Intervertebral-spreader-assisted anterior cervical discectomy and fusion prevents postoperative axial pain by alleviating facet joint pressure

Abstract

Objective To evaluate the relationship of postoperative cervical axial pain with different vertebral distraction methods used during ACDF procedures in cervical spondylosis patients. Methods Ninety-four single-level cervical spondylotic myelopathy patients with significantly loss of intervertebral disc height who underwent ACDF surgery in our institute between January 2018 and January 2020 were enrolled. Cervical spine lateral radiographs were taken preoperatively, 3 days, 1-month, 2-month and 6-month after the surgery. The intervertebral disc height (IDH), interfacet distance (IFD), JOA (Japanese Orthopaedic Association) score, NDI (Neck Disability Index) score, nVAS (Neck Visual Analogue Scale) score and aVAS (Arm Visual Analogue Scale) score were measured. The correlation of clinical parameters and intervertebral disc height was evaluated. Then the correlation of clinical outcomes and different distraction method was evaluated. The patients were randomly divided into two groups, one uses Casper pin distractor system alone for distraction (Caspar alone group) and the other uses spreader assisted distraction method (Casper + spreader group). In biomechanical study, four cervical spine cadavers were selected for facet pressure measurements under different vertebral distraction methods, and the facet joint pressure was measured using force sensors. Results Satisfactory cervical fusion and neurological recovery were achieved in all patients. No significant correlation of IDH, IFD, JOA, NDI or aVAS with nVAS score was found. No significant difference between the change in disc height and clinical outcomes was found. However, by comparing the clinical parameters of patients in different vertebral distraction groups, we found significant changes in the early nVAS and NDI scores (P = 0.11, P = 0.48) of the Casper + spreader group (3 days postoperation), and was associated with a better nVAS score at 2 months postoperation (P < 0.05). The biomechanical study in cervical cadavers also showed significantly and continuously decreased facet joint pressure in the spreader assisted vertebral distraction group (P < 0.01). Conclusions Spreader-assisted vertebral distraction method effectively alleviates postoperative neck pain in degenerative cervical spondylosis patients treated with ACDF. The mechanism may be related to the transient relief of facet joint pressure during the vertebral distraction procedure in ACDF.

Preoperative Cervical Cobb Angle Is a Risk Factor for Postoperative Axial Neck Pain after Anterior Cervical Discectomy and Fusion with Zero‐Profile Interbody

“…The cervical facet joint capsule is rich in receptors that can sense the intensity of physiological stimulation, and can produce a painful sensation when overstretched 19 . It is reported that uneven distraction of the facet joint is more likely to cause axial pain than an evenly over‐distracted facet joint 5 . Thus, we believe that a poor lordosis with axial distraction using zero‐profile implants may cause uneven joint distraction during the early months after the surgery, which may cause severe postoperative axial pain.…”

“…The zero‐profile (Zero‐P) integrated interbody system can reduce the risk of instrument failure and postoperative dysphagia compared to traditional plate and cage system, which significantly increased the clinical outcome of ACDF treated CSM patients 4 . However, recent studies showed that postoperative axial pain is still a prominent complication that plagues many treated patients 5,6 …”

“…4 However, recent studies showed that postoperative axial pain is still a prominent complication that plagues many treated patients. 5,6 Defined as the neck pain spreading from the nuchal to the shoulder or periscapular regions, axial pain is diagnosed only after excluding the possibilities of diseases related with other systems. 7 There are literatures report that axial pain can occur in up to 35.4% of the patients who received ACDF surgery and interbody implementation.…”

“… 4 However, recent studies showed that postoperative axial pain is still a prominent complication that plagues many treated patients. 5 , 6 …”

Cervical alignment and clinical outcome of anterior decompression with fusion vs. posterior decompression with fixation in kyphotic cervical spondylotic myelopathy

“…The incidence of axial symptoms can be up to 29.91% after ACDF ( Zhou et al, 2018 ) and 19.25% after laminoplasty ( Chen et al, 2021 ). Postoperative neck pain alleviation may be related to the transient relief of facet joint pressure during the vertebral distraction procedure in ACDF ( Xu et al, 2022 ). In the present study, cervical kyphotic correction causes significant improvement of axial symptoms postoperatively than preoperatively.…”