Postoperative Changes in Moderate to Severe Nonspecific Low Back Pain After Cervical Myelopathy Surgery

Kim, Chi Heon; Chung, Chun Kee; Lee, Urim; Choi, Yunhee; Park, Sung Bae; Jung, Jin Chul; Hwang, Sung Hwan; Yang, Seung Heon

doi:10.1016/j.wneu.2018.04.224

Cited by 13 publications

(14 citation statements)

References 32 publications

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“…Cervical myelopathy surgery occasionally provides long-term relief of LBP. [38][39][40] Accordingly, cervical decompression preceding lumbar surgery may be beneficial for patients with tandem spinal stenosis presenting primarily with LBP. However, treatment targets are difficult to identify because the clinical features of cervical pathology-related LBP remain unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Another possible reason is that cervical spinal cord compression can cause pain that is referred to the low back, 36,37 although the underlying pathophysiology remains unclear. Cervical myelopathy surgery occasionally provides long-term relief of LBP 38–40 . Accordingly, cervical decompression preceding lumbar surgery may be beneficial for patients with tandem spinal stenosis presenting primarily with LBP.…”

Section: Discussionmentioning

confidence: 99%

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Relief of Low Back Pain After Posterior Decompression for Lumbar Spinal Stenosis

Kakiuchi

Wada

Harada

et al. 2021

Spine

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Study Design. A retrospective study.Objective. The aim of this study was to confirm that decompression for lumbar spinal stenosis (LSS) relieves low back pain (LBP) as adequately as it relieves leg pain and to identify predictors for inadequate LBP relief. Summary of Background Data. Although decompression for LSS is generally thought to yield worse results for LBP than for leg pain, some studies have reported similar improvements in pain scores between LBP and leg pain. To treat LBP or take measures to prevent inadequate LBP relief, reliable predictors for LBP relief should be identified. Methods. We retrospectively reviewed 175 patients who underwent posterior element-preserving decompression and evaluated the relief of LBP and leg pain using numeric rating scales (NRSs). Associations between demographic, clinical, or imaging parameters and LBP relief at 1 and 4 years were analyzed by stepwise linear regression analyses. The imaging parameters included Modic change type 1, disc degeneration, foraminal stenosis, vertebral slipping (within Grade 1), scoliosis (<158) and lordosis. Results. The mean improvements in LBP and leg pain NRS scores from baseline were 5.22 and 4.70 points (P ¼ 0.064, paired t test) at 1 year and 5.12 and 4.62 points (P ¼ 0.068) at 4 years, respectively. Poor LBP scores at 4 years were significantly associated with long-lasting LBP (beta ¼ 0.31, P < 0.0001) and moderate or severe arm symptoms with cervical spinal cord compression or intramedullary hyperintense signal on T2weighted MRI (beta ¼ 0.22, P ¼ 0.0014). The imaging parameters of the lumbar spine failed to show clear associations with poor LBP scores at 4 years, although Modic change type 1 showed a significant association with poor LBP scores at 1 year (beta ¼ 0.28, P < 0.0001). Conclusion.Posterior decompression relieves LBP as well as leg pain. Long-lasting LBP and concurrent symptomatic cervical myelopathy are important predictors for inadequate LBP relief. There were no reliable imaging parameters predictive of inadequate LBP relief. K e y w o r d s : a r m s y m p t o m , c e r v i c a l m y e l o p a t h y , decompression, disc degeneration, duration of LBP, foraminal stenosis, leg pain, low back pain, lumbar spinal stenosis, Modic change Type 1, numeric rating scale, predictor, spinous process-splitting approach, suspension laminoplasty.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Relief of Low Back Pain After Posterior Decompression for Lumbar Spinal Stenosis

Kakiuchi

Wada

Harada

et al. 2021

Spine

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“…Third, cervical cord compression may cause low back pain by disrupting the spinal sagittal axis [21,22]. Fourth, findings such as pain, sensory impairment, and spasticity caused by cervical pathology may cause decreased physical activity and thus indirectly cause low back pain [24]. For these reasons, it is thought that it may affect low back pain directly or indirectly.…”

Section: ! "#$%And!'! ()!*!'+! "#$%And!+! ()!*'-! !!/0%12!mentioning

confidence: 99%

“…Studies by Kim et al [24] and Epstein et al [26] thought that physical activity might help improve low back pain by causing patients with cervical decompression surgery to be more active. In our study, we found that although the VAS Low Back was statistically significantly decreased in both groups (VAS Low Back (-0.3, -0.9)), it was statistically significantly decreased in group 2 (p < 0.01).…”

Section: ! "#$%And!'! ()!*!'+! "#$%And!+! ()!*'-! !!/0%12!mentioning

confidence: 99%

Postoperative changes in nonspecific low back pain after atlantoaxial stabilization surgery

Sezer

AÇIKALIN

2023

The European Research Journal

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Objectives: Posterior atlantoaxial stabilization can be technically challenging. Postoperative C2 nerve dysfunction occurs as a complication of this procedure or when a lateral mass is exposed and sacrificed for screw placement. Patients with cervical pathology sometimes complain of low back pain simultaneously. In this study, we aimed to investigate the results of C1-C2 posterior stabilization and C2 nerve root sacrifice on postoperative lumbar complaints. Methods: Twenty-six patients who underwent multicentric posterior C1-C2 stabilization due to atlantoaxial dislocation were retrospectively included in the study. Those that were not sacrificed the C2 nerve root during stabilization were considered group 1 (n = 12), and those that were sacrificed the C2 nerve root were considered group 2 (n = 14). A visual Analogue Scale (VAS) was used for the neck, arm, low back, and leg pain. The EQ-5D Index was used as the overall quality of life scale. Results: Six months postoperatively, both groups showed significant (p < 0.01) improvement in VAS neck, arm, and low back scores between preoperative and postoperative. In addition, there was no significant improvement in the VAS leg and EQ-5D score in either of the groups. While no significant decrease was found in occipital neuralgia in group 1, it showed significant (p < 0.01) improvement in occipital neuralgia in group 2. Conclusions: Although the exact pathophysiology is unknown, cervical stabilization surgery and sacrification of the C2 nerve root in this surgery can, directly and indirectly, improve low back pain.

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“…1 Patients may experience such as persistent deficit due to incomplete decompression, C5 palsy, postoperative pain, postoperative kyphosis and late deterioration because of disease progression. [7][8][9][10][11][12][13][14][15] The optimal approach is known to be determined by the depth and length of OPLL, sagittal alignment in the cervical spine, severity of stenosis, and history of previous surgery. 10 However, there have long been disputes about the optimum surgical approach of OPLL.…”

Section: Introductionmentioning

confidence: 99%

The Clinical Implications and Complications of Anterior Versus Posterior Surgery for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament; An Updated Systematic Review and Meta-Analysis

Kim

Lee

et al. 2019

Neurospine

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Objective: Theoretically, the optimal approach is determined by the status of ossification of the posterior longitudinal ligament (OPLL) and sagittal alignment. However, there have long been disputes about the optimum surgical approach of OPLL. This study is to compare risk-effectiveness between anterior decompression and fusion (ADF) and laminoplasty and laminectomy with fusion (LP/LF) for the patient with cervical myelopathy due to multilevel cervical OPLL. Methods: We searched core databases, and compared complication and outcomes between ADF and LP/LF for patients with multiple OPLL for the cervical spine. The incidence of complications such as neurologic deterioration, C5 palsy, and dura tear was assessed. Changes in JOA score between baseline and final evaluations were assessed for 2 groups. The minimal clinically important difference (MCID) was utilized for evaluating clinical significance. We calculated Peto odds ratio (POR) and mean difference for the incidence and continuous variables, respectively. Results: We included data from 21 articles involving 3,872 patients with cervical myelopathy with OPLL. Major neurologic deficits such as paraplegia, quadriplegia developed 2.17% in the ADF group and 1.11% in the LP/LF group, and POR was 2.16. Mean difference of JOA score improvement of 2 groups was 1.30, and the mean difference showed a statistical significance. However, 1.3 points of JOA improvement cannot reach 2.5 points of the MCID. Conclusion: Anterior surgery often led to rare but critical complications, and the difference of neurological improvement between 2 groups was below a clinically meaningful level. Posterior surgeries may be appropriate in the treatment of multilevel cervical myelopathy with OPLL.

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Postoperative Changes in Moderate to Severe Nonspecific Low Back Pain After Cervical Myelopathy Surgery

Cited by 13 publications

References 32 publications

Relief of Low Back Pain After Posterior Decompression for Lumbar Spinal Stenosis

Relief of Low Back Pain After Posterior Decompression for Lumbar Spinal Stenosis

Postoperative changes in nonspecific low back pain after atlantoaxial stabilization surgery

The Clinical Implications and Complications of Anterior Versus Posterior Surgery for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament; An Updated Systematic Review and Meta-Analysis

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