Is more lordosis associated with improved outcomes in cervical laminectomy and fusion when baseline alignment is lordotic?

Sielatycki, John A.; Armaghani, Sheyan J.; Silverberg, Arnold; McGirt, Matthew J.; Devin, Clinton J.; O’Neill, Kevin

doi:10.1016/j.spinee.2016.04.009

Cited by 24 publications

(21 citation statements)

References 25 publications

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“…Conversely, in the current study, we insisted that adequate decompression of the spinal cord in the operation may be a pivotal factor in early postoperative neurological recovery, which was not yet clearly associated with correction of cervical kyphosis. This result was in agreement with recent reports [18][19][20], indicating that there were no correlations between cervical sagittal alignment parameters and postoperative outcomes for the patients with maintained cervical lordosis who underwent posterior decompression and fusion at 1-year follow-up.…”

Section: Discussionsupporting

confidence: 93%

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Is correction of kyphosis necessary by posterior approach for the treatment of multilevel cervical degenerative myelopathy? An observational study

Du¹,

Wang²,

Wang³

et al. 2020

Preprint

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Background: The purpose of this study was to determine whether sagittal lordotic alignment, clinical outcomes and axial symptoms (AS) could be improved by kyphotic correction after posterior approach for multilevel cervical degenerative myelopathy (CDM).Methods: We retrospectively reviewed 109 patients with multilevel CDM with kyphosis who had undergone laminoplasty (Group LP, 53 patients) and laminectomy with lateral mass screw fixation (Group LCS, 56 patients) between January 2014 and December 2018. Curvature index (CI) was measured according to the pre- and postoperative radiographic parameters. The recovery rate was calculated based on the Japanese Orthopedic Association (JOA) score. AS severity was quantified by Neck Disability Index (NDI).Results: Analysis of postoperative follow-up data showed significant differences in CI (t = 8.64, P < 0.001), correction of CI (t = 8.97, P < 0.001) and NDI (t = 3.37, P < 0.001) between Group LP and LCS, whereas no significant differences in JOA score (t = 1.21, P = 0.23) and recovery rate (t = 1.52, P = 0.13). There were significant differences in JOA score (t = 98.29, 96.41, P < 0.001), CI (t = 17.07, 16.17, P < 0.001) and NDI (t = 37.46, 52.15, P < 0.001) between pre- and postoperative follow-up in Group LP and LCS. Correction of CI showed negative correlation with axial symptom severity (r = -0.51, P < 0.001), and no association with recovery rate (r = 0.14, P = 0.15).Conclusions: Satisfied neurological improvement was obtained by LP and LCS for patients with multilevel CDM, while kyphotic correction in Group LCS caused significant improvement of AS than that in Group LP. However, in a short-term postoperative follow-up, we could not demonstrate that kyphotic correction is associated with a better recovery in clinical outcomes.

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Section: Discussionsupporting

confidence: 93%

“…All data regarding age, gender, decompressed levels, preoperative symptoms and follow-up period were reviewed and statistically analyzed (Table 1). 13.5 (11)(12)(13)(14)(15)(16)(17)(18) *Statistic tests: no statistically significant differences between the two groups.…”

Section: Methodsmentioning

confidence: 99%

Is correction of kyphosis necessary by posterior approach for the treatment of multilevel cervical degenerative myelopathy? An observational study

Du¹,

Wang²,

Wang³

et al. 2020

Preprint

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“…14 However, no study to date has established a correlation between total cervical lordosis and clinical outcome. 3,5,8,[10][11][12][13] Guigui et al 8 observed that 31% of patients transitioned from a lordotic to a straight or kyphotic spine following laminectomy, with an average change of 14.5 in this patient group, but with no difference in clinical outcome compared with patients who remained lordotic.…”

Section: Radiologic Measurements Versus Clinical Datamentioning

confidence: 99%

“…However, development of kyphosis following cervical laminectomy has not clearly been shown to influence clinical outcome. 3,5,8,[10][11][12][13] Decompression allows dorsal migration of the spinal cord away from anterior compressive osteophytes, decreases compression of the spinal canal itself, and improves vascular perfusion 3 in neutral or lordotic cervical spine curves. Cervical kyphosis may impede the posterior drift of the neural structures away from anterior compressive elements, resulting in residual compression of the spinal cord.…”

Section: Introductionmentioning

confidence: 99%

Sagittal Alignment After Laminectomy Without Fusion as Treatment for Cervical Spondylotic Myelopathy: Follow-up of Minimum 4 Years Postoperatively

Löfgren

Osman

Blomqvist

et al. 2019

Global Spine Journal

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Objectives: The aims of this study were to evaluate the incidence of sagittal malalignment including kyphosis following cervical laminectomy without fusion as treatment for cervical spondylotic myelopathy and to assess any correlation between malalignment and clinical outcome. Study Design: Retrospective cohort study. Methods: In all, 60 patients were followed up with conventional radiography at an average of 8 years postoperatively. The cervical lordosis (C2-C7 Cobb angle), C2-C7 sagittal vertical axis (cSVA) and C7 slope were measured on both preoperative and postoperative images. Patients completed a questionnaire covering Neck Disability Index (NDI), visual analogue scale for neck pain, and general health (EQ-5D). Results: Mean C2-C7 Cobb angle was 8.6° (SD 9.0) preoperatively, 3.4° (10.7) postoperatively and 9.6° (14.5) at follow-up. Ultimately, 3 patients showed >20° cervical kyphosis. Mean cSVA was 16.3 mm (SD 10.2) preoperatively, 20.6 mm (11.8) postoperatively, and 31.6 mm (11.8) at follow-up. Mean C7 slope was 20.4° (SD 8.9) preoperatively, 18.4° (9.4) postoperatively, and 32.6° (10.2) at follow-up. The preoperative to follow-up increase in cSVA and C7 slope was statistically significant (both P < .0001), but not for cervical lordosis. The preoperative to follow-up change in cSVA correlated moderately with preoperative cSVA ( r = 0.43, P = .002), as did the corresponding findings regarding C7 slope ( r = 0.52, P = .0001). A comparison of radiographic measurements with clinical outcome showed no strong correlations. Conclusions: No preoperative to follow-up change in cervical lordosis was found in this group; 5.0% developed >20° kyphosis. No clear correlation between sagittal alignment and clinical outcome was shown.

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“…Our results agreed with Sielatycki et al . [31] in a study of patients with maintained cervical lordosis who underwent posterior decompression and lateral mass fixation, they found no correlations between cervical sagittal alignment and postoperative outcomes. Neither baseline nor postoperative myelopathy severity was associated with either the amount of SVA or degree of lordosis.…”

Section: Discussionmentioning

confidence: 99%

Effect of sub-axial cervical lateral mass screw fixation on functional outcome in patients with cervical spondylotic myelopathy

Hamdan

Mahmoud²,

Mamoun

et al. 2019

Asian J Neurosurg

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Background:The role of laminectomy alone as an etiology of postoperative cervical instability is well known. Cervical sagittal malalignment of the spine has been linked to unfavorable functional outcome, so the effect of restoration of sagittal spinal alignment on functional outcomes and treatment effectiveness has recently gained attention.Objective:This is a prospective observational study aims to observe the possible relation between cervical sagittal alignment and functional outcomes following sub-axial cervical lateral mass screw fixation in patients with cervical spondylotic myelopathy.Patients and Methods:Thirty patients were included in this study all suffering from cervical spondylotic mylopathy (CSM) who underwent cervical laminectomy and screw-rod fixation and followed up over 6 months. Functional outcome accessed using Nurick myelopathy score and neck disability index (NDI)?. We also used the Cobb angle method (C2–C7) as a parameter for radiographic assessment of the cervical sagittal alignment which was measured preoperatively and postoperatively on lateral neutral views of cervical X-ray.Results:All the patients underwent cervical laminectomy and fixation in a range of 3–5 levels. Two intraoperative facet fractures and four facet joint violations were observed. All the patients were followed-up for at least 6 months. There were significant improvements of the motor power (88.5%), Nurick score (90%), and NDI (90%) postoperatively. The mean preoperative Cobb angle for all patients was −8.51° ± 14.07° standard deviation (SD) which changed to −10.29 ± 12.43 SD at the end of follow-up.Conclusion:Combing posterior decompression with lateral mass screw– rod in patients with CSM was effective in improving or at least maintaining cervical alignment with the good functional outcome.

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Is more lordosis associated with improved outcomes in cervical laminectomy and fusion when baseline alignment is lordotic?

Cited by 24 publications

References 25 publications

Is correction of kyphosis necessary by posterior approach for the treatment of multilevel cervical degenerative myelopathy? An observational study

Is correction of kyphosis necessary by posterior approach for the treatment of multilevel cervical degenerative myelopathy? An observational study

Sagittal Alignment After Laminectomy Without Fusion as Treatment for Cervical Spondylotic Myelopathy: Follow-up of Minimum 4 Years Postoperatively

Effect of sub-axial cervical lateral mass screw fixation on functional outcome in patients with cervical spondylotic myelopathy

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