Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament

Lee, Chang Kyu; Shin, Dong Ah; Yi, Seong; Kh, Kim; Shin, Hocheol; Yoon, Do Heum; Ha, Yoon

doi:10.3171/2015.4.spine141004

Cited by 76 publications

(54 citation statements)

References 25 publications

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“…This goes conform with other studies [22]. Due to different reasons (cage subsidence, loss of lordosis due to surgical technique) all of the delta groups ended up at similar mean one-year Cobb angles, and may be why there does not appear to be a difference comparing clinical parameter.…”

Section: Discussionsupporting

confidence: 90%

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The influence of sagittal profile alteration and final lordosis on the clinical outcome of cervical spondylotic myelopathy. A Delta-Omega-analysis

Koeppen¹,

Piepenbrock²,

Kroppenstedt³

et al. 2017

PLoS ONE

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PurposeDecompression and maintaining or restoring a cervical lordosis are major goals in the surgical treatment of cervical spondylotic myelopathy (CSM). Numerous studies support the assumption that cervical lordosis is a key factor for neurological recovery and pain reduction. However, even kyphotic patients can be asymptomatic. The balance of the spine is subject of an increasing number of publications. The main purpose of the study was to evaluate the validity of lordotic alignment on the course of CSM and to set this parameter in context with well-validated tools, namely the modified Japanese Orthopaedic Association scoring system (mJOAS) and the visual analogue scale (VAS), to predict and measure the clinical outcome after surgery.MethodsThis is a retrospective study with prospectively collected data of a heterogeneous cohort. The authors analyzed the records of 102 patients suffering from CSM that underwent decompressive surgery and instrumentation. Clinical outcome was assessed by using the mJOAS, VAS and Odom’s criteria. The radiological analysis involved comparison of pre- and postoperative radiographs. The patients were divided into subgroups to be able to compare the influence of various amounts of correction (3 Delta-groups: <0°, 1–7° and ≥8°) and final lordosis (4 Omega-groups: 0–7°, 8–14°, 15–21°, ≥22°).Results219 levels were fused in 102 patients. Surgery improved the clinical outcome of all groups significantly. A lordotic profile was achieved in all analyzed groups. Patients that showed small lordosis after surgery (<8°) did not have an inferior clinical outcome compared to patients with larger cervical lordosis (>14°). The comparison of Odom’s criteria showed that preoperatively kyphotic patients benefitted more from surgery than lordotic patients (p = 0.029), but no differences could be seen comparing neck pain and neurological improvement. The improvement of pain and neurological impairment measured by VAS and mJOAS supports the statistical impact and validity of the data despite comparatively small numbers of patients. The lack of postoperative kyphosis is a major limitation of the study to encompass the impact of sagittal alignment on clinical outcome.ConclusionsDecompression and stabilization appear to be key elements of surgical treatment of CSM. While the achievement of cervical lordosis remains a major goal of surgery, clinical improvement is not hindered in patients who show small lordosis. However, kyphosis should be eliminated in symptomatic patients. The terms “balance” and “physiologic lordosis” remain complex entities without clear definition. To check the results of our study controlled randomized trials to validate and determine the exact role of cervical balance on the course of CSM would be helpful.

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Section: Discussionsupporting

confidence: 90%

“…Nonetheless, numerous studies also exist that do not see any clear correlation between clinical outcome and cervical lordosis [2, 22, 23]. Furthermore, patients with a severe kyphosis can often not be corrected into a physiological lordosis but still profit substantially from surgery [24].…”

Section: Introductionmentioning

confidence: 99%

The influence of sagittal profile alteration and final lordosis on the clinical outcome of cervical spondylotic myelopathy. A Delta-Omega-analysis

Koeppen¹,

Piepenbrock²,

Kroppenstedt³

et al. 2017

PLoS ONE

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show abstract

“…For patients with OPLL, Iwasaki et al [17] observed deterioration of cervical alignment after laminoplasty, but there was no significant difference in surgery-related outcomes between patients with lordotic and those with kyphotic alignment. Lee et al [18] reported that, although laminoplasty increased the probability of kyphosis, the cervical sagittal alignment and clinical outcome were not clearly related in patients with OPLL. In this study, we attributed the lower JOA recovery rate of the NEP group to their severe canal occupying ratio and poor preoperative neurological function.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of laminoplasty for cervical ossification of the posterior longitudinal ligament with K-line (−) in the neck neutral position but K-line (+) in the neck extension position

Zhang²,

Zhang³

et al. 2017

Medicine

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Patients with cervical ossification of the posterior longitudinal ligament (OPLL) who are K-line (−) are thought to have poor clinical outcomes after laminoplasty. The aim of this study is to compare the clinical results of patients with OPLL who were K-line (−) in the neck neutral position but K-line (+) in the neck extension position (NEP group) with patients with OPLL who were K-line (+) in the neck neutral position (NNP group).Retrospectively, 42 patients who underwent cervical laminoplasty for OPLL by our surgical group during 2012 and 2013 were reviewed and were followed for at least 2 years. The patients were divided into 2 groups according to K-line status. Standing plain radiographs of the cervical spine were obtained pre- and postoperatively. Cervical spine alignment parameters included the C2–7 Cobb angle and range of motion (ROM) measured on lateral radiographs. Clinical evaluation included pre- and postoperative JOA, NDI, and VAS scores.Ten patients were classified in the NEP group, and 32 patients were classified in the NNP group. Preoperatively, the OPLL involved segments were 4.10 ± 1.66 in the NEP group and 2.53 ± 1.16 in the NNP group (P = .005). The canal-occupying ratios were 58.40 ± 11.11% in the NEP group and 29.08 ± 11.38% in the NNP group (P < .001). The mean Cobb angle of both the groups had not changed significantly at the last follow-up. The mean cervical ROM of both the groups had decreased at the last follow-up. The mean JOA score of the NEP group improved significantly from 9.70 ± 2.16 to 12.50 ± 2.27 (P = .014). The mean JOA score of the NNP group improved significantly from 11.91 ± 1.69 to 14.93 ± 1.58 (P < .001). The mean JOA recovery rate was 32.71 ± 40.45% in the NEP group and 59.00 ± 33.80% in the NNP group (P = .036). The NDI scores of both groups were significantly decreased, and the VAS scores of both groups had not changed significantly at the last follow-up.Laminoplasty is a relatively effective and safe procedure for patients with K-line (−) in the neck neutral position but K-line (+) in the neck extension position. Instead of anterior surgery, we recommend laminoplasty for those patients with OPLL extending to 3 or more segments.

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“…However, postoperative cervical kyphosis occurs at 5% to 30% after ELAP, even if preoperative CL is maintained [5][6][7] , and there are some studies investigating the preoperative factors related to postoperative cervical kyphosis after ELAP [5][6][7][8] . Lee et al reported that in 35 of 50 cases (70%), CL decreased after ELAP 9) . In cases with OPLL, a postoperative kyphotic deformity would be a particularly critical complication because laminoplasty does not decompress the The proportion of men was higher in OPLL than that of CSM.…”

Section: Introductionmentioning

confidence: 97%

Cervical Kyphotic Deformity after Laminoplasty in Patients with Cervical Ossification of Posterior Longitudinal Ligament with Normal Sagittal Spinal Alignment

Matsuoka

Endo

Nishimura

et al. 2018

Spine Surg Relat Res

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Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament

Cited by 76 publications

References 25 publications

The influence of sagittal profile alteration and final lordosis on the clinical outcome of cervical spondylotic myelopathy. A Delta-Omega-analysis

The influence of sagittal profile alteration and final lordosis on the clinical outcome of cervical spondylotic myelopathy. A Delta-Omega-analysis

Clinical outcome of laminoplasty for cervical ossification of the posterior longitudinal ligament with K-line (−) in the neck neutral position but K-line (+) in the neck extension position

Cervical Kyphotic Deformity after Laminoplasty in Patients with Cervical Ossification of Posterior Longitudinal Ligament with Normal Sagittal Spinal Alignment

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