Prevalence And Risk Factors Of Axial Neck Pain In Patients Undergoing Multilevel Anterior Cervical Decompression With Fusion Surgery

Objectives: The aim of this study was to explore prevalence and risk factors for axial neck pain in patients undergoing multilevel anterior cervical decompression with fusion surgery.Methods: In this study,76 patients,who underwent multilevel anterior cervical decompression with fusion surgery from Jan.2012 to Jan.2017,were retrospectively reviewed.Postoperative axial pain was divided into 4 grades: "No" “mild” "moderate" “severe ".Based on the postoperative axial neck pain,the patients were classified into 2 groups: axial pain group,including patients with obvious pain and related pain treatment and no axial pain group,including patients with no axial pain or slightly uncomfortable and without treatment.The patients were followed up one year after cervical anterior surgery.The possible effect factors included demographic variables(age,sex,BMI,smoking,drinking,heart disease,hypertension,diabetes,preoperative kyphosis,preoperative JOA scores and ODI)and surgery-related variables(surgical option,lesions vertebral,spinal canal stenosis rate,superior fusion segment,presence of intramedullary high signal intensity,intervertebral distraction index).Rehabilitation exercises variables(braking time and exercise intensity).Results: Of all 76 patients,21 had postoperative axial pain,the incidence of which was 27.6%(21/76).The percentage of patients with cervical kyphosis(47.6% vs 21.8%,P<0.001)before operation in the axial symptom group was significantly higher than that in the non-axial symptom group,and the difference was statistically significant.The intervertebral distraction index in axial symptom group was significantly higher than that in non-axial symptom group(1.07±0.24 vs 1.03±0.02,P<0.001),and the results were significantly different from those in non-axial symptom group.Compared with the non-axial symptom group,the cervical base braking time in the axial symptom group was longer after operation(7.16±1.47 vs 6.19±1.18,P=0.004),and there was a significant difference between the axial symptom group and the non-axial symptom group.Compared with the non-axial symptom group,the rehabilitation intensity of the neck in the axial symptom group was lower(3.27±1.17 vs 4.60±0.83,P<0.001),and there was a significant difference between the axial symptom group and the non-axial symptom group.Among the other related variables,there was no significant difference between the two groups.At the last follow-up,all patients achieved satisfactory neurological improvement and improvements of clinical symptom have no obvious difference at the last follow-up.Conclusions: Overall,preoperative kyphosis,overdistraction of the fusion segment,poorer pehabilitation exercises could predict postoperative axial neck pain for patients undergoing 3-and 4-level anterior cervical decompression with fusion surgery.