Prevalence and risk factors of axial neck pain in patients undergoing multilevel anterior cervical decompression with fusion surgery

Abstract

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.

Predictors of poor outcome in cervical spondylotic myelopathy patients underwent anterior hybrid approach: focusing on change of local kyphosis

“…Hence, the measurement of local kyphosis angle had greater meaning to the prevention of poor postoperative outcome. In previous study, Uchida et al [10] explained also that correction of local cervical kyphosis was beneficial to improve the recovery of neurological function, whereas excessive correction of cervical kyphosis would give rise to short-term axial pain after surgery [23]. Not all patients could maintain the effect of surgical correction with the passage of time.…”

Predictors of poor outcome in cervical spondylotic myelopathy patients underwent anterior hybrid approach: focusing on change of local kyphosis

“…Whereas, excessive correction of cervical kyphosis would give rise to short-term axial pain after surgery. [23] Not all patients could maintain the effect of surgical correction with passage of time. In this study, there were seventeen patients with the worsening of postoperative local alignment as a result of each kind of suggestion factor.…”

Impact of Smoking On Surgical Outcomes For Patients Undergoing Cervical Surgery: A Systematic Review And Meta-Analysis

“…Three studies reported the postoperative incidence of axial neck pain 15,40,45 . Signi cant heterogeneity was observed, and a random-effects model was used (I²=64%, p=0.06).…”

“…(OR=1.54, 95% CI: 0.75-3.16, p=0.24). After performing sensitivity analysis and removing the study by Liu et al 45 the only article on anterior cervical surgery, the heterogeneity was reduced to 39% (Fig. 8).…”