Cervical Proprioception, Muscle activity patterns and Range of motion in patients after 6 months of decompression surgery

Cervical Radiculopathy (CR) is broadly defined as “Pain in a radicular pattern in one or both upper extremities related to compression and/or irritation of one or more cervical nerve roots. Frequent signs and symptoms include varying degrees of sensory, motor, and reflex changes as well as dysesthesias and paresthesia’s related to nerve roots without evidence of spinal cord dysfunction”.

In the patients who do not respond to conservative treatment are referred for surgery. The indications for surgical management include individuals with growing motor weakening, or unremitting radicular pain after 6 to 12 weeks of conservative treatment.

After cervical discectomy, patients had neck pain, significantly lower ROM especially the extension to a greater extent followed by flexion and rotation range of motion restriction. Muscle strength was also reported to be lowest in rotators, lower in extensors and low in flexor group and hand muscles. Patients after ACDF surgery were also reported with decreased neck muscle endurance and balance.

A basic Cervico-Cephalic sensitivity test was developed by Revel et al. with the goal of identifying changes in Cervical proprioception. In particular, this method assesses the subject’s capacity to precisely move their heads to a subjective straight-ahead posture while wearing blindfolds.

The muscle strength/ activation remains as a significant domain of Cervical activity and requires to be assessed. A gold standard to achieve this is the Electromyography (EMG) recording. Two of the biggest and most visible muscles in the cervical region is the sternocleidomastoid muscle (SCM) and the upper trapezius muscle (UT). Accurate motions of the head and neck require proper cooperation and coordination between those two muscles.

Patient follow up post-surgery, focus is on symptoms especially pain/ tingling/ radiation; while ROM and Muscle activation parameters are frequently missed, while proprioception which has an important role in maintenance of postural reactions, balance etc due to linkage to the vestibular, visual connections remains as the least addressed component.

These evaluations may be difficult to perform in the initial days/ weeks post-surgery due to the presence of kinesiophobia, localised pain at surgical site and muscle guarding

Thus, assessing a patient at an interval of atleast 6 months post-surgery which allows for natural course of recovery is viable and could provide vital insights and is therefore justified.

Scoping through the available literature reveals a literature gap in comprehensively and collectively analyzing the components of Proprioception, muscle activation and ROM post-decompression surgery for Cervical radiculopathy at a longer follow up period like 6 months. An objective understanding in this regard, further should help in improving the patient care and recovery by adopting early guided strategies in the course of rehabilitation. Thus, there is a strong and justified need to perform this proposed study.