Postoperative Severe Headache Following Cervical Posterior Surgical Fixation from C2 Distally

STUDY DESIGN Retrospective study. PURPOSE To identify the prevalence of severe headache occurring after cervical posterior surgical fixation (PSF) and to evaluate the clinical and radiological findings associated with severe headache after surgery. OVERVIEW OF LITERATURE Several studies have reported on the axial pain after cervical surgery. However, to our knowledge, the incidence of severe headache after cervical PSF has not been elucidated. METHODS The medical records and radiological assessment of patients who underwent surgical treatment from August 2002 to May 2012 were reviewed to identify the prevalence and risk factors for severe headaches occurring following PSF from C2 distally. Neck disability index scores (NDI) (the item for neck pain), the type of C2 screw, number of cervical fused levels (1-6), and smoking habit were calculated preoperatively and postoperatively. In addition, radiological parameters (T1 slope angle, C1/2 angle, C2-7 Cobb angle, C2-7 sagittal vertical axis and C1-implant distance) were assessed for all patients. Severe headache was defined as a high NDI headache score (>4 out of 5). RESULTS Eighty-two patients met the inclusion criteria. The mean age was 59.2 years (range, 21-78 years), and the mean number of fused levels was 5.1. The mean follow-up period was 2.9 years (range, 1-10.9 years). While only one severe headache occurred de novo postoperatively in a patient in the C3 or C4 distally group (total 30 patients, average age of 50.2 years), 11 patients in the C2 distally group (p=0.04) had severe headache occur postoperatively. The radiological parameters were not significantly different between the postoperative milder headache and severe headache (SH) groups. The SH group had a significantly higher preoperative NDI score (neck pain) (p<0.01). CONCLUSIONS Newly occurring severe headaches can occur in 18% of patients after PSF from C2 distally. The patients with newly occurring severe headaches had significantly higher preoperative NDI score (neck pain).