Persistent Local Pain After Posterior Spine Surgery for Thoracic Lesions

Sakaura, Hironobu; Hosono, Noboru; Mukai, Yoshihiro; Fujii, Ryutaro; Iwasaki, Motoki; Yoshikawa, Hideki

doi:10.1097/01.bsd.0000211275.81862.91

Cited by 10 publications

(9 citation statements)

References 19 publications

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“…Sakaura et al [34] found that the muscles at the cervicothoracic junction around the C7 spinous process played a central role in the development of this postoperative axial pain. Consequently, axial pain inherent in laminoplasty was reported to be reduced by preserving the C7 spinous process and its muscle and ligament attachments [6,7,32,42].…”

Section: Discussionmentioning

confidence: 99%

Axial pain after posterior cervical spine surgery: a systematic review

et al. 2010

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Posterior operative approach has been the standard treatment for cervical compressive myelopathy, and axial pain after laminoplasty or laminectomy as a postoperative complication is now gradually receiving more and more attention. The objective of this study was to provide a systematic review of the current understanding of axial pain after cervical laminoplasty and laminectomy, and summarize clinical features, influence factors and preventive measures of axial pain after posterior decompressive surgery based on a review of literature published in the English language. Axial pain distributes over nuchal, periscapular and shoulder regions. Posterior surgery is not the major cause of axial pain, but axial pain can be worsened by the procedure. There are many clinical factors that influence postoperative axial pain such as age, preoperative axial pain, different surgical technique and postoperative management, but most of them are still controversial. Several surgical modifications have been innovated to reduce axial pain. Less invasive surgery, reconstruction of the extensor musculature, avoiding detachment of the semispinalis cervicis muscle and early removal of external immobilization have proved to be effective. Axial pain is under the influence of multiple factors, so comprehensive methods are required to reduce and avoid the postoperative axial pain. Because of methodological shortcomings in publications included in this systematic review, different results from different studies may be produced due to differences in study design, evaluation criteria, sample size, and incidence or severity of axial pain. More high-quality studies are necessary for drawing more reliable and convincing conclusions.

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Section: Discussionmentioning

confidence: 99%

Axial pain after posterior cervical spine surgery: a systematic review

et al. 2010

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“…of vertebral arches is essential because sinking or nonunion of the expanded lamina can induce postoperative axial pain. 18 Sakaura et al 19 reported that the muscles at the cervicothoracic junction around the C7 spinous process played a central role in the development of this postoperative axial pain. Because the C7 spinous process is the origin of the trapezius, rhomboid minor muscles, and nuchal ligament, sacrifi cing this spinous process can cause great damage to the posterior musculature of the cervical spine.…”

Section: A 7bmentioning

confidence: 99%

Clinical Application of a New Plate Fixation System in Open-door Laminoplasty

Jiang¹,

Chen²,

Chen³

et al. 2012

Orthopedics

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The purpose of this retrospective clinical series was to evaluate the benefits and complications of plate fixation for open-door laminoplasty in cervical spondylotic myelopathy with multilevel spinal stenosis compared with open-door laminoplasty without fixation. Forty-nine patients underwent open-door laminoplasty for cervical myelopathy with multilevel spinal stenosis with at least 13 months of follow-up. A plate was used as the sole method of fixation between the lateral mass and lamina with 3 screws. Computed tomography scans obtained pre- and postoperatively were assessed for plate complications and spinal canal enlargement. Pre- and postoperative neurological condition was assessed by the Japanese Orthopedic Association (JOA) myelopathy score. Overall cervical spine range of motion (ROM) was measured in full flexion and extension radiographs pre- and postoperatively. No restenosis due to door reclosure was noted, and no plates failed. No screws were backed out or broken. Almost all patients showed neurological improvement. The JOA score increased by 3.9±0.7 points in the suture group and 4.3±0.8 points in the plate group (P>.05). The postoperative increase in mean anteroposterior diameter of the spinal canal from C3 to C7 was 4.5±0.6 mm in the suture group and 5.1±0.5 mm in the plate group. The greater mean anteroposterior diameter increase in the plate group was statistically significant (P<.01). The mean cervical ROM decreased in the plate and suture groups postoperatively (P<.001). No significant difference was found in mean cervical ROM reduction between the groups (P>.05). No difference in axial symptoms was found between the 2 groups.

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“…10 In clinical research, the authors of one study reported that axial pain was induced after upper thoracic surgery and required detachment and spreading of the spinous process or vertebral arch at the cervicothoracic junction; these results were in contrast to those after middle or lower thoracic surgery, which was associated with no strong postoperative pain around the surgical wound. 19 These findings suggest that the connection of the nuchal muscles with the C-7 spinous process is very important and related to the pathology of postoperative axial neck pain. Focusing on preserving the large spinous process of C-7 as the important origin of the nuchal muscles, Hosono et al 6 conducted a comparative study of conventional C3-7 laminoplasty and C3-6 laminoplasty by limiting the range of decompression with preservation of the C7 spinous process.…”

Section: Discussionmentioning

confidence: 87%

Effect of preservation of the C-6 spinous process and its paraspinal muscular attachment on the prevention of postoperative axial neck pain in C3–6 laminoplasty

Mori¹,

Ueta²,

Maeda³

et al. 2015

SPI

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OBJECT Axial neck pain after C3–6 laminoplasty has been reported to be significantly lesser than that after C3–7 laminoplasty because of the preservation of the C-7 spinous process and the attachment of nuchal muscles such as the trapezius and rhomboideus minor, which are connected to the scapula. The C-6 spinous process is the second longest spinous process after that of C-7, and it serves as an attachment point for these muscles. The effect of preserving the C-6 spinous process and its muscular attachment, in addition to preservation of the C-7 spinous process, on the prevention of axial neck pain is not well understood. The purpose of the current study was to clarify whether preservation of the paraspinal muscles of the C-6 spinous process reduces postoperative axial neck pain compared to that after using nonpreservation techniques. METHODS The authors studied 60 patients who underwent C3–6 double-door laminoplasty for the treatment of cervical spondylotic myelopathy or cervical ossification of the posterior longitudinal ligament; the minimum follow-up period was 1 year. Twenty-five patients underwent a C-6 paraspinal muscle preservation technique, and 35 underwent a C-6 nonpreservation technique. A visual analog scale (VAS) and VAS grading (Grades I–IV) were used to assess axial neck pain 1–3 months after surgery and at the final follow-up examination. Axial neck pain was classified as being 1 of 5 types, and its location was divided into 5 areas. The potential correlation between the C-6/C-7 spinous process length ratio and axial neck pain was examined. RESULTS The mean VAS scores (± SD) for axial neck pain were comparable between the C6-preservation group and the C6-nonpreservation group in both the early and late postoperative stages (4.1 ± 3.1 vs 4.0 ± 3.2 and 3.8 ± 2.9 vs 3.6 ± 3.0, respectively). The distribution of VAS grades was comparable in the 2 groups in both postoperative stages. Stiffness was the most prevalent complaint in both groups (64.0% and 54.5%, respectively), and the suprascapular region was the most common site in both groups (60.0% and 57.1%, respectively). The types and locations of axial neck pain were also similar between the groups. The C-6/C-7 spinous process length ratios were similar in the groups, and they did not correlate with axial neck pain. The reductions of range of motion and changes in sagittal alignment after surgery were also similar. CONCLUSIONS The C-6 paraspinal muscle preservation technique was not superior to the C6-nonpreservation technique for preventing postoperative axial neck pain.

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Persistent Local Pain After Posterior Spine Surgery for Thoracic Lesions

Cited by 10 publications

References 19 publications

Axial pain after posterior cervical spine surgery: a systematic review

Axial pain after posterior cervical spine surgery: a systematic review

Clinical Application of a New Plate Fixation System in Open-door Laminoplasty

Effect of preservation of the C-6 spinous process and its paraspinal muscular attachment on the prevention of postoperative axial neck pain in C3–6 laminoplasty

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