Kim Andrew H, Avendano John P, Greenberg Marc, Pathiravasan Chathurangi H, Skolasky Richard L, Gupta Mihir, Lee Sang Hun
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Department of Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA.
Global Spine J. 2025 Feb 13:21925682251319544. doi: 10.1177/21925682251319544.
Systematic Review and Meta-Analysis.
We analyzed patient-reported outcomes (PROs) focused on axial neck pain following cervical laminoplasty (CL) and foraminotomy (CF) for symptomatic cervical spondylosis to determine whether motion-preserving procedures targeting compressive radiculopathy/myelopathy also provide relief of axial neck pain and to investigate risk factors for persistent postoperative axial neck pain.
The PubMed and Cochrane Library databases were systematically searched for articles published from 2014 to 2023 describing pain-related outcomes following CL and CF. Data regarding PROs, reoperation rates, and risk factors for postoperative axial neck pain were also collected.
Thirty studies met inclusion criteria for analysis. There were 2499 cases (2129 CL and 370 CF) with mean ages of 63.2 and 59.3 years for CL and CF, respectively. CL patients had improved mean postoperative visual analogue scale and neck disability index (NDI) scores compared to preoperative values, with mean differences of -1.97 (CI -2.52, -1.42; < 0.0001) and -12.27 (CI -15.01, -9.54; < 0.0001), respectively. CF patients had improved mean postoperative NDI scores compared to preoperative values, with mean difference of -15.15 (CI -23.79, -6.50; = 0.0064). Presence of anterolisthesis, loss of cervical muscle volume, diabetes, age, and regional malalignment are independent predictors of postoperative axial neck pain.
Motion-sparing cervical decompressive surgery performed for compressive radiculopathy or myelopathy can also provide significant relief of axial neck pain, suggesting that preoperative axial neck pain is not an absolute contraindication to non-fusion decompressive surgery for degenerative cervical pathologies.
系统评价与荟萃分析。
我们分析了以症状性颈椎病行颈椎椎板成形术（CL）和椎间孔切开术（CF）后患者报告的以轴性颈痛为重点的结局，以确定针对压迫性神经根病/脊髓病的保留运动功能手术是否也能缓解轴性颈痛，并研究术后持续性轴性颈痛的危险因素。
系统检索PubMed和Cochrane图书馆数据库，查找2014年至2023年发表的描述CL和CF后疼痛相关结局的文章。还收集了有关患者报告结局、再次手术率和术后轴性颈痛危险因素的数据。
30项研究符合纳入分析标准。共有2499例病例（2129例CL和370例CF），CL组和CF组的平均年龄分别为63.2岁和59.3岁。与术前值相比，CL患者术后平均视觉模拟量表和颈部功能障碍指数（NDI）评分有所改善，平均差值分别为-1.97（可信区间-2.52，-1.42；P<0.0001）和-12.27（可信区间-15.01，-9.54；P<0.0001）。与术前值相比，CF患者术后平均NDI评分有所改善，平均差值为-15.15（可信区间-23.79，-6.50；P=0.0064）。椎体前滑脱、颈肌体积减少、糖尿病、年龄和局部排列不齐是术后轴性颈痛的独立预测因素。
为压迫性神经根病或脊髓病施行的保留运动功能的颈椎减压手术也能显著缓解轴性颈痛，这表明术前轴性颈痛并非退行性颈椎病变非融合减压手术的绝对禁忌证。
