282 Does Axial Cervical Pain Improve With Surgical Fusion? A Meta-analysis

Abstract

INTRODUCTION: Isolated axial neck pain is a prevalent condition that causes significant morbidity and productivity loss. METHODS: This study searched for RCTs and cohort studies in English language databases with a minimum 6-month follow-up, limited to patients with axial neck pain/cervical radiculopathy and pre/post-operative NDI and VAS scores. Literature reviews, meta-analyses, systematic reviews, surveys, and case studies were excluded. Two patient groups were analyzed: the arm pain predominant (pAP) cohort and the neck pain predominant (pNP) cohort. A 30% reduction in PROMs scores from baseline represented the Minimal Clinically Important Difference (MCID). RESULTS: Five studies with 5,221 patients met the inclusion criteria. Patients with pAP had a slightly greater reduction in PROMs scores than those with pNP. NDI reduction was 41.34 % (16.3/39.42) in pNP patients (p < 0.0001) and 45.12% (15.86/35.15) in pAP patients (p < 0.0001). Surgical improvement was comparable between the two groups (16.3 vs. 15.86 points, p = 0.3193) .Patients with pNP had a greater reduction in neck pain (53.4%; 3.60/6.74, p < 0.0001) compared to pAP (50.30%; 2.46/4.89, p < 0.0001), with a significant difference in VAS scores (3.6 vs. 2.46, p < 0.0134). Patients with pNP had 43.6% (1.96/4.5) improvement in arm pain (p < 0.0001), while pAP patients had 66.12% (4.43/6.7) improvement (p < 0.0001), with significantly higher VAS scores for arm pain in pAP patients (4.43 vs. 1.96 points, p < 0.0051). CONCLUSIONS: Surgical intervention is increasingly supported for primary axial neck pain, with studies demonstrating greater improvements in neck pain than arm pain, exceeding MCID and reaching SCB. However, given the multifaceted nature of the condition, further research is needed to determine optimal patients and pathologies for surgery.