Liu Sen, Yang Da-Long, Zhao Ruo-Yu, Yang Si-Dong, Ma Lei, Wang Hui, Ding Wen-Yuan
Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.
Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.
J Orthop Surg Res. 2019 Apr 4;14(1):94. doi: 10.1186/s13018-019-1132-y.
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.
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).
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.
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.
本研究旨在探讨接受多节段颈椎前路减压融合手术患者的轴性颈痛患病率及危险因素。
本研究回顾性分析了2012年1月至2017年1月期间接受多节段颈椎前路减压融合手术的88例患者。根据术后轴性颈痛情况，将患者分为两组：轴性疼痛组和无轴性疼痛组。在颈椎前路手术后3周、3个月和1年对患者进行随访，以进行早期和长期临床评估。可能的影响因素包括人口统计学变量（年龄、性别、体重指数、吸烟、饮酒、心脏病、高血压、糖尿病、术前后凸畸形、术前轴性颈痛、术前JOA评分和ODI）以及手术相关变量（手术方式、椎体病变、椎管狭窄率、上融合节段、脊髓内高信号强度的存在情况）。
轴性颈痛的患病率为27.3%（88例中的24例）。我们的结果表明，术前轴性颈痛（62%对23%，P<0.001）和术前后凸畸形（42%对21.9%，P<0.001）是多节段颈椎前路手术后轴性疼痛的危险因素。此外，对于术前存在颈椎后凸畸形的患者，与无轴性疼痛组相比，轴性颈痛组术前C2-7角明显更高（13.31±2.33对7.33±2.56，P<0.001），后凸畸形矫正范围更大（20.24±4.12对12.34±3.12，P<0.001）。然而，对于所有术后出现轴性症状的患者，在早期随访（3周）时，无颈椎后凸畸形患者的轴性疼痛改善率明显更高（P=0.032），在中期（P=0.554）和长期随访（P=0.902）时未发现显著差异，在最后一次随访时临床症状改善无明显差异。
总体而言，术前轴性颈痛和后凸畸形可预测接受多节段颈椎前路减压融合手术患者的轴性颈痛，颈椎后凸畸形的恢复可能有助于神经功能的长期恢复，但也可能面临短期轴性疼痛的风险，可通过适度恢复颈椎曲度来降低这种风险。
