Outcome Study of Surgical Treatment for Axial Neck Pain

South Med J. 2001;94(6) 

In This Article

Abstract and Introduction

Background. We reviewed our surgical treatment of chronic axial cervical pain over a 4-year period to determine whether surgery in selected cases was associated with favorable outcomes.
Methods. We retrospectively studied 27 consecutive cases (20 patients with follow-up) of longstanding axial cervical spine pain treated surgically by a single surgeon from June 1994 through August 1998. Diagnostic workup included the following when appropriate: Minnesota Multiphasic Personality Inventory (MMPI) with interview, provocative diskography (with a nonpainful control level), single photon emission computed tomography (SPECT), and diagnostic facet injection. Twenty patients (74%) responded to a postoperative telephone survey.
Results. For general outcome measures, 85% of patients reported satisfaction with pain relief and surgical result. Ninety-five percent stated they would repeat the procedure; 85% manifested improvement in Prolo score.
Conclusions. Surgical treatment of chronic axial neck pain, when preceded by thorough evaluation, can yield excellent clinical results.

Chronic axial neck pain is an important public health concern. Although the Quebec Task Force on Whiplash-Associated Disorders considered whiplash to be essentially a benign and self-limited condition, nevertheless 13% of patients continued to have neck pain at 6 months after injury, with decline to 3% at 1-year follow-up.[1] Annual incidence of compensated cases in Quebec for 1987 was 70 per 100,000, with a total of more than $18 million in reimbursements. In this study, chronic and recurrent neck pain accounted for 15.7% of total costs. In a 10-year follow-up, Gore et al[2] reported poor correlation with radiographic abnormalities and found that 32% of cases of neck pain will progress to chronic pain syndromes. The anatomic basis of axial neck pain has been well reviewed by Swezey.[3]

One of us (R.M.V.) has previously described a nomenclature for chronic axial neck pain, or type III syndrome.[4] These cases encompass patients who have neck pain with only axial symptoms, in the absence of radiculopathy (type I syndrome) or myelopathy (type II syndrome). Similar clinical findings and presenting complaints have been described as internal disk disruption, discogenic pain syndrome, motion segment pain, and facet syndrome. As noted in the earlier study,[4] the surgical treatment of this entity is unpredictable and often unsatisfactory.

A variety of diagnostic interventions useful in evaluation of neck pain have been described, including magnetic resonance imaging (MRI), facet injection with or without concomitant local anesthetic block, and diskography. The clinical efficacy of these diagnostic modalities is unclear.[5,6,7,8,9,10,11,12] Efficacy of diagnostic cervical diskography also remains debatable.[10,11,13,14]

Preoperative evaluation in our series included various combinations of diskography, facet injection with local anesthetic block, SPECT, MRI, computed tomography (CT), and flexion-extension radiographs. Both anterior and posterior surgical approaches were used, depending upon the type of disease noted on preoperative evaluation. To standardize our outcomes measurement, we used four separate scales: a general outcomes scale; a modification of the Prolo scale, originally presented as an outcomes measure for posterior lumbar interbody fusions as an economic and functional outcomes indicator[15]; the short-form McGill Pain Questionnaire, as presented by Melzack[16] to assess continued neck pain at time of follow-up; and the Medical Outcomes Study Short-Form 36 as a measure of general health at time of follow-up. The subjective nature of patient health perception has been previously described.[17,18,19] A separate measure of patient satisfaction and subjective opinion of operative outcome and pain resolution is offered.

Our findings show that excellent clinical results may be obtained via surgical intervention for axial neck pain. Thorough preoperative evaluation and patient selection are important predicators of operative success.

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