Does Cervical Spine Treatment Reduce Low Back Pain?

Although cervical spine pathology is not recognized as a cause of low back pain (LBP), roughly one-third of patients with LBP also have neck pain. Our study examined whether management of cervical disk displacements reduces the severity and frequency of lower body pain and numbness in patients with lumbar symptoms and cervical spine lesions. Lower body symptoms were recorded before and after a physical therapy program targeted at the cervical spine. There was an overall 44% reduction of lower body pain and numbness; 82% of complaints of severe pain and 74% of complaints described to be constant were no longer made after cervical treatments. Management of cervical lesions improved lower back and lower extremity pain and numbness. (J Musculoskel Med. 2011;28:333-338) _____________________________________________________________________________________________ Cervical spine pathology is not recognized as a cause of low back pain (LBP), but about one-third of patients with LBP also have neck pain. We conducted a study to examine whether management of cervical disk displacements reduces the severity and frequency of lower body pain and numbness in patients who have lumbar symptoms and cervical spine lesions. In this article, we report our findings. Background LBP, which affects 60% to 80% of the adult US population, is the fifth most common reason for visiting a physician.1-3 Textbooks document that the causes of LBP often are very difficult to determine; for up to 85% of patients, no specific cause can be found.4,5 Few or no references suggest a cervical cause or cervical enhancement of low back and lower extremity symptoms. However, 35.4% of persons who reported having LBP also reported having neck pain in a study that analyzed data from the 2002 National Health Interview Survey.6 A pattern has become apparent in this clinical practice. Reassessment of patients who did not show anticipated improvements of lumbar symptoms after treatments focused on the lumbar spine often revealed abnormal upper extremity and upper motor neuron findings indicative of an overlying cervical lesion. Cervical MRI scans of these patients showed singleor multiple-level posterior cervical disk displacements that were indenting the thecal sac; in some of the cases, there was cervical cord contact or compression. We propose that a portion of patients who present with persistent LBP and lower extremity symptoms are experiencing cervical spine–triggered lumbar symptoms. The anatomy of the cervical spine is such that 75% to 80% of posterior-directed cervical disk protrusions do not result in isolated cervical root compression or radiculopathy.1,7 They instead cause central compressive forces on the thecal sac, central canal, or cervical cord that result in cervical cord dysfunction or a mild myelopathy. The patients are not aware of the resulting upper extremity dysfunction and do not complain of neck pain or upper extremity symptoms. However, physical examination reveals both upper and lower extremity weakness, hyperreflexia, and sensory alterations at and below the level of the cervical lesions.8,9 We think that the cervical lesion triggers the more bothersome lumbar and lower extremity symptoms, resulting in mild weakness and dysfunction at and below the cervical level, causing weakness, imbalance, and neural processing problems of crucial core and lumbar paraspinal muscles. The resulting torso dysfunction leads to lumbar segmental instability, dysfunction of the lumbar “3-joint complex,” and faster progression of the Kirkaldy-Willis degenerative cascade. The lumbar segmental instability and degenerative cascade then trigger low back and radicular leg symptoms.10,11 We hypothesize that in patients who have displaced cervical disks, physical therapy and nonsurgical decompression result in a reduction of lower body pain and numbness. Our study objective was to