J Korean Neurosurg Soc.  2013 May;53(5):288-292. 10.3340/jkns.2013.53.5.288.

Vertebral Distraction during Anterior Cervical Discectomy and Fusion Causes Postoperative Neck Pain

• Ha SM
• Kim JH
• Oh SH
• Song JH
• Kim HI
• Shin DA

• KMID: 1426196
• DOI: http://doi.org/10.3340/jkns.2013.53.5.288

Abstract

OBJECTIVE
Vertebral distraction is routinely performed during anterior cervical discectomy and fusion (ACDF). Overdistraction can injure the facet joints and may cause postoperative neck pain consequently. The purpose of this study was to investigate the clinical relevance of distraction force during ACDF.
METHODS
This study included 24 consecutive patients with single level cervical disc disease undergoing single level ACDF. We measure the maximum torque just before the the arm of the Caspar retractor was suspended by the rachet mechanism by turning the lever on the movable arm using a torque meter. In order to turn the lever using the torque driver, we made a linear groove on the top of the lever. We compared the neck disability index (NDI) and visual analogue scale (VAS) scores between the high torque group (distraction force>6 kgf.cm) and the low torque group (distraction force< or =6 kgf.cm) at routine postoperative intervals of 1, 3, 5 days and 1, 3, 6 months.
RESULTS
The VAS scores for posterior neck pain had a linear correlation with torque at postoperative 1st and 3rd days (y=0.99x-1.1, r2=0.82; y=0.77x-0.63, r2=0.73, respectively). VAS scores for posterior neck pain were lower in the low torque group than in the high torque group on both 1 and 3 days postoperatively (3.1+/-1.3, 2.6+/-1.0 compared with 6.0+/-0.6, 4.9+/-0.8, p<0.01). However, the difference in NDI scores was not statistically significant in all postoperative periods.
CONCLUSION
Vertebral distraction may cause posterior neck pain in the immediate postoperative days. We recommend not to distract the intervertebral disc space excessively with a force of more than 6.0 kgf.cm.

Keyword

Postoperative pain; Zygapophyseal joint; Spinal fusion; Cervical spine

MeSH Terms

Arm
Diskectomy
Humans
Intervertebral Disc
Neck
Neck Pain
Pain, Postoperative
Spinal Fusion
Torque
Zygapophyseal Joint

Figure

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  Fig. 1 An illustration of the measurement of distraction force by a torque driver and the Caspar retractor.

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  Fig. 2 The correlation between the VAS scores for neck pain and distraction force throughout the postoperative period in patients undergoing ACDF. VAS : visual analogue scale, ACDF : anterior cervical discectomy and fusion.

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  Fig. 3 The comparison of VAS scores for posterior neck pain throughout the postoperative period between the low torque group and the high torque group. VAS : visual analogue scale.

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  Fig. 4 The comparison of NDI scores throughout the postoperative period between the low torque group and the high torque group. NDI : neck disability index.

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