Effect of posterior cervical expansive open-door laminoplasty on cervical sagittal balance

Pan, Yubo; Ma, Xun; Feng, Haoyu; Chen, Chen; Qin, Zhiyong; Huang, Yi

doi:10.1007/s00586-020-06563-9

Cited by 19 publications

(13 citation statements)

References 31 publications

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“…It appeared that as the number of levels increased, the capacity to maintain lordosis decreased ( 14 ). Unlike ACDF, LP causes damage to the posterior cervical column and the muscle-ligament complex, leading to partial loss of the weight-bearing function and disorder of sagittal balance ( 16 , 19 ). Cervical spine has a tendency to tilt forward after LP, resulting in the need for greater muscle strength at the back of the neck to maintain an upright neck.…”

Section: Discussionmentioning

confidence: 99%

“…Cervical spine has a tendency to tilt forward after LP, resulting in the need for greater muscle strength at the back of the neck to maintain an upright neck. Therefore, continuous muscle contraction is required to maintain proper neck position, and further, muscle spasm may occur, which is an important cause of postoperative axial pain ( 16 ). It was also reported that LP reduces lordosis and straightens the cervical spine ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

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Comparison of 3-level anterior cervical discectomy and fusion and open-door laminoplasty in cervical sagittal balance: A retrospective study

Wang

Huang²,

Wu³

et al. 2022

Front. Surg.

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ObjectiveTo compare the clinical efficacy and radiological outcomes of 3-level anterior cervical discectomy and fusion (ACDF) and open-door laminoplasty (LP).MethodsA total of 74 patients from January 2017 to January 2020 were enrolled in this retrospective study. There were two groups. Group A (30 cases) received 3-level ACDF, while Group B (44 cases) received open-door LP. Clinical evaluation included perioperative parameters, Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) scores. Radiological evaluation included cervical curve depth (CCD), C2–7 angle, C2–7 sagittal vertical axis (cSVA), C7 slope (C7S), and T1 slope (T1S).ResultsPerioperative parameters such as blood loss, drainage volume after surgery, and hospital stay of patients in Group A were significantly less than those in Group B (P < .001). NDI scores decreased and JOA scores increased significantly after surgery in both groups (P < .05). There was a significant difference in both scores postoperatively and at 1 month after surgery between the two groups (P < .05). CCD and C2–7 angle of Group A increased significantly postoperatively at 1 month after surgery and at final follow-up (FFU) (P < .05). There was a significant difference in CCD and the C2–7 angle between the two groups postoperatively at 1 month after surgery and at FFU (P < .05). T1S increased significantly in Group A postoperatively and at 1 month after surgery (P < .05).Conclusion3-level ACDF and open-door LP achieved favorable clinical outcomes and ACDF benefited patients in the early stage of rehabilitation. Compared with open-door LP, 3-level ACDF had advantages of reconstructing cervical lordosis with increased CCD and C2–7 angle.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of 3-level anterior cervical discectomy and fusion and open-door laminoplasty in cervical sagittal balance: A retrospective study

Wang

Huang²,

Wu³

et al. 2022

Front. Surg.

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“…However, this technique always has a major defect damaging the posterior muscular-ligament complex, which often leads to the loss of cervical sagittal lordosis and a tendency of tilting forward (manifest as CSVA increasing) (18). In a retrospective study including 108 patients with CSM, Pan et al found that the CL decreased from 13.9°to 10.7°, and the CSVA increased from 21 mm to 25 mm after cervical laminoplasty (19). Lin et al also reported a significant increase in CSVA from 20.8 mm to 25.7 mm and a decrease of C3-C7 curvature from 11.6°to 7.8°in 37 patients with CSM treated by open-door laminoplasty (20).…”

Section: Discussionmentioning

confidence: 99%

The discrepancy between preoperative cervical sagittal vertical axis and T1 slope predisposes inferior clinical outcomes in patients with cervical spondylotic myelopathy after cervical laminoplasty

et al. 2022

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ObjectiveCervical sagittal parameters have been widely used to predict clinical outcomes in patients with cervical spondylotic myelopathy (CSM). This study aims to coin a novel cervical sagittal parameter defined as the ratio of cervical sagittal vertical axis to T1 slope (CSVA/T1S) and to investigate the correlation between CSVA/T1S and postoperative HRQOL after laminoplasty.MethodsA total of 102 CSM patients treated with cervical laminoplasty from our database were retrospectively reviewed. All patients were followed up for >12 months. Radiological parameters were measured using lateral cervical radiographs, including occiput-C2 lordosis (OC2), cervical lordosis (CL), CSVA, and T1S. Clinical parameters included the Japanese Orthopedic Association (JOA) score, neck disability index (NDI), and JOA recovery rate. Patients were grouped by preoperative T1S, T1S-CL, and CSVA/T1S value, respectively. Clinical and radiological outcomes were compared between the groups.ResultsPatients with high CSVA/T1S had greater OC2 and CSVA but lower CL than those in the low CSVA/T1S group pre-and postoperatively. With respect to HRQOL results, the final NDI was 12.46 ± 9.11% in the low CSVA/T1S group, which was significantly lower than that in the high CSVA/T1S group (17.68 ± 8.81%, P = 0.040). Moreover, only CSVA/T1S was detected to be significantly correlated with final NDI (r = 0.310, P = 0.027). No significant correlation was found between clinical results and other cervical sagittal parameters, including T1S, CSVA, and T1S-CL.ConclusionsPreoperative CSVA/T1S was correlated with postoperative NDI in patients with CSM after cervical laminoplasty. Patients with low preoperative CSVA/T1S achieved better neurological function improvement after cervical laminoplasty. Cervical laminoplasty could be an appropriate choice for patients with lower preoperative CSVA/T1S.

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“…A periosteal detacher was then utilized to conduct the auxiliary distraction of the opening side along the inner edge of the lateral mass in order to attain an appropriate opening distance. Suitably-sized titanium plates were fixed separately on the lateral mass and vertebral plate [ 10 ]. Next, the surgeon adjusted the position of the titanium plates and fixed them in place using screws, and the final position was confirmed through C-arm fluoroscopy.…”

Section: Methodsmentioning

confidence: 99%

Comparison of blood loss between tranexamic acid-soaked absorbable Gelfoam and topical retrograde injection via drainage catheter plus clamping in cervical laminoplasty surgery

Chen

et al. 2022

BMC Musculoskelet Disord

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Background To compare the safety and efficacy of tranexamic acid (TXA)-soaked absorbable Gelfoam and the retrograde injection of TXA through a drain with drain-clamping in degenerative cervical laminoplasty patients. Methods Patients were assigned into either TXA retrograde injection (TXA-RI), TXA-soaked absorbable Gelfoam (TXA-Gel), or control groups. The demographics, operative measurements, volume and length of drainage, length of hospital stay, complete blood cell count, coagulopathy, postoperative complications, and blood transfusion were recorded. Results We enrolled 133 patients, with 44, 44, and 45 in the TXA-RI, TXA-Gel, and control groups, respectively. The baseline characteristics did not differ significantly among the three groups. The TXA-RI group exhibited a lower volume and length of postoperative drainage compared to the TXA-Gel and control groups (126.60 ± 31.27 vs. 156.60 ± 38.63 and 275.45 ± 75.27 mL; 49.45 ± 9.70 vs 58.70 ± 10.46 and 89.31 ± 8.50 hours, all P < 0.01). The TXA-RI group also had significantly shorter hospital stays compared to the control group (5.31 ± 1.18 vs 7.50 ± 1.25 days, P < 0.05) and higher hemoglobin and hematocrit levels (12.58 ± 1.67 vs 11.28 ± 1.76 g/dL; 36.62 ± 3.66% vs 33.82 ± 3.57%, both P < 0.05) at hospital discharge. In the TXA-RI and TXA-Gel groups, the D-dimmer (DD) and fibrinogen (FIB) were significantly lower than those in the control group after surgery (P < 0.05). None of the patients required blood transfusion. No complications, including thromboembolic events, were reported. Conclusion Topical retrograde injection of TXA through a drain with drain-clamping at the conclusion of unilateral posterior cervical expansive open-door laminoplasty may effectively reduce postoperative blood loss and the length of hospital stays without increasing postoperative complications.

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Effect of posterior cervical expansive open-door laminoplasty on cervical sagittal balance

Cited by 19 publications

References 31 publications

Comparison of 3-level anterior cervical discectomy and fusion and open-door laminoplasty in cervical sagittal balance: A retrospective study

Comparison of 3-level anterior cervical discectomy and fusion and open-door laminoplasty in cervical sagittal balance: A retrospective study

The discrepancy between preoperative cervical sagittal vertical axis and T1 slope predisposes inferior clinical outcomes in patients with cervical spondylotic myelopathy after cervical laminoplasty

Comparison of blood loss between tranexamic acid-soaked absorbable Gelfoam and topical retrograde injection via drainage catheter plus clamping in cervical laminoplasty surgery

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