Changes in cervical sagittal alignment and the effects on cervical parameters in patients with cervical spondylotic myelopathy after laminoplasty

Changes in cervical sagittal parameters and the impact on axial symptoms after two types of posterior single-door cervical decompression surgeries

OBJECTIVE

The present study aimed to assess the impact of two posterior single-door cervical decompression procedures on axial symptoms and cervical sagittal parameters in patients with cervical spondylosis.

METHODS

A retrospective study was performed on the clinical records of 185 patients diagnosed with cervical spondylosis who had surgical interventions from January 2021 to January 2023. The patients were categorized into two groups: a study group that underwent laminoplasty combined with C3 laminectomy, and a control group that received the standard C3-7 single-door laminoplasty procedure. The groups were compared based on postoperative Japanese Orthopaedic Association (JOA) scores, incidence of axial symptoms, and cervical parameters such as range of motion (ROM), cervical curvature index (CCI), and C2-7 Cobb angle.

RESULTS

No notable differences were observed in JOA scores and the rates of neurological function recovery between the groups. The occurrence of axial symptoms was markedly reduced in the study group when compared to the control group, with rates of 22.50 % and 61.54 %, respectively.(P < 0.05). Postoperatively, a significant reduction in CCI was observed in both groups (P < 0.05). However, the study group showed a markedly more substantial improvement in CCI than the control group, with the difference reaching statistical significance (P < 0.05). Additionally, the study group showed significantly less loss of ROM and cervical curvature than the control group post-surgery (P < 0.05).

CONCLUSION

Compared to conventional single door laminoplasty, laminoplasty with C3 laminectomy more effectively decompresses nerves in patients with cervical spondylosis while preserving the structural and functional integrity of the cervical spine and minimizing postoperative axial symptoms. This surgical approach is crucial for maintaining cervical sagittal balance and functional integrity.

Comparison of Staggered and Conventional Posterior Single-Door Laminoplasty

OBJECTIVE

This study aimed to delineate the clinical and radiological outcomes between 2 different single-door laminoplasty techniques, the staggered approach and the conventional one-sided approach, in treating cervical spondylotic myelopathy.

METHODS

This is a retrospective chart review that involved 67 patients who had cervical spondylotic myelopathy with symptoms lasting for ≥3 months and underwent staggered laminoplasty (Group A, n = 35) or conventional laminoplasty (Group B, n = 32). Outcomes measures included intraoperative parameters, the Japanese Orthopaedic Association score, visual analog scale for pain, cervical curvature, cervical range of motion, and radiographic parameters that reflected the level of postoperative muscle atrophy. Follow-up assessments were available at 3, 6, and 12 months postoperation.

RESULTS

The mean ages in Group A and Group B were 57.11 (standard deviation [SD], 8.02) and 55.28 (SD, 8.47) years, respectively, with a gender distribution of 40.00% female in Group A and 40.63% in Group B (P > 0.05). The average operative times were 130.86 (SD, 11.80) and 129.84 (SD, 10.51) minutes, respectively (P > 0.05). However, intraoperative blood loss in milliliters was significantly higher in Group A (196.06; SD, 32.69) compared to Group B (155.03; SD, 37.80) (P < 0.001). Japanese Orthopaedic Association scores revealed no significant postoperative differences between the 2 groups. Nevertheless, Group A exhibited less visual analog scale pain, reduced postoperative range of motion loss at 6 and 12 months, and less alteration in cervical curvature and decreased severity in muscle atrophy at 3, 6, and 12 months postsurgery.

CONCLUSIONS

Patients who underwent staggered single-door laminoplasty experienced more favorable outcomes in some metrics than those who received the conventional technique.

Revisiting Post-Laminectomy Kyphosis and Challenges in Its Management: A Case Report

The posterior ligamentous complex plays a pivotal role in spinal stability during complex movements, especially at the cervical vertebral level. Its disruption leads to the development of post-laminectomy kyphosis. The present case emphasizes the challenges in managing post-laminectomy kyphosis, restoring spinal alignment, and the importance of the posterior tension band as a spine stabilizer. A 19-year-old male underwent C2-C5 laminectomy for cervical C3 neurofibroma at an outside hospital. The patient remained stable for five months and then developed cervical kyphosis, leading to myelopathy. Clinical examination revealed significant neurological deficits, including spasticity, clonus, loss of hand dexterity, and sensory abnormalities. Imaging revealed C3 retrolisthesis with severe cervical kyphosis, cord compression, and myelomalacia. The management involved cervical traction with gradual increments in the weight and correction of the cervical sagittal balance. Principles of kyphotic deformity correction were applied, and C2 pedicle with C3-C5 lateral mass fixation was performed. The patient's modified Japanese Orthopaedic Association score improved from 10 to 16 at six months' follow-up. Post-laminectomy, the disruption of the posterior ligamentous complex increases the range of motion, particularly in the cervical spine, leading to instability and kyphosis. Surgical interventions such as laminoplasty, laminotomy, and laminectomy with posterior cervical fusion aim to mitigate the risk of kyphosis, with techniques such as bone-to-bone ligament-preserving laminoplasty and ultrasonic bone scalpel showing promise in further reducing the risk of kyphosis. The key determinant for the prevention of kyphosis is the integrity of the posterior ligamentous complex. The management of cervical kyphosis includes appropriate pre-operative planning, which includes the evaluation of cervical and spinopelvic parameters. For a posterior spinal approach, one may choose to consider laminotomy, laminoplasty, or laminectomy along with posterior cervical fusion.

Clinical parameters of laminoplasty and laminectomy with fusion in the treatment of cervical spondylosis and analysis of postoperative sagittal balance

Background/aim

Cervical spondylosis is a progressive disease that causes degenerative changes affecting the spine, intervertebral discs, facets, and ligaments. With anterior and posterior surgical interventions, effective treatments can be applied in cervical spondylotic myelopathy (CSM). The relationship between regional and global spinal alignment and functional and pain outcomes was examined and it was revealed that these parameters play a significant role in obtaining good results. The aim of this study was to compare the perioperative and follow-up results of patients with CSM who underwent laminoplasty or laminectomy with fusion.

Materials and method

CSM patients who were operated on between 2015 and 2020 and had at least 2 years of clinical and radiological follow-up were analyzed retrospectively. The patients were divided into 2 groups as the laminoplasty group and the laminectomy with fusion group, according to a simple random method. Demographic, clinical, radiological, and perioperative parameters were examined. Measurements were made by an independent observer using Surgimap and 2 years was considered to be sufficient time for the spine to take its final shape.

Result

A total of 112 patients, including 68 males and 44 females, were included. Of these patients, 69 were in the laminectomy with fusion group, and 43 were in the laminoplasty group. Patient ages ranged from 39 to 85 years. The mean follow-up period was 36.28 months. In both groups, at the 3-month follow-up, a statistically significant improvement in the clinical parameters (neck disability index, visual analogue scale, modified Japanese Orthopaedic Association scores) was observed. When the preoperative cervical radiological parameters were evaluated, no statistically significant difference was found between the groups. The C2-C7 lordotic angles and the cervical SVA values were increased in the postoperative period, for both groups (p < 0.001). Although it is noteworthy that the increases were higher in the laminectomy with fusion group, no statistically significant difference was found between the groups.

Conclusion

Deformity in a spinal segment may indirectly affect another segment. Being aware of the compensatory mechanisms and radiological parameters will help in determining the effective treatment plan.

Relationship between Severity of Disease and Postoperative Neurological Recovery in Patients with Cervical Spondylotic Myelopathy Combined with Developmental Spinal Stenosis

Objective

The study aimed to investigate the correlation between the severity of disease and postoperative neurological recovery in patients with cervical spondylotic myelopathy (CSM) combined with developmental spinal stenosis.

Methods

A retrospective analysis of the clinical data of 114 CSM patients combined with developmental spinal stenosis admitted to our hospital from June 2019 to June 2020 was performed. All of the patients who underwent posterior cervical unidoor vertebroplasty were divided into the mild, moderate, and severe groups according to the Torg-Pavlov ratio. The clinical data including patients' age, course of spinal cord high signal change, and first onset age were collected. The recovery time, preoperative, and postoperative Japanese Orthopaedic Association (JOA) scores of patients in each group were compared with the calculation of the improvement rate. The correlation between the severity of disease and postoperative neurological recovery in CSM patients combined with developmental spinal stenosis was analyzed by Pearson correlation. The factors influencing postoperative neurological recovery were analyzed using multivariate logistic regression analysis. The receiver operating characteristic curve (AUC) was used to evaluate the value of each influencing factor in predicting postoperative recovery.

Results

Significant differences were observed in the proportion of linear hyperintensity changes in the spinal cord, the age of first onset, the course of the disease, and the Torg-Pavlov ratio among the mild, moderate, and severe groups (P  <  0.05). The postoperative recovery time of the moderate and severe groups was significantly higher than that of the mild group, while the preoperative JOA score was significantly lower than that of the mild group. On the other hand, the postoperative recovery time of the severe group was prominently higher than that of the moderate group, whereas the preoperative JOA score was observably lower than that of the moderate group (P  <  0.05). Pearson correlation analysis showed that the postoperative recovery time was significantly negatively correlated with the Torg-Pavlov ratio, age at first onset, and disease course (r = -0.359, -0.502, -0.368, P  <  0.05), while it was positively correlated with spinal cord linear high-signal changes (r = 0.641, P  <  0.05). Multifactorial logistic regression analysis revealed that the Torg-Pavlov ratio, age at first onset, and disease course were protective factors, while spinal cord linear high-signal alterations were risk factors affecting the recovery time of postoperative neurological function (P  <  0.05). The area under the curve (AUC) of the Torg-Pavlov ratio, linear hyperintensity changes in the spinal cord, age at first onset, and disease duration in predicting the postoperative neurological recovery time were 0.794, 0.767, 0.772, and 0.802, respectively. The AUC predicted by the combined detection of each factor was 0.876, which was better than the area under the curve of single prediction.

Conclusion

Patients with CSM combined with developmental spinal stenosis were characterized by younger age of onset, a short course of the disease, and linear changes in the spinal cord high signal. The degree of developmental spinal stenosis may affect the postoperative recovery time of neurological function in CSM patients but had little effect on postoperative neurological recovery. The Torg-Pavlov ratio, age of first onset, course of the disease, and changes in the spinal cord linear hyperintensity were the factors that affected postoperative neurological recovery, which may provide a basis for reasonably predicting a postoperative neurological recovery in patients with CSM combined with developmental spinal stenosis.