 and my ROM did not improve. As my surgeon put it, the pain is limiting my range of motion now so after fusion it may not get worse and it could get better. I too cannot turn my head to speak to someone.

Best of luck on your surgery.