General Session: Cervical-2
Presented by: M. Kawakami - View Audio/Video Presentation (Members Only)
M. Kawakami(1), Y. Ishimoto(1), K. Nagata(1), T. Kitagawa(1), T. Matsuoka(1)
(1) Wakayama Medical University Kihoku Hospital, Spine Care Center, Ito Gun, Japan
Introduction: Axial pain has been reported as a complication of cervical laminoplasty. Psychological factors are thought to result in the initiation and chronicity of pain. However, it is still unknown which factors including psychological distress are associated with axial pain in patients with cervical myelopathy. The purpose of this study was to elucidate factors associated with axial pain in patients treated with cervical laminoplasty compared with healthy volunteers.
Methods: Prospectively collected data of patients treated with laminoplasty for cervical myelopathy were reviewed at 1 year postoperatively. Patients with previous spine surgery, other spinal disorders and concomitant conditions, which could compromise outcomes assessment, were excluded. Data obtained from 56 patients (Patient group, 43 males and 13 females, mean age of 65 years) were compared with 70 healthy volunteers (Control group, 34 men and 37 women, mean age of 63 years). Evaluation items were visual analog scale (VAS) for axial pain, numbness in the upper extremity, numbness from chest to toe and tightness in the chest, the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), Neck Disability Index (NDI), SF-36, Self-Rating Questionnaire for Depression (SRQ-D), Hospital Anxiety and Depression Scale (HADS) and Pain Catastrophizing Scale (PCS). Sagittal alignments of the cervical spine including lordosis were evaluated radiologically. Factors associated with axial pain before and after surgery were statistically compared with those in the control group. Mann-Whitney U test, Spearman's rank correlation coefficient and multiple regression analysis were used for statistical analysis. A p-value of less than 0.05 was considered significant.
Results: Axial pain was observed in 70% of subjects in the control group, 80 and 91% of patients before and after surgery, respectively. Preoperative axial pain (mean VAS 41mm) was more severe than that in the control group (24mm) (P< 0.05), but was improved after surgery (34mm, P=0.01) and not significant different from the control group. Axial pain in the control group was statistically correlated with SRQ-D and PCS (r=0.33 and 0.24, P< 0.05). Preoperative axial pain was significantly correlated with SRQ-D, NDI, cervical spine and upper extremity dysfunction and QOL of JOACMEQ (r = 0.30, 0.41, -0.34, -0.32 and -0.53, P< 0.05). While, postoperative axial pain was significantly correlated with numbness from chest to toe and tightness in the chest (r=0.32 and 0.46, P< 0.05). Utilizing multiple regression analysis, a significant model that postoperative axial pain=33.82+0.92*VAS for numbness in the upper extremity-19.9*gender-0.17*Role Physical (SF-36)-0.15*acquired point of QOL (JOACMEQ) was obtained (R=0.99, R2=0.98). There were no significant correlations between axial pain and radiological findings.
Discussion and Conclusion: Although the incidence of axial pain was higher in the patient group than that in the control group, severity of postoperative axial pain was not statistically different from that in the healthy volunteers. Axial pain in the control group and preoperative patients might be related to psychological factors such as depressive status. While, residual numbness of the upper extremity and disturbance of physical activity and QOL could influence postoperative axial pain. Collectively, these results suggest that causes of axial pain in patients treated with cervical laminoplasty are different from those in the normal subjects and are quite unlike in pre and postoperative axial pain.