Cheever Kelly, McDevitt Jane, Phillips Jacqueline, Kawata Keisuke
Department of Kinesiology, College for Health, Community and Policy, University of Texas at San Antonio, One UTSA cir, San Antonio, TX, 78429, USA.
Depart of Health and Rehabilitation Science, College of Public Health, Temple University, Philadelphia, PA, USA.
Sports Med. 2021 Sep;51(9):1875-1891. doi: 10.1007/s40279-021-01469-y. Epub 2021 Apr 23.
Patients with cervicogenic symptoms following a concussion have shown a disproportionate rate of delayed symptom resolution. However, the prevalence of cervicogenic symptoms in the acute stages following a concussion and the percentage of those patients who continue on to suffer delayed symptom resolution is poorly described in the literature.
To provide a comprehensive report on the clinical prevalence, diagnostic methods, and potential treatment options for cervicogenic symptoms that are elicited during acute and chronic phases following a concussion.
Electronic searches were conducted in PubMed, SPORTDiscus, ICL, CINAHL and PEDro, from inception to May 2020, to identify original research articles on concussion involving cervicogenic symptoms. We assessed each included article for risk of bias, methodological quality, level of evidence and evidence quality. The articles were categorized into three topics: (1) prevalence of post-concussion cervicogenic symptoms; (2) diagnostic testing for cervicogenic symptoms, and (3) treatment techniques for cervicogenic symptoms.
The initial review resulted in 1443 abstracts, of which 103 abstracts met the inclusion criteria of our research. After the review of full text, 80 articles were excluded, which resulted in a total of 23 articles for this systematic review. Prevalence of cervicogenic symptoms in the acute stages ranged from 7 to 69% and increased to 90% in patients experiencing persistent post-concussive symptoms. Neck pain at initial evaluation increased risk of developing persistent post-concussive symptoms (PPCS) by 2.58-6.38 times. Patient-reported outcome measures (e.g., Neck Disability Index, Dizziness Handicap Inventory, and Rivermead Post-Concussion Questionnaire) can identify patients with cervicogenic symptoms that should be further differentiated by clinical testing. Lastly, treatment using graded cervical manual therapy has shown to reduce time to symptom resolution and medical clearance.
Cervicogenic symptoms are prevalent in the acute and chronic stages following concussion, which if not diagnosed appropriately increase the likelihood of PPCS. Several clinical tests are available to help differentiate cervicogenic symptoms; however, lack of awareness and hesitation by practitioners limits their use. More randomized controlled trials are necessary to evaluate the effectiveness of cervical specific treatment programs for PPCS.
脑震荡后出现颈源性症状的患者症状延迟缓解的比例过高。然而，脑震荡急性期颈源性症状的患病率以及这些患者中继续出现症状延迟缓解的比例在文献中描述甚少。
全面报告脑震荡急性和慢性期引发的颈源性症状的临床患病率、诊断方法及潜在治疗方案。
于2020年5月前在PubMed、SPORTDiscus、ICL、CINAHL和PEDro数据库进行电子检索，以识别涉及颈源性症状的脑震荡原始研究文章。我们评估了每篇纳入文章的偏倚风险、方法学质量、证据水平和证据质量。文章分为三个主题：（1）脑震荡后颈源性症状的患病率；（2）颈源性症状的诊断测试；（3）颈源性症状的治疗技术。
初步检索得到1443篇摘要，其中103篇摘要符合我们的研究纳入标准。在全文审查后，排除了80篇文章，最终共有23篇文章纳入本系统评价。急性期颈源性症状的患病率为7%至69%，在持续存在脑震荡后症状的患者中升至90%。初始评估时的颈部疼痛使发生持续性脑震荡后症状（PPCS）的风险增加2.58至6.38倍。患者报告的结局指标（如颈部功能障碍指数、头晕残障量表和Rivermead脑震荡后问卷）可识别出应通过临床检查进一步鉴别颈源性症状的患者。最后，分级颈椎手法治疗已显示可缩短症状缓解时间和医疗许可时间。
颈源性症状在脑震荡后的急性和慢性期普遍存在，若未得到恰当诊断会增加发生PPCS的可能性。有多种临床检查可帮助鉴别颈源性症状；然而，从业者缺乏认识和犹豫不决限制了这些检查的应用。需要更多随机对照试验来评估针对PPCS的颈椎特异性治疗方案的有效性。
