An Analysis of Neuroforaminal Pressures with Varying Head and Arm Positions

Farmer, James C.; Wisneski, Ronald J.

doi:10.1097/00007632-199408150-00010

Cited by 70 publications

(29 citation statements)

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“…The decreased VAS score and dissimilar pain distribution reported in the control group with spondylosis compared with the study group corroborate with previous findings. The added advantage of extension in enhancing the reported complaints is supported by biomechanical studies that have shown an increase in neuroforaminal [10] and intradiscal [13] pressures in response to extension of the cervical spine. Fig.…”

Section: Discussionmentioning

confidence: 94%

What is the Best Way to Apply the Spurling Test for Cervical Radiculopathy?

Anekstein

Blecher

Smorgick

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background A diagnosis of cervical radiculopathy is based largely on clinical examination, including provocative testing. The most common maneuver was described in 1944 by Spurling and Scoville. Since then, several modifications of the original maneuver have been proposed to improve its value in the diagnosis of cervical radiculopathy. Questions/Purposes We assessed the ability of six known variations of the Spurling test to reproduce the complaints of patients diagnosed with cervical radiculopathy. Methods We prospectively enrolled 67 patients presenting with cervical radicular-like symptoms and concordant radiographic findings. Each patient underwent six distinct provocative cervical spine maneuvers by two examiners, during which three parameters were recorded: (1) pain intensity (VAS score), (2) paresthesia intensity (0 -no paresthesia, 1 -mild to moderate, and 2 -severe), and (3) characteristic pain distribution (0 -no pain, 1 -neck pain only, 2 -arm pain only, 3 -pain elicited distal to the elbow). The interobserver reliability of the reported VAS score (measured by the intraclass coefficient correlation) ranged from 0.78 to 0.96 and the calculated kappa values of the categorical parameters ranged from 0.58 to 1.0 for paresthesia intensity and from 0.63 to 1.0 for pain distribution. Differences in scores elicited between the two examiners for the 67 patients were resolved by consensus. Results A maneuver consisting of extension, lateral bending, and axial compression resulted in the highest VAS score (mean, 7) and was associated with the most distally elicited pain on average (mean, 2.5). The highest paresthesia levels were reported after applying extension, rotation, and axial compression (mean, 1). These maneuvers, however, were the least tolerable, causing discontinuation of the examination on three occasions. Conclusions Whenever cervical radiculopathy is suspected our observations suggest the staged provocative maneuvers that should be included in the physical evaluation are extension and lateral bending first, followed by the addition of axial compression in cases with an inconclusive effect. Level of Evidence Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 94%

What is the Best Way to Apply the Spurling Test for Cervical Radiculopathy?

Anekstein

Blecher

Smorgick

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…In man, many ex vivo as well as in vivo studies have been conducted to evaluate the influence of normal range of neck flexion and extension on cervical intervertebral foramina dimensions (Yoo et al 1992;Humphreys et al 1998;Lu et al 2000;Muhle et al 2001;Nuckley et al 2002;Kitagawa et al 2004;Ebraheim et al 2006), local pressure on nerve roots (Schnebel et al 1989;Farmer and Wisneski 1994;Hubbard and Winkelstein 2008) and corresponding electrophysiological findings (Sabbahi and Abdulwahab 1999;Morishita et al 2006). The studies on intervertebral foramina dimensions documented a decrease in foramina dimensions caused by extension and ipsilateral bending and an increase caused by flexion and contralateral bending.…”

Section: Introductionmentioning

confidence: 99%

The effect of ex vivo flexion and extension on intervertebral foramina dimensions in the equine cervical spine

Sleutjens

Voorhout

Kolk

et al. 2010

Equine Veterinary Journal

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SummaryReasons for performing study: In dressage, the head and neck position has become an issue of concern as certain extreme positions may imply a welfare risk for the horse. In man, extension and flexion of the cervical spine cause a decrease and increase in intervertebral foramina dimensions, respectively. However, in horses, the influence of flexion and extension on foramina dimensions and its possible interference with peripheral nerve functioning remains unknown.

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“…11,13,17,28,39,43 The average annual incidence rate of cervical radiculopathy is 83 per 100 000 for the population in its entirety, with an increased prevalence occurring in the fifth decade of life (203 per 100 000). 33 The location and pattern of symptoms will vary, depending on the nerve root level affected, and can include sensory and/or motor alterations if the dorsal and/or ventral nerve root is involved.…”

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confidence: 99%