Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> The authors undertook a study to explore the predisposing risk factors, frequency of occurrence, and clinical implications of kyphosis following laminectomy for cervical spondylotic myelopathy (CSM).</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> Preoperative radiological studies were available in 46 patients with CSM who had undergone laminectomy. Records were reviewed to obtain demographic data and operative reports. Preoperative radiographs were assessed to determine spinal alignment. In a follow-up interview the authors established clinical outcome and patient satisfaction. Postoperative cervical alignment and mobility was also determined by assessing lateral neutral, flexion, and extension x-ray films.</jats:p> <jats:p content-type="fine-print">Preoperatively, the cervical spine was shown to be kyphotic in four (9%) of 46, straight in 20 (43%) of 46, and lordotic in 22 (48%) of 46 patients. Nine (21%) of 42 patients with either straight or lordotic alignment demonstrated in the preoperative period developed kyphosis after surgery. Kyphosis developed in six (30%) of 20 patients in whom straight spinal alignment was demonstrated preoperatively and in only three (14%) of 22 patients in whom lordosis was found preoperatively. Clinically, 13 (29%) of 45 patients improved and 19 (42%) of 45 remained unchanged after an average 4-year follow-up period; 36 (80%) patients believed that their surgery was successful (one patient, who was mentally retarded, could not respond to the follow-up questionnaire). Spinal alignment was not predictive of outcome; cervical mobility as demonstrated on flexion and extension, however, correlated with improved functional performance (p = 0.005).</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> Kyphosis may develop in up to 21% of patients who have undergone laminectomy for CSM. Progression of the deformity appears to be more than twice as likely if preoperative radiological studies demonstrate a straight spine. In this study, clinical outcome did not correlate with either pre- or postoperative sagittal alignment.</jats:p>

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

“…There was consensus in the literature that preoperative severity (n = 2) was not significantly associated with postoperative radiculopathy. 24,65 Risk factors for stability complications such as instability (n = 1) 25 and postoperative kyphosis (n = 2) 35,64 were assessed by 3 studies. Guigui et al reported that patients who were younger (p = 0.03), had a hypermobile spine (p < 0.0001), had greater preoperative range of motion (p < 0.0001), and received a C-2 laminectomy (p = 0.0164) were more susceptible to spinal destabilization.…”

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

“…Although progressive cervical kyphosis after cervical laminectomy has been associated with myelopathy, postlaminectomy kyphotic deformity is not clearly related to the postoperative clinical outcome. 11 Moreover, patients with cervical kyphosis, as well as patients whose postoperative cervical alignment changes from lordotic to straight, often have poor surgical outcomes after laminoplasty. 7 Due to these concerns, a variety of laminoplasty techniques have been developed to decrease postoperative kyphotic deformity.…”

Anterior migration of spinal cord after cervical corpectomy

“…The complications of decompression surgeries for cervical spondylotic myelopathy have been widely discussed, including approach relevant lesions [17,18], decompression relevant nerve lesions [19,20], fusion relevant adjacent segment disease [21] and others [22][23][24]. Migration of spinal cord is one of the complications of decompression surgical procedure which has been reported for years [10][11][12].…”