The new proposal of the relationship between axial pain and hinge fracture and facet involvement after open-door laminoplasty with titanium spacers

Study Design: This was a retrospective, observational study. Objectives: Postoperative axial pain (AP) is a well-known complication of cervical posterior surgery. It can be caused by various reasons, but the etiology remains unclear. This study aimed to investigate risk factors for postoperative AP after open-door laminoplasty. A previous meta-analysis revealed muscle damage, female, age of <60 years, and longer collar application as possible risk factors for postoperative AP after cervical posterior procedures. However, the postoperative AP etiology, specifically for open-door laminoplasty, has been inconclusive and remains conflicting. Methods: This retrospective study included 129 adult patients who underwent open-door cervical laminoplasty for degenerative diseases in our single institution from January 2015 to October 2021. Postoperative AP was defined as intolerable pain on the neck or shoulder that lasted for >1 month postoperatively. We compared the demographic and radiographic characteristics of AP and non-AP groups. Results: Postoperative AP developed in 62 (48.1%) patients. Intraoperative hinge fracture (HF) and facet involvement by miniscrews were significantly greater in the AP group than in the non-AP group (P < 0.05). Using a logistic regression model, multivariate analysis revealed that HF was significantly associated with postoperative AP (odds ratio = 2.83, 95% confidence interval = 1.28-6.44, P = 0.011). Conclusions: HF and facet involvement were risk factors for postoperative AP after open-door laminoplasty with titanium spacers. Careful surgical manipulation is required to prevent postoperative AP.