STUDY DESIGN: Retrospective study. PURPOSE: To identify the prevalence of severe headache occurring after cervical posterior surgical fixation (PSF) and to evaluate the clinical and radiological findings associated with severe headache after surgery. OVERVIEW OF LITERATURE: Several studies have reported on the axial pain after cervical surgery. However, to our knowledge, the incidence of severe headache after cervical PSF has not been elucidated. METHODS: The medical records and radiological assessment of patients who underwent surgical treatment from August 2002 to May 2012 were reviewed to identify the prevalence and risk factors for severe headaches occurring following PSF from C2 distally. Neck disability index scores (NDI) (the item for neck pain), the type of C2 screw, number of cervical fused levels (1–6), and smoking habit were calculated preoperatively and postoperatively. In addition, radiological parameters (T1 slope angle, C1/2 angle, C2–7 Cobb angle, C2–7 sagittal vertical axis and C1-implant distance) were assessed for all patients. Severe headache was defined as a high NDI headache score (>4 out of 5). RESULTS: Eighty-two patients met the inclusion criteria. The mean age was 59.2 years (range, 21–78 years), and the mean number of fused levels was 5.1. The mean follow-up period was 2.9 years (range, 1–10.9 years). While only one severe headache occurred de novo postoperatively in a patient in the C3 or C4 distally group (total 30 patients, average age of 50.2 years), 11 patients in the C2 distally group (p=0.04) had severe headache occur postoperatively. The radiological parameters were not significantly different between the postoperative milder headache and severe headache (SH) groups. The SH group had a significantly higher preoperative NDI score (neck pain) (p<0.01). CONCLUSIONS: Newly occurring severe headaches can occur in 18% of patients after PSF from C2 distally. The patients with newly occurring severe headaches had significantly higher preoperative NDI score (neck pain).
Follow-Up Studies ; Headache* ; Humans ; Incidence ; Medical Records ; Neck ; Prevalence ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking

STUDY DESIGN: Retrospective study. PURPOSE: To investigate safety profile of open door laminoplasty plates. OVERVIEW OF LITERATURE: Few reports have documented potential complications related to the use of cervical laminoplasty plates. METHODS: Records and radiographs of consecutive plated laminoplasty patients of one academic surgeon were analyzed. Group 1 had screw back-out, defined as change in screw position, and group 2 did not. RESULTS: Forty-two patients (mean age, 56.9) underwent "open-door" cervical laminoplasty using 165 plates. Mean follow-up was 24 months (range, 12-49 months). Mean Nurick grade improved from 2.1 to 0.9 postoperatively. Cervical lordosis (C2-7) was 12.1degrees preoperatively and 10.0degrees postoperatively. Range-of-motion was 27.0degrees preoperatively and 23.4degrees postoperatively. Partial screw back-out was noted in 27 of 165 plates (16.4%) and in 34 of 660 screws (5.2%). Of the 34 screws, 27 (79.4%) were at either the most cranial (12/27, 44.4%) or the most caudal (15/27, 55.5%) level. Cranially, 11/12 screws (91.7%) had back-out. Caudally, 9/15 lateral mass screws (60.0%) backed-out versus 6 laminar screws (40.0%). Of the 22 patients with screw back-out, 15 (68.2%) occurred <3 months postoperative and 6 (27.3%) occurred 4-12 months postoperative. No statistical differences were found between group 1 and 2 for age, gender, preoperative and postoperative lordosis, focal sagittal alignment, range-of-motion, or Nurick grade. Despite screw backout in 22 patients, there were no plate dislodgements, laminoplasty closure, or neurological deterioration. CONCLUSIONS: Although screw back-out may occur with the use of cervical laminoplasty plates, the use of these plates without a bone block appears to be safe and reliable. As screw back-out is most common at the cranial and caudal ends of the laminoplasty, we recommend using the maximum number of screws (typically 2 for the lateral mass and 2 for the spinous process) at these levels to secure the plate to the bone.
Animals ; Follow-Up Studies ; Humans ; Lordosis ; Retrospective Studies