AMA Guides® Newsletter - Issue Archive

Articles

1. Cervical Lordosis: The Significance of Decreased, Straightened, and Reversed Curves

   Charles N. Brooks, Marjorie Eskay-Auerbach, James B. Talmage, Allan F. Tencer

   Pages 3–5

   DOI: 10.1001/amaguidesnewsletters.2015.NovDec01

   Abstract

   The normal cervical spine is straight in the coronal plane and usually is lordotic (curved convex anteriorly) in the sagittal plane, and although cervical spine deformity occurs in the coronal plane (eg, scoliosis), sagittal plane deformities are more common. For example, cervical lordosis can be increased (hyperlordosis) within the normal range, decreased (hypolordosis), absent (a straight cervical spine with 0° of curvature on a lateral X ray), or reversed (kyphosis). Primary deformity of the cervical spine often is congenital (eg, wedge vertebra); secondary sagittal deformities may be due to disc degeneration accompanying aging, disease such as ankylosing spondylitis, or surgery (eg, for postlaminectomy kyphosis). Decreased, straightened, or reversed cervical lordosis (DSRCL) may be idiopathic and can be voluntary, and evaluators must differentiate DSRCL that does not change over time vs sagittal plane alignment that varies over time or with a change in posture or position. DSRCL usually is asymptomatic, but severe cervical kyphosis can cause neck pain, myelopathy, dysphagia, loss of horizontal gaze, and other symptoms that are sufficiently severe to result in disability and to require surgical correction. Reports of DSRCL due to spasm, particularly at times temporally remote to an injury, should be met with extreme skepticism. Kyphosis of sufficient severity to be symptomatic usually is a postoperative deformity, not an effect of whiplash.
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2. The Effects of Functional Restoration on Disability and Impairment

   Steven Feinberg

   Pages 6–12

   DOI: 10.1001/amaguidesnewsletters.2015.NovDec02

   Abstract

   The treatment of chronic pain conditions is difficult, time consuming, expensive, and, all too often, unsuccessful. An effective alternative is chronic pain rehabilitation or functional restoration (FR). An FR team works together to help patients achieve better outcomes with reduced disability. The basic treatment goals of early and chronic FR rehabilitation programs are functional improvement; improved abilities in performance of activities of daily living (ADL); a return to leisure, sport, and vocational activities; and improved pharmacologic management of pain and related affective distress. Individuals at risk of developing chronic pain conditions may benefit from an FR program because physical and psychological interventions can be used before the disability becomes chronic. FR programs emphasize a multidisciplinary, biopsychosocial approach in which physicians, psychologists, and occupational, physical, and relaxation therapists work in concert. FR treatment includes quantification of physical deficits, psychosocial and socioeconomic assessment, and an emphasis on reconditioning the injured area or body part. The team-centered approach includes simulation of work or activity; disability management using cognitive–behavioral approaches; psychopharmacologic management that focuses on improving analgesia, sleep, and affective distress; and, in appropriate cases, detoxification. FR is a patient-centered, whole-person, team approach that focuses on helping patients achieve individual goals that enable them to improve physical and psychosocial function, decrease pain, lessen disability, and improve quality of life, including return to work.
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