Incidence and Risk Factors for the Development of Axial Symptoms Following Posterior Single-Door Laminoplasty: A Retrospective Analysis

Abstract

PurposePosterior single-door laminoplasty(PSLP) is a widely practiced clinical procedure, but the occurrence of postoperative axial syndrome(AS) remains a significant concern. The aim of this study was to identify risk factors associated with AS and develop a risk prediction model. MethodsClinical data from 226 patients who underwent PSLP between June 2017 and June 2022 were collected. Through Logistic model analysis, the risk factors of AS are clarified and the intensity of each risk factor is explained in the form of forest plot. Subsequently, we constructed a predictive model and plotted Receiver Operating Characteristic(ROC) curves to assess the model's predictive value. ResultsIn the end, 87 cases were diagnosed with AS, resulting in an incidence rate of 38.5%. Logistic regression analysis revealed that preoperative encroachment rate of anterior spinal canal(Pre-op ERASC), intraoperative facet joints destruction(Intra-op FJD), intraoperative open-door angle(Intra-op OA), postoperative loss of cervical curvature(Post-op LCC), and postoperative loss of cervical range of motion(Post-op LCROM) were independent risk factors for AS. Conversely, preoperative cervical curvature(Pre-op CC) and postoperation early function training(Post-op EFT) were protective factors against AS. The Youden index indicated that the cut-off values for Pre-op ERASC and Pre-op CC were 26.6°and 16.5, respectively. The risk prediction model for AS was constructed and a nomogram was plotted. The model has high clinical value. ConclusionPre-op ERASC, Pre-op CC, Intra-op FJD, Intra-op OA, Post-op LCC, Post-op LCROM, and Post-op EFT are independent influencing factors for AS occurrence. The risk model has good practicability.