Where should a laminoplasty start? The effect of the proximal level on post-laminoplasty loss of lordosis

Michael, Keith W.; Neustein, Thomas M.; Rhee, John M.

doi:10.1016/j.spinee.2016.01.188

Cited by 35 publications

(27 citation statements)

References 14 publications

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“…Other factors have been reported to be associated with kyphotic deformity after laminoplasty, such as severity of posterior muscular-ligament complex damage and the cephalic level of decompression. [ 12 , 28 ] To avoid these variables, all patients have the same cranial level of decompression, C3, and surgical operation, traditional open-door laminoplasty, in this study. In clinical practice, it is very important to evaluate global sagittal balance and regional cervical alignment while performing planned laminoplasty for patients with CSM.…”

Section: Discussionmentioning

confidence: 99%

Impact of global spine balance and cervical regional alignment on determination of postoperative cervical alignment after laminoplasty

et al. 2018

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The aim of this study is to analyze the combined impact of preoperative T1 slope (T1S) and C2-C7 sagittal vertical axis (C2-C7 SVA) on determination of cervical alignment after laminoplasty.Forty patients undergoing laminoplasty for cervical spondylotic myelopathy (CSM) with more than 2 years follow-up were enrolled. Three parameters, including cervical lordosis, T1S, and C2-C7 SVA, were measured by preoperative and postoperative radiographs. Receiver operating characteristics (ROC) curve analysis was used to determine the optimal cut-off values of preoperative T1S and C2-C7 SVA for predicting postoperative loss of cervical lordosis. Patients were classified into 4 categories based on cut-off values of preoperative T1S and C2-C7 SVA. The primary outcome was postoperative C2-C7 SVA. Change in radiographic parameters between 4 groups were compared and analyzed.Optimal cut-off values for predicting loss of cervical lordosis were T1S of 20 degrees and C2-C7 SVA of 22 mm. Patients with small C2-C7 SVA, no matter what the value of T1S, got slight loss of cervical lordosis and increase in C2-C7 SVA. Patients with low T1S and large SVA (T1 ≤20° and SVA >22 mm) got postoperative correction of kyphosis and decrease of C2-C7 SVA. However, patients with high T1S and large SVA (T1 >20° and SVA >22 mm) got mean postoperative C2-C7 SVA value of 37.06 mm, close to the threshold value of 40 mm.Determination of cervical alignment after laminoplasty relies on the equilibrium between destruction of cervical structure, kyphotic force, and adaptive compensation of whole spine, lordotic force. Lower T1S means bigger compensatory ability to adjust different severity of cervical sagittal malalignment, and vice versa.

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Section: Discussionmentioning

confidence: 99%

Impact of global spine balance and cervical regional alignment on determination of postoperative cervical alignment after laminoplasty

et al. 2018

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“…The factors leading to post-laminoplasty kyphotic deformity are complex. Several possible factors have been proposed, including age, preoperative cervical sagittal malalignment, destruction of posterior structures, posterior muscle dystrophy, and the cephalad vertebral level undergoing laminoplasty (CVLL) 6 7 8 . However, the mechanisms of post-laminoplasty kyphotic deformity have not been fully clarified yet.…”

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confidence: 99%

Multivariate analysis of factors associated with kyphotic deformity after laminoplasty in cervical spondylotic myelopathy patients without preoperative kyphotic alignment

Cao

Zhang

Yang

et al. 2017

Sci Rep

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The risk factors of post-laminoplasty kyphosis in patients with cervical spondylotic myelopathy (CSM) without preoperative kyphotic alignment are not well known. This study aimed to compare clinical and radiological data between patients with or without post-laminoplasty kyphosis and to investigate the factors associated with post-laminoplasty kyphosis in CSM patients without preoperative kyphotic alignment. Patients (n = 194) who received unilateral expansive open-door cervical laminoplasty with miniplate fixation and completed a 1-year follow-up were enrolled. Patients were grouped according to whether they suffered from postoperative kyphosis (P) or not (NP). Postoperative kyphosis was observed in 21 (10.8%) patients. The recovery rates of the Japanese Orthopaedic Association scores at the 1-year follow-up in the P group were inferior to those in the NP group (31.9% vs. 65.2%, P < 0.001). Logistic regression with post-laminoplasty kyphosis as the dependent variable showed independent risks associated with an increased C2–7 sagittal vertical axis (SVA, odds ratio [OR] = 1.085, 95% confidence interval [CI] = 1.025–1.203, P = 0.015), destroyed facet joints (OR = 1.132, 95% CI = 1.068–1.208, P < 0.001), and cephalad vertebral level undergoing laminoplasty (CVLL, OR = 2.860, 95% CI = 1.164–6.847, P = 0.021). These findings suggest that CVLL, C2–7 SVA, and destroyed facet joints are associated with kyphosis after laminoplasty in CSM patients without preoperative kyphotic alignment.

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“…29 Michael et al demonstrated that beginning laminoplasty at the C3 level, rather than C4 level, accelerated the LCL. 28 Recently, the peculiarity of the C2/C3 level in laminoplasty has drawn the attention of spinal surgeons. 30 Anatomically, the space between the spinous processes of C2 and C3 is relatively narrow compared to others due to anatomical peculiarity of C2 spinous process, which may lead to bony impingement between the spinous processes of C2 and C3 during motion of the neck, especially after C3 laminoplasty which caused posteriorly shifted arch of C3.…”

Section: Discussionmentioning

confidence: 99%

The impact of plating level on the postoperative loss of cervical lordosis in alternative skipped-level plating laminoplasty

Lin

Huang

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: The aim of this study is to evaluate the impact of plating level on the loss of cervical lordosis (LCL) after laminoplasty with skipped-level plating. Methods: This retrospective study included patients who underwent alternative skipped-level plating laminoplasty from C3 to C6. Patients were divided into two groups according to the plating level. Group 1 had miniplate fixed at C3 and C5 (C3/C5 group), while patients in group 2 were fixed at C4 and C6 (C4/C6 group). The outcome of interest was the difference of LCL between the two groups; meanwhile, kyphosis development after laminoplasty was also compared. Results: A total of 70 patients were included in our study with a mean age of 60.44 ± 9.97 years. The median follow-up was 15 (12, 16) months. Median lordosis was 15.43° (9.35°, 22.23°) before surgery and 9.88° (4.15°, 18.94°) after, with a median LCL of 4.48° (−0.66°, 8.11°). There were 17 patients in the C3/C5 group, whereas 53 patients in the C4/C6 group. While preoperative C2–C7 Cobb’s angle was comparable between the two groups (15.32° (9.73°, 23.84°) vs. 15.51° (9.03°, 21.70°), p = 0.864), there were statistical differences regarding postoperative C2–C7 Cobb’s angle (6.54° (2.49°, 16.42°) vs. 10.62° (5.89°, 18.85°), p = 0.006) and LCL (4.74° (4.17°, 12.03°) vs. 4.07° (−1.89°, 6.69°), p = 0.034) between the C3/C5 group and the C4/C6 group. In all, 94.1% (16 of 17) of patients showed some degree of LCL after laminoplasty in the C3/C5 group, which was significantly higher when compared with 64.2% (34 of 52) of C4/C6 group ( p = 0.038). Before surgery, there were no kyphosis patients in either the C3/C5 group or the C4/C6 group. Postoperatively, four patients (23.5%) developed kyphotic alignment in the C3/C5 group, but only one (1.9%) in the C4/C6 group ( p = 0.013). Conclusions: Cervical alignment was compromised after laminoplasty. When alternative skipped-level plating is adopted in laminoplasty from C3 to C6, plating at C4/C6 may better preserve cervical lordosis than plating at C3/C5 after surgery.

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Where should a laminoplasty start? The effect of the proximal level on post-laminoplasty loss of lordosis

Cited by 35 publications

References 14 publications

Impact of global spine balance and cervical regional alignment on determination of postoperative cervical alignment after laminoplasty

Impact of global spine balance and cervical regional alignment on determination of postoperative cervical alignment after laminoplasty

Multivariate analysis of factors associated with kyphotic deformity after laminoplasty in cervical spondylotic myelopathy patients without preoperative kyphotic alignment

The impact of plating level on the postoperative loss of cervical lordosis in alternative skipped-level plating laminoplasty

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