Evaluation of pain as a preference-based health status measure in patients with cervical spondylotic myelopathy undergoing central corpectomy

Abstract

BACKGROUND: Assessment of pain in patients with cervical spondylotic myelopathy (CSM) before and after decompressive surgery has not been adequately addressed in the literature. The purpose of this study was to ascertain the intensity of various pain scores in patients with cervical spondylotic myelopathy (CSM) before and after surgery, and to assess their correlation with other outcome measures. METHODS: In this prospective study, 51 patients with CSM were assessed preoperatively and 1 year or more after uninstrumented central corpectomy (CC) using the Visual Analogue Scale (VAS), Nurick grade, patient perceived outcome score (PPOS) and SF-36. RESULTS: At presentation, there was a higher incidence of neck pain (43.1%) and arm pain (51%) than low axial pain (23.5%), with the mean VAS scores being 53.6 ± 27.4, 55.5 ± 27.4 and 34.0 ± 20.3, respectively. Following surgery, the mean neck, arm and low axial pain scores decreased significantly (p < 0.05) to 14.4 ± 22.6, 5.2 ± 11.8 and 16.0 ± 26.1, respectively. Improvement in pain scores demonstrated poor agreement (κ <0.2) with PPOS, Nurick grade recovery rate (NGRR), and the physical component summary (PCS) and mental component summary (MCS) of the SF-36. Pain scores did not influence quality of life as assessed by SF-36. CONCLUSIONS: Pain was reported by about half the patients with CSM, but was not severe in any of them. Following decompressive surgery, the intensity of all these pain components decreased significantly. Low axial pain, a reflection of CSM-related spasticity perceived in the lumbosacral region, became prominent in many patients after surgery.