Objectives The 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. Methods In 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). Results The 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. Conclusions Overall, 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.

Objectives. To investigate the risk factors of total blood loss (TBL) and hidden blood loss (HBL) in adolescent idiopathic scoliosis (AIS) patients undergoing posterior orthopedic surgery. Methods. The AIS patients who visited department of spine surgery between January 2015 and December 2020 were retrospectively reviewed. Those with a history of posterior orthopedic surgery for AIS were identified, and their clinical data were collected. Gross formula was used to calculate the TBL and HBL. SPSS 20.0 was used for statistical analysis. The potential risk factors of TBL and HBL were assessed by independent t -test or univariate analysis. The risk factors of TBL and HBL were determined by multiple linear regression. Results. A total of 114 patients were included in this study. Operative time ( P < 0.001 ), postoperative platelets (PLT) ( P = 0.001 ), the number of surgical fixation segments ( P < 0.001 ), implanted screws ( P < 0.001 ), hospital stay ( P = 0.006 ), type of scoliosis ( P < 0.001 ), and correction angle of scoliosis ( P = 0.063 ) were the potential risk factors of TBL. Operative time ( P < 0.000 ), postoperative PLT ( P = 0.095 ), the number of surgical fixation segments ( P < 0.001 ), implanted screws ( P < 0.001 ), type of scoliosis ( P < 0.001 ), correction angle of scoliosis ( P = 0.073 ), and total blood volume ( P = 0.098 ) were the potential risk factors of HBL. Multiple linear regression analysis showed that operative time ( P = 0.003 ) and the number of surgical fixation segments ( P = 0.014 ) were risk factors of TBL, while the number of surgical fixation segments ( P = 0.004 ) was a risk factor of HBL. Conclusions. In AIS patients undergoing posterior internal fixation surgery, the operative time and the number of surgical fixation segments are risk factors of TBL, and the number of surgical fixation segments is a risk factor of HBL. Surgeons need to consider these factors when making surgical strategies for AIS patients.

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