Cervical Sagittal Imbalance is a Predictor of Kyphotic Deformity After Laminoplasty in Cervical Spondylotic Myelopathy Patients Without Preoperative Kyphotic Alignment

Sakai, Kenichiro; Yoshii, Toshitaka; Hirai, Takashi; Arai, Yoshiyasu; Torigoe, Ichiro; Tomori, Masaki; Sato, Hírokazu; Okawa, Atsushi

doi:10.1097/brs.0000000000001206

Cited by 127 publications

(97 citation statements)

References 23 publications

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“…19 On the other hand, Sakai et al showed that a cutoff age of 75 years and 42 mm of the center gravity of the head to C-7 sagittal vertical axis (distance between anterior margin of external auditory canal plumb line and posterior-cranial corner of the C-7 vertebral body) were associated with postoperative kyphotic deformity. 38 Smith et al noted that the sagittal imbalance correlated directly with myelopathy symptoms and progression. 40 Some evidence has suggested the addition of fusion if range of motion is more than 20° as it has correlated with poorer outcomes due to postoperative kyphosis development in a group of elderly patients (n = 45) 60-86 years of age.…”

Section: Radiological Predictorsmentioning

confidence: 99%

Surgical outcomes of elderly patients with cervical spondylotic myelopathy: a meta-analysis of studies reporting on 2868 patients

Madhavan¹,

Chieng²,

Foong³

et al. 2016

FOC

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OBJECTIVE Cervical spondylotic myelopathy usually presents in the 5th decade of life or later but can also present earlier in patients with congenital spinal stenosis. As life expectancy continues to increase in the United States, the preconceived reluctance toward operating on the elderly population based on older publications must be rethought. It is a known fact that outcomes in the elderly cannot be as robust as those in the younger population. There are no publications with detailed meta-analyses to determine an acceptable level of outcome in this population. In this review, the authors compare elderly patients older than 75 years to a nonelderly population, and they discuss some of the relevant strategies to minimize complications. METHODS In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors performed a PubMed database search to identify English-language literature published between 1995 and 2015. Combinations of the following phrases that describe the age group (“elderly,” “non-elderly,” “old,” “age”) and the disease of interest as well as management (“surgical outcome,” “surgery,” “cervical spondylotic myelopathy,” “cervical degenerative myelopathy”) were constructed when searching for relevant articles. Two reviewers independently assessed the outcomes, and any disagreement was discussed with the first author until it was resolved. A random-effects model was applied to assess pooled data due to high heterogeneity between studies. The mean difference (MD) and odds ratio were calculated for continuous and dichromatic parameters, respectively. RESULTS Eighteen studies comprising elderly (n = 1169) and nonelderly (n = 1699) patients who received surgical treatment for cervical spondylotic myelopathy were included in this meta-analysis. Of these studies, 5 were prospective and 13 were retrospective. Intraoperatively, both groups required a similar amount of operation time (p = 0.35). The elderly group had lower Japanese Orthopaedic Association (JOA) scores (MD −1.36, 95% CI −1.62 to −1.09; p < 0.00001) to begin with compared with the nonelderly group. The nonelderly group also had a higher postoperative JOA score (MD −1.11, 95% CI −1.44 to −0.79; p < 0.00001), therefore demonstrating a higher recovery rate from surgeries (MD −11.98, 95% CI −16.16 to −7.79; p < 0.00001). The length of stay (MD 4.14, 95% CI 3.54–4.73; p < 0.00001) was slightly longer in the elderly group. In terms of radiological outcomes, the elderly group had a smaller postoperative Cobb angle but a greater increase in spinal canal diameter compared with the nonelderly group. The complication rates were not significant. CONCLUSIONS Cervical myelopathy is a disease of the elderly, and age is an independent factor for recovery from surgery. Postoperative and long-term outcomes have been remarkable in terms of improvement in mobility and independence requiring reduced nursing care. There is definitely a higher potential risk while operating on the elderly population, but no significant difference in the incidence of postoperative complications was noted. Withholding surgery from the elderly population can lead to increased morbidity due to rapid progression of symptoms in addition to deconditioning from lack of mobility and independence. Reduction in operative time under anesthesia, lower blood loss, and perioperative fluid management have been shown to minimize the complication rate. The authors request that neurosurgeons weigh the potential benefit against the risks for every patient before withholding surgery from elderly patients.

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Section: Radiological Predictorsmentioning

confidence: 99%

Surgical outcomes of elderly patients with cervical spondylotic myelopathy: a meta-analysis of studies reporting on 2868 patients

Madhavan¹,

Chieng²,

Foong³

et al. 2016

FOC

View full text Add to dashboard Cite

show abstract

“…It is necessary to consider the effect of age on the development of sagittal imbalance with kyphotic change. Sakai et al [19] reported that advanced age was a risk factor for kyphotic deformity after laminoplasty in CSM patients with normal preoperative sagittal alignment. In the thoracolumbar spine, a decrease of lumbar lordosis and an increase of thoracic kyphosis are associated with increasing age, which results in increased SVA as an indicator of the sagittal global balance [20][21][22].…”

Section: Discussionmentioning

confidence: 99%

“…To maintain the lordotic curvature of the cervical spine in the condition with sagittal imbalance, it is necessary to preserve and enhance the strength of the cervical extensor muscles. There are several less-invasive methods for saving cervical posterior structures to maintain cervical lordosis after laminoplasty [19]. However, it is generally assumed that extensor muscles already show age-related degradation in elderly patients, which will worsen the deterioration of the cervical extension mechanism postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Differences in radiological and functional outcomes between cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament after multi-level laminoplasty

Kim

Jeon

2020

Preprint

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Objective The purpose of this study was to compare the radiological and functional outcomes between patients with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) after multi-level laminoplasty. Methods This study included 75 patients (32 with CSM and 43 with OPLL) with preserved cervical sagittal balance who underwent multi-level laminoplasty for cervical myelopathy. The radiological outcomes were analyzed using the following parameters: C2–C7 Cobb angle in neutral (C27AN), flexed (C27AF), and extended (C27AE) neck postures; C2–C7 range of motion (C27ROM); T1 slope (T1S); and C2–C7 sagittal vertical axis (C27SVA). The functional outcomes were analyzed using the modified Japanese Orthopedic Association (mJOA) score, Nurick grade, and recovery rate. The radiological and functional outcomes between the two groups were evaluated 12-months postoperatively. Results C27AF, C27ROM, and C27SVA in the CSM group and C27ROM in the OPLL group decreased significantly (p < 0.05). There was a significant difference in ΔC27SVA between the two groups (9.41 ± 17.06 mm vs. 1.10 ± 17.15 mm, p < 0.05). However, there were no significant intra- or intergroup changes and differences in C27AN (p > 0.05). The functional outcomes including mJOA score (p = 0.251), Nurick grade (p = 0.316), and recovery rate (p = 0.435) showed no significant intergroup differences. Conclusions Although there were no significant differences in functional outcomes between the two groups, the CSM group showed a greater deterioration in sagittal balance with an increase of C27SVA than the OPLL group after multi-level laminoplasty.

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“…However, in the D group, the pre-versus postoperative C2-C7 sagittal angles were not significantly different, and only two patients (22%) had kyphosis postoperatively. Because the postoperative progression of cervical kyphosis has been proved to be one of the poorer predictors of the clinical outcome 13) , we considered that laminoplasty for patients with CDAS without DAS might not influence adverse effects on the clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

Radiological Examination of Postoperative Cervical Alignment and Stability in Patients with Dialysis-Associated Spondylosis Excluding Destructive Spondyloarthropathy: Comparison with Patients with Cervical Spondylotic Myelopathy

Baba

Matsumoto

Tomari

et al. 2018

Spine Surg Relat Res

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Introduction: Several reports have demonstrated the surgical treatment strategy for patients with dialysis-associated spondylosis in the cervical spine (CDAS) with destructive spondyloarthropathy (DSA). However, studies focusing on the clinical outcome of patients with CDAS without DSA remain scarce. We aimed to review the treatment strategy of patients with CDAS but without DSA. Methods: The clinical data and surgical records of consecutive patients with CDAS without DSA (n = 9; D-group) and cervical spondylotic myelopathy (CSM) (n = 30; C-group) who underwent modified double-door laminoplasty(DDL) were reviewed retrospectively. We investigated four radiologic factors in the pre-and postoperative periods that have been reported to be the risk factors for worsening of clinical symptoms in various studies and examined statistical comparison between the D and C groups. Results: In the D group, the pre-versus postoperative C2-C7 sagittal angles were not significantly different, and only two patients (22%) had kyphosis postoperatively. There was a significant difference in the pre-and postoperative C2-C7 angles in the two groups (P = 0.031). Regarding the change in segmental alignment, the local open angle increased at the C4/C5 level in the D group. Also there was a significant difference in the local angles between the two groups at C4/5 and C5/6 (P = 0.00038, and 0.037), suggesting that postoperative segmental mobility at C4/5 and C5/6 was higher in the D group than in the C group. Conclusions: In the present study, DDL in patients with CDAS without DSA did not adversely affect the postoperative alignment and stability compared with CSM patients with CSM. However, patients in the D group may have a chance to develop DSA change at the C4/5 level in the future, and careful long-term follow-up is warranted.

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Cervical Sagittal Imbalance is a Predictor of Kyphotic Deformity After Laminoplasty in Cervical Spondylotic Myelopathy Patients Without Preoperative Kyphotic Alignment

Abstract: 4.

Cited by 127 publications

References 23 publications

Surgical outcomes of elderly patients with cervical spondylotic myelopathy: a meta-analysis of studies reporting on 2868 patients

Surgical outcomes of elderly patients with cervical spondylotic myelopathy: a meta-analysis of studies reporting on 2868 patients

Differences in radiological and functional outcomes between cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament after multi-level laminoplasty

Radiological Examination of Postoperative Cervical Alignment and Stability in Patients with Dialysis-Associated Spondylosis Excluding Destructive Spondyloarthropathy: Comparison with Patients with Cervical Spondylotic Myelopathy

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