Arm Pain Versus Neck Pain: A Novel Ratio as a Predictor of Post-Operative Clinical Outcomes in Cervical Radiculopathy Patients

Passias, Peter G.; Hasan, Saqib; Radcliff, Kris E.; Isaacs, Robert E.; Bianco, Kristina; Jalai, Cyrus M.; Poorman, Gregory W.; Worley, Nancy; Horn, Samantha R.; Boniello, Anthony J.; Zhou, Peter L.; Arnold, Paul M.; Hsieh, Patrick C.; Vaccaro, Alexander R.; Gerling, Michael C.

doi:10.14444/5078

Cited by 23 publications

(32 citation statements)

References 41 publications

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“…in addition, using both methods, multivariate analysis revealed that having aPD symptoms (being in the a group or aPD group) was an independent predictor of improvement in nDi (P = 0.049 and P = 0.020, respectively). these results are similar to a recently published retrospective study by Passias et al 17 the authors of that study noted that arm pain greater than neck pain at baseline was associated with increased odds of arm pain improvement and PCS scores after surgery. in addition, a higher baseline nDi score was associated with reduced odds of improvement in neck pain postoperatively.…”

Section: Discussionsupporting

confidence: 91%

How Do Patients With Predominant Neck Pain Improve After Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy?

et al. 2022

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Background: the presence of predominant pain in the arm vs the neck as a predictor of postoperative outcomes after anterior cervical discectomy and fusion (aCDF) has been seldom reported; therefore, the purpose of this study was to determine whether patients with predominant neck pain improve after surgery compared to patients with predominant arm pain or those with mixed symptoms in patients undergoing aCDF for radiculopathy.Methods: a retrospective cohort study was conducted on patients who underwent aCDF at a single center from 2016 to 2018. Patients were split into groups based on preoperative neck and arm pain scores: neck (n) pain dominant group (visual analog scale [vaS] neck ≥ vaS arm by 1.0 point); neutral group (vaS neck < vaS arm by 1.0 point); or arm (a) pain dominant group (vaS arm ≥ vaS neck by 1.0 point), using a threshold difference of 1.0 point. Subsequently, individuals were substratified into 2 groups based on the arm to neck pain ratio (anr): non-arm pain dominant defined as anr ≤1.0 and arm pain dominant (aPD) defined as anr >1.0. Patient-reported outcome measurements including neck Disability index (nDi), Physical Component Score-12, and Mental Component Score (MCS-12) were compared between groups.Results: no significant differences between groups when stratifying patients using a threshold difference of 1.0 point. When stratifying patients using the anr, those in the aPD group had significantly higher postoperative MCS-12 (P = 0.008) and nDi (P = 0.011) scores. in addition, the aPD group showed a greater magnitude of improvement for MCS-12 and nDi scores (P = 0.043 and P = 0.038, respectively). Multiple linear regression showed that the a and the aPD groups were both independent predictors of improvement in nDi.Conclusion: Patients with dominant arm pain showed significantly greater improvement in terms of MCS-12 and nDi scores compared to patients with dominant neck pain.Clinical Relevance: to compare the impact of aCDF on arm and neck pain in the context of cervical radiculopathy using patient-reported outcome measures as an objective measurement.

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Section: Discussionsupporting

confidence: 91%

How Do Patients With Predominant Neck Pain Improve After Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy?

et al. 2022

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“…Reduction in levels of neck and arm pain has been thought to be important factors influencing the recovery of disability in individuals with CR (Engquist et al, ; Passias et al, ). However, the reduction in neck and arm pain explained only a third of the influence of self‐efficacy on the recovery of disability.…”

Section: Discussionmentioning

confidence: 99%

Probing the mechanisms underpinning recovery in post‐surgical patients with cervical radiculopathy using Bayesian networks

Liew

Peolsson

Scutari

et al. 2020

European Journal of Pain

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Eur J Pain. 2020;24:909-920. wileyonlinelibrary.com/journal/ejp | 909 Abstract Background: Rehabilitation approaches should be based on an understanding of the mechanisms underpinning functional recovery. Yet, the mediators that drive an improvement in post-surgical pain-related disability in individuals with cervical radiculopathy (CR) are unknown. The aim of the present study is to use Bayesian networks (BN) to learn the probabilistic relationships between physical and psychological factors, and pain-related disability in CR. Methods: We analysed a prospective cohort dataset of 201 post-surgical individuals withCR. In all, 15 variables were used to build a BN model: age, sex, neck muscle endurance, neck range of motion, neck proprioception, hand grip strength, self-efficacy, catastrophizing, depression, somatic perception, arm pain intensity, neck pain intensity and disability. Results: A one point increase in a change of self-efficacy at 6 months was associated with a 0.09 point decrease in a change in disability at 12 months (t = −64.09, p < .001). Two pathways led to a change in disability: a direct path leading from a change in self-efficacy at 6 months to disability, and an indirect path which was mediated by neck and arm pain intensity changes at 6 and 12 months. Conclusions: This is the first study to apply BN modelling to understand the mechanisms of recovery in post-surgical individuals with CR. Improvements in painrelated disability was directly and indirectly driven by changes in self-efficacy levels. |

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“…Both of these analytic methods have been previously applied in the cervical spine, but not in the lumbar spine. 16,17…”

Section: Study Design and Patient Outcomesmentioning

confidence: 99%

Do Patients with Back Pain-Dominant Symptoms Improve After Lumbar Surgery for Radiculopathy or Claudication?

et al. 2021

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Background: Currently, few studies have examined whether patients with back or leg pain-predominant symptoms fare better clinically after lumbar spine surgery; therefore, the purpose of this study was to determine whether patients with back pain-dominant symptoms improved to a similar degree as patients with mixed or leg pain-dominant symptoms after lumbar surgery.Methods: A retrospective cohort study was conducted at a single academic center, in which patients were stratified into three groups: (1) back pain-dominant group (B) (visual analog score [VAS] back -VAS leg ! 1.0 point), (2) neutral group (N) (VAS back -VAS leg , 1.0 point), or (3) leg pain-dominant group (L) (VAS leg -VAS back ! 1.0 point), using a VAS threshold difference of 1.0 point. As a secondary analysis, the VAS leg-to-back pain (LBR) ratio was used to further stratify patients: (1) nonleg pain-dominant (NLPD) group (LBR 1.0) or (2) leg pain-dominant (LPD) group (LBR . 1.0). Patient outcomes, including physical component score of the short form-12 survey (PCS-12), mental component score of the short form-12 survey (MCS-12), and Oswestry Disability Index (ODI), were identified and compared between groups using univariate and multivariate analysis.Results: There were no significant differences in preoperative, postoperative, or delta scores for PCS-12 or ODI scores between groups. In patients undergoing decompression surgery, those with back pain-dominant or mixed symptoms (B, N, or NLPD groups) did not improve with respect to MCS-12 scores after surgery (P . .05), and those with leg pain-dominant symptoms (LPD group) had greater delta MCS-12 scores (P ¼ .046) and greater recovery rates (P ¼ .035). Multiple linear regression did not find LPD to be an independent predictor of PCS-12 or ODI scores.Conclusion: Patients undergoing lumbar decompression surgery and leg pain-dominant symptoms noted a greater improvement in MCS-12 scores; however, there were no differences in PCS-12 or ODI scores.Level of Evidence: III. Clinical Relevance: Patients undergoing lumbar decompression surgery demonstrate no major clinically significant differences when split up by pain-dominance groups. Lumbar SpineKeywords: patient-reported outcome measurements (PROMs), physical component score of the short form-12 (PCS-12), mental component score of the short form-12 (MCS-12), Oswestry Disability Index (ODI), visual analog scale back pain (VAS back), visual analog scale leg pain (VAS leg), VAS pain dominance, lumbar surgery

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Arm Pain Versus Neck Pain: A Novel Ratio as a Predictor of Post-Operative Clinical Outcomes in Cervical Radiculopathy Patients

Cited by 23 publications

References 41 publications

How Do Patients With Predominant Neck Pain Improve After Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy?

How Do Patients With Predominant Neck Pain Improve After Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy?

Probing the mechanisms underpinning recovery in post‐surgical patients with cervical radiculopathy using Bayesian networks

Do Patients with Back Pain-Dominant Symptoms Improve After Lumbar Surgery for Radiculopathy or Claudication?

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