Comment on: Text neck misdiagnosed as fibromyalgia. Reply

Dear Editor, We thank Dr Ney Meziat-Filho and others [1] for their interest in our paper [2] and for their valuable comments. Moreover, we agree that, as they pointed out, the habit of using smartphones in a neck-flexed posture alone causes neck pain is questionable. The term ‘text neck’ was proposed by a chiropractor, Dr Dean L. Fishman, and it is used to define both a bad postural position and a syndrome associated with the prolonged and inappropriate use of handheld mobile devices, including smartphones. However, it is not a well-studied disease concept.

In Japan, with the spread of smartphones and personal computers, the number of patients who experience pain in the head, neck, shoulders and back, and paresthaesia in the upper extremities is increasing. Furthermore, it is widely known that in such patients, lateral images of the cervical spine taken by X-ray or MRI show that the cervical spine is deformed into a straight line, in contrast to the cervical spine in healthy subjects, which has a forward convex arch. In Japan, this finding in the cervical spine is called a ‘straight neck’. Additionally, this cervical spine deformity is often accompanied by cervical disc herniation and spinal canal stenosis; thus, patients often complain of chronic pain in the shoulders, shoulder blades and back, and discomfort and stiffness in the hands. We propose that the main problem related to cervical spine deformity is that it is not widely recognized. As cervical spine deformity does not appear to have any major abnormalities initially, it is not of interest in the field of orthopaedic surgery because it is not indicated for surgery. Our search on PubMed yielded no results when we searched for the term ‘straight neck’, which is commonly used to denote this cervical spine deformity in Japan. Moreover, there are very few papers on text neck, which signifies the same disease concept and symptoms. We aimed to raise awareness of the fact that cervical spine deformity, which is often overlooked as a minor problem, can significantly reduce the quality of life of patients. In addition to not being widely recognized, patients with muscle pain and stiffness may be misdiagnosed with fibromyalgia or seronegative RA because blood tests and serological tests show no abnormalities. We wished to raise awareness of the possibility that such patients may receive the wrong medical care and treatment for long periods of time.

Our aim is that the ‘straight neck’ cervical deformity seen in patients with text neck will be widely recognized, that medical knowledge will be accumulated, and that this disease concept and treatment optimization will progress in the future.

Data availability statement

Data are available upon reasonable request from any qualified researchers, who engage in rigorous, independent scientific research, and will be provided following review and approval of a research proposal and Statistical Analysis Plan (SAP) and execution of a Data Sharing Agreement (DSA). All data relevant to this study are included in the article.

Funding

No specific funding was received from any funding bodies in the public, commercial, or not-for-profit sectors to carry out the work described in this article.

Disclosure statement: The authors have no conflicts of interest to declare.

Patient consent: The patient provided written consent for publication of the images in the original case report.

Acknowledgements

T.H. wrote the manuscript. All authors have read and approved the final manuscript.

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