Impact of Axial Neck Pain on Quality of Life After Laminoplasty

Study Design. A prospective study. Objective. The aim of this study was to elucidate the impact of axial pain following cervical laminoplasty on health-related quality of life (HRQOL). Summary of Background Data. Axial neck pain is a frequently encountered complication after laminoplasty. However, limited information is available regarding the time-dependent changes in axial pain and the impact of this pain on clinical outcomes, including HRQOL. Methods. One hundred sixty-two consecutive patients with cervical myelopathy underwent double-door laminoplasty using hydroxyapatite spacers from 2008 to 2012. The outcome measures included the Japanese Orthopaedic Association score (JOA score), the EuroQol 5 Dimension Questionnaire (EQ-5D), and the Short Form-36 survey (SF-36). The intensity of axial pain was assessed using an 11-point numerical rating scale (NRS). These assessments were conducted preoperatively and at 6-month, 1-year, and 2-year follow-ups. Patient satisfaction with outcome was graded using a 7-point NRS at the 2-year follow-up. Result. One hundred twenty-one patients completed the 2-year follow-up. The mean axial pain intensity decreased slightly over time; however, the decrease was not significant. The JOA score, EQ-5D score, and all SF-36 domains, excluding general health perceptions, improved significantly compared with baseline levels at the 6-month follow-up or later. Baseline axial pain intensity showed a significant negative correlation with baseline HRQOL only in the SF-36 bodily pain domain. In contrast, axial pain intensity showed significant negative correlations with all HRQOL measures at the 6-month follow-up. At the 2-year follow-up, patients with an axial pain intensity >= 3 showed significantly worse outcomes than did patients with a pain intensity <3 in the EQ-5D score, SF-36 score, and patient satisfaction grades, but not in the JOA score. Conclusion. Axial neck pain has a significant negative impact on clinical outcomes, including a wide range of HRQOL measures and patient satisfaction with outcome, in patients undergoing conventional double-door laminoplasty.