Laminoplasty In Patients Research Articles

Segmental cervical instability does not drive the loss of cervical lordosis after laminoplasty in patients with cervical spondylotic myelopathy

BACKGROUND/CONTEXTKyphotic deformity after cervical laminoplasty (CLP) often leads to unfavorable neurological recovery due to insufficient indirect decompression of the spinal cord. Existing literature has described that segmental cervical instability is a contraindication for CLP because it is a potential risk factor for kyphotic changes after surgery; however, this has never been confirmed in any clinical studies. PURPOSETo confirm whether segmental cervical instability was an independent risk factor for postoperative kyphotic change and to examine whether segmental cervical instability led to poor neurological outcomes after CLP for cervical spondylotic myelopathy (CSM). STUDY DESIGN/SETTINGA retrospective study PATIENT SAMPLEPatients who underwent CLP for CSM between January 2013 and January 2021 with a follow-up period of ≥1 year were enrolled. OUTCOME MEASURESCervical radiographic measurements including C2–C7 lordosis (C2–7 angle), cervical sagittal vertical axis, C7 slope, flexion range of motion (fROM) and extension ROM (eROM) were assessed using neutral and flexion-extension views. Segmental cervical instability was classified into anterolisthesis (AL) of ≥2 mm displacement, retrolisthesis (RL) of ≥2 mm displacement, and translational instability (TI) of ≥3 mm translational motion. The amount of C2–7 angle loss at the follow-up period compared to the preoperative measurements was defined as cervical lordosis loss (CLL). Neurological outcomes were assessed using the recovery rate of the Japanese Orthopedic Association score (JOA-RR). METHODSCLL was compared among patients with and without segmental cervical instability. Further, multiple linear regression model for CLL was built for the evaluation with adjustment of the reported risks, including cervical sagittal vertical axis, C7 slope, fROM, eROM, and patient age together with AL, RL, and TI, as independent variables. The JOA-RR was also compared between patients with and without segmental cervical instability. RESULTSA total of 138 patients (mean age, 68.7 years; 65.9% male) were included in the analysis. AL, RL, and TI were found in 12 (8.7%), 33 (23.9%), and 16 (11.6%) patients, respectively. Comparisons among the groups showed that AL led to greater CLL; however, RL and TI did not. Multiple linear regression analysis revealed that greater CLL is significantly associated with greater fROM and smaller eROM (regression coefficient [β]=0.328, 95% confidence interval: 0.178 to 0.478, p<.001; β=−0.372, 95% confidence interval: −0.591 to −0.153, p=.001, respectively). However, there were no significant statistical associations in the AL, RL, and TI. Whereas, patients with AL tended to exhibit lower JOA-RR than those without AL (37.8% vs. 52.0%, p=.108). CONCLUSIONSSegmental cervical instability is not the definitive driver for loss of cervical lordosis after CLP in patients with CSM; thus, is not a contraindication in and of itself. However, it is necessary to consider the indications for CLP, according to individual cases of patients with AL on baseline radiograph, which is a sign of poor neurological recovery.

The effect of disruption of the repaired nuchal ligament on clinical outcomes after posterior cervical spine surgery: A retrospective comparative study.

This study aimed to investigate whether disruption of the repaired nuchal ligament (NL) affects clinical outcomes following posterior cervical spine surgery. This retrospective study included 101 patients (65 males, 36 females) who underwent posterior cervical spine surgery, 69 of whom received laminoplasty (LP), and 32 posterior decompression and fusion (PDF). The NL was split during the surgical approach and repaired at the time of wound closure. The frequency and spinal levels of NL disruption at one month, six months, and one year postoperatively were evaluated on mid-sagittal and axial magnetic resonance images. Postoperative axial symptoms, Neck Disability Index, T1 slope, flexion and extension angle, C2-C7 lordotic angle, and decrease rate of C2-C7 range of motion (ROM) were examined at six months and/or one year postoperatively. Based on the NL disruption levels, the patients were divided into the upper group (C2-C5), lower group (C6-T1), and non-disruption group. Although the lower group contained patients with NL disruption (10%) after LP at final follow-up, all PDF patients belonged to the non-disruption group. For the LP patients, the postoperative axial symptoms, Neck Disability Index, T1 slope, flexion and extension angle, and C2-C7 lordotic angle did not significantly differ between the lower and non-disruption groups; however, the rate of C2-C7 ROM decrease in the lower group (48%) was considerably larger than that in the non-disruption group (33%) after LP. Evidence from this study has shown that postoperative disruption of the repaired NL has no significant effect on postoperative axial symptoms and C2-C7 alignment, but it can affect the rate of decrease in C2-C7 ROM after LP. Level III, Therapeutic Study.

Perioperative Complications of Laminoplasty in Degenerative Cervical Myelopathy -A Comparative Study Between Ossification of Posterior Longitudinal Ligament and Cervical Spondylotic Myelopathy Using a Nationwide Inpatient Database.

Retrospective cohort study. Laminoplasty (LAMP) is one of the effective methods to successfully achieve surgical decompression in patients with degenerative cervical myelopathy (DCM). However, little evidence exists regarding the perioperative complications in LAMP for patients with ossification of the longitudinal ligament (OPLL) compared with cervical spondylotic myelopathy (CSM). We aimed to investigate the perioperative complication rates and medical costs of DCM, including OPLL and CSM patients who underwent LAMP using a large national inpatient database. This study identified patients who underwent LAMP for OPLL and CSM from 2010 to 2016 using the Japanese Diagnosis Procedure Combination database. We compared the incidence of perioperative complications (systemic and local), reoperation rates, medical costs during hospitalization, and mortality were between the OPLL and CSM groups after propensity score matching. This study included 22,714 patients (OPLL: 7485 patients, CSM: 15,229 patients). Consequently, 7169 pairs were matched. More perioperative systemic complications were detected in the OPLL group (one complication: 9.1% vs 7.7%; P = .002), especially for pneumonia (.5% vs .2%; P = .001) and dysphagia (.5% vs .2%; P = .004). The local complication rate was also higher in the OPLL group (paralysis: 1.1% vs .6%, P = .006; spinal fluid leakage: .4% vs .1%, P = .002). The hospitalization costs were approximately $2300 higher ($19,024 vs $16,770; P < .001) in the OPLL group. More perioperative complications and higher medical costs were noted in patients with OPLL than in patients with CSM who underwent LAMP.

Laminectomy with instrumented fusion vs. laminoplasty in the surgical treatment of cervical ossification of the posterior longitudinal ligament: A multicenter retrospective study

Laminectomy with instrumented fusion (LF) has demonstrated better prevention of ossification of posterior longitudinal ligament (OPLL) growth compared to laminoplasty (LP). There remains uncertainty, however, as to which surgical approach is more beneficial with respect to clinical outcomes and complications. We retrospectively reviewed 273 cervical OPLL patients of more than 3 levels, from the two institutions’ databases, who underwent LF or LP between January 1998 and January 2016. Each 273 patient (85 with LF, 188 with LP) was assessed for postoperative neurologic and radiologic outcomes, complications and reoperations. The mean length of follow-up was 40.11 months. There were baseline differences between cohorts. Overall, postoperative JOA recovery rate at last follow up was significantly better in the LP group with similar improvement in visual analog neck score. Postoperative C2-7 Cobb angle was decreased compared to baseline for both LF and LP cohorts, but there was no significant difference between groups. Complications occurred in 19 (22.35%) LF patients, and 11 (5.85%) LP patients, with higher incidence of C5 palsy and instrumentation failure in the LF group. Four LF patients (4.71%) and five LP patients (2.66%) underwent reoperation during the follow up period.

Clinical outcomes of laminoplasty for patients with lysosomal storage disease including mucopolysaccharidosis and mucolipidoses: a retrospective cohort study

BackgroundAlthough the clinical efficacy of laminoplasty in adult cervical spondylotic myelopathy or ossification of posterior longitudinal ligament has been frequently reported, there are only few reports of laminoplasty for patients with lysosome storage diseases (LSDs). Therefore, this study aimed to report the midterm clinical and radiological outcomes of patients with LSDs after cervical laminoplasty.MethodsSix patients with LSD who underwent laminoplasty with/without C1 laminectomy for cervical myelopathy were enrolled. Clinical evaluations, including the cervical Japanese Orthopedic Association (cJOA) score and visual analog scale (VAS) scores for upper extremity numbness, and radiographic parameters, including C2–C7 lordotic angle, atlanto-dens interval (ADI), and ⊿ADI, were evaluated preoperatively, at 2 years postoperatively, and at the final follow-up.ResultsFive patients had mucopolysaccharidoses (type I: n = 1, II: n = 3, VII: n = 1) and one patient had mucolipidoses type III. The mean age of patients at surgery was 27.5 years, and the mean postoperative follow-up period was 61 months. All mucopolysaccharidoses cases required C1 posterior arch resection with C2–C7 laminoplasty. No critical complications were observed postoperatively. There were no significant differences in C2–C7 angle (p = 0.724) and ⊿ADI (p = 0.592) between the preoperative and final follow-ups. The cJOA score and VAS for numbness significantly improved at the final follow-up (p = 0.004 and p = 0.007, respectively).ConclusionsThe cervical myelopathy in patients with LSD could be safely and effectively treated with laminoplasty with/without C1 posterior arch resection after excluding patients with atlantoaxial instability. Atlantoaxial stability and symptom improvement could be maintained at an average of 5 years postoperatively.

Erector Spinae Plane Block for Perioperative Pain Control and Short-term Outcomes in Lumbar Laminoplasty: A Randomized Clinical Trial.

BackgroundSpine surgery causes severe pain and can be associated with significant opioid utilization; however, the evidence for opioid-sparing analgesic techniques such as erector spinae plane (ESP) block from controlled studies is limited. We aimed to investigate the analgesic effects of ESP block in lumbar laminoplasty.MethodsIn this prospective, double-blind, controlled single-center trial, 62 consecutive elective lumbar laminoplasty patients were randomized into either a control group (Group G, N=32) or a treatment group (Group E, N=30). Group G received general anesthesia and multimodal analgesia, similar to group E, while Group E received additional bilateral ESP block after induction of general anesthesia. The primary outcome was postoperative pain scores for the first 48 h after surgery, and the secondary outcomes analyzed included intraoperative anesthetic usage, perioperative analgesic consumption, return of bowel function and satisfaction for acute pain management indicated by overall benefit of analgesia score (OBAS).ResultsSignificant differences in pain scores over time were found between the two groups (P=0.010), with Group E patients having significantly lower pain scores than Group G during the first six hours (P=0.000). The opioid consumption in Group G was significantly higher than in Group E both intraoperatively (P=0.000) and postoperatively (P=0.0005). Group E patients had lower intraoperative sevoflurane requirement, improved satisfaction with pain management, and earlier return of bowel function than Group G patients.ConclusionESP block is effective in reducing postoperative pain scores and lowering opioid utilization (both intraoperatively and postoperatively), resulting in improved patient satisfaction for pain management in lumbar laminoplasty.

P108. Impact of C3 involvement on postoperative kyphosis following cervical laminoplasty: Comparison between high and low T1 slope

<h3>BACKGROUND CONTEXT</h3> The impact of T1 slope (T1S) has emerged as a predictor of kyphotic alignment change after laminoplasty. Although it was reported that higher T1S had more pronounced lordotic curvature before surgery and higher loss of cervical lordosis (CL) after surgery, few studies have attempted to investigate these findings with the extent of laminoplasty. <h3>PURPOSE</h3> The goals of the present study were to investigate the impact of C3 involvement on the kyphosis following cervical laminoplasty in patients with high and low T1 slope. <h3>STUDY DESIGN/SETTING</h3> The data from ossification of the posterior longitudinal ligament (OPLL) patients who had undergone laminoplasty between January 2016 and January 2019 were retrospectively reviewed. <h3>PATIENT SAMPLE</h3> Patients were divided into two groups according to preoperative T1 slope, and subgroup analysis was done according to the C3 involvement in performing laminoplasty. <h3>OUTCOME MEASURES</h3> The involvement of C3 segment in performing laminopalsty, C1-2 angle, C0-2 angle, cervical lordosis and T1 slope was measured and compared. <h3>METHODS</h3> Univariate tests and multivariate logistic regression analysis were used to assess the statistical relationship between postoperative kyphosis and radiological and surgical variables. <h3>RESULTS</h3> Eighty-six patients were divided into two groups above and below preoperative T1S (20.0°). There were 33 patients (38.3%) in low T1S group and 53 patients (61.7%) in high T1S group. Twenty-three patients (26.7%) were performed with C3 involved laminoplasty. In multivariate logistic regression analysis, C3 involvement (OR; 9.671, 2.820-33.158, p=0.000), high T1S (OR; 4.888,1.543-15.487, p=0.007) and low T1S-CL (OR; 0.128, 0.037-0.449, p=0.001) were significantly associated with postoperative kyphosis. In the subsequent subgroup analysis, C3 involvement was emerged as independent risk factor in high T1S group, increasing the odds of postoperative kyphosis by 27.315 -fold (1.560-478.282, p=0.024). In high T1S group, the loss of CL was greater (p = 0.017) when C3 was involved whereas in low T1S group, the C3 involvement did not show the statistically significant difference in the change of CL (p = 0.190). <h3>CONCLUSIONS</h3> C3 involvement, low T1S-CL and high T1S increased the risk of postoperative kyphosis. Patients with high T1 slope tended to exbibit a greater loss of CL when the laminoplasty was performed extending to C3 segment. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Effectiveness of additional C2 decompression of the cervical spinal canal after cervical laminoplasty: a retrospective cohort study

Purpose This study aimed to assess the effects of additional C2 decompression of the cervical spinal canal on the postoperative outcomes after cervical laminoplasty in patients with cervical stenosis caused by ossification of the posterior longitudinal ligament (OPLL). Materials and methods This retrospective cohort study included patients with cervical stenosis due to OPLL and treated between April 2014 and December 2015. The patients who underwent C2-7 (additional C2 decompression) and C3-7 posterior decompression were compared using the Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) scores, axial symptom scores, and intervals between the posterior margin of the vertebral body and the K-line. Results There were 36 and 24 patients in the additional C2 decompression and control groups, respectively. The JOA scores were higher in the additional C2 decompression group than the controls at 1 and 3 years (p < 0.05). Upper extremity motor function after the operation and at 1 and 3 years and lower extremity motor function after operation were improved in the additional C2 decompression group (all p < 0.05 vs. controls). VAS scores were lower in the additional C2 decompression group than controls at 1 year (p < 0.05). Axial symptom scores in the additional C2 decompression group were decreased postoperatively but increased at 1 and 3 years (p < 0.05 vs. controls). Finally, the posterior shift of the K-line in the additional C2 decompression group was significant (from 0.98 to 1.68 cm, p < 0.05). Conclusions Additional C2 decompression might improve the effectiveness of cervical laminoplasty in patients with cervical stenosis caused by OPLL.

Gap between flexion and extension ranges of motion: a novel indicator to predict the loss of cervical lordosis after laminoplasty in patients with cervical spondylotic myelopathy.

Kyphotic deformity resulting from the loss of cervical lordosis (CL) is a rare but serious complication after cervical laminoplasty (CLP), and it is essential to recognize the risk factors. Previous studies have demonstrated that a greater flexion range of motion (fROM) and smaller extension ROM (eROM) in the cervical spine are associated with the loss of CL after CLP. Considering these facts together, one can hypothesize that an indicator representing the gap between fROM and eROM (gROM) is highly useful in predicting postoperative CL loss. In the present study, the authors aimed to investigate the risk factors of marked CL loss after CLP for cervical spondylotic myelopathy (CSM), including the gROM as a potential predictor. Patients who had undergone CLP for CSM were divided into those with and those without a loss of more than 10° in the sagittal Cobb angle between C2 and C7 at the final follow-up period compared to preoperative measurements (CL loss [CLL] group and no CLL [NCLL] group, respectively). Demographic characteristics, surgical information, preoperative radiographic measurements, and posterior paraspinal muscle morphology evaluated with MRI were compared between the two groups. fROM and eROM were examined on neutral and flexion-extension views of lateral radiography, and gROM was calculated using the following formula: gROM (°) = fROM - eROM. The performance of variables in discriminating between the CLL and NCLL groups was assessed using the receiver operating characteristic (ROC) curve. This study included 111 patients (mean age at surgery 68.3 years, 61.3% male), with 10 and 101 patients in the CLL and NCLL groups, respectively. Univariate analyses showed that fROM and gROM were significantly greater in the CLL group than in the NCLL group (40.2° vs 26.6°, p < 0.001; 31.6° vs 14.3°, p < 0.001, respectively). ROC curve analyses revealed that both fROM and gROM had excellent discriminating capacities; gROM was likely to have a higher area under the ROC curve than fROM (0.906 vs 0.860, p = 0.094), with an optimal cutoff value of 27°. The gROM is a highly useful indicator for predicting a marked loss of CL after CLP. For CSM patients with a preoperative gROM exceeding 30°, CLP should be carefully considered, since kyphotic changes can develop postoperatively.

Spino cranial angle as a predictor of loss of cervical lordosis after laminoplasty in patients with cervical myelopathy

BackgroundTo explore the relationship between spino cranial angle (SCA) and loss of cervical lordosis (LOCL), and to determine whether SCA has the ability to predict LOCL for patients with cervical myelopathy.MethodsA total of 68 consecutive patients with cervical myelopathy who received laminoplasty (LAMP) were selected to the current study. C2–C7 lordosis was defined as a representation of the cervical alignment. Alignment change > 0° was considered LOCL. Multiple linear regression analysis was applied to evaluate the association between LOCL and various sagittal parameters at preoperative, such as SCA, CL, T1s and cSVA. Linear regression analysis was applied to evaluate the relationships between LOCL and preoperative SCA in each subgroup.ResultsPatients were assigned to three groups depending on the quartile of preoperative SCA. The first quarter of patients were defined as the low SCA group, the last quarter were defined as the high SCA group and the middle half were defined as the middle SCA group. There was no statistically significant difference in age, sex and the type of OPLL among the three groups. Patients in the low SCA group showed more cervical lordosis before surgery and more LOCL after LAMP (p < 0.001). After linear regression analysis for SCA and LOCL, preoperative SCA was negatively correlated with LOCL in the low SCA group (r = − 0.857, p < 0.001) and high SCA group (r = − 0.515, p = 0.034). However, there was no significant correlation between preoperative SCA and LOCL in the middle SCA group (r = 0.027, p = 0.881).ConclusionsPatients with lower SCA had more lordosis preoperatively and performed more LOCL after LAMP at 2 years of follow-up. Both too high or low preoperative SCA were negatively correlated with the degree of LOCL, while when the SCA fluctuates in a suitable range, it is easier to compensate for the changes of cervical sagittal alignment.

The Preoperative Cross-sectional Area of the Deep Cervical Extensor Muscles Does Not Predict Loss of Lordosis After Cervical Laminoplasty.

This was a retrospective, single center. The objective of this study was to investigate the association between the cross-sectional area (CSA) of the deep extensor muscles (DEM) and postlaminoplasty alignment. The preoperative CSA of the semispinalis cervicis (SC) has been reported to correlate with loss of lordosis (LL) after laminoplasty, with a CSA <154.5 mm2 associated with a 10 degrees LL. Laminoplasty patients at the University of California San Francisco between 2009 and 2018 by 2 spine surgeons were retrospectively studied. Patients with previous cervical surgery or nondegenerative diagnoses were excluded. Measurements included the C2-C7 Cobb, T1 slope, and cervical sagittal vertical axis. Preoperative DEM CSA was measured on magnetic resonance imaging. Variables associated with lordosis were analyzed with univariate analysis and multivariate logistic regression, and association between postoperative cervical alignment and the musculature was evaluated. Seventy-six patients with a mean age of 64 years were included. The average follow-up was 22.53 months. The overall average CSA of the DEM was 2274.55 mm2 and that of the SC was 275.64 mm2. Means of both CSAs were higher in men (P<0.001). Linear regression showed no correlation between LL with CSA of the DEM or the SC (r=0.005, P=0.119; r=0.001, P=0.095). Univariate and multivariate regression showed no differences in the CSA of the DEM and SC between groups with and without LL (P=0.092, 0.117 and 0.163, 0.292). There was no correlation in LL with sex or body mass index (P>0.05). Preoperative CSA of the deep cervical extensor muscles may not predict LL after cervical laminoplasty. The correlation between the preoperative SC CSA and postoperative cervical alignment may not be as strong as previously reported.

Spinal Cord Drift Following Laminoplasty Versus Laminectomy and Fusion for Cervical Spondylotic Myelopathy.

Cervical laminoplasty and laminectomy and fusion (LF) are posterior-based surgical techniques for the surgical treatment of cervical spondylotic myelopathy (CSM). Interestingly, the comparative amount of spinal cord drift obtained from these procedures has not been extensively described. The purpose of this study is to compare spinal cord drift between cervical laminoplasty and LF in patients with CSM. The laminoplasty group consisted of 22 patients, and the LF group consisted of 44 patients. Preoperative and postoperative alignment was measured using the Cobb angle (C2-C7). Spinal cord position was measured on axial T2-magnetic resonance imaging of the cervical spine preoperatively and postoperatively. Spinal cord drift was quantified by subtracting preoperative values from postoperative values. Functional improvement was assessed using the modified Japanese Orthopaedic Association (mJOA) score. Mean spinal cord drift was higher following LF compared to laminoplasty (2.70 vs 1.71 mm, P < .01). Using logistic regression analysis, there was no correlation between sagittal alignment and spinal cord drift. Both groups showed an improvement in mJOA scores postoperatively compared to their preoperative values (laminoplasty, +2.0, P = .012; LF, +2.4, P < .01). However, there was no difference in mJOA score improvement postoperatively between both groups (P = .482). This study demonstrates that patients who had LF for CSM achieved more spinal cord drift postoperatively compared to those who had laminoplasty. However, the increased drift did not translate into superior functional outcome as measured by the mJOA score. 3. Spinal cord drift following LF may differ from laminoplasty in patients undergoing surgery for CSM. This finding should be considered when assessing CSM patients for surgical intervention.

K-line in patients with cervical ossification of the posterior longitudinal ligament: relationship with change in sagittal cervical curvature and laminoplasty outcomes.

To analyze how K-line is related to change in sagittal cervical curvature and laminoplasty outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL). The study retrospectively analyzed 81 patients with OPLL who had undergone posterior cervical single-door laminoplasty and arch plate fixation between June 2011 and June 2017. Fifty-five were K-line positive (K[+]) and 26 were K-line negative (K[-]). Clinical and radiological results were compared between the groups. Patients were followed up for at least 2years. Before the operation, Japanese Orthopedic Association (JOA) score, visual analogue scale (VAS) score, neck disability index (NDI), and short-form-36 (SF-36) quality of life score did not differ significantly between the groups. Neurological function was improved in both groups after the procedure. At last follow-up, JOA score, VAS score, NDI, SF-36 score, and JOA score improvement rate differed significantly between the groups. Before the operation, at the 3-month and final follow-ups, C2-7 Cobb angle, T1 slope, and C2-7 SVA differed significantly between the groups. The changes were more marked in the K(-) group than in the K(+) group. The incidence of cervical kyphosis differed significantly between the groups (P < 0.05), as well as between patients with lordosis < 7° and those with lordosis ≥ 7°. K-line negativity and lordosis < 7° may predict kyphosis after laminoplasty in patients with OPLL. The cervical curvature in patients with OPLL tends towards kyphosis and anteversion after laminoplasty, which contributes to the reduced clinical effect of the procedure.

Surgical Options in Treating Ossification of the Posterior Longitudinal Ligament: Single-Center Experience

Ossified posterior longitudinal ligament (OPLL) of the cervical spine can lead to spinal stenosis and become clinically symptomatic. The optimal approach in addressing OPLL is a debated topic and dependent on factors such as preoperative lordosis and levels affected. In this study, we retrospectively identified patients undergoing operative management for OPLL. Demographics, operative details, radiographic parameters, outcome measurements, and complications were compared between the different approaches for OPLL treatment. We identified a total of 44 patients with 16 undergoing laminoplasty (Plasty), 18 anterior corpectomy and diskectomy (Ant), and 10 laminectomy and instrumentation (Linst). Ant had least OPLL levels with median (range) 3 (2-5), compared with Plasty 4 (2-7) and Linst 4 (3-6). Plasty was associated with the shortest operative time and hospital stay. Ant showed significant correction in kyphosis from 0.5° (-13 to 16°) to 9.5° (-7 to 20°). There was loss in lordosis in Plasty and Linst. Sagittal balance significantly increased irrespective of surgical approach with the least increase in the Ant group. Complications were least in the Plasty group with similar overall improvement in outcome measurements. All 3 approaches in the management of OPLL were associated with clinical improvement without 1 approach surpassing the others. Laminoplasty had the advantage of addressing more levels of stenosis than the anterior approach and was associated with a shorter operating time. Laminoplasty patients had a shorter hospital stay than those undergoing laminectomy and instrumentation and appeared to have fewer complications than the other approaches. Laminoplasty is the preferred approach in patients with preserved motion and lordosis, with the anterior approach effective in the correction of kyphosis.

Influence of SCA on clinical outcomes and cervical alignment after laminoplasty in patients with multilevel cervical spondylotic myelopathy

BackgroundTo study the impact of changes in spino-cranial angle (SCA) on sagittal alignment and to investigate the relationship between SCA and Neck Disability Index (NDI) scores after laminoplasty (LP)Material and methodsIn total, 72 patients with multilevel cervical spondylotic myelopathy (MCSM) after laminoplasty (LP) were retrospectively enrolled. Based on the optimal cut-off values of preoperative SCA, patients were classified into low SCA and high SCA groups. Radiographic data were measured, including spino-cranial angle (SCA), T1-slope (T1s), C2–7 lordosis (CA), T1s minus CA (T1sCA), and C2–7 sagittal vertical axis (cSVA). JOA and NDI scores were both applied to assess postoperative and follow-up clinical efficacy. Pearson correlation coefficient and linear regression analysis were respectively calculated between radiographic data and between SCA and NDI.ResultsThe preoperative SCA was significantly correlated with T1s (r = − 0.795), CA (r = − 0.857), and cSVA (r = 0.915). A receiver operating characteristic (ROC) curve model predicted a threshold of SCA (value of 85.2°). At the follow-up period, patients with lower SCA had a higher T1s and CA and a lower cSVA, simultaneously accompanied by greater △T1s, △CA, and △cSVA. The linear regression model demonstrated that SCA in the higher group was positively correlated with NDI, and patients with higher SCA had worse NDI scores (pre: p < 0.001; post: p < 0.001; F/U: p = 0.003) and greater changes of NDI (post: p < 0.010; F/U: p = 0.002).ConclusionSCA may be a good predictor of evaluating sagittal balance and planning surgery. Changes in sagittal alignment in the low SCA group were affected more easily, and a higher SCA was associated with worse quality of life. Laminoplasty could be a good choice for patients with lower SCA.

Exceptional Conditions for Favorable Neurological Recovery After Laminoplasty in Cases with Cervical Myelopathy Caused by K-line (-) Ossification of Posterior Longitudinal Ligament.

A retrospective observational study. To clarify the exceptional conditions for a favorable neurological recovery after laminoplasty (LMP) for cervical myelopathy caused by K-line (-) ossification of the posterior longitudinal ligament (OPLL). The K-line-based classification of cervical OPLL was developed to predict insufficient neurological recovery after LMP. For patients with K-line (-) OPLL, LMP generally yields the least improvement because of inadequate decompression of the spinal cord; however, there are some exceptional cases wherein LMP promotes favorable neurological recoveries. We retrospectively reviewed the medical records of 106 consecutive patients who underwent LMP for cervical OPLL to determine the demographic data, radiographic findings, and neurological recoveries of the patients as assessed preoperatively and 2 years postoperatively by their Japanese Orthopedic Association (JOA) scores. The factors associated with favorable outcomes after LMP in patients with K-line (-) were then investigated. Of 106 total patients, 31 were classified as K-line (-), of whom 21 achieved the least neurological recovery after LMP (JOA recovery rate <50%), while the remaining 10 patients achieved favorable outcomes (JOA recovery rate ≥50%). Among the K-line (-) group patients, those with ext-K-line (+), which changed to K-line (+) in the neck-extended position, and the patients with up-K-line (-), in whom the lesion responsible for myelopathy in the upper cervical spine (C3 or above), showed favorable neurological recoveries after LMP. Our data shows that, even for patients with K-line (-) OPLL, a favorable neurological recovery can be expected after LMP in cases in which the OPLL is in the upper cervical spine or the K-line changes to (+) in the neck-extended position. This means that K-line-based predictions of surgical outcomes after LMP should be indicated for patients with OPLL in the middle and lower cervical spine with limited extension mobility.Level of Evidence: 4.

Risk Factors for Poor Outcome of Cervical Laminoplasty: Multivariate Analysis in 505 Patients with Cervical Spondylotic Myelopathy.

The risk factors for poor outcome after cervical laminoplasty in patients with cervical spondylotic myelopathy (CSM) were demonstrated. These findings suggest that advanced age, long-term CSM symptoms, and lower score of preoperative 10-second step test are risk factors for poor cervical laminoplasty outcomes in patients with CSM. Study Design.. A prospective study. Objective.. The aim of this study was to characterize the risk factors for poor outcome following cervical laminoplasty in patients with cervical spondylotic myelopathy (CSM). Summary of Background Data.. Previous research has identified a variety of potential predictive factors that might affect outcomes after cervical laminoplasty. However, no study till date has assessed the effects of such risk factors, including internal medicine comorbidity and quantitative performance tests, on the outcome of laminoplasty in a large series of patients with CSM. Methods.. A total of 505 consecutive patients with CSM (311 males; 194 females; mean age, 66.6 years; age range, 41–91 years) who underwent double-door laminoplasty were prospectively included. The average postoperative follow-up period was 26.5 months (range, 12–66 months). We evaluated the recovery rate (RR) on the basis of the Japanese Orthopaedic Association score. Logistic regression analysis was performed to identify the risk factors for poor outcome, which was defined as a postoperative RR of &lt;50%. Relationship between outcome and various clinical and imaging predictors was examined. Results.. Two hundred ninety-five patients had good outcomes with RR &gt;50%, whereas 210 patients had poor outcomes with RR &lt;50%. Compared with the good-outcome group, the poor-outcome group had a significantly higher prevalence of diabetes and hypertension and use of anticoagulant/antiplatelet agent and smoking history (P &lt; 0.05). Multivariate logistic regression analysis showed independent risks associated with increased age (odds ratio [ORs] = 1.029, 95% confidence interval [CI] = 1.004–1054, P = 0.023). Logistic regression analysis determined that symptom duration of CSM (OR = 1.017, 95% CI = 1.008–1.026, P &lt; 0.001) and preoperative 10-second step test (OR = 0.922, 95% CI = 0.865–0.983, P = 0.013) were significant risk factors for poor outcome. Conclusion.. These findings suggest that advanced age, long-term CSM symptoms, and lower score of preoperative 10-second step test are risk factors for poor outcome in patients with CSM. Level of Evidence: 2

31. A comparison of various surgical treatments for cervical spondylotic myelopathy: a propensity score matched analysis

BACKGROUND CONTEXT Several established options for the treatment of cervical spondylotic myelopathy (CSM) exist, but the ideal surgical technique remains elusive due to the lack of comprehensive comparative analyses. PURPOSE To examine the short-term outcomes between ACDF, laminectomy and fusion (LF), and laminoplasty (LP) for patients with CSM. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE Adult patients with a primary diagnosis of CSM who underwent ACDF, LF, vs LP from 2016 to 2017. OUTCOME MEASURES Perioperative complications, readmissions, and reoperations. METHODS A prospectively-collected, multicentered national database with a propensity score matching to compare the short-term outcomes for LP, LF, and ACDF. Bivariate analyses involved both chi-square/Fisher exact test and t-tests on perioperative factors. Multivariate analyses were performed to determined independent risk factors for short term outcomes. RESULTS A total of 564 patients remained after propensity score matching, with 188 patients in each cohort. The any complication rate was highest in LF (11.2%) vs ACDF (4.3%) and LP (7.5%), p=0.066. LF group was more likely to undergo a reoperation within 30 days than LP patients (OR5, 4.3% vs 1.1%, p=0.042). Compared to ACDF, LP were more likely to have LOS>1 day (OR12, 88.3% vs 37.8%, p CONCLUSIONS LF is associated with the highest morbidity, readmission, and reoperation. Top reoperation reasons were wound complications and persistent myelopathic symptoms. LP had the lowest readmission rates; however, longer LOS than ACDF likely related to the longer operative time and greater proportion of patients requiring discharge to a skilled nursing facility. In early postop, LF carries the highest risk for complications requiring reoperation. LP is associated with longer LOS than ACDF without an increase in individual/overall complications, readmissions, and reoperations. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Anterior Decompression and Fusion Versus Laminoplasty for Cervical Myelopathy Caused by Soft Disk Herniation: A Long-term Prospective Multicenter Study.

A prospective multicenter study. The purpose of this study was to determine whether laminoplasty (LP) is comparable for myelopathy caused by cervical disk herniation (CDH). Anterior decompression and fusion (ADF) has conventionally been used for myelopathy caused by CDH with stable outcomes. However, recurrence of myelopathy due to adjacent segment degeneration are its drawbacks. The efficacy of LP without discectomy has been sporadically reported, but no long-term prospective study has been conducted to verify it. Patients with cervical myelopathy caused by CDH were studied. The first 30 patients and the next 30 patients were treated with ADF and LP, respectively. The outcomes were compared between the 22 ADF patients and the 20 LP patients who had completed the follow-up examination scheduled 10 years after surgery. There was no statistically significant difference in the postoperative severity or recovery rate of myelopathy between the 2 groups 10 years after surgery. One patient in the ADF group underwent LP for secondary myelopathy due to adjacent segment degeneration 2 years after the surgery. Reoperation was not required for patients in the LP group. Postoperative neck pain was significantly more severe in the LP group than in the ADF group. ADF and LP for cervical myelopathy caused by CDH achieve similarly favorable outcomes. Recurrence of myelopathy caused by adjacent segment degeneration is a disadvantage of ADF while residual neck pain is a disadvantage of LP.

Analysis of Cervical Spine Alignment and its Relationship with Other Spinopelvic Parameters After Laminoplasty in Patients with Degenerative Cervical Myelopathy.

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.