Depth by ultrasound from skin surface to the C6 transverse process while applying pressure

Multicenter, Randomized, Placebo-controlled Crossover Trial Evaluating Topical Lidocaine for Mechanical Cervical Pain

BACKGROUND

There are few efficacious treatments for mechanical neck pain, with controlled trials suggesting efficacy for muscle relaxants and topical nonsteroidal anti-inflammatory drugs. Although studies evaluating topical lidocaine for back pain have been disappointing, the more superficial location of the cervical musculature suggests a possible role for topical local anesthetics.

METHODS

This study was a randomized, double-blind, placebo-controlled crossover trial performed at four U.S. military, Veterans Administration, academic, and private practice sites, in which 76 patients were randomized to receive either placebo followed by lidocaine patch for 4-week intervals (group 1) or a lidocaine-then-placebo patch sequence. The primary outcome measure was mean reduction in average neck pain, with a positive categorical outcome designated as a reduction of at least 2 points in average neck pain coupled with at least a 5-point score of 7 points on the Patient Global Impression of Change scale at the 4-week endpoint.

RESULTS

For the primary outcome, the median reduction in average neck pain score was -1.0 (interquartile range, -2.0, 0.0) for the lidocaine phase versus -0.5 (interquartile range, -2.0, 0.0) for placebo treatment (P = 0.17). During lidocaine treatment, 27.7% of patients experienced a positive outcome versus 14.9% during the placebo phase (P = 0.073). There were no significant differences between treatments for secondary outcomes, although a carryover effect on pain pressure threshold was observed for the lidocaine phase (P = 0.015). A total of 27.5% of patients in the lidocaine group and 20.5% in the placebo group experienced minor reactions, the most common of which was pruritis (P = 0.36).

CONCLUSIONS

The differences favoring lidocaine were small and nonsignificant, but the trend toward superiority of lidocaine suggests more aggressive phenotyping and applying formulations with greater penetrance may provide clinically meaningful benefit.

EDITOR’S PERSPECTIVE

Accessory articulation of the transverse processes in the cervical spine

Accessory articulation between the transverse processes of the C6 and C7 vertebrae is an extremely rare anatomic variant that has only been previously described in two instances. In this report, we present the case of a 25-year-old male who sustained numerous injuries associated with a physical assault. A CT study of the cervical spine revealed a linear lucency mimicking a fracture but found on closer inspection to represent an accessory articulation between the anterior tubercles of the right transverse processes of the C6 and C7 vertebrae. In this report, we summarize this patient's clinical course, and provide an up-to-date review of the current literature, imaging characteristics, and potential mechanisms of the development of this anatomic variant. Our case also includes an incomplete version of the anomaly contralaterally as well as features of secondary osseous stress hypertrophy; these features have not been previously described and may aid in diagnosis. Finally, we provide the first-ever augmented reality model of this variant to fully convey its geometry and facilitate its unequivocal identification.

Stent-Assisted Coil Embolization of a Vertebro-Vertebral Arteriovenous Fistula Secondary to Oriental Acupuncture: A Case Report

A vertebro-vertebral arteriovenous fistula is an abnormal communication between the vertebral artery and adjacent venous structures. Trauma is the most common cause of vertebral arteriovenous fistulas; however, the fistulas can also occur spontaneously. We herein report a case of a traumatic vertebro-vertebral arteriovenous fistula that occurred following the application of oriental acupuncture in the posterior neck region. A 64-year-old previously healthy female patient took over-the-counter medicine for cervical pain that occurred several months before the acupuncture session but showed no improvement. She had undergone oriental acupuncture treatment in the posterior lower neck region 1 month before visiting our hospital. After the treatment, she gradually developed tinnitus, accompanied by dizziness. Abnormal aneurysmal dilated vessels were observed in the right vertebral artery on computed tomography angiography. The patient was immediately admitted and underwent diagnostic angiography. She subsequently underwent stent-assisted coil embolization, which gradually resolved her dizziness and tinnitus.