12. Residual paresthesia and satisfaction after surgery for cervical myelopathy

Abstract

BACKGROUND

Surgical intervention for degenerative cervical myelopathy (DCM) is intended to improve or prevent further decline in the patient's physical function and overall quality of life (QOL). Despite improvements in both myelopathy and QOL post-surgery, many patients express dissatisfaction due to the persistence of severe residual paresthesia.

PURPOSE

This study seeks to determine the frequency of residual paresthesia following DCM surgery and to evaluate its impact on clinical outcomes and patient satisfaction.

STUDY DESIGN/SETTING

A multi-center, prospective cohort study

PATIENT SAMPLE

The study included 187 patients who underwent laminoplasty for DCM.

OUTCOME MEASURES

Assessed measures included preoperative factors, variations in clinical scores (JOA scores, VAS of upper extremity paresthesia, VAS of neck pain, NDI, EQ-5D-5l, and JOACMEQ), radiographic parameters (cervical sagittal vertical axis, C2-C7 angle, and C2-7 range of motion), and a 5-level satisfaction scale at 1 year postoperatively.

METHODS

Participants were categorized into two groups based on their VAS scores for upper extremity paresthesia at 1-year post-surgery: severe paresthesia (>40 mm) and no/mild paresthesia (≤40 mm). Comparative analysis of preoperative factors, changes in clinical scores and radiographic factors, and satisfaction levels at 1-year post-surgery was performed between the groups.

RESULTS

Out of 187 patients, 86 experienced severe residual paresthesia 1-year postoperatively. Preoperative pain scale scores were significantly linked to postoperative residual paresthesia, independent of age, initial paresthesia severity, and other preoperative clinical scores (p=0.032). Mixed-effect modeling indicated that patients with severe residual paresthesia showed significantly less improvement in QOL (p=0.046) and myelopathy (p=0.037) compared to those with no/mild paresthesia. Logistic regression revealed that residual paresthesia was a significant predictor of lower treatment satisfaction, independent of myelopathy and QOL improvements (adjusted odds ratio: 2.5, p=0.010).

CONCLUSION

At one year postoperatively, 45% of DCM patients exhibited severe residual paresthesia, correlating with significantly lower satisfaction with their treatment despite improvements in myelopathy and QOL. These findings suggest that a multidisciplinary approach addressing residual paresthesia, including pharmacological management of neuropathic pain, may be essential for improving patient outcomes.