Abstract
BackgroundFor patients with spinal canal stenosis in the upper cervical spine who undergo C3–7 laminoplasty alone, it remains impossible to achieve full decompression due to its limited range. This study explores the extension of expansive open-door laminoplasty (EODL) to C1 and C2 for the treatment of cervical spinal stenosis of the upper cervical spine and its effects on cervical sagittal parameters.MethodsA retrospective analysis of 33 patients presenting with symptoms of cervical spondylosis myelopathy (CSM) and ossification in the posterior longitudinal ligament (OPLL) of the upper cervical spine from February 2013 to December 2015 was performed. Furthermore, the changes in the C0–2 Cobb angle, C1–2 Cobb angle, C2–7 Cobb angle, C2–7 SVA, and T1-Slope in lateral X-rays of the cervical spine were measured before, immediately after, and 1 year after the operation. JOA and NDI scores were used to evaluate spinal cord function.ResultsThe C0–2 and C1–2 Cobb angles did not significantly increase (P = 0.190 and P = 0.081), but the C2–7 Cobb angle (P = 0.001), C2–7 SVA (P < 0.001), and T1-Slope (P < 0.001) significantly increased from preoperative to 1 year postoperative. In addition, C2–7 SVA was significantly correlated with the T1-Slope (Pearson = 0.376, P < 0.001) and C0–2 Cobb angle (Pearson = 0.287, P = 0.004), and the C2–7 SVA was negatively correlated with the C2–7 Cobb angle (Pearson = − 0.295, P < 0.001). The average preoperative and postoperative JOA scores were 8.3 ± 1.6 and 14.6 ± 1.4 points, respectively, indicating in a postoperative neurological improvement rate of approximately 91.6%. The average preoperative and final follow-up NDI scores were 12.62 ± 2.34 and 7.61 ± 1.23.ConclusionsThe sagittal parameters of patients who underwent EODL extended to C1 and C2 included loss of cervical curvature, increased cervical anteversion and compensatory posterior extension of the upper cervical spine to maintain visual balance in the field of vision. However, the changes in cervical spine parameters were far less substantial than the alarm thresholds reported in previous studies. We believe that EODL extended to C1 and C2 for the treatment of patients with spinal canal stenosis in the upper cervical spine is a feasible and safe procedure with excellent outcomes.
Highlights
For patients with spinal canal stenosis in the upper cervical spine who undergo C3–7 laminoplasty alone, it remains impossible to achieve full decompression due to its limited range
In the present study, we explored the effects of extending expansive open-door laminoplasty (EODL) to C1 and C2 for the treatment of cervical spinal stenosis of the upper cervical spine
The inclusion criteria were as follows: (1) patients with spinal canal stenosis in the upper cervical spine; (2) patients with cervical myelopathy due to cervical ossification confirmed by imaging data (X-ray, Computed tomography (CT) and Magnetic resonance imaging (MRI)); and (3) patients who had been followed up for at least 12 months after the operation
Summary
For patients with spinal canal stenosis in the upper cervical spine who undergo C3–7 laminoplasty alone, it remains impossible to achieve full decompression due to its limited range. In our clinical practice, some patients with spinal canal stenosis in the upper cervical spine who underwent only C3–7 laminoplasty did not achieve full decompression due to its limited range. In some cases, new-onset compression or folding angle occurred during the postoperative shift of the spinal cord. In such situations, patients may experience poor improvement of symptoms or repeated aggravation after temporary relief. In the present study, we explored the effects of extending EODL to C1 and C2 for the treatment of cervical spinal stenosis of the upper cervical spine. EODL may damage the posterior cervical muscle-ligament complex during lamina exposure [4, 5], and this may lead to the loss of cervical stability, postoperative axial symptoms and even kyphosis deformity, which affects patient quality of life
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