Postural changes of the cervical spine in patients with nontoxic goiter

Purpose: To investigate differences in cervical spine posture and range of motion and self-reported neck pain and headache between patients with nonto xic goiter compared with a matched control group. Design: An observational, controlled, blinded study. Setting: The ambulatory outpatient facility of a university hospital. Participants: Twenty-five nontoxic goiter patients and 25 matched nongoiter ous control subjects from the Department of Endocrinology. Intervention: Participants were X-rayed from a lateral position in neutral, full flexion and full extension, and the radiographs were evaluated by a b linded examiner for anterior head carriage, maximal flexion, maximal extens ion and the extent and severity of any degenerative changes in the cervical spine. The degree of postural neck muscle tenderness was evaluated by a bl inded rheumatologist using a validated Total Tenderness Score system. In addition, the two groups were compared for their self-reported frequency of neck pain and headaches. Results: A significant increase in anterior head carriage was found among t he goiter patients (p =.01), together with a corresponding decrease in flex ion (p =.01), whereas the corresponding increase in extension was not stati stically significant (p =.16). A higher prevalence of headaches was found i n the goiter group (p =.06), but there was no difference in neck muscle ten derness (p =.40) or frequency of neck problems (p =.40) between the groups. The severity of degenerative changes in the cervical spine (p =.22) and th e number of vertebral levels with degenerative changes (p =.13) were simila r in the two groups. Conclusions: Goiters of >100 g seem to alter the posture of the cervical sp ine, possibly resulting in a tendency for more frequent headaches. The chan ges do not seem to cause more neck pain, muscle tenderness or degeneration of the cervical spine.