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Kyphotic change of cervical sagittal alignment after modified expansive open-door laminoplasty
摘要
Introduction: Expansive open-door laminoplasty (EOLP) for multilevel cervical spondylotic myelopathy (MCSM) is an effective decompression method. From a literature review, we noted that patients who receive surgery through posterior approaches tended to experience kyphotic changes in cervical alignment and increased axial neck pain. Modified EOLP (MEOLP) was developed to alleviate these complications by avoiding excessive facet joint violation and decreasing soft tissue dissection of the posterior elements. Purpose: This study aimed to determine the risk factors for poor surgical outcomes and to determine the correlation between sagittal alignment parameters and clinical outcomes. Methods: The patients in this prospective cohort study were diagnosed as having MCSM and had received MEOLP. They were followed-up for at least 12 months postoperatively. Functional and radiographic parameters were collected postoperatively. Functional and sagittal parameters were obtained from a wholespine standing lateral view, and their correlations were analyzed. Multiple regression analyses of the risk factors of poor neurologic recovery and cervical kyphotic change were performed. Results: In total, 50 patients were included. The Japanese Orthopedic Association (JOA) recovery rate was 85.4 ± 16.1%. Neurologic function significantly improved after MEOLP. Cervical lordosis (CL) and C6/7 lordotic angle decreased with time, and the change of C6/7 significantly contributed to changes in CL. The loss of CL was significantly correlated with a poorer JOA recovery rate. Postoperative C6/7 kyphotic change significantly contributed to post- MEOLP cervical kyphotic change according to our study. Conclusion: Although MEOLP enabled favorable functional recovery, gradual kyphotic changes of CL and C6/7 Cobb angle during the 12-month follow-up were still noted. C6/7 kyphotic changes were highly correlated with the kyphotic change of CL, which appeared to affect the JOA recovery rate negatively. Further investigations are needed for understanding the relationship between the local kyphotic change and the degeneration change of C6/7.
延伸閱讀
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