Psychological predictors of quality of life after anterior cervical discectomy and fusion for degenerative cervical spine disease

Acupuncture modulation of chronic neuropathic pain and its association with brain functional properties

Chronic neuropathic pain has been one of the prominent causes of disability, and acupuncture has shown promise in treatment. The present study aimed to characterize acupuncture modulation of chronic neuropathic pain and explore the related functional brain changes. Sixty chronic sciatica patients were divided into acupuncture group or sham acupuncture group and received 10 sessions of treatment during 4 weeks. The Visual Analog Scale (VAS) for leg pain, Oswestry Disability Index (ODI), and resting-state functional magnetic resonance images were assessed at baseline and after treatment. Then, fractional amplitudes of low-frequency fluctuations (fALFF) and support vector regression (SVR) analyses were performed. Compared to sham acupuncture, acupuncture significantly improved symptoms, including VAS for leg pain and ODI. In addition, acupuncture exhibited increased fALFF of the right superior parietal lobule (SPL) and right postcentral gyrus (PoCG). Furthermore, the actual 4-week ODI values were positively correlated with the SVR predicted values based on the right SPL fALFF and baseline clinical measurements. These results indicate that the spontaneous neural activity of the right SPL and right PoCG may be involved in the modulation of acupuncture in chronic neuropathic pain. In addition, the spontaneous neural activity of the right SPL might be used as the predictor of response to acupuncture therapy. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry, ChiCTR2100044585, http://www.chictr.org.cn PERSPECTIVE: This clinical neuroimaging study elucidated the neural basis of acupuncture in chronic sciatica. Neurological indicators and clinical measurements could be used as potential predictors of acupuncture response. This study combines neuroimaging and artificial intelligence techniques to highlight the potential of acupuncture for the treatment of chronic neuropathic pain.

The use of the Core Yellow Flags Index for the assessment of psychosocial distress in patients undergoing surgery of the cervical spine

BACKGROUND

Psychosocial distress (the presence of yellow flags) has been linked to poor outcomes in spine surgery. The Core Yellow Flags Index (CYFI), a short instrument assessing the 4 main yellow flags, was developed for use in patients undergoing lumbar spine surgery. This study evaluated its ability to predict outcome in patients undergoing cervical spine surgery.

METHODS

Patients with degenerative spinal disorders (excluding myelopathy) operated in one centre, from 2015 to 2019, were asked to complete the CYFI at baseline and the Core Outcome Measures Index (COMI) at baseline and 3 and 12 months after surgery. The relationship between CYFI and COMI scores at baseline as well as the predictive ability of the CYFI on the COMI follow-up scores were tested using structural equation modelling.

RESULTS

From 731 eligible patients, 547 (61.0 ± 12.5 years; 57.2% female) completed forms at all three timepoints. On a cross-sectional basis, preoperative CYFI and COMI scores were highly correlated (β = 0.54, in men and 0.51 in women; each p < 0.001). CYFI added significantly and independently to the prediction of COMI at 3 months' FU in men (β = 0.36) and 12 months' FU in men and women (both β = 0.20) (all p < 0.001).

CONCLUSION

The CYFI had a low to moderate but significant and independent association with cervical spine surgery outcomes. Implementing the CYFI in the preoperative workup of these patients could help refine outcome predictions and better manage patient expectations.

Health-Related Quality of Life is Associated With Pain, Kinesiophobia, and Physical Activity in Individuals Who Underwent Cervical Spine Surgery

OBJECTIVE

To determine the association between health-related quality of life (HRQOL) and neck pain, kinesiophobia, and modalities of physical activity in individuals with postoperative degenerative cervical myelopathy and radiculopathy (DCM/R) because postoperative pain after cervical spine surgery is likely to persist, causing kinesiophobia and avoidance of physical activity.

METHODS

A questionnaire was distributed to 280 individuals with DCM/R. The questionnaire comprised the following four items: HRQOL (EuroQol 5-dimensions 5-level), neck pain (numerical rating scale [NRS]), kinesiophobia (11-item Tampa Scale for Kinesiophobia [TSK-11]), and physical activity (paid work, light exercise, walking, strength training, and gardening). Hierarchical multiple regression analysis was performed using the NRS, TSK-11, and physical activity as independent variables.

RESULTS

In total, 126 individuals provided analyzable responses (45.0%). After including the NRS score as an independent variable to the multiple regression equation for participants' background, the independent rate of the regression equation significantly improved by only 4.1% (R2=0.153). The addition of the TSK-11 score significantly improved this effect by 11.1% (R2=0.264). Finally, the addition of physical activity also significantly improved the explanatory rate by 9.9% (R2=0.363).

CONCLUSION

Neck pain, kinesiophobia, and physical activity (specifically paid work and walking) were independently associated with HRQOL in individuals with postoperative DCM/R.

Validating the preoperative Japanese Core Outcome Measures Index for the Neck and comparing quality of life in patients with cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament by the patient-reported outcome measures

PURPOSE

This cross-sectional study serves two main purposes. Firstly, it aims to validate the preoperative Japanese Core Outcome Measures Index for the Neck (COMI-Neck) in patients with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL). Secondly, it seeks to elucidate differences in preoperative quality of life (QOL) between these two cervical pathologies using patient-reported outcome measures (PROMs).

METHODS

A total of 103 preoperative patients (86 with CSM and 17 with OPLL) scheduled for cervical spine surgery were included in the study. Validated PROMs, including the Japanese COMI-Neck, Neck Disability Index (NDI), EuroQol-5 Dimension-3 level (EQ-5D-3L), and SF-12v2, were used to assess QOL. Baseline demographic and clinical data were collected, and statistical analyses were performed to compare the PROMs between CSM and OPLL groups.

RESULTS

The Japanese COMI-Neck demonstrated good construct validity, with positive correlations with NDI and negative correlations with EQ-5D-3L and SF-12v2. Comparison of preoperative PROMs between CSM and OPLL groups revealed differences in age, body mass index, and EQ-5D-3L scores. The CSM group had higher NDI scores for concentration and lower EQ-5D-3L scores for self-care compared to the OPLL group.

CONCLUSIONS

This study validated the preoperative Japanese COMI-Neck in CSM and OPLL patients and identified specific QOL issues associated with each condition. The findings highlight the importance of considering disease-specific QOL and tailoring treatment plans accordingly. Further research should include postoperative assessments and a more diverse population to enhance generalizability.

Integrating jigsaw puzzle thinking into practice: the assessment of cervical spine radiculopathy

PURPOSE OF REVIEW

Cervical spine radiculopathy (CSR) presents a complex socioeconomic problem for patients, clinicians, families, employers and healthcare systems. Due to the heterogeneity of clinical presentation and underlying mechanisms, clinical assessment can be challenging. This review will examine the literature on the underlying pathophysiology and studies investigating the holistic assessment strategies for this disabling condition. The authors will focus particular attention on the psychological factors associated with CSR and the physical and imaging strategies to establish a diagnosis.

RECENT FINDINGS

Contemporary CSR assessment should identify the underlying pathomechanisms and how this may impact the somatosensory nervous system integrity and function. No physical assessment test in isolation will establish CSR diagnosis; therefore, clinicians should utilise a cluster of tests and recognise the potential limitations as part of a clinical reasoning framework. The assessment of the somatosensory nervous system can provide insights into particular subgroups of CSR presentation, which may provide interesting opportunities to continue to enhance individualised assessment and management strategies for CSR. The interplay between psychological factors can influence the diagnosis and recovery times for a person with CSR, and clinicians should continue to explore how these factors may influence a person's prognosis. The authors will discuss the opportunities for future research and limitations of contemporary approaches to assessment, underpinned by evidence, and how this supports a clinical assessment to establish CSR diagnosis.

SUMMARY

Research should continue to investigate how clinicians assess the interplay between physical and psychological factors to inform the establishment of CSR. Specifically, there is a need to investigate the validity and reliability of combining somatosensory, motor and imaging assessment findings to reach a diagnosis and inform onward management plans.

Predictors of Quality of Life in Patients With Degenerative Cervical Myelopathy Receiving Nonsurgical Management Due to Chronic Pain

BACKGROUND

Most patients with degenerative cervical myelopathy (DCM) experience pain, and their quality of life (QoL) is poor.

AIMS

This study aimed to identify predictors of QoL, including demographic, clinical, physical, and psychosocial characteristics, in chronic pain patients with DCM receiving non-surgical management.

DESIGN

A descriptive study design was used.

SETTING

Participants were recruited at the pain clinic at a university hospital in Seoul, South Korea.

PARTICIPANTS/SUBJECTS

The subjects included 157 inpatients and outpatients with DCM receiving non-surgical management.

METHODS

We administered a written, structured, self-reported questionnaire, which included standard validated measures for the main variables of interest.

RESULTS

The median number of pain sites was two, and the average and most pain severities were 4.63 ± 2.35 and 5.71 ± 2.32 out of 10 within one month, respectively. Stepwise multiple regression analysis revealed that depression, education level, and headache were factors influencing physical QoL. Depression, education level, and marital status were factors influencing psychological QoL, whereas depression and education level were factors influencing social relationships QoL. Finally, the factors influencing environmental QoL were depression, educational level, and marital status.

CONCLUSIONS

Demographic characteristics, including educational level and marital status, clinical characteristics, including pain site, and psychological characteristics, including depression, were identified as factors influencing QoL in chronic pain patients with DCM receiving non-surgical management.

CLINICAL IMPLICATIONS

Healthcare professionals should consider demographic, clinical, and psychological characteristics when evaluating patients... QoL. In addition, it is necessary to pay attention to the QoL of participants who are single and have lower levels of education, headache pain, and high levels of depression. These patients are likely to have low QoL and strategies to improve their QoL should be developed.

Association of psychological factors with limb disability in patients with cervical radiculopathy: comparison with carpal tunnel syndrome

Background

Regarding musculoskeletal conditions, patient’s psychological distress, are shown to be associated with higher disability. Cervical radiculopathy (CR) and carpal tunnel syndrome (CTS), are two conditions caused by entrapment of cervical nerve roots and carpal median nerve, respectively. This study aims to investigate the association of psychological factors including depression, anxiety, and pain catastrophizing, with measures of upper limb patient-reported and performance-based disability, in patients with CR, and compare the obtained results with our similar study on CTS.

Methods

In a cross-sectional study, we recruited 92 patients with CR, and investigated their disability level using patient-reported questionnaires (Quick Disabilities of the Arm, Shoulder and Hand (DASH) and pain Likert Scale) and by measuring grip and pinch strength. We also assessed their psychological status with Hospital Anxiety and Depression Scale questionnaire for depression (HADS-D) and anxiety (HADS-A) and also Pain Catastrophizing Scale (PCS) tools. We performed correlational coefficient analysis between disability and psychological scores and regression analysis of dependent variables (Pain, DASH, grip and pinch scores) and independent (psychological) variables. Finally, Z observed value was calculated to compare correlational coefficients between two diseases of CTS and CR.

Results

The results of the correlational coefficient analysis indicate that all three HADS-A, HADS-D and PCS scores correlated with DASH score (r = 0.49, 0.37, 0.38 for HADS-A, HADS-D and PCS, respectively; p < 0.001 for all three). HADS-A also significantly correlated with VAS pain score (r = 0.41, P < 0.001) and grip strength (r = − 0.25, P = 0.016). Linear regression analysis revealed that anxiety has a notable value for DASH and VAS pain scores as well as grip strength. Fisher’s r correlation coefficient to z transformation, revealed that there was no difference between two diseases of CTS and CR in terms of the resulted r coefficients from correlational coefficient analysis between disability and psychological distress.

Conclusion

It is concluded that psychological disorders are associated with disability in CR patients, with anxiety also correlating with objective disability parameter of grip strength. Finally, both CTS and CR patients’ disabilities associate with anxiety, depression, and catastrophysing thinking in a similar manner.

Level of evidence

Level IV (cross-sectional study).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05593-2.

Association of ≥ 12 months of delayed surgical treatment for cervical myelopathy with worsened postoperative outcomes: a multicenter analysis of the Quality Outcomes Database

OBJECTIVE

Degenerative cervical myelopathy (DCM) results in significant morbidity. The duration of symptoms prior to surgical intervention may be associated with postoperative surgical outcomes and functional recovery. The authors' objective was to investigate whether delayed surgical treatment for DCM is associated with worsened postoperative outcomes.

METHODS

Data from 1036 patients across 14 surgical centers in the Quality Outcomes Database were analyzed. Baseline demographic characteristics and findings of preoperative and postoperative symptom evaluations, including duration of symptoms, were assessed. Postoperative functional outcomes were measured using the Neck Disability Index (NDI) and modified Japanese Orthopaedic Association (mJOA) scale. Symptom duration was classified as either less than 12 months or 12 months or greater. Univariable and multivariable regression were used to evaluate for the associations between symptom duration and postoperative outcomes.

RESULTS

In this study, 513 patients (49.5%) presented with symptom duration < 12 months, and 523 (50.5%) had symptoms for 12 months or longer. Patients with longer symptom duration had higher BMI and higher prevalence of anxiety and diabetes (all p < 0.05). Symptom duration ≥ 12 months was associated with higher average baseline NDI score (41 vs 36, p < 0.01). However, improvements in NDI scores from baseline were not significantly different between groups at 3 months (p = 0.77) or 12 months (p = 0.51). Likewise, the authors found no significant differences between groups in changes in mJOA scores from baseline to 3 months or 12 months (both p > 0.05).

CONCLUSIONS

Surgical intervention resulted in improved mJOA and NDI scores at 3 months, and this improvement was sustained in both patients with short and longer initial symptom duration. Patients with DCM can still undergo successful surgical management despite delayed presentation.