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A randomised controlled trial on the effectiveness of a lateral glide cervical spine mobilisation on cervicobrachial (neck and arm) painCervicobrachial (neck and arm) pain is a painful condition which, when chronic, leads to high levels of disability. Small-scale, short-term (<2 months follow-up) studies have identified that lateral glide mobilisation reduces cervicobrachial pain. However, long-term (>6 months) effectiveness of this intervention on cervicobrachial pain is unknown. Purpose: The main objective was to identify whether the lateral glide cervical mobilisation was effective in reducing pain levels in the long-term for patients with chronic cervicobrachial pain. Secondary objectives included evaluating effects of the lateral glide mobilisation on; patient perceived recovery, function and disability, cost, and harm. Methods: Ninety-nine participants with chronic cervicobrachial pain were recruited to the trial from an acute Hospital Trust in the United Kingdom. A randomised controlled trial was undertaken. Participants were randomised to receive lateral glide with selfmanagement (n = 49); or self-management alone (n = 50). Assessments were made on four occasions (at weeks 0 (baseline), 6, 26 and 52 post intervention). The primary outcome measure was the Visual Analogue Scale (VAS) for pain. Secondary outcomes measures included; the Global Rating of Change score (GROC), the Neck and Upper Limb Index score (NULI), the Short-from 36 (SF36) and cervical active range of motion (AROM). In addition to these outcomes the costs (quantity of physiotherapy appointments) and reported number of harmful effects in response to intervention were evaluated. An intention to treat approach was used. Analysis of Covariance evaluated between-group differences on VAS (pain) at the primary end point (52 weeks). Multi-level modelling was the main method used for longitudinal analysis of other continuous outcomes. Mann-Whitney tests were used to evaluate ordinal data. Results: Primary outcome: No statistically significant between-group differences were identified for pain (using VAS) at six weeks (p = 0.52; CI -14.72 to 7.44) and one year (p = 0.37; CI -17.76 to 6.61) post-intervention. The VAS outcomes correlated well with GROC scores (p < 0.001). Secondary outcomes: There was a statistically significant difference in NULI scores favouring self-management alone (p = 0.03), but no between-group differences for SF36 (p = 0.07). Cervical AROM indicated no statistically significant findings for most movements measured (p < 0.05). The cost of providing the lateral glide and self-management were twice that of providing self-management alone. Minor harm was reported in both groups, with 11% more harm being associated with the lateral glide. Conclusion(s): According to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE), there is low strength of evidence to support recommendation for the use of the lateral glide for chronic cervicobrachial pain in clinical practice. Future research in the form of a well-designed longitudinal observational study might identify clinically important differences among therapeutic options for specific sub-groups of patients with cervicobrachial pain. Implications: The results of this study indicate that in the long-term 'less is more' with a minimal intervention approach based on self-management strategies being a more cost-effective way to manage chronic cervicobrachial pain than hands-on manual therapy in the form of the lateral glide mobilisation.
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A rare case of Paget's disease affecting the cervical spine.We present the case of a 75-year-old man with a rapidly progressive cervical myelopathy on a background of a 3-year history of neck pain and a severely degenerative cervical spine. The patient developed progressive myelopathy over a six-month period and suffered from worsening kyphosis. Suspicion of an underlying oncological process prompted transfer to our tertiary referral unit. Biopsy was consistent for Paget's disease, an extremely rare diagnosis of the cervical spine. Magnetic resonance imaging revealed cord compression between C4 and C6 with associated cord signal change indicative of myelopathy. A three-level corpectomy and posterior instrumented fusion was performed. There was significant blood loss (3.5l) intraoperatively, consistent with a diagnosis of Paget's disease of the bone. Cell salvage was used, as was neuromonitoring for both the anterior and posterior part of the procedure. Postoperatively, neurological function improved slightly and the patient required community neurorehabilitation to allow independent living.