Explanatory Factors for Neck-Related Disability, Headache, and Pain After Cervical Decompression Surgery in Individuals With Cervical Radiculopathy and Neck-Related Headache: A National Registry-Based Study With 2-Year Follow-up

Objective: To investigate explanatory factors associated with neck-related disability, headache, and neck and arm pain 2 years after anterior cervical decompression and fusion (ACDF) or posterior cervical foraminotomy (PCF) in individuals with cervical radiculopathy (CR) and neck-related headache.Methods: This registry-based cohort study used prospectively collected data with a 2-year follow-up from the Swedish Spine Registry. Individuals who underwent ACDF (n=1,866) or PCF (n=357) for CR between January 2016 and March 2021 and reported preoperative neck-related headache were included. Standard analysis of covariance models were used to identify explanatory factors for the absolute values of Neck Disability Index (NDI), NDI-headache, Numerical Rating Scale (NRS) neck pain, and NRS arm pain at the 2-year follow-up after ACDF or PCF.Results: Explanatory factors explained 33% and 32% of the neck-related disability, 20% and 35% of the headache, 21% and 13% of the neck pain, and 16% and 24% of the arm pain at 2-year follow-up after ACDF and PCF, respectively, in individuals with CR and neck-related headache. The preoperative value of these outcomes had the greatest impact, except for neck and arm pain after PCF, where neck-related disability had a greater impact.Conclusion: Neck-related disability, headache, and neck and arm pain after ACDF and PCF in individuals with CR and neck-related headache are associated with preoperative levels of these outcomes, as well as demographic, lifestyle, surgical factors and self-reported health, that should be considered before surgery. The models explained 13%–35% of the variance in the outcomes, indicating that a substantial proportion remains unexplained.