Does Extension Dysfunction Affect Postoperative Loss of Cervical Lordosis in Patients Who Undergo Laminoplasty?

Lee, Su Hun; Son, Dong Wuk; Lee, Jung Hoon; Sung, Soon Ki; Lee, Sang Weon; Song, Geun Sung

doi:10.1097/brs.0000000000002887

Cited by 32 publications

(51 citation statements)

References 17 publications

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“…Various risk factors have been reported for kyphotic alignment change after laminoplasty. [9][10][11][12][13][14][15][16][17] For example, Machino et al 15 reported that the cut-off value of the preoperative C2-7 lordosis angle for the prediction of post-laminoplasty kyphosis was 7° in patients with CSM without a preoperative kyphotic angle.…”

Section: Discussionmentioning

confidence: 99%

“…We evaluated both static alignment and dynamic image parameters to identify useful predictors for postoperative kyphotic alignment change. Lee et al 17…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Several reports have described preoperative predictors of the loss of CL after laminoplasty. [9][10][11][12][13][14][15][16][17] Recently, the T1 slope has been reported to be an important factor for predicting postoperative kyphosis as the kyphotic alignment change was greater in patients with a high T1 slope. 9,10,12 Other studies have focused on whole-spine alignment parameters for predicting postoperative kyphotic changes.…”

Section: Introductionmentioning

confidence: 99%

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Cervical Lordosis Ratio as a Novel Predictor for the Loss of Cervical Lordosis After Laminoplasty

et al. 2021

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Objective: Maintaining cervical lordosis (CL) after laminoplasty is important for indirect decompression of the spinal cord. This study aimed to identify preoperative dynamic radiographic predictors for the loss of CL after laminoplasty. Methods:We retrospectively analyzed 141 consecutive patients who underwent cervical laminoplasty for cervical myelopathy. The following radiographic parameters were measured before surgery and at 1-year of follow-up: CL, C7 slope, C2-7 sagittal vertical axis (SVA), C2-7 range of motion (ROM), CL in flexion, CL in extension, ROM of flexion (Flex ROM), and ROM of extension. The CL ratio (CLR) was defined as 100 × Flex ROM/C2-7 ROM. ΔCL was defined as postoperative CL -preoperative CL.Patients were classified into two groups: group K (kyphotic change group, ΔCL ≤-10) and group C (control group, ΔCL >-10). Results:The patient population comprised 94 men and 47 women (mean age, 70.9 ± 9.4 years), with 24 patients (17.0%) classified into group K. CL, C7 slope, and CLR were significantly higher in group K than in group C. The groups did not significantly differ in age, sex, C2-7 SVA, and C2-7 ROM. On multivariable analysis, the CLR was significantly associated with postoperative kyphotic changes. On receiver-operating characteristic curve analysis (area under the curve = 0.717, P <0.001), the cut-off value for CLR was 68.9%, with sensitivity and specificity of 87.5% and 57.3%, respectively. Conclusion:The CLR, reflecting the balance between flexion and extension mobility, was identified as a novel predictor for CL loss after laminoplasty, with a cut-off value of 68.9%.

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Section: Discussionmentioning

confidence: 99%

“…We evaluated both static alignment and dynamic image parameters to identify useful predictors for postoperative kyphotic alignment change. Lee et al 17…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cervical Lordosis Ratio as a Novel Predictor for the Loss of Cervical Lordosis After Laminoplasty

et al. 2021

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“…Previous studies revealed that the abnormal atlantoaxial joint accelerates spinal degeneration as it involves the disorder of the muscular–ligament balance system and mechanical stress conduction 4–7 . The atlantoaxial joint allows for flexion and extension of 15° and 30° of axial rotation 7 .…”

Section: Introductionmentioning

confidence: 99%

Flexion Dysfunction of Atlanto‐Occipital Joint Associated with Cervical Spondylosis

Long

et al. 2021

Orthopaedic Surgery

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Objective To investigate the association between atlanto‐occipital radiographic alignment in flexion and cervical spondylosis (CS). Methods This is a retrospective case‐control study. CS patients were recruited from our hospital, and the age/gender/body mass index (BMI)‐matched healthy controls were selected from the subjects in health examinations at the same hospital between January 2015 and May 2019. A total of 464 subjects was included in the study. There are 282 males and 182 females. The ages of patients were 20 to 67 years, and the mean age was 33.9 years. CS patients were considered the case group. Based on surgical treatments, they were subdivided into non‐operation group and operation group. The operation group and non‐operation group had 45 and 187 patients, respectively, while 232 subjects were included in the control group. The angle between McGregor's line and C1 line (O‐C1 angle) was evaluated on images taken in flexion (F‐OC) and neutral positions (N‐OC) independently. The relationship between the FOC (FOC=F‐OC—N‐OC) and Neck Disability Index (NDI) was examined, and the involvement of the FOC in the onset of CS was analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut‐off for detecting an increased risk of CS. Results The median follow‐up time was 51.6 months (25–115 months). The case groups, especially the operation group, tended to be older (55.8 ± 11.2 vs 41.6 ± 13.8 vs 23.5 ± 5.5 years, P < 0.001), have a higher NDI score (12.2 ± 4.5 vs 6.2 ± 2.1 vs 3.2 ± 1.2, P < 0.001), and longer medical history (10.5 ± 9.5 vs 6.8 ± 11.2 years, P < 0.001). One‐way analysis of variance showed statistically significant differences in FOC between the control and case groups (1.4° ± 1.2° vs 3.6° ± 1.9° vs 7.2° ± 2.0°, P < 0.001). Besides, a post‐hoc Tukey test showed a lower FOC in the operation group compared with that in the non‐operation group (1.4° ± 1.2° vs 3.6° ± 1.9°, P < 0.001). Using FOC as a radiological predictive model to predict CS, the cut‐off value was 4.2°. Using FOC as a radiological predictive model to predict CS, the area under the curve (AUC) was 0.86 (95% CI: 0.78–0.92, P < 0.001). In the univariable risk analysis model, conditional logistic regression showed that the FOC level was an independent factor with an important role in the risk of CS. The odds rose to 8.2 times when FOC reached the level under 4.2° (OR = 8.2; 95% CI: 6.4–10.0; P < 0.001). There existed a significant negative correlation between FOC levels and NDI (r = −0.451, P = 0.016). Conclusions Stiff O‐C1, which is defined as FOC ≤ 4.2°, represented decreased flexion dysfunction of atlanto‐occipital joint and is closely associated with high risk for the occurrence of CS. This finding could show a possible relationship between upper and lower cervical spine and help spine surgeons to understand the pathological process of CS and implement appropriate management.

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“…Previous studies revealed that the abnormal atlantoaxial joint accelerates spinal degeneration as the disorder of the muscular-ligament balance system and mechanical stress conduction [4][5][6][7]. The atlantoaxial joint allows for exion and extension of 15 degrees and 30 degrees of axial rotation [7].…”

Section: Introductionmentioning

confidence: 99%

Flexion Dysfunction of Atlanto-occipital Joint as a Risk Factor for Cervical Spondylosis

Long¹,

Yi²,

Tan³

2020

Preprint

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BACKGROUND: There exist varied craniocervical flexion angles from the teenagers to the elderly. To our best knowledge, there is no prior study to examine the role of range of motion (ROM) of the atlanto-occipital joint in the pathogenesis of cervical spondylosis (CS). The purpose of this study was to investigate the association between atlanto-occipital radiographic alignment in flexion and CS.METHODS: 232 CS patients, including 45 patients who accepted surgical treatment, were retrospectively reviewed. The angle between McGregor’s line and C1 line (O-C1 angle) was evaluated on images taken in flexion (F-OC) and neutral positions (N-OC) independently. The relationship between the FOC (FOC=F-OC—N-OC) and Neck Disability Index (NDI) was examined, and the involvement of the FOC in the onset of CS was analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off for detecting an increased risk of CS.RESULTS: The FOC showed a significant correlation with NDI(P<0.05). The mean FOC was significantly lower in the CS groups than in the control group (P<0.001). Logistic regression analysis showed involvement of the FOC in the onset of CS, and the threshold value according to receiver operating characteristic curve analysis was 4.2 degree, with the odds ratio of 8.2 (95% CI:6.4–10.0; P<0.001). CONCLUSION: Stiff atlanto-occipital joint, represented by low FOC, is an independent risk factor in the incidence of CS compared with healthy individuals. This parameter can help spine surgeons to identify these people to implement appropriate preventive and management steps.

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Does Extension Dysfunction Affect Postoperative Loss of Cervical Lordosis in Patients Who Undergo Laminoplasty?

Cited by 32 publications

References 17 publications

Cervical Lordosis Ratio as a Novel Predictor for the Loss of Cervical Lordosis After Laminoplasty

Cervical Lordosis Ratio as a Novel Predictor for the Loss of Cervical Lordosis After Laminoplasty

Flexion Dysfunction of Atlanto‐Occipital Joint Associated with Cervical Spondylosis

Flexion Dysfunction of Atlanto-occipital Joint as a Risk Factor for Cervical Spondylosis

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