The effect of an anterior cervical operation for cervical radiculopathy or myelopathy on associated headaches.

摘要

BACKGROUND: Headaches related to the cervical spine have been reported by various authors, and modalities of treatment are as varied as their speculated causes. The purpose of this study was to determine if anterior cervical reconstructive surgery (cervical arthrodesis and disc arthroplasty) for the treatment of radiculopathy or myelopathy also helps to alleviate associated headaches. METHODS: We conducted a post hoc analysis of study cohorts combined from prospective studies comparing the results of Prestige and Bryan cervical arthroplasty devices and those of anterior cervical arthrodesis with allograft and anterior instrumentation. A total of 1004 patients (51.6% were male) were evaluated with use of the Neck Disability Index questionnaire preoperatively and at five points postoperatively, with the latest evaluation at twenty-four months, resulting in a follow-up of 803 patients. RESULTS: At the twenty-four-month follow-up, the improvement from baseline with regard to headache was significant in both groups (p < 0.0001), with patients who underwent arthroplasty reporting numerically better pain scores. Most arthroplasty and arthrodesis patients (64% and 58.5%, respectively) had improvement in the pain score of at least one grade. Conversely, the pain scores for 8.4% of those who had an arthroplasty and 13.7% of those who had arthrodesis worsened by at least one grade. For the remainder, the score was unchanged. Overall, the patients who had an arthroplasty had significant improvement more frequently than did the patients who had arthrodesis (p = 0.011). CONCLUSIONS: At two years postoperatively, patients undergoing anterior cervical operations, both those who have an arthroplasty and those who have an arthrodesis, for cervical radiculopathy and myelopathy can be expected to have significant improvement from baseline with regard to headache symptoms.