Axial pain after posterior cervical spine surgery: a systematic review

Wang, Shanjin; Jiang, Sheng‐Dan; Jiang, Lei‐Sheng; Dai, Li-Yang

doi:10.1007/s00586-010-1600-x

Cited by 120 publications

(102 citation statements)

References 48 publications

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“…15,17 In contrast, Asian spine surgeons developed EL and usually prefer it. Strict indications for LF and EL differ according to cervical lordosis and instability.…”

Section: Discussionmentioning

confidence: 99%

Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes

Lee

Kang

et al. 2015

SPI

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OBJECT Posterior cervical surgery, expansive laminoplasty (EL) or laminectomy followed by fusion (LF), is usually performed in patients with multilevel (≥ 3) cervical spondylotic myelopathy (CSM). However, the superiority of either of these techniques is still open to debate. The aim of this study was to compare clinical outcomes and postoperative kyphosis in patients undergoing EL versus LF by performing a meta-analysis. METHODS Included in the meta-analysis were all studies of EL versus LF in adults with multilevel CSM in MEDLINE (PubMed), EMBASE, and the Cochrane library. A random-effects model was applied to pool data using the mean difference (MD) for continuous outcomes, such as the Japanese Orthopaedic Association (JOA) grade, the cervical curvature index (CCI), and the visual analog scale (VAS) score for neck pain. RESULTS Seven studies comprising 302 and 290 patients treated with EL and LF, respectively, were included in the final analyses. Both treatment groups showed slight cervical lordosis and moderate neck pain in the baseline state. Both groups were similarly improved in JOA grade (MD 0.09, 95% CI −0.37 to 0.54, p = 0.07) and neck pain VAS score (MD −0.33, 95% CI −1.50 to 0.84, p = 0.58). Both groups evenly lost cervical lordosis. In the LF group lordosis seemed to be preserved in long-term follow-up studies, although the difference between the 2 treatment groups was not statistically significant. CONCLUSIONS Both EL and LF lead to clinical improvement and loss of lordosis evenly. There is no evidence to support EL over LF in the treatment of multilevel CSM. Any superiority between EL and LF remains in question, although the LF group shows favorable long-term results.

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“…15,17 In contrast, Asian spine surgeons developed EL and usually prefer it. Strict indications for LF and EL differ according to cervical lordosis and instability.…”

Section: Discussionmentioning

confidence: 99%

Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes

Lee

Kang

et al. 2015

SPI

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“…Cervical spine decompression surgery has been frequently performed to gain neurologic recovery and pain reduction to improve functional outcome . However, persistent pain following cervical spine surgery is not uncommon .…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Persistent Shoulder Pain After Cervical Spine Surgery

Kholinne

Kwak

Sun

et al. 2019

Orthopaedic Surgery

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ObjectiveTo define risk factors of having persistent shoulder pain following cervical spine surgery.MethodsFrom April 1995 to May 2012, 862 patients underwent cervical spine surgery in a tertiary referral university hospital. Ninety‐six patients were referred to a shoulder surgeon for persistent shoulder pain over 3 months after cervical spine surgery. Thirty‐five were excluded from the study due to failure to follow‐up or lack of radiographic data. We analyzed a total of 61 patients as patient group (PG) compared to age, sex, and surgeon matched control group (CG) with no shoulder pain after surgery. Medical records were reviewed for age, sex, level of cervical surgery, approach of cervical surgery, underlying medical problems, final diagnosis of the shoulder pathology, and shoulder visual analog scale (VAS) score. The pre‐ and post‐operative variables for level of cervical surgery, approach of cervical surgery, underlying medical history, and shoulder VAS were compared and analyzed in this study.ResultsThe number of patients with lower cervical level surgery was significantly higher (91 patients, 74.6%) compared to upper cervical level surgery (31 patients, 25.4%) (P = 0.005). Anterior approach was more frequently used (70 patients, 57.3%) compared to posterior approach (52 patients, 42.7%) (P < 0.001). The final diagnosis of shoulder pathology in PG were rotator cuff disease in 31 patients, adhesive capsulitis in 18 patients, and calcific tendinitis in 10 patients respectively. No significant difference for preoperative shoulder VAS score was found in both groups. A lower level of cervical spine pathology in patients (C4‐T1 level) and posterior approach surgery were factors that significantly presented with more shoulder pain. Subgroup analysis revealed no statistical difference for level of cervical surgery and approach of cervical surgery among groups with different shoulder pathology.ConclusionsThe current study includes patients with persistent shoulder pain following cervical surgery without having evidence of concurrent preexisting shoulder pathology documented previously. We suggest that posterior approach and lower level of cervical surgery patients could be clinically relevant risk factors for persistent shoulder pain following cervical spine surgery.

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“…1 The advantages of the posterior approach compared with the anterior approach include indirect decompression without destabilizing the disk space, intuitive operation while exposing multiple levels, and less risk of postoperative instability and adjacent level degeneration. [2][3][4] Studies have reported more satisfactory surgical outcomes using laminoplasty or laminectomy [5][6][7][8] ; however, postoperative problems, such as C5 palsy, axial pain, segmental instability, restriction of neck motion, perineural adhesions, and loss of lordotic curvature, have also been reported.…”

Section: Introductionmentioning

confidence: 99%

C5 nerve root palsy after posterior cervical spine surgery

Fang

Wang

et al. 2017

J Orthop Surg (Hong Kong)

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Background: C5 palsy is a serious complication after cervical decompression surgery in which the patient shows a deterioration in power of the deltoid or biceps brachii by at least one grade in the manual muscle test without aggravation of lower extremity function. Although there are several hypotheses regarding the etiology of C5 palsy, the pathogenesis and preventive measures remain unidentified and many other controversies remain. Objective: To systematically review the clinical features, risk factors, mechanism, and preventive measures of C5 palsy after posterior cervical decompression surgery. Materials and methods: PubMed was searched to identify eligible studies that contained more than 10 cases and focused on C5 palsy. Microsoft Excel was used to analyze the data. Statistical comparisons were made when appropriate. Results: Out of 718 papers involving C5 palsy, 28 met the inclusion criteria. The average incidence rate was 7.8% (range, 1.4-23.0%). Risk factors for C5 palsy included age, male gender, ossification of the posterior longitudinal ligament, and stenosis of the C4-C5 intervertebral foramen. C5 palsy occurred from immediately to 2 months after surgery, and recovery time ranged from 48 h to 41 months. Hypotheses for the mechanism of C5 palsy included root involvement and spinal cord impairment. Foraminotomy and intraoperative neuromonitoring were the two main methods used to prevent C5 palsy. Conclusion: C5 palsy is a serious complication occurring at the early stage after cervical decompression surgery. Foraminotomy and intraoperative neuromonitoring were the two main methods to prevent C5 palsy. The incidence of C5 palsy is low, but it can place a serious burden on the patients' quality of life and finances. The risk factors and mechanism of C5 palsy are still controversial. However, under conservative therapy, the prognosis is usually good. Higher quality studies are necessary for drawing more reliable and convincing conclusions about this disease.

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Axial pain after posterior cervical spine surgery: a systematic review

Cited by 120 publications

References 48 publications

Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes

Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes

Risk Factors for Persistent Shoulder Pain After Cervical Spine Surgery

C5 nerve root palsy after posterior cervical spine surgery

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