Impact of K-Line (–) in the Neck-Flexion Position on Patient-reported Outcomes After Cervical Laminoplasty For Patients With Ossification of the Posterior Longitudinal Ligament

Kimura, Atsushi; Sugawara, Ryo; Inoue, Hirokazu; Endo, Teruaki; Takeshita, Katsushi

doi:10.1097/bsd.0000000000000891

Cited by 15 publications

(20 citation statements)

References 18 publications

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“…The K-line theoretically is a reflection of cervical alignment and the thickness of the ossification foci, two factors that are important in spinal cord compression [7,16]. Previous studies have reported that open-door laminoplasty could improve the neurological symptoms of patients with OPLL, especially for those in the Kline (+) group relative to those with K-line (-) [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Influence of K-line on intraoperative and hidden blood loss in patients with ossification of the posterior longitudinal ligament when undergoing unilateral open-door laminoplasty

Wang

et al. 2021

J Orthop Surg Res

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Background The K-line is a virtual straight line that connects the midpoints of the anteroposterior spinal canal diameter from C2 to C7 on a cervical lateral X-ray film. Patients with cervical ossification of the posterior longitudinal ligament (OPLL), in which the peak of the OPLL exceeds the K-line (K-line [-]), are less likely to experience sufficient decompression after laminoplasty compared with patients for whom the OPLL does not exceed the K-line (K-line [+]). This retrospective study investigated the influence of K-line position relative to the OPLL on intraoperative and hidden blood loss during unilateral open-door laminoplasty for OPLL. Methods Data were retrospectively analyzed of 108 patients with OPLL who underwent unilateral open-door laminoplasty between April 2015 and March 2018. Patient cases were categorized as K-line (+) or (-). The evaluated perioperative parameters were haematocrit, haemoglobin, intraoperative and hidden blood loss, surgical time, postoperative drainage, and complications. Radiological parameters included ossification occupancy ratio and C2-7 lordosis. Results The K-line (+) and K-line (-) groups were statistically comparable with regard to age, gender, body mass index, OPLL classification, medication history, C2-7 lordosis, postoperative haemoglobin and haematocrit, postoperative drainage, hidden blood loss, and complications. The occupying ratio of the K-line (-) group was significantly greater than that of the K-line (+) group (49.5 ± 15.3% cf. 42.3 ± 10.1%; P = 0.006), and the intraoperative blood loss was also significantly higher (286 ± 110.5 mL cf. 205.5 ± 98.3 L, P = 0.003). The hidden blood loss of the K-line (-) group was higher than that of the K-line (+), but not significantly (295.5 ± 112.6 mL cf. 265.6 ± 103.8 mL; P = 0.072). Conclusion Intraoperative and hidden blood loss associated with unilateral open-door laminoplasty can be predicted by the spatial relationship of the K-line and osteophyte. This relationship is a simple and practical index that may help surgeons determine the appropriate surgical strategy for patients with OPLL.

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Section: Discussionmentioning

confidence: 99%

Influence of K-line on intraoperative and hidden blood loss in patients with ossification of the posterior longitudinal ligament when undergoing unilateral open-door laminoplasty

Wang

et al. 2021

J Orthop Surg Res

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“…posterior approach for K-line negative deformities were wellexplained in previous studies. 3,20,21 Laminoplasty frequently induces progression of the OPLL, compared with fusion surgery, and young patients with mixed or continuous types of ossification face a higher risk of progression after surgery. 22,23 In addition, laminoplasty is known to be associated with aggravation of kyphosis.…”

Section: Discussionmentioning

confidence: 99%

Vertebral Body Sliding Osteotomy for Cervical Myelopathy With Rigid Kyphosis

et al. 2020

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Cervical spondylotic myelopathy is surgically demanding when associated with rigid kyphosis. Posterior surgery cannot restore cervical lordosis, and adequate decompression is not possible with rigid kyphosis. Vertebral body sliding osteotomy (VBSO) is a safe and novel technique for anterior decompression in patients with multilevel cervical spondylotic myelopathy. It is safe in terms of dural tear, pseudarthrosis, and graft dislodgement, which are demonstrated at high rates in anterior cervical corpectomy and fusion. In addition, VBSO is a powerful method for restoring cervical lordosis through multilevel anterior cervical discectomy and fusion above and below the osteotomy level. It may be a feasible treatment option for patients with cervical spondylotic myelopathy and kyphotic deformity. This is a technical note and literature review that describes the procedures involved in VBSO.

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“…The indications for laminoplasty for patients with DCM in this study varied slightly from institution to institution; they were generally that the cervical alignment in the neutral position was not kyphotic or that the k-line in the flexion position was positive. 11 In laminoplasty, the muscles attached to the C2 spinous process were preserved, as well as those attached to C7, as much as possible. Institutional review board approval was obtained before the initiation of the study (M2016-017).…”

Section: Study Populationmentioning

confidence: 99%

Factors contributing to neck pain in patients with degenerative cervical myelopathy: A prospective multicenter study

Inose

Hirai

Yoshii

et al. 2022

J Orthop Surg (Hong Kong)

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Purpose Although the understanding of the mechanisms of low back pain due to spinopelvic sagittal imbalance has strengthened, the understanding of the mechanisms of neck pain remains insufficient. Thus, this study aimed to identify the factors associated with preoperative and postoperative neck pain in patients with degenerative cervical myelopathy who underwent laminoplasty. Methods In this prospective multicenter study, we prospectively enrolled patients who were scheduled for laminoplasty for degenerative cervical myelopathy. The associations between different variables and the Numerical Pain Rating Scale (NRS) scores for neck pain were investigated using univariate and multiple linear regression models. Results In total, 92 patients were included in the current study. The univariate analysis showed that age, sex, cervical lordosis in neutral and extension, and thoracic kyphosis were significantly associated with the preoperative NRS score for neck pain; moreover, preoperative cervical lordosis in extension and range of motion and postoperative cervical lordosis in neutral, flexion, and extension were significantly associated with the postoperative NRS Scale score for neck pain. Stepwise multiple regression analysis showed that the independent factors contributing to preoperative neck pain were preoperative cervical lordosis in extension, sex, and age. The independent preoperative predictor and contributor to postoperative neck pain were preoperative cervical lordosis in extension and postoperative cervical lordosis in extension, respectively. Conclusions Cervical lordosis in extension showed significant association with neck pain in patients with degenerative cervical myelopathy. Therefore, when performing laminoplasty for patients with a low cervical lordosis in extension, attention should be paid to residual postoperative neck pain.

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Impact of K-Line (–) in the Neck-Flexion Position on Patient-reported Outcomes After Cervical Laminoplasty For Patients With Ossification of the Posterior Longitudinal Ligament

Cited by 15 publications

References 18 publications

Influence of K-line on intraoperative and hidden blood loss in patients with ossification of the posterior longitudinal ligament when undergoing unilateral open-door laminoplasty

Influence of K-line on intraoperative and hidden blood loss in patients with ossification of the posterior longitudinal ligament when undergoing unilateral open-door laminoplasty

Vertebral Body Sliding Osteotomy for Cervical Myelopathy With Rigid Kyphosis

Factors contributing to neck pain in patients with degenerative cervical myelopathy: A prospective multicenter study

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