The time course of cervical alignment after cervical expansive laminoplasty

Choi, Il; Roh, Sung Woo; Rhim, Seung Chul; Jeon, Sang Ryong

doi:10.1097/md.0000000000013335

Cited by 23 publications

(12 citation statements)

References 12 publications

(19 reference statements)

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“…First, our follow-up period was 2 years, which was relatively short. Since it has been reported that most alignment changes after laminoplasty occur within the first 6 months postoperatively, and many cases do not worsen 1 year postoperatively, 27 the evaluation performed 2 years postoperatively in the present study can be considered reasonable. However, reoperation after laminoplasty in OPLL is associated with increased ossification and kyphosis 14 and may have a greater impact on QOL in the long term.…”

Section: Discussionmentioning

confidence: 81%

Factors Associated With Loss of Cervical Lordosis After Laminoplasty for Patients With Cervical Ossification of the Posterior Longitudinal Ligament

Nakashima

Imagama

Yoshii

et al. 2023

Spine

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Study Design. A prospective multicenter study. Objective. The objective of this study was to investigate the incidence of loss of cervical lordosis after laminoplasty for cervical ossification of the posterior longitudinal ligament (OPLL). We also sought to determine associated risk factors and the relationship with patient-reported outcomes. Summary of Background Data. Loss of cervical lordosis is a sequelae often observed after laminoplasty, which may adversely impact surgical outcomes. Cervical kyphosis, especially in OPLL, is associated with reoperation, but risk factors and relationship to postoperative outcomes remain understudied at this time. Materials and Methods. This study was conducted by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. We included 165 patients who underwent laminoplasty and completed Japanese Orthopaedic Association (JOA) score or Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaires (JOACMEQ), as well as Visual Analog Scales (VAS) for pain, with imaging. The participants were divided into two groups: those with loss of cervical lordosis of >10° or 20° after surgery and those without loss of cervical lordosis. A paired t test was applied to evaluate the association between changes in cervical spinal angles, range of motion, and cervical JOA and VAS scores before and at 2 years postoperatively. Mann-Whitney U test was used for JOACMEQ. Results. Postoperative loss of cervical lordosis >10° and >20° was observed in 32 (19.4%) and 7 (4.2%), respectively. JOA, JOACMEQ, and VAS scores were not significantly different between those with, and without, loss of cervical lordosis. Preoperative small extension range of motion (eROM) was significantly associated with postoperative loss of cervical lordosis, and the cutoff values of eROM were 7.4° [area under the curve (AUC): 0.76] and 8.2° (AUC: 0.92) for loss of cervical lordosis >10° and >20°, respectively. A large occupation ratio of OPLL was also associated with loss of cervical lordosis, with a cutoff value of 39.9% (AUC: 0.94). Laminoplasty resulted in functional improvement in most patient-reported outcomes; however, neck pain and bladder function tended to become worse postoperatively in cases with postoperative loss of cervical lordosis >20°. Conclusions. JOA, JOACMEQ, and VAS scores were not significantly different between those with, and without, loss of cervical lordosis. Preoperative small eROM and large OPLL may represent factors associated with loss of cervical lordosis after laminoplasty in patients with OPLL.

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Section: Discussionmentioning

confidence: 81%

Factors Associated With Loss of Cervical Lordosis After Laminoplasty for Patients With Cervical Ossification of the Posterior Longitudinal Ligament

Nakashima

Imagama

Yoshii

et al. 2023

Spine

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“…29 Another retrospective cohort study found that the risk of cervical kyphosis after laminoplasty is high when the preoperative CLA is <8.2°. 30 Nevertheless, several investigations have found that preoperative CLA did not correlate with postlaminoplasty loss of cervical lordosis. 17 Similar to the above results, we found that preoperative CLA is not significantly associated with postoperative cervical kyphosis and does not predict postoperative cervical kyphosis.…”

Section: Discussionmentioning

confidence: 98%

“…A prospective cohort study reported that a 7.0° cutoff for preoperative C2–C7 lordotic angle predicts postlaminoplasty kyphosis in patients without preoperative kyphotic alignment 29 . Another retrospective cohort study found that the risk of cervical kyphosis after laminoplasty is high when the preoperative CLA is <8.2° 30 . Nevertheless, several investigations have found that preoperative CLA did not correlate with postlaminoplasty loss of cervical lordosis 17 .…”

Section: Discussionmentioning

confidence: 99%

Preoperative Range of Motion in Extension May Influence Postoperative Cervical Kyphosis After Laminoplasty

Ren

Shen

Ding

et al. 2023

Spine

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Study Design. Retrospective observational study.Objective. The objective of this study was to investigate factors associated with cervical kyphosis after laminoplasty. Summary of Background Data. Many factors are reportedly associated with the deterioration of cervical curvature after laminoplasty, including cervical lordosis angle, cervical spine range of motion (ROM), T1 slope, and C2-C7 sagittal vertical axis. Postlaminoplasty kyphosis or deterioration of cervical curvature is likely caused by multiple factors. There is currently no consensus on these issues. Materials and Methods. Data of patients treated with laminoplasty for degenerative cervical myelopathy at our institution during 2008-2018 were reviewed. The following variables were collected for each patient: age and sex; follow-up time; surgery involving C3 (yes or no); surgery involving C7 (yes or no); distribution of segments operated on; number of laminae operated on; flexion, extension, and total ROM; cervical lordotic angle; longitudinal distance index; curvature index; C2-C7 sagittal vertical axis; and T1 slope. Logistic regression analysis was used to assess possible risk factors for postoperative kyphosis. Receiver operating characteristic curves were constructed to determine the cutoff values of risk factors.Results. The study cohort comprised 151 patients. Logistic regression analysis indicated that sex, number of laminae operated on, and preoperative extension ROM were significantly associated with postoperative cervical kyphosis (P < 0.05). There was significantly greater postoperative kyphosis in women than in men; the more segments operated on, the greater the risk of postoperative kyphosis, and the larger the preoperative extension ROM, the lower the risk of postlaminoplasty kyphosis. Receiver operating characteristic curve analysis showed that the cutoff value for preoperative extension ROM is 22.1°. Conclusions. Preoperative extension ROM may be associated with the development of postoperative kyphosis. The cutoff value of preoperative extension ROM that suggested the prospect of postoperative kyphosis in our sample was 22.1°.

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“…Third, the follow-up period was 1 year. Choi et al [ 33 ] reported that changes in cervical sagittal alignment generally reach a plateau at 6 months after CLP. Thus, the follow-up period was enough to investigate the risks for LCL after CLP.…”

Section: Discussionmentioning

confidence: 99%

Effect of preoperative dynamic cervical sagittal alignment on the loss of cervical lordosis after laminoplasty

Liu

Shi

Wang

et al. 2023

BMC Musculoskelet Disord

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Purpose Cervical laminoplasty (CLP) is a developed surgical procedure for the treatment of cervical spondylotic myelopathy (CSM), but only a few of those studies focus on preoperative dynamic cervical sagittal alignment and the study of different degrees of loss of cervical lordosis (LCL) is lacking. This study aimed to analyze patients who underwent CLP to investigate the effect of cervical extension and flexion function on different degrees of LCL. Methods In this retrospective case–control study, we analyzed 79 patients who underwent CLP for CSM between January 2019 and December 2020. We measured the cervical sagittal alignment parameters on lateral radiographs (neutral, flexion, and extension positions) and used Japanese Orthopedic Association (JOA) score to assess clinical outcomes. We defined the extension ratio (EXR) as 100 × Ext ROM (cervical range of extension)/ROM (cervical range of motion). We observed the relationships between collected variables (demographic and radiological variables) and LCL. Patients were classified into the following three groups according to the LCL: stability group: (LCL ≤ 5°); mild loss group (5° < LCL ≤ 10°); and severe loss group (LCL > 10°). We compared the differences of collected variables (demographic, surgical and radiological variables) among the three groups. Results Seventy-nine patients were enrolled (mean age 62.92 years; 51 men, 28 women) in the study. Among the three groups, cervical Ext ROM was the best in the stability group (p < 0.01). Compared with the stability group, range of flexion (Flex ROM) was significantly higher (p < 0.05) and EXR was significantly lower (p < 0.01) in the severe loss group. Compared with the severe loss group, JOA recovery rates were better (p < 0.01) in the stability group. Receiver-operating characteristic curve (ROC) analysis to predict LCL > 10° (area under the curve = 0.808, p < 0.001). The cutoff value for EXR was 16.80%, with sensitivity and specificity of 72.5% and 82.4%, respectively. Conclusion CLP should be carefully considered for patients with a preoperative low Ext ROM and high Flex ROM, as a significant kyphotic change is likely to develop after surgery. EXR is a useful and simple index to predict significant kyphotic changes.

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The time course of cervical alignment after cervical expansive laminoplasty

Cited by 23 publications

References 12 publications

Factors Associated With Loss of Cervical Lordosis After Laminoplasty for Patients With Cervical Ossification of the Posterior Longitudinal Ligament

Factors Associated With Loss of Cervical Lordosis After Laminoplasty for Patients With Cervical Ossification of the Posterior Longitudinal Ligament

Preoperative Range of Motion in Extension May Influence Postoperative Cervical Kyphosis After Laminoplasty

Effect of preoperative dynamic cervical sagittal alignment on the loss of cervical lordosis after laminoplasty

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