RF90#031
Rapid Fire
The Factors Affecting and Characteristics of Residual Neuropathic Pain after Cervical Laminoplasty for Myelopathy
Shun Nokariya (Department of Orthopaedic Surgery, Kitasato University, School of Medicine), Masayuki Miyagi, MD, PhD (Department of Orthopaedic Surgery, Kitasato University, School of Medicine); Gen Inoue, MD, PhD, (Department of Orthopaedic Surgery, Kitasato University, School of Medicine); Toshiyuki Nakazawa, MD, PhD, (Department of Orthopaedic Surgery, Kitasato University, School of Medicine); Takayuki Imura, MD, PhD, (Department of Orthopaedic Surgery, Kitasato University, School of Medicine); Yoshihide Tanaka, MD, (Department of Orthopaedic Surgery, Kitasato University, School of Medicine); Yusuke Mimura, MD, (Department of Orthopaedic Surgery, Kitasato University, School of Medicine); Yuji Yokozeki, MD, PhD, (Department of Orthopaedic Surgery, Kitasato University, School of Medicine); Yuki Horiuchi, MD, (Department of Orthopaedic Surgery, Kitasato University, School of Medicine); Masashi Takaso, MD, PhD (Department of Orthopaedic Surgery, Kitasato University, School of Medicine)
Neuropathic pain (NeP) is commonly observed in patients with degenerative cervical myelopathy (DCM) and is associated with more severe pain and impaired quality of life (QOL) compared to other chronic pain conditions. Although laminoplasty is a widely applied surgical treatment for DCM with generally favorable outcomes, but residual postoperative pain remains a clinical concern. This study aimed to evaluate the presence of postoperative NeP using the PainDETECT questionnaire and to identify its associated risk factors, as well as its impact on surgical outcomes. We conducted a retrospective, single-center observational study of 151 patients who underwent cervical laminoplasty for DCM between September 2013 and March 2023. Patients completed the revised Japanese version of the PainDETECT questionnaire at least six months postoperatively and were classified into NeP (+) and NeP (−) groups using a cutoff score of 13. Clinical characteristics, including age, sex, body mass index, presence of diabetes, duration of illness, preoperative Japanese Orthopaedic Association (JOA) score, and radiological findings, were evaluated. Surgical outcomes were assessed using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) and EuroQol five-dimension scale (EQ-5D). Logistic regression analysis was performed to identify risk factors for residual NeP. Of the 151 patients, 43 (28.5%) were classified into the NeP (+) group. The NeP (+) group demonstrated significantly worse postoperative outcomes in JOACMEQ domains (cervical spine function, upper and lower limb function, and QOL; all p < 0.01) and EQ-5D score (p < 0.001). Multiple logistic regression analysis revealed that lower preoperative JOA score (OR, 0.857; p = 0.020) and longer duration of illness (OR, 1.026; p = 0.005) were independent risk factors for residual postoperative NeP. These findings indicate residual NeP is relatively common following laminoplasty for DCM and is significantly associated with poorer postoperative functional outcomes and QOL and that lower preoperative JOA scores and longer duration of illness may serve as independent predictors of postoperative residual NeP.