New RCT Shows Improved Pain, Motion & Nerve Function with Lordosis Correction

Ibrahim Moustafa Moustafa Abu Amer, PT Basic Science Department, Faculty of Physical Therapy, Cairo University, Egypt	Deed E. Harrison, DC President CBP Seminars, Inc. Vice President CBP Non-Profit, Inc. Chair PCCRP Guidelines Editor—AJCC

We’re excited to announce that a new randomized control trial (RCT) has been performed and completed using 3-point bending cervical extension traction (Pope 2-way) to improve the cervical lordosis. Approximately 2 years, ago, I was contacted by Ibrahim Moustafa from the University of Cairo. He was working on a research investigation for part of his graduation requirements. Ibrahim was interested in investigating the usage of 2-way traction in a population of patients suffering from cervical spondylotic radiculopathy with concomitant reduction of the cervical lordosis. I was asked to be an advisor on this graduate project. In May of this year, Ibrahim sent me the completed draft of his study. Currently this project has been edited and the study has been submitted for review and hopeful publication in a spine related journal.

STUDY ABSTRACT

TITLE: The Efficacy of Cervical Lordosis Rehabilitation for Nerve Root Function, Pain, and Segmental Motion in Cervical Spondylotic Radiculopathy: A Randomized Control Trial.

AUTHORS: Ibrahim Moustafa Abu Amer, PT, Aliaa Attiah Mohamed Diaab PT, Deed E. Harrison DC,

Background: There is a general agreement about the relevance of conservative treatment for cervical spondylotic radiculopathy (CSR); however the precise treatment protocol for this disorder in specific patient groups remains unanswered.

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

Subjects: Thirty patients with lower CSR and with a cervical lordosis less than 25° as measured using posterior body tangent lines from C2-C7 - were included in the study. The patients were assigned randomly into two groups of equal number, study and control groups respectively.

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).

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. Appropriate physical rehabilitation for CSR should include sagittal cervical correction, as it may to lead greater and longer lasting improved function.

cervical lordosis, Chiropractic BioPhysics, traction, Nerve Root Function