Abstract
ObjectivesThe aim of this study was to explore the prevalence and risk factors for axial neck pain in patients undergoing multilevel anterior cervical decompression with fusion surgery.MethodsIn this study, 88 patients, who underwent multilevel anterior cervical decompression with fusion surgery from January 2012 to January 2017, were retrospectively reviewed. Based on the postoperative axial neck pain, the patients were classified into two groups: axial pain group and no axial pain group. The patients were followed up 3 weeks, 3 months, and 1 year after cervical anterior surgery for the early- and long-term clinical evaluation. The possible effect factors included demographic variables (age, sex, BMI, smoking, drinking, heart disease, hypertension, diabetes, preoperative kyphosis, preoperative axial neck pain, preoperative JOA scores, and ODI) and surgery-related variables (surgical option, vertebral lesions, spinal canal stenosis rate, superior fusion segment, presence of intramedullary high signal intensity).ResultsThe prevalence of axial neck pain was 27.3% (24 cases of 88). Our results showed that preoperative axial neck pain (62% vs 23%, P < 0.001) and preoperative kyphosis (42% vs 21.9%, P < 0.001) were risk factors for axial pain after multilevel anterior cervical surgery. Additionally, for patients with preoperative cervical kyphosis, compared to no axial pain group, the axial neck group was significantly more likely to exist a higher preoperative angle of C2–7 (13.31 ± 2.33 vs 7.33 ± 2.56, P < 0.001) and a higher correction range for kyphosis (20.24 ± 4.12 vs 12.34 ± 3.12, P < 0.001). However, for all the patients with postoperative axial symptoms, the improvement rate of axial pain was significantly higher for patients without cervical kyphosis at the early-term follow-up (3 weeks) (P = 0.032), no significant differences were found at the medium-term (P = 0.554) and long-term follow-up (P = 0.902), and improvements of clinical symptom have no obvious difference at the last follow-up.ConclusionsOverall, preoperative axial neck pain and kyphosis could predict axial neck pain for patients undergoing multilevel anterior cervical decompression with fusion surgery, and recovery of cervical kyphosis may contribute to the long-term recovery of neural function, but may also suffer from risk of short-term axial pain, which could be reduced through moderate cervical curvature recovery.
Highlights
Cervical spondylotic myelopathy (CSM) is a common clinical degenerative disease with an incidence of about 53.5% [1, 2], seriously impacting quality of life and even causing disability for the elderly population [3, 4], which can lead to defecation dysfunction even paralysis if accompanied by cervical cord injury
Based on the postoperative axial neck pain, the patients were classified into two groups: the axial pain group, including patients with obvious pain and related pain treatment, and the no axial pain group, including patients with no axial pain or with slight discomfort and without treatment
According to the statistical analyses of demographic variables, preoperative axial neck pain (62% vs 23%, P < 0.001) and preoperative kyphosis (42% vs 21.9%, P < 0.001) had a significant difference between the two groups (Figs. 2 and 3)
Summary
Cervical spondylotic myelopathy (CSM) is a common clinical degenerative disease with an incidence of about 53.5% [1, 2], seriously impacting quality of life and even causing disability for the elderly population [3, 4], which can lead to defecation dysfunction even paralysis if accompanied by cervical cord injury. In many cases, anterior cervical decompression with fusion surgery is still associated with unresolved complications, including dysphagia, postoperative hematoma (neck), hoarseness, esophageal injury, injury to major vessels, wound infection (neck), graft extrusion, axial neck pain, C5 palsy, reduction in neck motion, pseudoarthrosis, nonunion, and revision and screw removal [9, 10]. Axial neck pain as a common complication after surgery, especially in patients undergoing multilevel anterior or posterior cervical decompression, severely threatens the physical and mental health and life quality of the patients. Axial pain has gradually been receiving more attention, compared with a monumental amount of coverage of posterior decompression, this complication associated with multilevel anterior cervical decompression is seldom described in large clinical series [18, 19]. The aim of this study was to explore prevalence and risk factors for axial neck pain in patients undergoing multilevel anterior cervical decompression with fusion surgery
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