What is the Preferred Angle of Traction to Decompress Cervical Nerve Roots?

Study Overview
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Brief Summary
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The purpose of the study is to investigate the effect of different angles of decompression on the Flexor Carpi Radialis (FCR) H-Reflex in patients with cervical radiculopathy

Detailed Description
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Cervical traction has long been defined as a distracting force that separate the cervical segments and relieve nerve roots compression. Yet, there is lack of knowledge that reports the effects of different traction decompression angles and determines the proper angle of pull among different angles of decompression system

Official Title
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What is the Preferred Angle of Traction to Decompress Cervical Nerve Roots?

Conditions
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Cervical Radiculopathy

Intervention / Treatment
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* Other: Cervical Traction from different angles


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients will be included in the study if they have C5-C6 and C6-C7 paramedian disc protrusion manifested by unilateral symptoms in C6-C7 roots dermatome and myotomes of the upper extremities, second grade of disc bulge (2-3mm) which was detected from T2 axial view of MRI, and diagnosed as cervical disc protrusion (C5- C7) for at least three months. Exclusion Criteria: - Patients will be excluded from the study if they have upper cervical spine disc pathology, cord compression and upper motor neuron symptoms, curvature abnormalities of the neck including reversed curve (kyphotic) and deformities, cervical rib syndrome, double crush syndrome, diabetic neuropathy, text neck, short neck (churchill neck), marked facet joint, neuro-central joint arthropathic pathology, osteoporotic patients.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: One independent variable with many levels.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: traction therapy from neutral position<br>Patients in this group will receive traction decompression from neutral neck position with rope angle (0°) | Other: Cervical Traction from different angles<br>* Intermittent traction will be applied, maximum force will be 16 kg, minimum force will be 12 kg, traction cycle of each minute consists of 20 seconds static traction at the maximum force then released down to the minimum force for 20 seconds then repeated for 20 seconds static traction. Traction session time will be 15 minutes, and the traction force will be increased progressively with speed (50%) of increment of force<br>|
| Active Comparator: traction therapy from lateral bending<br>patients will undergo traction decompression from (30°) lateral bending of the neck toward the non-affected side | Other: Cervical Traction from different angles<br>* Intermittent traction will be applied, maximum force will be 16 kg, minimum force will be 12 kg, traction cycle of each minute consists of 20 seconds static traction at the maximum force then released down to the minimum force for 20 seconds then repeated for 20 seconds static traction. Traction session time will be 15 minutes, and the traction force will be increased progressively with speed (50%) of increment of force<br>|
| Active Comparator: traction from flexion with lateral bending and rotation<br>patients will be treated with traction decompression from (15°) neck flexion, (30°) lateral bending toward non- affected side and (15°) rotation to the affected side. | Other: Cervical Traction from different angles<br>* Intermittent traction will be applied, maximum force will be 16 kg, minimum force will be 12 kg, traction cycle of each minute consists of 20 seconds static traction at the maximum force then released down to the minimum force for 20 seconds then repeated for 20 seconds static traction. Traction session time will be 15 minutes, and the traction force will be increased progressively with speed (50%) of increment of force<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Flexor Carpi radialis H-reflex | The peak-to-peak amplitudes of four FCR-HR traces will be measured and averaged for each patient | Changes from Baseline to 6-weeks after treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Traction, Decompression angles