Nie Cong, Chen Kaiwen, Zhu Y U, Song Huan, Lyu Feizhou, Jiang Jianyuan, Xia Xinlei, Zheng Chaojun
Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040, China.
Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY, 10212, USA.
Musculoskelet Sci Pract. 2022 Dec;62:102669. doi: 10.1016/j.msksp.2022.102669. Epub 2022 Sep 30.
Postoperative axial pain (PAP) is a significant complication after cervical laminoplasty.
To investigate pain sensitization in PAP patients and effects of time-dependent resistance isometric exercise compared to active range-of-motion exercise on PAP.
Retrospective cohort analysis.
211 patients undergoing postoperative 12-week exercises were evaluated for pressure pain threshold (PPT), temporal summation (TS) and both cross-sectional area and fatty infiltration of paraspinal muscles preoperatively and 3 months postoperatively. There patients underwent Numeric rating pain scale (NRS) and neck disability index (NDI) 3 and 6 months postoperatively.
At postoperative 3-month assessments, fewer patients undergoing isometric exercise showed PAP compared to range-of-motion exercise group (14/98 vs. 34/113; P = 0.006), and pain-related assessments in the former were lower than the latter (NRS at rest: 0.3 ± 0.8 vs. 0.7 ± 1.4, P = 0.014; NRS with movements: 0.4 ± 1.0 vs. 1.0 ± 1.7, P = 0.015; NDI: 2.4 ± 6.3 vs. 6.7 ± 10.9, P = 0.002). Postoperative cross-sectional area was smaller in isometric exercise group (603.5 ± 190.2) than in range-of-motion exercise group (678.7 ± 215.5) (P = 0.033), and the former showed higher local-area PPT and lower TS than the latter (PPT: 3.9 ± 1.8 vs. 3.1 ± 1.6, P = 0.002; TS: 1.8 ± 0.9 vs. 2.2 ± 1.0, P = 0.003). PAP patients showed lower local-area PPT and greater TS than those without PAP in both isometric (PPT: 2.8 ± 0.7 vs. 4.0 ± 1.9, P = 0.019; TS: 2.4 ± 0.6 vs. 1.7 ± 0.9, P = 0.011) and range-of-motion (PPT: 2.2 ± 0.9 vs. 3.6 ± 1.7, P < 0.001; TS: 2.8 ± 0.8 vs. 1.9 ± 0.9, P < 0.001) exercise groups.
Both peripheral and central sensitization are involved in PAP. Time-dependent isometric exercise has more positive effects on PAP than range-of-motion exercise because of its advantages in improving pain sensitization.
术后轴性疼痛（PAP）是颈椎椎板成形术后的一种重要并发症。
研究PAP患者的疼痛敏化情况，以及与主动活动范围锻炼相比，时间依赖性抗阻等长锻炼对PAP的影响。
回顾性队列分析。
对211例接受术后12周锻炼的患者在术前及术后3个月评估其压力疼痛阈值（PPT）、时间总和（TS）以及椎旁肌的横截面积和脂肪浸润情况。这些患者在术后3个月和6个月接受数字评分疼痛量表（NRS）和颈部功能障碍指数（NDI）评估。
在术后3个月的评估中，与活动范围锻炼组相比，进行等长锻炼的患者出现PAP的较少（14/98 vs. 34/113；P = 0.006），且前者的疼痛相关评估低于后者（静息时NRS：0.3±0.8 vs. 0.7±1.4，P = 0.014；活动时NRS：0.4±1.0 vs. 1.0±1.7，P = 0.015；NDI：2.4±6.3 vs. 6.7±10.9，P = 0.002）。等长锻炼组术后的横截面积（603.5±190.2）小于活动范围锻炼组（678.7±215.5）（P = 0.033），且前者的局部PPT高于后者，TS低于后者（PPT：3.9±1.8 vs. 3.1±1.6，P = 0.002；TS：1.8±0.9 vs. 2.2±1.0，P = 0.003）。在等长锻炼组（PPT：2.8±0.7 vs. 4.0±1.9，P = 0.019；TS：2.4±0.6 vs. 1.7±0.9，P = 0.011）和活动范围锻炼组（PPT：2.2±0.9 vs. 3.6±1.7，P < 0.001；TS：2.8±0.8 vs. 1.9±0.9，P < 0.001）中，PAP患者的局部PPT均低于无PAP的患者，TS均高于无PAP的患者。
外周和中枢敏化均与PAP有关。时间依赖性等长锻炼在改善疼痛敏化方面具有优势，因此对PAP的积极影响比活动范围锻炼更大。
