Pre- and Intraoperative Factors Associated With Improvement of Neck Pain After Laminoplasty for the Treatment of Cervical Myelopathy.

Abstract

Study design: Retrospective cohort study.

Objective: To (1) determine whether preoperative neck pain improves after laminoplasty for cervical myelopathy and identify factors that could predict improvements in neck pain.

Methods: A total of 88 patients with preoperative neck pain visual analogue scale (VAS) of ≥4, who underwent laminoplasty for cervical myelopathy, and were followed-up for >2 years were retrospectively reviewed. Patients demonstrating ≥50% improvement in VAS scores for neck pain 2 years postoperatively compared toㅇ preoperative assessment were included in neck pain improved (NP-improved) group. The remaining patients were assigned to neck pain unimproved (NP-unimproved) group.

Results: Overall, 54 patients (61.4%) were included in NP-improved group and 34 patients (38.6%) were included in NP-unimproved group. NP-unimproved group more frequently underwent C3 laminectomy (P = 0.026) and had lesser degree of preoperative C2-C7 lordosis (P = 0.006) in the extension position compared to that in the NP-improved group. Furthermore, undergoing C3 laminectomy was associated with lower probability of achieving a ≥50% improvement in neck pain VAS scores (P = 0.018), while greater preoperative C2-C7 lordosis in the extension position was associated with a higher possibility of neck pain improvement (P = 0.048). A cut-off value of 20.5° for C2-C7 lordosis in the extension position predicted a ≥50% improvement in neck pain.

Conclusion: Preoperative neck pain should not be considered contraindication for laminoplasty as 61.4% of patients experienced ≥50% improvement in neck pain post-operatively. C3 laminectomy decreases the probability of neck pain improvement after laminoplasty, while greater C2-C7 lordosis in the extension position is associated with neck pain improvement.