Differences in Cervical Sagittal Alignment Changes in Patients Undergoing Laminoplasty and Anterior Cervical Discectomy and Fusion

Abstract

ObjectiveAnterior cervical discectomy and fusion (ACDF) and laminoplasty (LP) are the most commonly performed procedures for degenerative cervical spondylosis. Cervical sagittal alignment (CSA) has recently been studied as an important predictor of clinical and radiological outcomes. The data from previous studies are insufficient for analysis using the recently designed CSA parameters, T1 slope (T1s), and T1s minus cervical angle (T1sCA). MethodsWe retrospectively collected data from patients who underwent ACDF and LP from January 2013 to May 2016. The CSA parameters included CA, sagittal vertical axis, T1s, and T1sCA. T1sCA values were used to evaluate the preoperative cervical balance (T1sCA>20°: imbalance). Clinical results were evaluated using the neck disability index (NDI) and recovery rate (RR) according to the Japanese Orthopedic Association scoring system. ResultsWe analyzed the data of 72 patients (ACDF, n=39; LP, n=33). Imbalance on ACDF was associated with an increase in CA (balance: preoperative [PRE], 15.64° → follow-up [F/U], 15.74°, p=0.953; imbalance: PRE, −1.14° → F/U, 8.045°, p=0.008), whereas balance on LP was associated with a significant decrease in CA (balance: PRE, 16.26°→ F/U, 11.59°, p=0.009; imbalance: PRE, 5.36°→ F/U, 2.38°, p=0.249). No significant difference was found in the RR and NDI changes in the ACDF group based on balance, but a significant difference was found in RR in the LP group (balance: 61.65%±19.88%, imbalance: 46.90%±15.71%, p=0.046). ConclusionWe found a significant difference in postoperative alignment in cases of ACDF and LP according to preoperative cervical sagittal balance. The postoperative clinical results of the LP group were more affected by F/U alignment than by the degree of alignment change.

Radiological and Clinical Outcomes of Anterior Cervical Discectomy and Fusion in Older Patients: A Comparative Analysis of Young-Old Patients (Ages 65–74 Years) and Middle-Old Patients (Over 75 Years)

“…The ACDF removes a compression lesion and increases the height of the neural foramen. 29 Certainly, ACDF generally has fewer muscle injuries, shorter operative time, quicker postoperative recovery, and minimal surgical risk. 30,31 When we synthesize our findings, ACDF can be safely performed in older patients.…”

T1 slope minus cervical lordosis in multilevel anterior cervical discectomy and fusion with or without plate: a mean 6-year follow up

“…Cervical alignment could be corrected by release of anterior tissue, removal of osteophyte, prepocess of disc and endplate bed, the shape of cages and sustaining of implants [5,18]. In addition, three levels occupies majority of the overall cervical spine and correction on operated segments is more suitable for stress distribution physiologically [19].…”

“…Staub et al [26] implied normative CL can be predicted via T1S-CL= 16.5° ± 2° based on 103 patients with cervical spine deformity. It is considered that there were differences between anterior and posterior approach on surgical-indications, internal-xtions, posterior muscle striping and preservation of ligament complex, where the solid xtion by lateral mass screw and bowstring effect from posterior muscle requires wider range of T1SCL [5,27]. In addition, spinal canal volume changes with extionextension posture while posterior such as LP enable a steady enlargement of spinal canal compared to ACDF [28], allowing larger deviation from neutral alignment without affecting QOL.…”

“…But SLC is not always awless and debates on comlications and e cacy between SLC and ACP have never be slient. Multilevel ACDF, through simple approach and direct decompression, makes up for the weakness of posterior surgery such as laminoplasty (LP) [5]. However, contrasted with single-or double-level, there were much fewer publications on multilevel ACDF with longterm follow-up.…”

“…On the one hand, the requirements for proper reconstruction for alignment was perhaps discrepant between LP and ACDF based on the different surgery-indications [5]. On the other hand, the alignment of 3-level ACDF was malleable because of wide surgical exposure, long-segment fusion and sometimes anterior-plating, which has not been quantized with QOL yet.…”