title: Localizing value of pain distribution patterns in cervical spondylosis.
abstract: METHODS
  Prospective observational study.
  
  
  OBJECTIVE
  To investigate the value of pain distribution in localizing appropriate surgical levels in patients with cervical spondylosis.
  
  
  BACKGROUND
  Previous studies have investigated the value of pain drawings in its correlation with various features in degenerative spine diseases including surgical outcome, magnetic resonance imaging findings, discographic study, and psychogenic issues. However, there is no previous study on the value of pain drawings in identifying symptomatic levels for the surgery in cervical spondylosis.
  
  
  METHODS
  The study collected data from patients with cervical spondylosis who underwent surgical treatment between August 2009 and July 2012. Pain diagrams drawn separately by each patient and physician were collected. Pain distribution patterns among various levels of surgery were analyzed by the chi-square test. Agreement between different pairs of data, including pain diagrams drawn by each patient and physician, intra-examiner agreement on interpretation of pain diagrams, inter-examiner agreement on interpretation of pain diagrams, interpretation of pain diagram by examiners and actual surgery, was analyzed by Kappa statistics.
  
  
  RESULTS
  The study group consisted of 19 men and 28 women with an average age of 55.2 years. Average duration of symptoms was 16.8 months. There was no difference in the pain distribution pattern at any level of surgery. The agreement between pain diagram drawn by each patient and physician was moderate. Intra-examiner agreement was moderate. There was slight agreement of inter-examiners, examiners versus actual surgery.
  
  
  CONCLUSIONS
  Pain distribution pattern by itself has limited value in identifying surgical levels in patients with cervical spondylosis.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Krishnapundha
authors.initials: K
authors.lastname: Bunyaratavej
authors.affiliation: Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Peerapong
authors.initials: P
authors.lastname: Montriwiwatnchai
authors.affiliation: Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Rungsak
authors.initials: R
authors.lastname: Siwanuwatn
authors.affiliation: Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Surachai
authors.initials: S
authors.lastname: Khaoroptham
keywords: Cervical spondylosis; Pain; Pain measurement