Preoperative uncinate-to-facet joint area ratio is associated with the magnitude of pain improvement after posterior cervical surgery in elderly patients: a retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Cervical foraminal stenosis causes radicular pain, and although posterior decompression is effective, many patients do not achieve adequate relief, making preoperative outcome prediction valuable. We investigated whether the preoperative ratio of the uncinate process area to the cervical facet joint area (UPA/CFJA) is associated with pain improvement after posterior surgery for cervical foraminal stenosis, and whether it discriminates clinically meaningful pain relief independently of baseline pain severity. Eighty-two patients treated with a pure posterior approach were retrospectively analyzed. The UPA and CFJA were measured on preoperative computed tomography at four levels (C3-4 to C6-7) bilaterally by four independent blinded observers (intraclass correlation coefficient for reliability). The primary outcome was 6-month improvement in the visual analog scale (VAS) pain score. Responders were defined a priori by percentage VAS-reduction thresholds for clinically meaningful (≥ 30%) and substantial (≥ 50%) relief. Associations were examined with correlation, multivariable linear regression, and logistic regression, with correction for multiple comparisons. At 6 months, the VAS fell from 6.5 to 3.5 ( p < 0.001). A higher UPA/CFJA ratio was associated with less pain improvement (ρ = −0.27, p = 0.014) and remained an independent predictor in multivariable regression (standardized β = −0.35 per standard deviation, p < 0.001), persisting after covariance adjustment for baseline VAS ( p < 0.001). For substantial (≥ 50%) pain reduction, the ratio discriminated well on its own (area under the curve 0.72, cross-validated 0.72) and independently predicted lower odds of relief (odds ratio 0.42 per + 0.1 unit, 95% CI 0.25–0.70, p = 0.001), independent of baseline pain; an absolute ≥ 2-point improvement was instead confounded by baseline severity, supporting the percentage-based definition. The ratio was not associated with upper-extremity motor change ( p = 0.78). An exploratory Youden-derived threshold (ratio ≈ 0.40) identified patients unlikely to achieve substantial relief with a sensitivity of 0.80 and specificity of 0.57, and the substantial-response model was well calibrated (Brier 0.198; Hosmer-Lemeshow p = 0.84). A higher UPA/CFJA ratio is associated with less pain improvement after posterior cervical surgery and discriminates substantial pain relief largely independently of baseline pain severity. This is an association observed in retrospective data rather than a demonstration of causality, and the ratio is not a validated predictor: it cannot at present be used to select an anterior versus a posterior approach, nor as a stand-alone clinical test. As a single, body-size-normalized index from routine preoperative imaging, it is nonetheless a promising hypothesis-generating morphometric marker for counselling and risk stratification that requires external validation. Not applicable; this was a retrospective observational study with no prospectively registered health-care intervention.
Source: BMC Surgery
Institution: Ankara Etlik City Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W7203827362
FWCI:
Cites:
Cited by:
Related to: