Residual Paresthesia After Surgery for Degenerative Cervical Myelopathy

Abstract

Study Design. Multi-center, prospective cohort study Objective. The current study aimed to identify the incidence of residual paresthesias after surgery for degenerative cervical myelopathy (DCM), and to demonstrate the impact of these symptoms on clinical outcomes and patient satisfaction. Summary of Background Data. Surgery for DCM aims to improve and/or prevent further deterioration of physical function and quality-of-life (QOL) in the setting of DCM. However, patients are often not satisfied with their treatment for myelopathy when they have severe residual paresthesias, even when physical function and QOL are improved after surgery. Methods. We included 187 patients who underwent laminoplasty for DCM. All patients were divided into two groups based on their visual analog scale score for paresthesia of the upper extremities at 1 year postoperatively (>40 vs ≤40 mm). Preoperative factors, change in clinical scores and radiographic factors, and satisfaction scales at 1 year postoperatively were compared between groups. We used mixed-effect linear and logistic regression modeling to adjust for confounders. Results. Overall, 86 of 187 patients had severe residual paresthesia at 1 year postoperatively. Preoperative patient-oriented pain scale scores were significantly associated with postoperative residual paresthesia(P=0.032). A mixed-effect model demonstrated that patients with severe postoperative residual paresthesia showed significantly smaller improvements in QOL (P=0.046) and myelopathy (P=0.037) than patients with no/mild residual paresthesia. Logistic regression analysis identified that residual paresthesia was significantly associated with the lower treatment satisfaction, independent of improvements in myelopathy and QOL (adjusted odds ratio: 2.5, P=0.010). Conclusion. In total, 45% of patients with DCM demonstrated severe residual paresthesia at 1 year postoperatively. These patients showed significantly worse treatment satisfaction, even after accounting for improvements in myelopathy and QOL. As such, in patients who experience higher preoperative pain, multidisciplinary approaches for residual paresthesia, including medications for neuropathic pain might lead to greater clinical satisfaction. Level of Evidence. III