Tags

Type your tag names separated by a space and hit enter

Investigation of axial symptoms after cervical laminoplasty, using questionnaire survey.
Spine J. 2006 May-Jun; 6(3):221-7.SJ

Abstract

BACKGROUND CONTEXT

Cervical laminoplasty is a good strategy for cervical myelopathy, but some postoperative patients complain of obstinate axial symptoms after surgery, that is, nuchal pain, neck stiffness, and shoulder pain. It was reported that these symptoms proved to be more serious than has been believed and should be considered in the evaluation of the outcome of cervical spinal surgery. However, axial symptoms are sometimes recognized before surgery, or also after corpectomy. Addressing this issue becomes complicated.

PURPOSE

We investigate the difference in axial symptoms before and after laminoplasty and discuss the characteristics of these symptoms as a surgical complication.

STUDY DESIGN/SETTING

We conducted a questionnaire survey and reviewed the medical records of respondents.

PATIENT SAMPLE

All of the 180 patients who underwent a spinous process-splitting laminoplasty for cervical myelopathy caused by degenerative disease in our institution from 1993 until 2002 and were followed for 2 years or longer after surgery.

OUTCOME MEASURES

Self-report measures and functional measures. The questionnaire elicited information as follows: the location and characteristics of pre- and postoperative symptoms, frequency and duration of postoperative symptoms, and impairment in activities of everyday living, analgesic use, and the duration of use of cervical orthosis after surgery.

METHODS

We divided axial symptoms into four characteristics based on previous reports: "pain," "heaviness," "stiffness," and "other." An illustration of the upper back on which respondents could mark each characteristic was utilized to acquire information about the location of axial symptoms. The following information was gathered from medical records and statistically analyzed: whether postoperative axial symptoms were related or not, age, sex, neurological findings, the period of cervical orthosis, surgery time, blood loss, with or without reconstruction surgery of the semispinalis cervicis muscle, and preoperative axial symptoms.

RESULTS

For all of the 51 respondents, the average time since surgery was 4.1 years at the time of investigation; 42 patients complained of postoperative axial symptoms; 26 patients stated the duration of symptoms after surgery to be "more than 2 years." The surgical outcome of this group, however, did not differ from that of the 2-year-or-less group. Axial symptoms, which accounted for 13.3% of all answers about postoperative impairment of everyday living, were similar to hand numbness. Of respondents with postoperative axial symptoms, 52.2% stated the frequency of affliction to be "all day long," but 34.8% replied "rarely" to frequency of use of analgesics. Axial symptoms in the nuchal region increased from 45.2% to 48.6% after surgery. "Stiffness" was the most common characteristic before and after surgery, but "pain" significantly increased from 24.6% before surgery to 38.4% after surgery. We speculate that the principal manifestation of axial symptoms might be pain and that the nuchal region might be the predominant region for axial symptoms. There was no significant difference in age, blood loss, operative time, sex, duration of use of cervical orthosis, reconstructive surgery, and preoperative symptoms between two groups--those who complained of axial symptoms after surgery, and those who did not.

CONCLUSIONS

In this survey, axial symptoms were not usually so severe as to require analgesic use and did not worsen the Japanese Orthopaedic Association score after surgery; symptoms were, however, considered to continuously affect everyday life as much as hand numbness. Regarding their features, we speculate the main characteristics of axial symptoms might be pain and that the nuchal region might be the predominant region for axial symptoms. Our data are consistent with the hypothesis that laminoplasty is not, as such, an effective treatment for axial neck pain and that axial symptoms may in fact be worsened by the procedure.

Authors+Show Affiliations

Department of Orthopedic Surgery, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka 570-8507, Japan. ohnari@takii.kmu.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16651214

Citation

Ohnari, Hiroyuki, et al. "Investigation of Axial Symptoms After Cervical Laminoplasty, Using Questionnaire Survey." The Spine Journal : Official Journal of the North American Spine Society, vol. 6, no. 3, 2006, pp. 221-7.
Ohnari H, Sasai K, Akagi S, et al. Investigation of axial symptoms after cervical laminoplasty, using questionnaire survey. Spine J. 2006;6(3):221-7.
Ohnari, H., Sasai, K., Akagi, S., Iida, H., Takanori, S., & Kato, I. (2006). Investigation of axial symptoms after cervical laminoplasty, using questionnaire survey. The Spine Journal : Official Journal of the North American Spine Society, 6(3), 221-7.
Ohnari H, et al. Investigation of Axial Symptoms After Cervical Laminoplasty, Using Questionnaire Survey. Spine J. 2006 May-Jun;6(3):221-7. PubMed PMID: 16651214.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Investigation of axial symptoms after cervical laminoplasty, using questionnaire survey. AU - Ohnari,Hiroyuki, AU - Sasai,Kunihiko, AU - Akagi,Shigeo, AU - Iida,Hirokazu, AU - Takanori,Saito, AU - Kato,Isashi, PY - 2005/06/30/received PY - 2005/08/28/revised PY - 2005/10/17/accepted PY - 2006/5/3/pubmed PY - 2006/7/6/medline PY - 2006/5/3/entrez SP - 221 EP - 7 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 6 IS - 3 N2 - BACKGROUND CONTEXT: Cervical laminoplasty is a good strategy for cervical myelopathy, but some postoperative patients complain of obstinate axial symptoms after surgery, that is, nuchal pain, neck stiffness, and shoulder pain. It was reported that these symptoms proved to be more serious than has been believed and should be considered in the evaluation of the outcome of cervical spinal surgery. However, axial symptoms are sometimes recognized before surgery, or also after corpectomy. Addressing this issue becomes complicated. PURPOSE: We investigate the difference in axial symptoms before and after laminoplasty and discuss the characteristics of these symptoms as a surgical complication. STUDY DESIGN/SETTING: We conducted a questionnaire survey and reviewed the medical records of respondents. PATIENT SAMPLE: All of the 180 patients who underwent a spinous process-splitting laminoplasty for cervical myelopathy caused by degenerative disease in our institution from 1993 until 2002 and were followed for 2 years or longer after surgery. OUTCOME MEASURES: Self-report measures and functional measures. The questionnaire elicited information as follows: the location and characteristics of pre- and postoperative symptoms, frequency and duration of postoperative symptoms, and impairment in activities of everyday living, analgesic use, and the duration of use of cervical orthosis after surgery. METHODS: We divided axial symptoms into four characteristics based on previous reports: "pain," "heaviness," "stiffness," and "other." An illustration of the upper back on which respondents could mark each characteristic was utilized to acquire information about the location of axial symptoms. The following information was gathered from medical records and statistically analyzed: whether postoperative axial symptoms were related or not, age, sex, neurological findings, the period of cervical orthosis, surgery time, blood loss, with or without reconstruction surgery of the semispinalis cervicis muscle, and preoperative axial symptoms. RESULTS: For all of the 51 respondents, the average time since surgery was 4.1 years at the time of investigation; 42 patients complained of postoperative axial symptoms; 26 patients stated the duration of symptoms after surgery to be "more than 2 years." The surgical outcome of this group, however, did not differ from that of the 2-year-or-less group. Axial symptoms, which accounted for 13.3% of all answers about postoperative impairment of everyday living, were similar to hand numbness. Of respondents with postoperative axial symptoms, 52.2% stated the frequency of affliction to be "all day long," but 34.8% replied "rarely" to frequency of use of analgesics. Axial symptoms in the nuchal region increased from 45.2% to 48.6% after surgery. "Stiffness" was the most common characteristic before and after surgery, but "pain" significantly increased from 24.6% before surgery to 38.4% after surgery. We speculate that the principal manifestation of axial symptoms might be pain and that the nuchal region might be the predominant region for axial symptoms. There was no significant difference in age, blood loss, operative time, sex, duration of use of cervical orthosis, reconstructive surgery, and preoperative symptoms between two groups--those who complained of axial symptoms after surgery, and those who did not. CONCLUSIONS: In this survey, axial symptoms were not usually so severe as to require analgesic use and did not worsen the Japanese Orthopaedic Association score after surgery; symptoms were, however, considered to continuously affect everyday life as much as hand numbness. Regarding their features, we speculate the main characteristics of axial symptoms might be pain and that the nuchal region might be the predominant region for axial symptoms. Our data are consistent with the hypothesis that laminoplasty is not, as such, an effective treatment for axial neck pain and that axial symptoms may in fact be worsened by the procedure. SN - 1529-9430 UR - https://www.unboundmedicine.com/medline/citation/16651214/Investigation_of_axial_symptoms_after_cervical_laminoplasty_using_questionnaire_survey_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(05)01029-6 DB - PRIME DP - Unbound Medicine ER -