Predictors of Residual Neck/Shoulder Symptom Following Surgery for Degenerative Cervical Myelopathy

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STUDY DESIGN: Prospective multicenter cohort study. OBJECTIVE: To determine the prevalence of residual neck/shoulder pain or stiffness after surgery for degenerative cervical myelopathy (DCM) and identify the factors associated with the persistence of these symptoms. SUMMARY OF BACKGROUND DATA: Neck/shoulder pain or stiffness is common in patients with DCM and may persist despite surgical treatment. However, the factors associated with the persistence of these symptoms remain unclear. METHODS: A total of 612 patients with preoperative neck/shoulder pain or stiffness who underwent surgery for DCM were included in this study. Residual neck/shoulder symptoms were defined as a visual analog scale (VAS) score of > 30 mm at 2 years after surgery. Demographic characteristics, radiographic findings, surgical variables, neurological function, and patient-reported outcome measures were compared between patients with and without residual neck/shoulder symptoms. Binary logistic regression analysis was performed to identify the independent predictors of residual neck/shoulder symptoms. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal preoperative VAS score threshold. RESULTS: Residual neck/shoulder pain or stiffness was observed in 416 (68.0%) patients at 2 years postoperatively. Multivariable analysis demonstrated that women (OR 1.780, 95% CI 1.152-2.751; P=0.009), duration of neurological symptoms (OR 1.011, 95% CI 1.004-1.018; P=0.002), and preoperative neck/shoulder VAS scores (OR 1.231, 95% CI 1.114-1.360; P<0.001) were independently associated with residual symptoms. ROC analysis identified a preoperative VAS score of 60 mm as the optimal threshold for predicting residual symptoms (area under the curve, 0.653; sensitivity, 62.7%; specificity, 65.8%). CONCLUSIONS: Women, prolonged neurological symptom duration, and greater preoperative symptom severity were independently associated with persistent postoperative neck/shoulder symptoms. These findings may inform preoperative counseling regarding the likelihood of persistent neck/shoulder symptoms after surgery for DCM. LEVEL OF EVIDENCE: II.

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