(I-589) Factors associated with long-term persistent pain and predictors of eventual improvement after surgery for cervical spondylotic myelopathy - a Quality Outcomes Database Study

Introduction: Pain associated with cervical spondylotic myelopathy (CSM) is a high recovery priority. While most patients improve with surgery a subset have persistent pain. The risk factors and prognosis for these patients are not known. The objective of this study is to determine the risk factors associated with long-term persistence of preoperative pain and predictors of eventual improvement.

Methods: The Quality Outcomes Database (QOD) CSM registry was queried for patients with preoperative neck or arm pain and 24-month follow-up. Univariate and multivariate analyses were performed to compare patients with and without persistent arm or neck pain at 24-months. Patients with pain at 12 months who improved by 24 months were analyzed.

Results: 61/436 (14%) of patients reported persistent neck pain 1 year post-operatively. 31/61 (50.8%) improved by 24-months. Failure to improve was associated with preop motor deficit (OR 14.08, p=.003), 3-12 month preop symptom duration (ref: < 3 months. OR 6.26, p=.039), and posterior approach (OR 9.29, p=.049). Compared with preop, 506/592 patients (85.4%) reported improved pain 2 years postop. Persistent pain was independently associated posterior approach (OR 2.56, p=.022), smoking (OR 1.88, p=.04), and co-morbid preop arm pain (OR 1.12, p=.04). Severe preoperative neck pain was independently associated with improvement: NRS 9-10 (OR 0.18, p<.001).
51/410 patients (12.4%) had persistent arm pain 12 months postoperatively. 36/51 (70.8%) improved by 24-months. Failure to improve was associated with mJOA (OR 1.46, p=.045) and levels treated (OR 2.5, p=.044). Compared with preop, 460/544 patients (84.6%) reported improved arm pain 2-years postop. Persistent pain was associated with mJOA (OR 1.11, p=.044) and levels treated (OR 2.7, p=.049). Severe preop arm pain was independently associated with improvement. Higher baseline QALY lowered the risk of persistent pain (OR 0.19, p = .027)

Conclusion : Most patients undergoing surgery for CSM with significant neck or arm pain improve. Among those with persistent pain 1-year post operatively, 50% (neck) and 70.1% (arm) report improvement with conservative management by 2 years post operatively. Persistent long-term neck pain was associated with posterior approach, smoking, and co-morbid preop arm pain. Persistent long-term arm pain was associated with mJOA and increased number of spinal levels treated.

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