Cervical alignment and clinical outcome of open-door laminoplasty vs. laminectomy and instrumentation in kyphotic multilevel cervical degenerative myelopathy

Du, Wei; Wang, Shuai; Wang, Haixu; Zhang, Jingtao; Wang, Feng; Zhang, Xu; Shen, Yong

doi:10.1007/s00402-021-04316-x

Cited by 5 publications

(6 citation statements)

References 34 publications

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“…Our early study ( Du et al, 2014 ) showed that enlarged laminectomy with fixation (removing the inside edge of facet joints and decompressing the nerve foramina) was an effective strategy for improving neurological function, restoring the normal cervical lordosis, and decreasing the incidence of axial symptoms and C5 root palsy for multilevel cervical degenerative myelopathy (CDM) associated with kyphosis. In the present study, our results showed that both ADF and PDF produce similar neurological improvement, in agreement with the recent reports ( Yoshii et al, 2020 ; Du et al, 2022 ). Therefore, we have good evidence that intraoperative adequate decompression of the spinal cord may be a pivotal factor in the early postoperative neurological recovery.…”

Section: Discussionsupporting

confidence: 94%

Cervical alignment and clinical outcome of anterior decompression with fusion vs. posterior decompression with fixation in kyphotic cervical spondylotic myelopathy

Wang

Zhang

et al. 2022

Front. Neurosci.

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Background contextCervical kyphosis is a common but potentially debilitating and challenging condition. There is controversy on the optimal surgical strategy for the treatment of kyphotic cervical spondylotic myelopathy (KCSM) using either anterior approach or posterior approach.IntroductionThe purpose of this study was to investigate the surgical efficacy of anterior decompression with fusion (ADF) vs. posterior decompression with fixation (PDF) for the treatment of KCSM, and to further analyze the changes of cervical spinal alignment parameters and axial symptoms (AS) severity after kyphotic correction.Materials and methodsWe retrospectively reviewed 117 patients with KCSM who had undergone ADF (58 patients) and PDF (59 patients) between January 2016 and December 2020. Cervical spinal alignment parameters, including curvature index (CI) and C2-7 Cobb angle, were measured on the PreOP and PostOP lateral radiographs. Recovery rate was calculated based on the Japanese Orthopedic Association (JOA) score. AS severity was quantified by Neck Disability Index (NDI). A P-value less than 0.05 was considered to be significant.ResultsThe patient mean age, gender, presenting symptoms and follow-up time were similar between the two groups (P > 0.05). However, there were statistically significant differences (P < 0.001) between the two groups regarding the operation levels, operating time and intraoperative blood loss. Analysis of PostOP follow-up data showed significant differences (P < 0.001) in CI, correction of CI, C2-7 Cobb angle, and NDI between the two groups, whereas no significant differences in JOA score (P = 0.16) and recovery rate (P = 0.14). There were significant differences (P < 0.001) in CI, C2-7 Cobb angle, JOA score, and NDI between PreOP and PostOP follow-up in each group. Correction of CI showed positive correlation with recovery of NDI in Group ADF (r = 0.51, P < 0.001), and in Group PDF (r = 0.45, P < 0.001).ConclusionSatisfied neurological improvement was obtained by ADF and PDF for patients with KCSM. Cervical kyphotic correction caused significant improvement of AS, and was more favorable with ADF than with PDF. Surgeons should pay full consideration of the merits and shortcomings of each approach when deciding on a surgical plan.

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Section: Discussionsupporting

confidence: 94%

Cervical alignment and clinical outcome of anterior decompression with fusion vs. posterior decompression with fixation in kyphotic cervical spondylotic myelopathy

Wang

Zhang

et al. 2022

Front. Neurosci.

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“…Laminoplasty is suggested as an alternative option because of its advantages in maintaining the motion of the cervical spine while maintaining the integrity of the posterior neck muscles and preventing epidural scar formation 26,32 . However, many reports have highlighted that laminoplasty can result in radiological kyphotic changes after surgery, although the risk is lower than that with laminoplasty alone 33,34 . The surgical technique allows wide exposure of the spinal canal, and it can easily be extended intraoperatively caudally, or rostrally.…”

Section: Discussionmentioning

confidence: 99%

“… 26 , 32 However, many reports have highlighted that laminoplasty can result in radiological kyphotic changes after surgery, although the risk is lower than that with laminoplasty alone. 33 , 34 The surgical technique allows wide exposure of the spinal canal, and it can easily be extended intraoperatively caudally, or rostrally. On the other hand, the disadvantages of this technique include possible extradural scar formation, loss of posterior spinal column integrity, and spinal instability and deformity.…”

Section: Discussionmentioning

confidence: 99%

Role of Posterior Longitudinal Ligament Complex in Spinal Deformity Secondary to Surgical Resection of the Intradural Tumor

Yin

Luo

Jin

et al. 2023

Orthopaedic Surgery

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Objective In most cases, complete resection of the intradural tumor is accompanied by long‐term neurological complications. Postoperative spinal deformity is the most common complication after surgical resection of intradural tumors, and posterior longitudinal ligament complex (PLC) plays an important role in postoperative spinal deformity. In this study, we investigated the role of PLC in spinal deformity after the surgical treatment of intradural tumors. Methods We analyzed the data of 218 consecutive patients who underwent intradural tumor resection from 2000 to 2018 in this retrospective study. Before 2010, patients underwent laminoplasty without maintaining the integrity of PLC (laminoplasty group, n = 155). After 2010, patients performed single‐port laminoplasty to maintain the integrity of PLC (laminoplasty retain posterior ligament complex group, n = 63). The score of quality of life, painful cortex, spinal cord movement, progressive kyphosis or scoliosis, perioperative morbidity, and neurological results were analyzed in the laminoplasty group and laminoplasty retain posterior ligament complex group. The distributed variable was shown as mean ± standard deviation and an independent t‐test or one‐way analysis of variance was calculated. Results There are 155 patients (71.1%) included in the laminoplasty group, and 63 patients (28.9%) in the laminoplasty retain posterior ligament complex group. The average age of patients was 42 ± 2.3 years, and the average modified McCormick score was 2. There were 158 (72.4%) patients with intramedullary tumors and 115 (52.7%) patients with extramedullary tumors. The length of hospital stays (8 days vs. 6 days; p = 0.023) and discharge to inpatient rehabilitation (48.4% vs. 26.9%; p = 0.012) were significantly lower in the laminoplasty retain posterior ligament complex group than the laminoplasty group. There was no significant difference in the risk of progressive deformity between the two groups at 18 months after surgery (relative risk 0.12; 95% confidence interval [CI] 0.43–1.25; p = 0.258) and at 20 months after surgery (relative risk 0.24; 95% CI 0.21–2.1). Conclusion Laminoplasty retains posterior ligament complex showed no impact on the spinal deformities compared with laminoplasty, but significantly improved the postoperative spinal activity, alleviated pain symptoms, and reduced hospital recovery time.

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“…In addition, it has been shown in several studies that it is di cult to predict postoperative outcomes from the recovery of cervical lordosis in different baseline populations. In a retrospective study by Du et al [20],…”

Section: Multivariate Linear Analysis Of the Factors Associated With ...mentioning

confidence: 99%

“…However, cervical sagittal abnormalities cannot be simply de ned as cervical kyphosis because the study of Diego et al [18] showed that cervical kyphosis could represent the normal cervical alignment in a large number of patients, and cervical sagittal imbalance should be de ned as a group with symptoms but unable to maintain a horizontal gaze. Kim et al [19] and Khalil et al [20] showed that cervical kyphosis accounted for approximately 30% of the asymptomatic subjects. Although ΔCL was found to be -6.01 ± 9.27 in our study, we did not nd a signi cant association between it and ΔcSVA and the relationship between postoperative value and clinical outcomes.…”

Section: Multivariate Linear Analysis Of the Factors Associated With ...mentioning

confidence: 99%

Analysis of risk factors for an increase in the cervical sagittal vertical axis after cervical laminectomy with lateral mass screw fixation

Wang

Wan

et al. 2023

Preprint

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Background: In recent studies on factors affecting quality-of-life (QOL) of patients after cervical laminectomy with fixation, cervical sagittal parameters were considered to have a strong association with the QOL.And among these parameters, the cervical sagittal vertical axis(cSVA) is regarded as the most important one. Therefore the purpose of this study is to analyze risk factors for an increase in the cSVA after cervical laminectomy with lateral mass screw fixation (LLMF). Methods: A retrospective analysis of 128 patients who underwent LLMF from October 2018 to June 2021. The following parameters were measured: McGregor's slope (McGS), C2 slope (C2S), C2-7 cobb angle (CL), cSVA, and T1 slope (T1S). Two groups were divided according to whether ΔcSVA is positive or negative, including the negative ΔcSVA group (Group N) and the positive ΔcSVA group (Group P). The basic characteristics of patients, clinical outcomes, and imaging parameters of the two groups were compared. Results: A total of 77 patients were included in this study (46 men and 31 women, a mean age of 61.44 ± 7.23 years, and a mean follow-up time of 18.60 ± 5.20 months). There were 28 patients in Group N and 49 in Group P. Patients in the two groups were similar in basic characteristics. C2S, cSVA, and NDI were significantly different postoperatively (p=0.002,0.001, and 0.031). Group P had larger changes of C2S, cSVA, and T1S than that of Group S (p=0.001,p＜0.001, and p=0.008). ΔcSVA was significantly correlated with ΔMCGS, ΔC2S, and ΔT1S (r=0.310,0.577, and 0.435). Multivariate linear analysis revealed that ΔcSVA was associated with the ΔC2S and ΔT1S (β=0.552 and 0.314). Postoperative C2S demonstrated a significant correlation with clinical outcomes. Conclusion: A smaller reduction in T1S after LLMF would be a risk factor for an increase in cSVA. Postoperative C2S increases would be necessary to maintain the horizontal gaze and the head's center of gravity if postoperative cSVA increases excessively. Postoperative C2S can also be a good predictor of clinical outcomes.

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Cervical alignment and clinical outcome of open-door laminoplasty vs. laminectomy and instrumentation in kyphotic multilevel cervical degenerative myelopathy

Cited by 5 publications

References 34 publications

Cervical alignment and clinical outcome of anterior decompression with fusion vs. posterior decompression with fixation in kyphotic cervical spondylotic myelopathy

Cervical alignment and clinical outcome of anterior decompression with fusion vs. posterior decompression with fixation in kyphotic cervical spondylotic myelopathy

Role of Posterior Longitudinal Ligament Complex in Spinal Deformity Secondary to Surgical Resection of the Intradural Tumor

Analysis of risk factors for an increase in the cervical sagittal vertical axis after cervical laminectomy with lateral mass screw fixation

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