Abstract
For patients with kyphosis of the cervical spine, laminoplasty is usually incapable of improving neurological symptoms as it worsens kyphotic alignment. Thus, laminoplasty is not recommended in the presence of kyphotic alignment. Nevertheless, laminoplasty may be selected for myelopathy due to multiple-segment intervertebral disc herniation or ossification of posterior longitudinal ligament despite kyphotic alignment. This study examined whether cervical alignment influences surgical outcomes. Cervical alignment before the surgery was classified into lordosis and non-lordosis, and the non-lordosis group was subclassified into reducible and non-reducible groups to determine the change in cervical alignment before and after the surgery and to analyze its relationship with spinopelvic parameters. The lordosis group showed an increase in upper cervical motion (C0-2 Range of Motion (ROM), C0-2ROM/C0-7ROM) after surgery, while the non-lordosis group exhibited a decrease in C2-7ROM and C0-7ROM. The C0-2ROM was maintained without any reduction in the reducible group, while there was no significant change in cervical alignment and ROM of the non-reducible group. None of these changes showed significant association with the spinopelvic parameters of other sites. However, having a non-reducible type non-lordosis is not a proper indication for laminoplasty, as it does not change the alignment after surgery. Therefore, cervical alignment and reducibility should be identified before surgery.
Highlights
Laminoplasty is an effective surgical method that is commonly applied in patients with myelopathy due to multiple-segment ossification of the posterior longitudinal ligament, cervical herniated intervertebral disc, and spinal stenosis
The angle of c-spine (C0-7 angle) was maintained as lordotic, and C0-7ROM and C2-7ROM decreased, while C0-2 ROM and C0-2/C0-7ROM increased. These results suggest that the ROM of the cervical motion, which was reduced in the lordosis group after the surgery, was compensated through the upper cervical motion (C0-2)
As in the lordosis group, C2-7ROM and C0-7ROM decreased after the surgery, while C0-2ROM did not increase. These results suggest that the additional decrease in ROM after the surgery could not be compensated by the upper cervical spine (C0-2) because C0-2ROM was already heavily used before the surgery
Summary
Laminoplasty is an effective surgical method that is commonly applied in patients with myelopathy due to multiple-segment ossification of the posterior longitudinal ligament, cervical herniated intervertebral disc, and spinal stenosis. This method is known to produce desired results to recover the blood flow of the decompressed spinal cord through nerve decompression via effective posterior migration of spinal cord after surgery if the lordotic alignment of the cervical spine is well maintained. 2t0o20f, 9c,e7r1v3ical spine because laminoplasty cannot achieve effective posterior migrati2oonf 1o7f spinal cord after surgery, and it possibly worsens the kyphotic alignment. Fignrdouinpgwthiatht tkhyeprhaotitoicoaf ltihgenmsuebnjetcctasnwbitehskuybpdhivoitdiceadliignntomreendtuocficbelervkicyaplhsopsiinse, icnomwphriicshesth2e6.k3%yp. hTohteic gcruoruvpatwurieth rkeycpohvoetrisc atloignlomrednotticcanalbiegnsmubednitvidinedtihneto lraetderuaclibrleadkiyopghraopshis, iunpwonhicehxttehneskioynp,hoatnicd cnuornv-arteudrue criebcloevkeyrsphtoosloisr,diontiwc haliicghntmheenktyipnhtohteiclaatleigranlmraednitoigsrsaupshtauinpeodn uexptoennseixotne,nasniodnn. oAnc-croerdduicnigblteo ktyhpishocsliass,siinfiwcahtiiochn,thaemkoypnghottihceali2g6n.3m%enot fis ssuubstjaeicntsedwuipthonkeyxptehnostiiocn.aAligccnomrdeinntg, t1o5t.h7i%s cl(aosfsifithceatifounl,l a9m58o-npgertshoen 2c6o.h3o%rt)ofwsausbdjeectetsrmwiinthedkayspnhoonti-creadluigcnibmleenkty,p1h5o.7si%s [(9o].f the full 958-person cohort) was determIninthedisarsengaornd-r,etdhuecaibultehkoyrsphcloassissif[i9e]d. the preoperative cervical alignment of the patients who undeInrwthenist rlaemgairndo,ptlhaestayuinthooursr cclliansiscifiinetdo tlhoerdporseios paenrdatnivoen-cloerrvdiocsails a(rliegdnumciebnlet vosf.tnhoenp-raetdieunctisbwle)htoo uanndaelyrwzeetnhtelarmeliantioopnlsahstipy ibneotwureecnlinthiceinchtoanlogredionsicsearnvdicanloanl-ilgonrmdoesnist b(reefdoureciabnledvasf.tenrosnu-rregdeuryciabnled) tiots arnealalytizoensthheiprewlaittihonosthhiepr bseptiwnoepenelvthice pchaaranmgeetienrsc.erTvhiceaal ualtihgonrms eenxttebnedfotrheeanandaalyftseirs siunrgdeertyeramnidniintsg rwelhateitohnesrhitphewipthreootpheerrastpivineopceerlvviiccaplaraalmigentmeresn. tThaeffaeucttshoprossetxotpenerdatthiveeancaelryvsiicsailnadleigtenrmmeinnitnganwdheotthheerr tshpeinporepoeplveircaptiavreamceertveircsa,laanldig,npmaretnictualffarelcyt,swphoestthopererthateivgerocueprvwiciatlhaplirgenompeernattiavnedkyopthheortiscpainliogpnemlveinct poafracmerevteicras,lanspdi,npeartsihcouwlasrlya, wshigetnhiefirctahnetgrcohuapngweithinprpeoopsteorpateirvaetikvyephcoetrivciaclailgnamligenntmoefncetrvaincdal soptihneer sshpoiwnospaeslvigicnipfiacraanmt cehtearnsg. eThinispsotsutdopyeirnatteinvde scetorvcicoanlfairlmignwmheentthaenr dkyopthheortiscpainliogpnemlveinctpoafracmerevtiecrasl.sTphinise swtuoduyldinbteenadpsrtoopceorninfidrmicawtihoenthfoerr lkaympihnootpiclaasltiygninmteenrmt osfocferrvadiciaollospgiicnaelwanoaullydsibse. a proper indication for laminoplasty in terms of radiological analysis
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