Restoring cervical lordosis by cervical extension traction methods in the treatment of cervical spine disorders: a systematic review of controlled trials

Paul A Oakley, Niousha Navid Ehsani, Ibrahim M Moustafa, Deed E Harrison, Paul A Oakley, Niousha Navid Ehsani, Ibrahim M Moustafa, Deed E Harrison

Abstract

[Purpose] To systematically review the literature on the use of cervical extension traction methods for increasing cervical lordosis in those with hypolordosis and cervical spine disorders. [Methods] Literature searches for controlled clinical trials were performed in Pubmed, PEDro, Cochrane, and ICL databases. Search terms included iterations related to the cervical spine, neck pain and disorders, and extension traction rehabilitation. [Results] Of 1,001 initially located articles, 9 met the inclusion/exclusion criteria. The trials demonstrated increases in radiographically measured lordosis of 12-18°, over 5-15 weeks, after 15-60 treatment sessions. Untreated controls/comparison groups not receiving extension traction showed no increase in cervical lordosis. Several trials demonstrated that both traction and comparison treatment groups experienced immediate pain relief. Traction treatment groups maintained their pain and disability improvements up to 1.5 years later. Comparative groups not receiving lordosis improvement experienced regression of symptoms towards pre-treatment values by 1 years' follow-up. [Conclusion] There are several high-quality controlled clinical trials substantiating that increasing cervical lordosis by extension traction as part of a spinal rehabilitation program reduces pain and disability and improves functional measures, and that these improvements are maintained long-term. Comparative groups who receive multimodal rehabilitation but not extension traction experience temporary relief that regresses after treatment cessation.

Keywords: Cervical lordosis; Spine traction; Systematic review.

2021©by the Society of Physical Therapy Science. Published by IPEC Inc.

Figures

Fig. 1.
Fig. 1.
Flow diagram of searched, screened, and included studies.

References

    1. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators: Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 2016, 388: 1545–1602.
    1. Guzman J, Hurwitz EL, Carroll LJ, et al. Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: A new conceptual model of neck pain: linking onset, course, and care: the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine, 2008, 33: S14–S23.
    1. Haldeman S, Kopansky-Giles D, Hurwitz EL, et al. : Advancements in the management of spine disorders. Best Pract Res Clin Rheumatol, 2012, 26: 263–280.
    1. Oakley PA, Moustafa IM, Harrison DE: Restoration of cervical and lumbar lordosis: CBP® methods overview. In: Bettany-Saltikov J (ed.) Spinal deformities in adolescents, adults and older adults. IntechOpen, 2019.
    1. Bland JH, Boushey DR: Anatomy and physiology of the cervical spine. Semin Arthritis Rheum, 1990, 20: 1–20.
    1. Ling FP, Chevillotte T, Leglise A, et al. : Which parameters are relevant in sagittal balance analysis of the cervical spine? A literature review. Eur Spine J, 2018, 27: 8–15.
    1. Pal GP, Sherk HH: The vertical stability of the cervical spine. Spine, 1988, 13: 447–449.
    1. Khalil N, Bizdikian AJ, Bakouny Z, et al. : Cervical and postural strategies for maintaining horizontal gaze in asymptomatic adults. Eur Spine J, 2018, 27: 2700–2709.
    1. Scheer JK, Tang JA, Smith JS, et al. International Spine Study Group: Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine, 2013, 19: 141–159.
    1. Ames CP, Blondel B, Scheer JK, et al. : Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy. Spine, 2013, 38: S149–S160.
    1. Harrison DD, Harrison DE, Janik TJ, et al. : Modeling of the sagittal cervical spine as a method to discriminate hypolordosis: results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects. Spine, 2004, 29: 2485–2492.
    1. McAviney J, Schulz D, Bock R, et al. : Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther, 2005, 28: 187–193.
    1. Seong HY, Lee MK, Jeon SR, et al. : Prognostic factor analysis for management of chronic neck pain: can we predict the severity of neck pain with lateral cervical curvature? J Korean Neurosurg Soc, 2017, 60: 456–464.
    1. Han K, Lu C, Li J, et al. : Surgical treatment of cervical kyphosis. Eur Spine J, 2011, 20: 523–536.
    1. Hohl M: Soft-tissue injuries of the neck in automobile accidents. Factors influencing prognosis. J Bone Joint Surg Am, 1974, 56: 1675–1682.
    1. Braaf MM, Rosne RS: Trauma of cervical spine as cause of chronic headache. J Trauma, 1975, 15: 441–446.
    1. Nagasawa A, Sakakibara T, Takahashi A: Roentgenographic findings of the cervical spine in tension-type headache. Headache, 1993, 33: 90–95.
    1. Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, et al. : Forward head posture and neck mobility in chronic tension-type headache: a blinded, controlled study. Cephalalgia, 2006, 26: 314–319.
    1. Vernon H, Steiman I, Hagino C: Cervicogenic dysfunction in muscle contraction headache and migraine: a descriptive study. J Manipulative Physiol Ther, 1992, 15: 418–429.
    1. Ferracini GN, Chaves TC, Dach F, et al. : Analysis of the cranio-cervical curvatures in subjects with migraine with and without neck pain. Physiotherapy, 2017, 103: 392–399.
    1. Buell TJ, Buchholz AL, Quinn JC, et al. : Importance of sagittal alignment of the cervical spine in the management of degenerative cervical myelopathy. Neurosurg Clin N Am, 2018, 29: 69–82.
    1. Shamji MF, Ames CP, Smith JS, et al. : Myelopathy and spinal deformity: relevance of spinal alignment in planning surgical intervention for degenerative cervical myelopathy. Spine, 2013, 38: S147–S148.
    1. Oakley PA, Cuttler JM, Harrison DE: X-ray imaging is essential for contemporary chiropractic and manual therapy spinal rehabilitation: radiography increases benefits and reduces risks. Dose Response, 2018, 16: 1–7.
    1. Mahmoud NF, Hassan KA, Abdelmajeed SF, et al. : The relationship between forward head posture and neck pain: a systematic review and meta-analysis. Curr Rev Musculoskelet Med, 2019, 12: 562–577.
    1. Moustafa IM, Youssef A, Ahbouch A, et al. : Is forward head posture relevant to autonomic nervous system function and cervical sensorimotor control? Cross sectional study. Gait Posture, 2020, 77: 29–35.
    1. Bess S, Protopsaltis TS, Lafage V, et al. International Spine Study Group: Clinical and radiographic evaluation of adult spinal deformity. Clin Spine Surg, 2016, 29: 6–16.
    1. Oakley PA, Ehsani NN, Harrison DE: Repeat radiography in monitoring structural changes in the treatment of spinal disorders in chiropractic and manual medicine practice: evidence and safety. Dose Response, 2019, 17: 1559325819891043.
    1. Diebo BG, Varghese JJ, Lafage R, et al. : Sagittal alignment of the spine: what do you need to know? Clin Neurol Neurosurg, 2015, 139: 295–301.
    1. Patwardhan AG, Khayatzadeh S, Havey RM, et al. : Cervical sagittal balance: a biomechanical perspective can help clinical practice. Eur Spine J, 2018, 27: 25–38.
    1. Patwardhan AG, Havey RM, Khayatzadeh S, et al. : Postural consequences of cervical sagittal imbalance: a novel laboratory model. Spine, 2015, 40: 783–792.
    1. Ames CP, Smith JS, Eastlack R, et al. International Spine Study Group: Reliability assessment of a novel cervical spine deformity classification system. J Neurosurg Spine, 2015, 23: 673–683.
    1. Protopsaltis T, Terran J, Soroceanu A, et al. International Spine Study Group: T1 slope minus cervical lordosis (TS-CL), the cervical answer to PI-LL, defines cervical sagittal deformity in patients undergoing thoracolumbar osteotomy. Int J Spine Surg, 2018, 12: 362–370.
    1. Lee SH, Kim KT, Seo EM, et al. : The influence of thoracic inlet alignment on the craniocervical sagittal balance in asymptomatic adults. J Spinal Disord Tech, 2012, 25: E41–E47.
    1. Plaugher G, Cremata EE, Phillips RB: A retrospective consecutive case analysis of pretreatment and comparative static radiological parameters following chiropractic adjustments. J Manipulative Physiol Ther, 1990, 13: 498–506.
    1. Harrison DD, Jackson BL, Troyanovich S, et al. : The efficacy of cervical extension-compression traction combined with diversified manipulation and drop table adjustments in the rehabilitation of cervical lordosis: a pilot study. J Manipulative Physiol Ther, 1994, 17: 454–464.
    1. Hurwitz EL, Aker PD, Adams AH, et al. : Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine, 1996, 21: 1746–1759, discussion 1759–1760.
    1. Shilton M, Branney J, de Vries BP, et al. : Does cervical lordosis change after spinal manipulation for non-specific neck pain? A prospective cohort study. Chiropr Man Therap, 2015, 23: 33.
    1. Fortner MO, Oakley PA, Harrison DE: Cervical extension traction as part of a multimodal rehabilitation program relieves whiplash-associated disorders in a patient having failed previous chiropractic treatment: a CBP® case report. J Phys Ther Sci, 2018, 30: 266–270.
    1. Fortner MO, Oakley PA, Harrison DE: Alleviation of posttraumatic dizziness by restoration of the cervical lordosis: a CBP® case study with a one year follow-up. J Phys Ther Sci, 2018, 30: 730–733.
    1. Fortner MO, Oakley PA, Harrison DE: Non-surgical improvement of cervical lordosis is possible in advanced spinal osteoarthritis: a CBP® case report. J Phys Ther Sci, 2018, 30: 108–112.
    1. Dennis AK, Oakley PA, Weiner MT, et al. : Alleviation of neck pain by the non-surgical rehabilitation of a pathologic cervical kyphosis to a normal lordosis: a CBP® case report. J Phys Ther Sci, 2018, 30: 654–657.
    1. Wickstrom BM, Oakley PA, Harrison DE: Non-surgical relief of cervical radiculopathy through reduction of forward head posture and restoration of cervical lordosis: a case report. J Phys Ther Sci, 2017, 29: 1472–1474.
    1. Hutton B, Salanti G, Caldwell DM, et al. : The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med, 2015, 162: 777–784.
    1. .
    1. de Morton NA: The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother, 2009, 55: 129–133.
    1. Maher CG, Sherrington C, Herbert RD, et al. : Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther, 2003, 83: 713–721.
    1. SIGN: Scottish Intercollegiate Guidelines Network. Sign 50: A Guideline Developer’s Handbook. 2019. .
    1. Lee CH, Heo SJ, Park SH, et al. : The functional and morphological changes of the cervical intervertebral disc after applying lordotic curve controlled traction: a double-blind randomized controlled study. Int J Environ Res Public Health, 2019, 16: 2162.
    1. Moustafa IM, Diab AA, Hegazy F, et al. : Does improvement towards a normal cervical sagittal configuration aid in the management of cervical myofascial pain syndrome: a 1-year randomized controlled trial. BMC Musculoskelet Disord, 2018, 19: 396.
    1. Moustafa IM, Diab AA, Harrison DE: The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study. Eur J Phys Rehabil Med, 2017, 53: 57–71.
    1. Moustafa IM, Diab AA, Hegazy FA, et al. : Does rehabilitation of cervical lordosis influence sagittal cervical spine flexion extension kinematics in cervical spondylotic radiculopathy subjects? J Back Musculoskeletal Rehabil, 2017, 30: 937–941.
    1. Moustafa IM, Diab AA, Taha S, et al. : Addition of a sagittal cervical posture corrective orthotic device to a multimodal rehabilitation program improves short- and long-term outcomes in patients with discogenic cervical radiculopathy. Arch Phys Med Rehabil, 2016, 97: 2034–2044.
    1. Moustafa IM: Does improvement towards a normal cervical configuration aid in the management of fibromyalgia. A randomized controlled trial. Bull Fac Ph Th Cairo Univ, 2013, 18: 29–41.
    1. Harrison DE, Harrison DD, Betz JJ, et al. : Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse load cervical traction with cervical manipulation: nonrandomized clinical control trial. J Manipulative Physiol Ther, 2003, 26: 139–151.
    1. Harrison DE, Cailliet R, Harrison DD, et al. : A new 3-point bending traction method for restoring cervical lordosis and cervical manipulation: a nonrandomized clinical controlled trial. Arch Phys Med Rehabil, 2002, 83: 447–453.
    1. Harrison DD, Janik TJ, Troyanovich SJ, et al. : Comparisons of lordotic cervical spine curvatures to a theoretical ideal model of the static sagittal cervical spine. Spine, 1996, 21: 667–675.
    1. Harrison DD, Janik TJ, Troyanovich SJ, et al. : Evaluation of the assumptions used to derive an ideal normal cervical spine model. J Manipulative Physiol Ther, 1997, 20: 246–256.
    1. Oakley PA, Harrison DD, Harrison DE, et al. : Evidence-based protocol for structural rehabilitation of the spine and posture: review of clinical biomechanics of posture (CBP) publications. J Can Chiropr Assoc, 2005, 49: 270–296.
    1. Harrison DE, Harrison DD, Haas JW: Structural rehabilitation of the cervical spine. Evanston: Harrison CBP® Seminars, Inc., 2002.
    1. Solomonow M, He Zhou B, Baratta RV, et al. : Biexponential recovery model of lumbar viscoelastic laxity and reflexive muscular activity after prolonged cyclic loading. Clin Biomech (Bristol, Avon), 2000, 15: 167–175.
    1. Harrison DE, Harrison DD, Colloca CJ, et al. : Repeatability over time of posture, radiograph positioning, and radiograph line drawing: an analysis of six control groups. J Manipulative Physiol Ther, 2003, 26: 87–98.
    1. Jackson BL, Barker WF, Pettibon BR, et al. : Reliability of the Pettibon patient positioning system for radiographic production. J Vertebr Subluxat Res, 2000, 4: 3–11.
    1. Gore DR: Roentgenographic findings in the cervical spine in asymptomatic persons: a ten-year follow-up. Spine, 2001, 26: 2463–2466.
    1. Peng L, Cooke MS: Fifteen-year reproducibility of natural head posture: a longitudinal study. Am J Orthod Dentofacial Orthop, 1999, 116: 82–85.
    1. Sandham A: Repeatability of head posture recordings from lateral cephalometric radiographs. Br J Orthod, 1988, 15: 157–162.
    1. Cooke MS, Wei SH: The reproducibility of natural head posture: a methodological study. Am J Orthod Dentofacial Orthop, 1988, 93: 280–288.
    1. Beck A, Killus J: Normal posture of spine determined by mathematical and statistical methods. Aerosp Med, 1973, 44: 1277–1281.
    1. Jenkins HJ, Downie AS, Moore CS, et al. : Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropr Man Therap, 2018, 26: 48.
    1. Harrison DE, Harrison DD, Janik TJ, et al. : Slight head extension: does it change the sagittal cervical curve? Eur Spine J, 2001, 10: 149–153.
    1. Hellsing E: Changes in the pharyngeal airway in relation to extension of the head. Eur J Orthod, 1989, 11: 359–365.
    1. Gehweiler JA, Jr, Clark WM, Schaaf RE, et al. : Cervical spine trauma: the common combined conditions. Radiology, 1979, 130: 77–86.
    1. Clark WN, Gehweiler JA, Laib R: Twelve significant signs of cervical spine trauma. Skeletal Radiol, 1979, 3: 201–205.
    1. Juhl JH, Miller SM, Roberts GW: Roentgenographic variations in the normal cervical spine. Radiology, 1962, 78: 591–597.
    1. Shekelle PG, Coulter I: Cervical spine manipulation: summary report of a systematic review of the literature and a multidisciplinary expert panel. J Spinal Disord, 1997, 10: 223–228.
    1. Colloca CJ, Keller TS: Electromyographic reflex responses to mechanical force, manually assisted spinal manipulative therapy. Spine, 2001, 26: 1117–1124.
    1. Fedorchuk CA, McCoy M, Lightstone DF, et al. : Impact of isometric contraction of anterior cervical muscles on cervical lordosis. J Radiol Case Rep, 2016, 10: 13–25.
    1. Zhou L, Fan J, Cheng L, et al. : Changes of cervical sagittal alignments during motions in patients with cervical kyphosis. Medicine (Baltimore), 2017, 96: e8410.
    1. Harrison DE, Oakley PA: Non-operative correction of flat back syndrome using lumbar extension traction: a CBP® case series of two. J Phys Ther Sci, 2018, 30: 1131–1137.
    1. Panjabi MM, White AA: Biomechanics in the musculoskeletal system. Philadelphia: Churchill Livingstone, 2001.
    1. Adams MA, Dolan P: Time-dependent changes in the lumbar spine’s resistance to bending. Clin Biomech (Bristol, Avon), 1996, 11: 194–200.
    1. Hukins DW, Kirby MC, Sikoryn TA, et al. : Comparison of structure, mechanical properties, and functions of lumbar spinal ligaments. Spine, 1990, 15: 787–795.
    1. Oliver MJ, Twomey LT: Extension creep in the lumbar spine. Clin Biomech (Bristol, Avon), 1995, 10: 363–368.
    1. Woo S, Livesay GA, Runco TJ, et al. : Structure and function of tendons and ligaments. In: Mow VC, Hayes WC, (eds.) Basics orthopaedic biomechanics, 2nd ed. Philadelphia: Lippincott-Raven, 1997, pp 209–52.
    1. Hey HW, Lau ET, Wong GC, et al. : Cervical alignment variations in different postures and predictors of normal cervical kyphosis: a new understanding. Spine, 2017, 42: 1614–1621.
    1. Park SM, Song KS, Park SH, et al. : Does whole-spine lateral radiograph with clavicle positioning reflect the correct cervical sagittal alignment? Eur Spine J, 2015, 24: 57–62.
    1. Carreon LY, Smith CL, Dimar JR, 2nd, et al. : Correlation of cervical sagittal alignment parameters on full-length spine radiographs compared with dedicated cervical radiographs. Scoliosis Spinal Disord, 2016, 11: 12.
    1. Baba H, Uchida K, Maezawa Y, et al. : Lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy: a magnetic resonance imaging study. J Neurol, 1996, 243: 626–632.
    1. Stein J: Failure of magnetic resonance imaging to reveal the cause of a progressive cervical myelopathy related to postoperative spinal deformity: a case report. Am J Phys Med Rehabil, 1997, 76: 73–75.
    1. Swank ML, Sutterlin CE, 3rd, Bossons CR, et al. : Rigid internal fixation with lateral mass plates in multilevel anterior and posterior reconstruction of the cervical spine. Spine, 1997, 22: 274–282.
    1. Kawakami M, Tamaki T, Yoshida M, et al. : Axial symptoms and cervical alignments after cervical anterior spinal fusion for patients with cervical myelopathy. J Spinal Disord, 1999, 12: 50–56.
    1. Naderi S, Ozgen S, Pamir MN, et al. : Cervical spondylotic myelopathy: surgical results and factors affecting prognosis. Neurosurgery, 1998, 43: 43–49, discussion 49–50.
    1. Grosso MJ, Hwang R, Mroz T, et al. : Relationship between degree of focal kyphosis correction and neurological outcomes for patients undergoing cervical deformity correction surgery. J Neurosurg Spine, 2013, 18: 537–544.
    1. Guo GM, Li J, Diao QX, et al. : Cervical lordosis in asymptomatic individuals: a meta-analysis. J Orthop Surg Res, 2018, 13: 147.
    1. Breig A: Adverse mechanical tension in the central nervous system. Analysis of cause and effect. Relief by functional neurosurgery. Stockholm: Almqvist & Wiksell International, 1978.
    1. Breig A: Chapter 6. Pathological stress in the pons-cord tissue tract and its alleviation by neurosurgical means. Clin Neurosurg, 1973, 20: 85–94.
    1. Breig A, Turnbull I, Hassler O: Effects of mechanical stresses on the spinal cord in cervical spondylosis. A study on fresh cadaver material. J Neurosurg, 1966, 25: 45–56.
    1. Breig A, el-Nadi AF: Biomechanics of the cervical spinal cord. Relief of contact pressure on and overstretching of the spinal cord. Acta Radiol Diagn (Stockh), 1966, 4: 602–624.
    1. Breig A, Troup JD: Focal intramedullary tension in patients with cord lesion and its surgical relief by spinal cord relaxation. Lancet, 1984, 1: 739–740.
    1. Oakley PA, Moustafa IM, Harrison DE: The Influence of sagittal plane spine alignment on neurophysiology and sensorimotor control measures: optimization of function through structural correction. In: Bernardo-Filho M, Sá-Caputo D, Seixas A, Taiar R (eds.) Neurological physical therapy. London: IntechOpen Publishers, 2021.
    1. Teo AQ, Thomas AC, Hey HW: Sagittal alignment of the cervical spine: do we know enough for successful surgery? J Spine Surg, 2020, 6: 124–135.
    1. Lin BJ, Hong KT, Lin C, et al. : Impact of global spine balance and cervical regional alignment on determination of postoperative cervical alignment after laminoplasty. Medicine (Baltimore), 2018, 97: e13111.
    1. Oakley PA, Sanchez LJ, Harrison DE: Medical radiologists may not consider the cervical lordosis in radiology reports: a comparison of subjective qualitative assessment versus object quantitative mensuration in 100 consecutive patients at one medical imaging center. J Contemp Chiropr, 2021, 4: 17–25.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera