Abstract
To assess whether preoperative T1 slope and cervical lordosis mismatching affect the surgical outcomes of patients with cervical spondylotic myelopathy (CSM) after laminoplasty. A total of 85 patients with CSM who underwent unilateral open-door laminoplasty between January 2013 and May 2017 were retrospectively reviewed. Based on preoperative T1 slope and C2-C7 lordosis matching, the patients were divided into 2 groups: the match group and the mismatch group. The T1 slope minus C2-C7 lordosis (T1S-CL) <20° was defined as matching. Radiographic parameters included T1 slope, C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), and T1S-CL. Clinical outcomes were based on the Neck Disability Index (NDI) and Japanese Orthopedic Association (JOA) scores. The preoperative T1S-CL had significant correlation with T1 slope (r= 0.283), C2-C7 lordosis (r= -0.611), and C2-C7 SVA (r= 0.331). At the final follow-up, patients in the mismatch group had a higher incidence of postoperative cervical kyphosis (P= 0.007) and C2-C7 SVA >40 mm (P= 0.043). The mismatch group also had greater △C2-C7 lordosis (P= 0.028), △C2-C7 SVA (P=0.042), and △T1S-CL (P= 0.044). Comparison of clinical outcomes revealed that patients in the match group had better NDI and JOA recovery (P < 0.05). T1S-CL is a clinically relevant parameter for surgical decision making because patients with T1S-CL mismatching are more likely to have postoperative kyphotic alignment changes and cervical sagittal imbalance. Laminoplasty might not be a suitable option for patients with T1S-CL mismatching.
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