Pain drawings predict outcome of surgical treatment for degenerative disc disease in the cervical spine

Abstract

Introduction: Pain drawings have been frequently used in the preoperative evaluation of spine patients. For lumbar conditions comprehensive research has established both the reliability and predictive value, but for the cervical spine most of this knowledge is lacking. The aims of this study were to validate pain drawings for the cervical spine, and to investigate the predictive value for treatment outcome of four different evaluation methods.

Methods: We carried out a post hoc analysis of a randomized controlled trial, comparing cervical disc replacement to fusion for radiculopathy related to degenerative disc disease. A pain drawing together with Neck Disability Index (NDI) was completed preoperatively, after 2 and 5 years. The inter- and intraobserver reliability of four evaluation methods was tested using κ statistics, and its predictive value investigated by correlation to change in NDI.

Results: Included were 151 patients, mean age of 47 years, female/male: 78/73. The interobserver reliability was fair for the modified Ransford and Udén methods, good for the Gatchel method, and very good for the modified Ohnmeiss method. Markings in the shoulder and upper arm region on the pain drawing were positive predictors of outcome after 2 years of follow-up, and markings in the upper arm region remained a positive predictor of outcome even after 5 years of follow-up.

Conclusions: Pain drawings were a reliable tool to interpret patients’ pain prior to cervical spine surgery and were also to some extent predictive for treatment outcome.

Key words:

• Cervical spine
• Neck Disability Index
• outcome
• pain drawing
• repeatability
• surgical treatment

Acknowledgements

The authors thank: Lars Lindhagen, Uppsala Clinical Research Center (UCRO), for statistical assistance; Stockholm Spine Center, Anna Arvidsson and Eva Gulle, for collecting/handling data and assisting at all times; and Hospital of Jönköping, Håkan Löfgren and Ludek Vavruch, for contributing with patients and collecting data.

Disclosure statement

A.M.: Board: Swedish Society of Spinal Surgeons.

Y.R.: Speaker’s bureau/paid presentations: AO Spine, DePuy Synthes, Medtronic. Board: Cervical Spine Research Society, European Section, AO Spine.

M.S.: Speaker’s bureau: DePuy Synthes.

C.O.: Speaker’s bureau: Anatomica, AO Spine, DePuy Synthes, Medtronic. Board: Cervical Spine Research Society, European Section.

Funding

Institutional research grants: DePuy Synthes, Stockholm County Council, Uppsala County Council, and Swedish Spine Surgery Society.