1Steamboat Orthopaedic and Spine Institute, Steamboat Springs, Colorado.
2Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
J Neurosurg Spine. 2021 Jul 9;35(4):399-409. doi: 10.3171/2020.12.SPINE202002. Print 2021 Oct 1.
The impact of the type of pain presentation on outcomes of spine surgery remains elusive. The aim of this study was to assess the impact of predominant symptom location (predominant arm pain vs predominant neck pain vs equal neck and arm pain) on postoperative improvement in patient-reported outcomes.
The Quality Outcomes Database cervical spine module was queried for patients undergoing 1- or 2-level anterior cervical discectomy and fusion (ACDF) for degenerative spine disease.
A total of 9277 patients were included in the final analysis. Of these patients, 18.4% presented with predominant arm pain, 32.3% presented with predominant neck pain, and 49.3% presented with equal neck and arm pain. Patients with predominant neck pain were found to have higher (worse) 12-month Neck Disability Index (NDI) scores (coefficient 0.24, 95% CI 0.15-0.33; p < 0.0001). The three groups did not differ significantly in odds of return to work and achieving minimal clinically important difference in NDI score at the 12-month follow-up.
Analysis from a national spine registry showed significantly lower odds of patient satisfaction and worse NDI score at 1 year after surgery for patients with predominant neck pain when compared with patients with predominant arm pain and those with equal neck and arm pain after 1- or 2-level ACDF. With regard to return to work, all three groups (arm pain, neck pain, and equal arm and neck pain) were found to be similar after multivariable analysis. The authors' results suggest that predominant pain location, especially predominant neck pain, might be a significant determinant of improvement in functional outcomes and patient satisfaction after ACDF for degenerative spine disease. In addition to confirmation of the common experience that patients with predominant neck pain have worse outcomes, the authors' findings provide potential targets for improvement in patient management for these specific populations.
疼痛表现类型对脊柱手术结果的影响仍不清楚。本研究旨在评估主要症状部位（主要手臂疼痛与主要颈部疼痛与颈部和手臂疼痛相等）对患者报告结果术后改善的影响。
查询质量结果数据库颈椎模块，以获取接受 1 或 2 级前路颈椎间盘切除融合术（ACDF）治疗退行性脊柱疾病的患者。
最终分析共纳入 9277 例患者。其中，18.4%的患者表现为主要手臂疼痛，32.3%的患者表现为主要颈部疼痛，49.3%的患者表现为颈部和手臂疼痛相等。与主要颈部疼痛的患者相比，主要颈部疼痛的患者在 12 个月时颈痛障碍指数（NDI）评分更高（更差）（系数为 0.24，95%CI 0.15-0.33；p<0.0001）。三组在术后 12 个月恢复工作的可能性和 NDI 评分达到最小临床重要差异的可能性方面没有显著差异。
来自国家脊柱登记处的分析表明，与主要手臂疼痛患者和颈部和手臂疼痛相等的患者相比，在接受 1 或 2 级 ACDF 后，主要颈部疼痛患者的手术 1 年后患者满意度和 NDI 评分更差。关于重返工作岗位，在多变量分析后，所有三组（手臂疼痛、颈部疼痛和手臂和颈部疼痛相等）均发现相似。作者的结果表明，主要疼痛部位，特别是主要颈部疼痛，可能是 ACDF 治疗退行性脊柱疾病后功能结果和患者满意度改善的重要决定因素。除了确认主要颈部疼痛患者的常见结果更差外，作者的发现为这些特定人群的患者管理提供了潜在的改善目标。
