Surgical and Functional Outcomes of Expansive Open-Door Laminoplasty for Patients With Mild Kyphotic Cervical Alignment

Abstract

Objective: To evaluate the cervical dynamics, neurological function, pain, and quality of life in patients with mild cervical kyphotic alignment who underwent expansive unilateral open-door laminoplasty (ELAP).Methods: In this retrospective single-center study, we reviewed the surgical outcomes of 80 patients with cervical spondylotic myelopathy who were followed for at least 2 years. The patients were categorized into the preoperative kyphotic group (C2–7 angle < 0°) and nonkyphotic group (angle ≥ 0°). We compared clinical information, radiographic parameters, Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) scores, and cervical Japanese Orthopaedic Association (JOA) scores between the groups.Results: The kyphotic and nonkyphotic groups comprised 17 and 63 patients, respectively. The preoperative C2–7 angles were -3.7° in the kyphotic group and 15.4° in the nonkyphotic group (p < 0.01). In the kyphotic group, kyphotic alignment improved to lordosis at the final follow-up (2.6°, p = 0.01). The preoperative (16.4° vs. 24.1°, p < 0.01) and finalfollow-up (17.8° vs. 24.5°, p < 0.01) C7 slopes were significantly smaller in the kyphotic group. ELAP reduced pain in the arms or hands (p = 0.02) and improved the JOA scores (p < 0.01) in the kyphotic group. Patient-reported outcomes assessed using the JOACMEQ showed comparable effective rates in both groups.Conclusion: Patients with mild cervical kyphosis showed smaller C7 slopes as a compensatory mechanism. Kyphotic angles significantly improved to lordosis after ELAP, resulting in favorable clinical outcomes. ELAP is a useful surgical option for patients even if they present mild kyphotic cervical angles.

Nationwide sample data analysis of additional surgery rate after anterior or posterior cervical spinal surgery

“…Additionally, one surgical technique does not fit every case; hence, there should be a trade-off between the positive and negative factors for each surgical technique. Therefore, the surgical decision in cervical spinal surgery is not unanimous and individualized on a case-by-case basis 4,[25][26][27][46][47][48][49] . Nonetheless, a consensus is reached through continued education with research, academic meetings, and correspondence between surgeons.…”

“…When the compressive lesions span more than three levels, posterior cervical surgeries such as laminoplasty or laminectomy with or without instrumented fusion are recommended 19 . For kyphotic cervical spine, anterior cervical surgery or posterior laminectomy with instrumentation is recommended 4 , 20 , 22 , 25 – 27 . Although previous studies have shown similar clinical outcomes between anterior and posterior cervical surgeries, the anterior surgery showed better cervical alignment 1 , 5 – 17 .…”

The Optimal Time between Embolization and Surgery for Hypervascular Spinal Metastatic Tumors : A Systematic Review and Meta-Analysis

“…In surgery for hypervascular metastatic spinal tumors, massive intraoperative bleeding may make major complications and safe operative resection technically challenging [ 2 , 5 , 8 , 16 ]. Preoperative transarterial embolization (TAE) of such tumors is a preemptive method to reduce intraoperative bleeding, and improve the surgeon’s ability to safely perform surgery, and maximize tumor resection [ 1 , 6 , 17 , 19 ]. TAE was first reported by Feldman et al [ 3 ] in 1975.…”