Axial symptoms after cervical laminoplasty / 中华骨科杂志

ABSTRACT

Axial symptom,also called axial pain or axial neck pain,is a common complication after posterior cervical spine surgery.The symptom can be neck pain,as well as rigid,tension and dullness.The incidence of axial syndrome is estimated between 5.2％ and 61.5％.Often,the symptom does not disappear spontaneously.The quality of patients' life as well as the effectiveness of cervical laminoplasty is affected.It can be divided into early and late axial pain based on the onset time.The mechanism and reason are different,but both are difficult to subside.The incident of axial symptom is relatively high in conventional laminoplasty.However the modified one which preserve posterior ligament-muscular structure can reduce the incidence significantly.C2 spinal process as the attachment of cervical semispinalis,could reduce the incidence of kyphosis after operation.And C7 spinal process is an important structure in posterior ligament-muscular structure.Both should be preserved as much as possible in order to maintain intact attachment of muscles,which facilitates the patient to restore soft tissue tension by rehabilitation.Rigid fixation is another method of modification,it could avoid re-close of the open door,and reduce soft tissue injury.However,attention must be paid not to destroy facet joint to cause new axial symptom.Risk factors of axial symptom include past shoulder and neck pain and stiffness,others remain controversial.There is no correlation between loss of range of motion after surgery as well as change of cervical alignment and axial symptom.It is more likely to be a different result due to muscle atrophy.Although there are no golden standard of laminoplasty,doctors should follow these principlespreserve C2 and C7 spinal process when possible,rigid fixation to avoid reclose,reduce immobilization after operation,and encourage patient to start rehabilitation as early as possible to reduce incident of axial symptom.