Department of Orthopaedics, Jichi Medical University, Tochigi, Japan.
Spine (Phila Pa 1976). 2018 Jan 1;43(1):10-15. doi: 10.1097/BRS.0000000000002267.
Retrospective analysis of prospective data.
The aim of this study was to reveal baseline predictors of persistent postlaminoplasty neck pain.
Axial neck pain is one of the most common complications after cervical laminoplasty; however, baseline predictors of persistent postlaminoplasty neck pain are unclear.
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.
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.
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.
前瞻性数据的回顾性分析。
本研究旨在揭示颈椎板成形术后持续性颈痛的基线预测因素。
颈椎痛是颈椎板成形术后最常见的并发症之一；然而，持续性颈痛的基线预测因素尚不清楚。
我们分析了 156 例因退行性颈椎病接受双开门颈椎板成形术并完成 2 年随访的患者数据。患者在术前和 2 年随访时使用 11 分数字评分量表评估过去 1 个月的平均颈痛强度。因变量为 2 年随访时出现中度至重度颈痛（数字评分量表≥4）的情况。自变量包括患者特征、基线影像学参数、手术变量、基线颈痛强度和基线功能，这些功能通过日本矫形协会评分和简易 36 项健康调查（SF-36）来测量。进行逻辑回归分析以确定颈椎板成形术后中度至重度颈痛的独立预测因素。
在 2 年随访时，51 例（32%）患者出现中度至重度颈痛，106 例（68%）患者无或轻度疼痛。单因素分析显示，颈椎前滑移比、当前吸烟率、基线颈痛强度和基线 SF-36 心理成分综合评分在两组间存在显著差异。多因素逻辑回归分析显示，2 年随访时中度至重度颈痛的独立预测因素包括前滑移、当前吸烟、中度至重度基线颈痛和较低的 SF-36 心理成分综合评分。前滑移和中度至重度基线颈痛也与术后身体功能显著下降相关。
前滑移不仅与持续性颈痛的最高比值相关，而且与功能结局显著恶化相关。在存在颈椎前滑移的患者中，应仔细确定颈椎板成形术的适应证。
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