Does Preoperative T1 Slope and Cervical Lordosis Mismatching Affect Surgical Outcomes After Laminoplasty in Patients with Cervical Spondylotic Myelopathy?

Rao, Hongming; Huang, Yuming; Lan, Zhibin; Zhang, Xu; Li, Guishuang; Xu, Weili

doi:10.1016/j.wneu.2019.06.193

Cited by 18 publications

(10 citation statements)

References 25 publications

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“…Rao et al [ 54 ] reported that a mismatch of preoperative T1s and cervical lordosis (CL) of more than 20° (T1s-CL ≥20°) was related to poor RR in CSM patients. Sharma et al [ 62 ] classified CSM and OPLL patients into four groups using T1s and the sagittal vertical axis (SVA).…”

Section: Resultsmentioning

confidence: 99%

Preoperative Radiological Parameters to Predict Clinical and Radiological Outcomes after Laminoplasty

Lee

Son

Shin

et al. 2021

J Korean Neurosurg Soc

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Many studies have focused on pre-operative sagittal alignment parameters which could predict poor clinical or radiological outcomes after laminoplasty. However, the influx of too many new factors causes confusion. This study reviewed sagittal alignment parameters, predictive of clinical or radiological outcomes, in the literature. Preoperative kyphotic alignment was initially proposed as a predictor of clinical outcomes. The clinical significance of the K-line and K-line variants also has been studied. Sagittal vertical axis, T1 slope (T1s), T1s-cervical lordosis (CL), anterolisthesis, local kyphosis, the longitudinal distance index, and range of motion were proposed to have relationships with clinical outcomes. The relationship between loss of cervical lordosis (LCL) and T1s has been widely studied, but controversy remains. Extension function, the ratio of CL to T1s (CL/T1s), and Sharma classification were recently proposed as LCL predictors. In predicting postoperative kyphosis, T1s cannot predict postoperative kyphosis, but a low CL/ T1s ratio was associated with postoperative kyphosis.

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Section: Resultsmentioning

confidence: 99%

Preoperative Radiological Parameters to Predict Clinical and Radiological Outcomes after Laminoplasty

Lee

Son

Shin

et al. 2021

J Korean Neurosurg Soc

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“…They reported that 20° of T1S-CL and 2.89 cm cervical SVA were considered cut-off values of postoperative neck pain. Rao et al [ 5 ] similarly set the cut-off value of preoperative T1S-CL as 20° and investigated the influence on surgical outcomes after open-door laminoplasty. Consequently, they reported that patients with preoperative T1S-CL > 20° demonstrated a postoperative kyphotic deformity.…”

Section: Discussionmentioning

confidence: 99%

“…The C2–C7 angle was measured, which was defined by the angle between the inferior end plate of C2 vertebra and the inferior endplate of C7 vertebra. T1-CL > 20° was defined as mismatching [ 5 ], and patients were divided into two based on their T1S-CL mismatching scores. Afterward, laminoplasty was conducted using an expansive double-door spinous process-splitting (Kurokawa) method [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

“…Remarkably, the association between T1S and cervical lordosis (CL) has been advocated. Several past reports have also investigated the influence of T1S minus CL (T1S-CL) on the surgical outcomes of cervical spine surgery, because the ideal degree of CL is considered to be different, depending on the magnitude of T1S, including two reports on cervical laminoplasty [ 5 , 6 ]. Besides, past reports included patients who experienced preoperative kyphosis of the cervical spine, which are considered to have affected the surgical results.…”

Section: Introductionmentioning

confidence: 99%

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Does T1 slope minus cervical lordosis mismatch affect surgical outcomes of cervical laminoplasty in the absence of preoperative severe kyphosis?

Sakamoto

Nakamoto

Yoshida

et al. 2022

BMC Musculoskelet Disord

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Background The impact of the T1 slope minus cervical lordosis (T1S-CL) on surgical outcomes in patients with degenerative cervical myelopathy undergoing laminoplasty (LP) remain uncertain. Methods One hundred patients who underwent cervical LP were retrospectively reviewed. Radiographic measurements included C2–C7 lordosis (CL), T1 slope (T1S), and C2–C7 sagittal vertical axis (SVA). Additionally, pain numeric rating scale, neck disability index (NDI), 12-Item Short-Form Health Survey, Euro QOL 5 dimensions (EQ5D), and Japanese Orthopedic Association score were investigated. According to past reports, T1S–CL > 20° was defined as mismatched. Then, based on T1S-CL mismatching, patients were divided into 2 groups. Results This research understudied 67 males and 33 females with a mean age of 67 y. Preoperatively, only eight patients showed a T1S-CL mismatch. While the C2–7 Cobb angles did not change significantly after surgery, the T1 slope (T1S) angle increased, increasing the T1S-CL as a result. As we compared the clinical outcomes based on the preoperative T1S-CL mismatching, there were no significant differences between the two groups. On the other hand, the number of patients in the mismatched group increased to 21 patients postoperatively. As we compared clinical outcomes based on the postoperative T1S-CL mismatching, the postoperative NDI score and preop/postop EQ5D score were significantly worse in the mismatch group. Conclusions Although cervical LP showed inferior outcomes in patients with postoperative T1S-CL mismatch even in the absence of severe preoperative kyphosis (> 10°), preoperative T1S-CL mismatch was not adversely prognostic.

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“…6 Factors such as the K-line, modified K-line, and T1 slope have been used to predict the likelihood of failure of LP. [7][8][9][10][11][12] Conversely, LF involves removing the entire spinous process and lamina with subsequent fusion of the posterolateral facets (Figure 1). The most common reasons for LF compared with LP have been instability in the form of spondylolisthesis and marginal kyphosis.…”

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confidence: 99%

Cervical Laminoplasty Versus Posterior Laminectomy and Fusion: Trends in Utilization and Evaluation of Complication and Revision Surgery Rates

McDonald

Hershman

Alsoof

et al. 2022

J Am Acad Orthop Surg

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Introduction: Cervical laminoplasty (LP) and laminectomy with fusion (LF) are common operations used to treat cervical spondylotic myelopathy. Conflicting data exist regarding which operation provides superior patient outcomes while minimizing the risk of complications. This study evaluates the trends of LP compared with LF over the past decade in patients with cervical myelopathy and examines long-term revision rates and complications between the two procedures. Methods: Patients aged 18 years or older who underwent LP or LF for cervical myelopathy from 2010 to 2019 were identified in the PearlDiver Mariner Database. Patients were grouped independently (LP versus fusion) and assessed for association with common medical and surgical complications. The primary outcome was the incidence of LP versus LF for cervical myelopathy over time. Secondary outcomes were revision rates up to 5 years postoperatively and the development of complications attributable to either surgery. Results: In total, 1,420 patients underwent LP and 10,440 patients underwent LF. Rates of LP (10.5% to 13.7%) and LF (86.3% to 89.5%) remained stable, although the number of procedures nearly doubled from 865 in 2010 to 1,525 in 2019. On matched analysis, LP exhibited lower rates of wound complications, surgical site infections, spinal cord injury, dysphagia, cervical kyphosis, limb paralysis, incision and drainage/ exploration, implant removal, respiratory failure, renal failure, and sepsis. Revision rates for both procedures at were not different at any time point. Conclusion: From 2010 to 2019, rates of LP have not increased and represent less than 15% of posterior-based myelopathy operations. Up to 5 years of follow-up, there were no differences in revision rates for LP compared with LF; however, LP was associated with fewer postoperative complications than LF.

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Does Preoperative T1 Slope and Cervical Lordosis Mismatching Affect Surgical Outcomes After Laminoplasty in Patients with Cervical Spondylotic Myelopathy?

Cited by 18 publications

References 25 publications

Preoperative Radiological Parameters to Predict Clinical and Radiological Outcomes after Laminoplasty

Preoperative Radiological Parameters to Predict Clinical and Radiological Outcomes after Laminoplasty

Does T1 slope minus cervical lordosis mismatch affect surgical outcomes of cervical laminoplasty in the absence of preoperative severe kyphosis?

Cervical Laminoplasty Versus Posterior Laminectomy and Fusion: Trends in Utilization and Evaluation of Complication and Revision Surgery Rates

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