Correlation of neural foraminal motion after surgical treatment of cervical radiculopathy with long-term patient reported outcomes.

Abstract

Post-surgical changes in adjacent segment motion are considered a factor in further development of degeneration and cervical radiculopathy. The objective was to examine the extent of correlations between physiological motion of cervical foramina and long-term patient reported outcomes (PRO). Biplane X-ray imaging and CT-based markerless tracking were used to measure 3D static and dynamic dimensions during neck axial rotation and extension from 18 patients treated for C5-6 radiculopathy with fusion or arthroplasty. Minimum foraminal height (FH.Min) and width (FW.Min), and their range (FH.Range and FW.Range) achieved during a motion task were calculated for adjacent levels (C4-5 and C6-7) at 2.0±0.6 years post-surgery. The modified Japanese Orthopedic Association score (mJOAS), the Neck Disability Index (NDI) including the visual analogue scale (VAS) for neck and arm pain, and the EuroQol EQ-5D score were recorded at 6.5±1.1 years post-surgery. The relationships between 6.5-year outcomes and 2-year foraminal motion were examined using regression. Worsening patient-reported outcomes were generally associated with lower values of FW.Min (P<0.05 to P<0.008), the associations being stronger for neck extension (r2 up to 0.43). Dynamic foraminal measurements from the C6-7 level more significantly and consistently correlated with mJOAS, EQ-5D and NDI Arm Pain VAS (r2=0.27 to 0.43; P<0.03 to P<0.008), whereas those from the C4-5 level correlated with NDI Neck Pain VAS (r2=0.33; P<0.02). Dynamic 3D foraminal dimensions at 2-year post-surgery, notably FW.Min measured in neck extension at adjacent levels, were associated with PRO at 6.5 years post-surgery. These relationships provide insight into the motion related factors in development of pain and loss of function, and may help develop markers or objective outcome measures.