Cervical Sagittal Balance as a Predictor for the Outcome of Multimodal Treatment Program for Non Specific Neck Pain

Abstract
Background: Sagittal balance represents the position of the occiput to the thoracic inlet. Sagittal balance keep normal lordotic curve in cervical region so any disturbance in cervical balance lead to pain and disability. Also it an important concept in spinal reconstruction and cervical sagittal imbalance has been linked to poor health-related quality of life scores due to disabling symptoms of neck pain and neurological deficit.
Aim of Study: The purpose of this study was to investigate the influence of cervical balance as predictor for the outcome measures of multimodal treatment program in patient with non specific neck pain.
Patients and Methods: Forty patients with non specific neck pain participated in this study. Patients were subdivided into two groups, twenty in each group. The first group was the group A with cervical sagittal imbalance, and the second group was the group B with cervical sagittal balance. Both groups received multimodal treatment (cervicothoracic stabi-lization training designed to restore cervical muscle endurance and coordination, relaxation training to reduce unnecessary muscle tension, behavioral support to reduce anxiety and fear of pain, eye fixation exercises to prevent dizziness and seated wobble-board training to improve postural control). We measured pain by Visual Analogue Scale (VAS), neck function by Neck Disability Index (NDI) and cervical Range of Motion (ROM) by cervical goniometer.
Results: Within-group analysis there was a significant difference of, NDI and ROM (flexion, extension, RT rotation and LT rotation) pre-treatment at groups A, B (p=0.0001). There was no significant difference of VAS, LT bending and RT bending pre-treatment (p-value >0.05). Between group analyses there was significant difference of NDI and ROM (flexion, extension, RT bending, LT bending, RT rotation and LT rotation) in two groups post-treatment as p-value <0.05 except VAS.
SVA (Sagittal Vertical Axis) contribute to interpretation of changes in ROM NDI except VAS.
Conclusion: Cervical sagittal balance is effective in predicting multimodal treatment outcome measures (ROM and neck function) in Nonspecific Neck Pain (NSNP). Patients with cervical sagittal balance have better outcome measures (improving ROM and improving neck function) than patients with cervical sagittal imbalance in case of non specific neck pain.