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Predictors of Persistent Axial Neck Pain After Cervical Laminoplasty

Kimura, Atsushi, MD, PhD; Shiraishi, Yasuyuki, MD; Inoue, Hirokazu, MD, PhD; Endo, Teruaki, MD, PhD; Takeshita, Katsushi, MD, PhD

doi: 10.1097/BRS.0000000000002267
CERVICAL SPINE
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Study Design. Retrospective analysis of prospective data.

Objective. The aim of this study was to reveal baseline predictors of persistent postlaminoplasty neck pain.

Summary of Background Data. Axial neck pain is one of the most common complications after cervical laminoplasty; however, baseline predictors of persistent postlaminoplasty neck pain are unclear.

Methods. We analyzed data from 156 patients who completed a 2-year follow-up after double-door laminoplasty for degenerative cervical myelopathy. Patients rated the average intensity of axial neck pain in the last month using an 11-point numerical rating scale preoperatively and at the 2-year follow-up. The dependent variable was the presence of moderate-to-severe neck pain (numerical rating scale ≥4) at the 2-year follow-up. The independent variables included patient characteristics, baseline radiological parameters, surgical variables, baseline axial neck pain intensity, and baseline functions, which were measured by the Japanese Orthopaedic Association score and the Short Form-36 survey (SF-36). Logistic regression analysis was performed to identify independent predictors of moderate-to-severe neck pain after laminoplasty.

Results. At the 2-year follow-up, 51 patients (32%) had moderate-to-severe neck pain, and 106 patients (68%) had no or mild pain. Univariate analysis revealed that the ratio of cervical anterolisthesis, ratio of current smoking, baseline neck pain intensity, and baseline SF-36 Mental Component Summary differed significantly between the groups. Multivariate logistic regression analysis showed that independent predictors of moderate-to-severe neck pain at the 2-year follow-up include the presence of anterolisthesis, current smoking, moderate-to-severe baseline neck pain, and lower SF-36 Mental Component Summary. The presence of anterolisthesis and moderate-to-severe baseline neck pain were also associated with significantly poorer physical function after surgery.

Conclusion. The presence of anterolisthesis was associated not only with the highest odds ratio of persistent neck pain but also with significantly poorer functional outcomes. Indications for cervical laminoplasty should be carefully determined in patients with cervical anterolisthesis.

Level of Evidence: 4

Department of Orthopaedics, Jichi Medical University, Tochigi, Japan.

Address correspondence and reprint requests to Atsushi Kimura, MD, PhD, Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan; E-mail: akimura@jichi.ac.jp

Received 16 February, 2017

Revised 18 April, 2017

Accepted 8 May, 2017

The manuscript submitted does not contain information about medical device(s)/drug(s).

The Investigation Committee on the Ossification of the Spinal Ligaments, Japanese Ministry of Public Health and Welfare grant funds were received in support of this work.

No relevant financial activities outside the submitted work.

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