{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T20:45:17Z","timestamp":1782765917912,"version":"3.54.5"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Axial neck pain is a prevalent condition that causes significant morbidity and productivity loss. This study aimed to review the current literature and define the impact of surgical intervention on the management of cervical axial neck pain.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A search was conducted of three databases (Ovid MEDLINE, Embase, and Cochrane) for randomized controlled trials and cohort studies written in the English language with a minimum 6-month follow-up. The analysis was limited to patients with axial neck pain\/cervical radiculopathy and preoperative\/postoperative Neck Disability Index (NDI) and visual analog scale (VAS) scores. Literature reviews, meta-analyses, systematic reviews, surveys, and case studies were excluded. Two patient groups were analyzed: the arm pain predominant (pAP) cohort and the neck pain predominant (pNP) cohort. The pAP cohort had preoperative VAS neck scores that were lower than the arm scores, whereas the pNP cohort was defined as having preoperative VAS neck scores higher than the arm scores. A 30% reduction in patient-reported outcome measure (PROM) scores from the baseline represented the minimal clinically important difference (MCID).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Five studies met the inclusion criteria, involving a total of 5221 patients. Patients with pAP showed a slightly higher percent reduction in PROM scores from baseline than those with pNP. The NDI reduction in patients with pNP was 41.35% (mean change in NDI score 16.3\/mean baseline NDI score 39.42) (p &lt; 0.0001), whereas those with pAP had a reduction of 45.12% (15.86\/35.15) (p &lt; 0.0001). Surgical improvement was slightly but similarly greater in pNP patients compared with pAP patients (16.3 vs 15.86 points, respectively; p = 0.3193). Regarding VAS scores, patients with pNP had a greater reduction in neck pain, with a change from baseline of 53.4% (3.60\/6.74, p &lt; 0.0001), whereas those with pAP had a change from baseline of 50.3% (2.46\/4.89, p &lt; 0.0001). The difference in VAS scores for neck pain improvement was significant (3.6 vs 2.46, p &lt; 0.0134). Similarly, patients with pNP had a 43.6% (1.96\/4.5) improvement in VAS scores for arm pain (p &lt; 0.0001), whereas those with pAP had 66.12% (4.43\/6.7) improvement (p &lt; 0.0001). The VAS scores for arm pain were significantly greater in patients with pAP (4.43 vs 1.96 points, respectively; p &lt; 0.0051).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Overall, despite significant variations in the existing literature, there is mounting evidence that surgical intervention can lead to clinically meaningful improvements in patients with primary axial neck pain. The studies suggest that patients with pNP tend to have better improvement in neck pain than in arm pain. In both groups, the average improvements exceeded the MCID values and reached substantial clinical benefit in all studies. Further research is necessary to identify which patients and underlying pathologies will benefit most from surgical intervention for axial neck pain because it is a multifaceted condition with many causes.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.4.spine23185","type":"journal-article","created":{"date-parts":[[2023,5,20]],"date-time":"2023-05-20T15:46:57Z","timestamp":1684597617000},"page":"345-354","source":"Crossref","is-referenced-by-count":2,"title":["Does axial cervical pain improve with surgical fusion? A meta-analysis"],"prefix":"10.3171","volume":"39","author":[{"given":"James S.","family":"Harrop","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn A.","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reyan K.","family":"Qasba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme","family":"Porto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John V.","family":"Wainwright","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Westchester Medical Center\/New York Medical College, Valhalla, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Thalheimer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merrie","family":"Schorsch","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander R.","family":"Vaccaro","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoher","family":"Ghogawala","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lahey Hospital & Medical Center, Burlington, Massachusetts; and"},{"name":"Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Best Pract Res Clin Rheumatol","first-page":"783","article-title":"The epidemiology of neck pain","volume":"24","author":"Hoy DG","year":"2010","unstructured":"Hoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Pract Res Clin Rheumatol. 2010;24(6):783\u2013792."},{"issue":"3","key":"b2","series-title":"J Neurosurg Spine","first-page":"357","article-title":"Development of new postoperative neck pain at 12 and 24 months after surgery for cervical spondylotic myelopathy: a Quality Outcomes Database study","volume":"38","author":"Sherrod BA","year":"2022","unstructured":"Sherrod BA, Michalopoulos GD, Mulvaney G,  Development of new postoperative neck pain at 12 and 24 months after surgery for cervical spondylotic myelopathy: a Quality Outcomes Database study. J Neurosurg Spine. 2022;38(3):357\u2013365."},{"key":"b3","series-title":"World Neurosurg","first-page":"e288","article-title":"Influence of predominant neck versus arm pain on anterior cervical discectomy and fusion outcomes: a follow-up study","volume":"160","author":"Patel MR","year":"2022","unstructured":"Patel MR, Jacob KC, Shah VP,  Influence of predominant neck versus arm pain on anterior cervical discectomy and fusion outcomes: a follow-up study. World Neurosurg. 2022;160:e288\u2013e295."},{"issue":"10","key":"b4","series-title":"J Clin Epidemiol","first-page":"e1","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration","volume":"62","author":"Liberati A","year":"2009","unstructured":"Liberati A, Altman DG, Tetzlaff J,  The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1\u2013e34."},{"issue":"6","key":"b5","series-title":"Article in German. Unfallchirurg","first-page":"488","article-title":"Development and validation of the visual analogue scale (VAS) spine score","volume":"104","author":"Knop C","year":"2001","unstructured":"Knop C, Oeser M, Bastian L, Lange U, Zdichavsky M, Blauth M. Development and validation of the visual analogue scale (VAS) spine score. Article in German. Unfallchirurg. 2001;104(6):488\u2013497."},{"issue":"7","key":"b6","series-title":"J Manipulative Physiol Ther","first-page":"409","article-title":"The Neck Disability Index: a study of reliability and validity","volume":"14","author":"Vernon H","year":"1991","unstructured":"Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14(7):409\u2013415."},{"issue":"11","key":"b7","series-title":"Spine (Phila Pa 1976)","first-page":"717","article-title":"Clinically meaningful improvement following cervical spine surgery: 30% reduction versus absolute point-change MCID values","volume":"46","author":"Khan I","year":"2021","unstructured":"Khan I, Pennings JS, Devin CJ,  Clinically meaningful improvement following cervical spine surgery: 30% reduction versus absolute point-change MCID values. Spine (Phila Pa 1976). 2021;46(11):717\u2013725."},{"issue":"6","key":"b8","series-title":"Spine J","first-page":"469","article-title":"Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion","volume":"10","author":"Carreon LY","year":"2010","unstructured":"Carreon LY, Glassman SD, Campbell MJ, Anderson PA. Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion. Spine J. 2010;10(6):469\u2013474."},{"key":"b9","article-title":"Quality Assessment of Systematic Reviews and Meta-Analyses","unstructured":"Quality Assessment of Systematic Reviews and Meta-Analyses. Accessed April 27, 2023.https:\/\/www.nhlbi.nih.gov\/health-topics\/study-quality-assessment-tools"},{"issue":"4","key":"b10","series-title":"Curr Rev Musculoskelet Med","first-page":"168","article-title":"Cervical spine: degenerative conditions","volume":"4","author":"Todd AG","year":"2011","unstructured":"Todd AG. Cervical spine: degenerative conditions. Curr Rev Musculoskelet Med. 2011;4(4):168\u2013174."},{"issue":"21","key":"b11","series-title":"Spine (Phila Pa 1976)","first-page":"2224","article-title":"Anterior discectomy and fusion for the management of neck pain","volume":"24","author":"Palit M","year":"1999","unstructured":"Palit M, Schofferman J, Goldthwaite N,  Anterior discectomy and fusion for the management of neck pain. Spine (Phila Pa 1976). 1999;24(21):2224\u20132228."},{"issue":"17","key":"b12","series-title":"Spine (Phila Pa 1976)","first-page":"1887","article-title":"Outcome of anterior cervical discectomy and fusion as perceived by patients treated for dominant axial-mechanical cervical spine pain","volume":"27","author":"Garvey TA","year":"2002","unstructured":"Garvey TA, Transfeldt EE, Malcolm JR, Kos P. Outcome of anterior cervical discectomy and fusion as perceived by patients treated for dominant axial-mechanical cervical spine pain. Spine (Phila Pa 1976). 2002;27(17):1887\u20131895."},{"issue":"3","key":"b13","series-title":"Global Spine J","first-page":"312","article-title":"The role of anterior cervical discectomy and fusion on relieving axial neck pain in patients with single-level disease: a systematic review and meta-analysis","volume":"10","author":"Oitment C","year":"2020","unstructured":"Oitment C, Watson T, Lam V,  The role of anterior cervical discectomy and fusion on relieving axial neck pain in patients with single-level disease: a systematic review and meta-analysis. Global Spine J. 2020;10(3):312\u2013323."},{"issue":"1","key":"b14","series-title":"Scand J Pain","first-page":"33","article-title":"A small group Whiplash-Associated-Disorders (WAD) patients with central neck pain and movement induced stabbing pain, the painful segment determined by mechanical provocation: fusion surgery was superior to multimodal rehabilitation in a randomized trial","volume":"12","author":"Nystr\u00f6m B","year":"2016","unstructured":"Nystr\u00f6m B, Svensson E, Larsson S, Schillberg B, M\u00f6rk A, Taube A. A small group Whiplash-Associated-Disorders (WAD) patients with central neck pain and movement induced stabbing pain, the painful segment determined by mechanical provocation: fusion surgery was superior to multimodal rehabilitation in a randomized trial. Scand J Pain. 2016;12(1):33\u201342."},{"issue":"4","key":"b15","series-title":"J Neurosurg Spine","first-page":"399","article-title":"Impact of predominant symptom location among patients undergoing cervical spine surgery on 12-month outcomes: an analysis from the Quality Outcomes Database","volume":"35","author":"Devin CJ","year":"2021","unstructured":"Devin CJ, Asher AL, Alvi MA,  Impact of predominant symptom location among patients undergoing cervical spine surgery on 12-month outcomes: an analysis from the Quality Outcomes Database. J Neurosurg Spine. 2021;35(4):399\u2013409."},{"issue":"2","key":"b16","series-title":"Int J Spine Surg","first-page":"240","article-title":"How do patients with predominant neck pain improve after anterior cervical discectomy and fusion for cervical radiculopathy?","volume":"16","author":"Divi SN","year":"2022","unstructured":"Divi SN, Goyal DKC, Woods BI,  How do patients with predominant neck pain improve after anterior cervical discectomy and fusion for cervical radiculopathy?. Int J Spine Surg. 2022;16(2):240\u2013246."},{"issue":"10","key":"b17","series-title":"Spine (Phila Pa 1976)","first-page":"E568","article-title":"Does the predominant pain location influence functional outcomes, satisfaction and return to work after anterior cervical discectomy and fusion for cervical radiculopathy?","volume":"46","author":"Goh GS","year":"2021","unstructured":"Goh GS, Yue WM, Guo CM, Tan SB, Chen JLT. Does the predominant pain location influence functional outcomes, satisfaction and return to work after anterior cervical discectomy and fusion for cervical radiculopathy? Spine (Phila Pa 1976). 2021;46(10):E568\u2013E575."},{"issue":"14","key":"b18","series-title":"Spine (Phila Pa 1976)","first-page":"E825","article-title":"Improvements in neck and arm pain following an anterior cervical discectomy and fusion","volume":"42","author":"Massel DH","year":"2017","unstructured":"Massel DH, Mayo BC, Bohl DD,  Improvements in neck and arm pain following an anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 2017;42(14):E825\u2013E832."},{"issue":"1","key":"b19","series-title":"J Surg Orthop Adv","first-page":"24","article-title":"A comparison of outcomes of anterior cervical discectomy and fusion in patients with and without radicular symptoms","volume":"15","author":"Eck JC","year":"2006","unstructured":"Eck JC, Humphreys SC, Hodges SD, Levi P. A comparison of outcomes of anterior cervical discectomy and fusion in patients with and without radicular symptoms. J Surg Orthop Adv. 2006;15(1):24\u201326."},{"issue":"6","key":"b20","series-title":"Neurosurg Focus","first-page":"E18","article-title":"Primary pain generator identification by CT-SPECT in patients with degenerative spinal disease","volume":"47","author":"Tender GC","year":"2019","unstructured":"Tender GC, Davidson C, Shields J,  Primary pain generator identification by CT-SPECT in patients with degenerative spinal disease. Neurosurg Focus. 2019;47(6):E18."},{"issue":"2","key":"b21","series-title":"J Neurosurg Spine","first-page":"168","article-title":"The utility of radionucleotide imaging in the surgical management of axial neck pain from cervical facet joint arthropathy","volume":"32","author":"Witiw CD","year":"2019","unstructured":"Witiw CD, Tsapenko N, Traynelis VC. The utility of radionucleotide imaging in the surgical management of axial neck pain from cervical facet joint arthropathy. J Neurosurg Spine. 2019;32(2):168\u2013173."},{"key":"b22","series-title":"World Neurosurg","first-page":"390","article-title":"The usefulness of single-photon emission computed tomography in defining painful upper cervical facet arthropathy","volume":"96","author":"Ravindra VM","year":"2016","unstructured":"Ravindra VM, Mazur MD, Bisson EF, Barton C, Shah LM, Dailey AT. The usefulness of single-photon emission computed tomography in defining painful upper cervical facet arthropathy. World Neurosurg. 2016;96:390\u2013395."},{"issue":"6","key":"b23","series-title":"Neurosurg Focus","first-page":"E19","article-title":"Preoperative SPECT imaging as a tool for surgical planning in patients with axial neck and back pain","volume":"47","author":"Brusko GD","year":"2019","unstructured":"Brusko GD, Perez-Roman RJ, Tapamo H, Burks SS, Serafini AN, Wang MY. Preoperative SPECT imaging as a tool for surgical planning in patients with axial neck and back pain. Neurosurg Focus. 2019;47(6):E19."},{"issue":"5","key":"b24","series-title":"Int J Spine Surg","first-page":"629","article-title":"Arm pain versus neck pain: a novel ratio as a predictor of post-operative clinical outcomes in cervical radiculopathy patients","volume":"12","author":"Passias PG","year":"2018","unstructured":"Passias PG, Hasan S, Radcliff K,  Arm pain versus neck pain: a novel ratio as a predictor of post-operative clinical outcomes in cervical radiculopathy patients. 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