Does the asymmetry and extension function of the preoperative cervical paraspinal extensor predict postoperative cervical sagittal deformity in patients who undergo modified laminoplasty?

Lin, Sibo; Lin, Taotao; Wu, Zhengru; Chen, Gang; Shangguan, Zhitao; Wang, Zhenyu; Liu, Wenge

doi:10.1016/j.spinee.2022.07.099

Cited by 7 publications

(6 citation statements)

References 36 publications

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“…In addition, the CSA of deep extensor muscles was smaller in the LCL group according to a study conducted by Kim [ 10 ]. A recent study found that the asymmetry of cervical extension muscles at the C6 level was associated with cervical sagittal imbalance after laminoplasty [ 25 ]. However, little attention has been paid to the anterior flexion muscles.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Decreased Hounsfield Unit Values of Cervical Vertebrae and the Relative Cross-Sectional Area of Flexion/Extension Paraspinal Muscles Are Novel Risk Factors for the Loss of Cervical Lordosis after Open-Door Laminoplasty

Shi

et al. 2023

JCM

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Open-door laminoplasty is widely used for patients with cervical spondylotic myelopathy (CSM). However, the loss of cervical lordosis (LCL) seems to be unavoidable in the long-term follow-up after surgery, which may affect the clinical outcomes. The risk factors for this complication are still unclear. In this study, patients who underwent open-door laminoplasty between April 2016 and June 2021 were enrolled. Cervical X-rays were obtained to measure the C2–7 Cobb angle, C2–7 sagittal vertical axis (SVA), T1 slope (T1S) and ranges of motion (ROM). Cervical computed tomography (CT) scans and magnetic resonance imaging (MRI) were collected to evaluate the cervical Hounsfield unit values (HU) and the relative cross-sectional area (RCSA) of paraspinal muscles, respectively. A total of 42 patients were included and the average follow-up period was 24.9 months. Among the patients, 24 cases (57.1%) had a LCL of more than 5° at a 1-year follow-up and were labeled as members of the LCL group. The follow-up JOA scores were significantly lower in the LCL group (13.9 ± 0.6 vs. 14.4 ± 0.8, p = 0.021) and the mean JOA recovery rate was negatively correlated with LCL (r = −0.409, p = 0.007). In addition, LCL was positively correlated to the preoperative T1S, flexion ROM, flexion/extension ROM and the RCSA of flexion/extension muscles, while it was negatively correlated to extension ROM and the HU value of cervical vertebrae. Furthermore, multiple linear regression showed that preoperative T1S, mean HU value of cervical vertebrae, flexion/extension ROM and the flexion/extension RCSA were independent risk factors for LCL. Spine surgeons should consider these parameters before performing open-door laminoplasty.

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Section: Discussionmentioning

confidence: 99%

Preoperative Decreased Hounsfield Unit Values of Cervical Vertebrae and the Relative Cross-Sectional Area of Flexion/Extension Paraspinal Muscles Are Novel Risk Factors for the Loss of Cervical Lordosis after Open-Door Laminoplasty

Shi

et al. 2023

JCM

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“…The postoperative cervical sagittal deformityis is the most serious complication after laminoplasty with removing spinal tumors. 36 , 37 Compared with laminoplasty to treat stenosis caused by degenerative spinal diseases, these deformities were more common after the removal of intramedullary spinal cord injuries. Typical complications for surgery were progressive deformities, axial pain in the area, and neurological symptoms associated with the deformity.…”

Section: Discussionmentioning

confidence: 99%

Role of Posterior Longitudinal Ligament Complex in Spinal Deformity Secondary to Surgical Resection of the Intradural Tumor

Yin

Luo

Jin

et al. 2023

Orthopaedic Surgery

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Objective In most cases, complete resection of the intradural tumor is accompanied by long‐term neurological complications. Postoperative spinal deformity is the most common complication after surgical resection of intradural tumors, and posterior longitudinal ligament complex (PLC) plays an important role in postoperative spinal deformity. In this study, we investigated the role of PLC in spinal deformity after the surgical treatment of intradural tumors. Methods We analyzed the data of 218 consecutive patients who underwent intradural tumor resection from 2000 to 2018 in this retrospective study. Before 2010, patients underwent laminoplasty without maintaining the integrity of PLC (laminoplasty group, n = 155). After 2010, patients performed single‐port laminoplasty to maintain the integrity of PLC (laminoplasty retain posterior ligament complex group, n = 63). The score of quality of life, painful cortex, spinal cord movement, progressive kyphosis or scoliosis, perioperative morbidity, and neurological results were analyzed in the laminoplasty group and laminoplasty retain posterior ligament complex group. The distributed variable was shown as mean ± standard deviation and an independent t‐test or one‐way analysis of variance was calculated. Results There are 155 patients (71.1%) included in the laminoplasty group, and 63 patients (28.9%) in the laminoplasty retain posterior ligament complex group. The average age of patients was 42 ± 2.3 years, and the average modified McCormick score was 2. There were 158 (72.4%) patients with intramedullary tumors and 115 (52.7%) patients with extramedullary tumors. The length of hospital stays (8 days vs. 6 days; p = 0.023) and discharge to inpatient rehabilitation (48.4% vs. 26.9%; p = 0.012) were significantly lower in the laminoplasty retain posterior ligament complex group than the laminoplasty group. There was no significant difference in the risk of progressive deformity between the two groups at 18 months after surgery (relative risk 0.12; 95% confidence interval [CI] 0.43–1.25; p = 0.258) and at 20 months after surgery (relative risk 0.24; 95% CI 0.21–2.1). Conclusion Laminoplasty retains posterior ligament complex showed no impact on the spinal deformities compared with laminoplasty, but significantly improved the postoperative spinal activity, alleviated pain symptoms, and reduced hospital recovery time.

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“…found a significant increase in PSEM CSA asymmetry below the spinal cord compression segment. Lin et al 29 . proposed that cervical extensor asymmetry in the C6 segment was associated with sagittal imbalance in the cervical spine after modified laminoplasty.…”

Section: Discussionmentioning

confidence: 99%

“…Fortin et al 11 found a significant increase in PSEM CSA asymmetry below the spinal cord compression segment. Lin et al 29 proposed that cervical extensor asymmetry in the C6 segment was associated with sagittal imbalance in the cervical spine after modified laminoplasty. Naghdi et al 17 found that the DEM asymmetry was associated with the degree of spinal cord compression and spinal canal occupancy in patients with degenerative CSM.…”

Section: Paravertebral Extensor Muscles Asymmetrymentioning

confidence: 99%

“…In patients with severe PSEM atrophy, internal fixation should be utilized while preserving the extensor insertion. The strategy not only prevented postoperative sagittal imbalance due to muscle atrophy, 24,29,[32][33][34][35] but also enhanced confidence in early postoperative rehabilitation exercises. 36 Rehabilitative exercises are important, regardless of whether surgery is indicated.…”

Section: Paravertebral Muscle Correlationmentioning

confidence: 99%

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Effects of Cervical Paravertebral Extensors in Patients with Cervical Ossification of the Posterior Longitudinal Ligament Grouped According to mK‐Line

Wang,

Cao,

Mou

et al. 2023

Orthopaedic Surgery

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ObjectivesThe objective of this study was to quantify the morphology, composition, and asymmetry of the paravertebral extensor muscles (PSEMs) in patients with cervical ossification of the posterior longitudinal ligament (OPLL) who had different modified K‐line (mK‐line) and the minimum interval between the mK‐line and OPLL (INTmin) values and to investigate the relationship between PSEMs and symptoms and outcomes following laminoplasty. These original findings elucidated that the atrophy of PSEMs could predict decompression outcomes and provided a theoretical basis for paraspinal muscle rehabilitation.MethodsA total of 94 consecutive patients who underwent laminoplasty for OPLL between January 2020 and January 2022 were enrolled in this retrospective study. The relative cross‐sectional areas (rCSA), functional cross‐sectional areas (rFCSA), and FCSA/CSA ratio of the multifidus (MF), semispinalis cervicalis (SSCe), semispinalis capitis (SSCa), and splenius capitis (SpCa) were measured at the C3–C7 segments on cervical magnetic resonance imaging (MRI). This study compared the differences between the mK‐line (+) group and the mK‐line (−) group, as well as between the INTmin <4 mm group and the INTmin ≥4 mm group, using the independent t‐test or Mann–Whitney test for continuous variables and the χ2‐test for categorical variables. The correlations between the PSEMs and symptoms were analyzed using either the Pearson or Spearman correlation coefficient.ResultsThe relative total CSA (rTCSA) of the PSEMs, especially the MF, was significantly smaller in the mK‐line (−) group. However, the FCSA/CSA of the right deep extensor muscle (DEM) was larger. The asymmetry of the MF TFCSA/TCSA showed a significant difference between the mK‐line groups. In the INTmin <4 mm group, the PSEMs rCSA and rFCSA were significantly smaller, while the bilateral MF TFCSA/TCSA and right SSCe TFCSA/TCSA were larger. The asymmetry of the superficial extensor muscle rCSA was significantly lower in the group with INTmin <4 mm. The postoperative modified Japanese Orthopedic Association score (mJOA) and mJOA recovery rate were positively correlated with the INTmin and DEM rCSA and negatively correlated with the asymmetry of MF FCSA/CSA.ConclusionsIn patients with mK‐line (−) or INTmin <4 mm, the PSEMs were smaller, and the DEM atrophy and composition changes were predominant. The MF asymmetry was higher in patients with mK‐lines (−), whereas the SEM atrophy and asymmetry were more prevalent in patients with INTmin <4 mm. The DEM was related to the preoperative and postoperative mJOA scores. DEM‐preserving surgery or DEM‐specific rehabilitation exercises can improve the recovery of patients with OPLL during the perioperative period. In addition, attention should be paid to the evaluation of the SEM, especially the SpCa at the C3 and C5 levels.

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Does the asymmetry and extension function of the preoperative cervical paraspinal extensor predict postoperative cervical sagittal deformity in patients who undergo modified laminoplasty?

Cited by 7 publications

References 36 publications

Preoperative Decreased Hounsfield Unit Values of Cervical Vertebrae and the Relative Cross-Sectional Area of Flexion/Extension Paraspinal Muscles Are Novel Risk Factors for the Loss of Cervical Lordosis after Open-Door Laminoplasty

Preoperative Decreased Hounsfield Unit Values of Cervical Vertebrae and the Relative Cross-Sectional Area of Flexion/Extension Paraspinal Muscles Are Novel Risk Factors for the Loss of Cervical Lordosis after Open-Door Laminoplasty

Role of Posterior Longitudinal Ligament Complex in Spinal Deformity Secondary to Surgical Resection of the Intradural Tumor

Effects of Cervical Paravertebral Extensors in Patients with Cervical Ossification of the Posterior Longitudinal Ligament Grouped According to mK‐Line

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