Postoperative Changes in Moderate to Severe Nonspecific Low Back Pain After Cervical Myelopathy Surgery

Cervical myelopathy patients sometimes experience concurrent nonspecific moderate to severe low back pain (msLBP). However, postoperative changes in msLBP after cervical myelopathy surgery have rarely been reported. Awareness of postoperative changes in msLBP may be helpful in consultation. Therefore, the objective of this study was to examine postoperative changes in msLBP.

Patients with cervical myelopathy and msLBP (a visual analog pain score ≥5/10) were reviewed prospectively, and 53 patients (male:female ratio, 28:25; mean age, 63.1 years) were enrolled. Cervical myelopathy was assessed with the Japanese Orthopedic Association score. Cervical laminoplasty was performed in 49 patients, and anterior cervical discectomy and fusion were performed in 4 patients. The patients were followed up postoperatively at 1, 3, 6, and 12 months and yearly thereafter. The primary endpoint was improvement of the visual analog scale score for back pain (VAS-B) by greater than 2.6/10. Prognostic factors were analyzed postoperatively at 12 months. The mean follow-up period was 16 ± 9 months.

MsLBP improved in 58%, 49%, 53%, 52%, and 59% of the patients at 1, 3, 6, 12, and 24 months postoperatively, respectively. The VAS-B worsened after improvement or vice versa in approximately 30% of the patients during the follow-up period. Lumbar decompression operations were performed in 5 patients at 4, 6, 7, 15, and 16 months postoperatively. The recovery rate of the JOA score was a positive prognostic factor.

Although the exact pathophysiology was not demonstrated, cervical myelopathy surgery may directly and indirectly improve msLBP.