• Koji Tamai, Hidetomi Terai, Masayoshi Iwamae, Minori Kato, Hiromitsu Toyoda, Akinobu Suzuki, Shinji Takahashi, Yuta Sawada, Yuki Okamura, Yuto Kobayashi, and Hiroaki Nakamura.
• Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
• Spine. 2024 Mar 15; 49 (6): 378384378-384.

Study DesignMulticenter, prospective cohort study.ObjectiveThe current study aimed to identify the incidence of residual paresthesias after surgery for degenerative cervical myelopathy (DCM), and to demonstrate the impact of these symptoms on clinical outcomes and patient satisfaction.Summary Of Background DataSurgery for DCM aims to improve and/or prevent further deterioration of physical function and quality-of-life (QOL) in the setting of DCM. However, patients are often not satisfied with their treatment for myelopathy when they have severe residual paresthesias, even when physical function and QOL are improved after surgery.Materials And MethodsThe authors included 187 patients who underwent laminoplasty for DCM. All patients were divided into two groups based on their visual analog scale score for paresthesia of the upper extremities at one year postoperatively (>40 vs. ≤40 mm). Preoperative factors, changes in clinical scores and radiographic factors, and satisfaction scales at one year postoperatively were compared between groups. The authors used mixed-effect linear and logistic regression modeling to adjust for confounders.ResultsOverall, 86 of 187 patients had severe residual paresthesia at one year postoperatively. Preoperative patient-oriented pain scale scores were significantly associated with postoperative residual paresthesia ( P =0.032). A mixed-effect model demonstrated that patients with severe postoperative residual paresthesia showed significantly smaller improvements in QOL ( P =0.046) and myelopathy ( P =0.037) than patients with no/mild residual paresthesia. Logistic regression analysis identified that residual paresthesia was significantly associated with lower treatment satisfaction, independent of improvements in myelopathy and QOL (adjusted odds ratio: 2.5, P =0.010).ConclusionIn total, 45% of patients with DCM demonstrated severe residual paresthesia at one year postoperatively. These patients showed significantly worse treatment satisfaction, even after accounting for improvements in myelopathy and QOL. As such, in patients who experience higher preoperative pain, multidisciplinary approaches for residual paresthesia, including medications for neuropathic pain, might lead to greater clinical satisfaction.Level Of Evidence3.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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