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Is cervical lordosis relevant in laminoplasty?
Spine J. 2013 Aug; 13(8):914-21.SJ

Abstract

BACKGROUND CONTEXT

Laminoplasty aims to decompress the spinal cord and stabilize the cervical spine in patients with multilevel cervical lesions. Not every patient with cervical compressive myelopathy is a good candidate for laminoplasty. Most studies recommend that neutral or kyphotic alignments are contraindications for laminoplasty. However, cervical sagittal alignment does not have a strong and consistent effect on the clinical outcomes of laminoplasty. Moreover, many reports on the effect of cervical sagittal alignment did not designate the ideal definition of alignment and used different definitions of lordosis.

PURPOSE

To identify the effect of preoperative cervical alignment according to two different definitions after midline splitting double-door laminoplasty.

STUDY DESIGN

Retrospective cohort study.

PATIENT SAMPLE

From August 2008 to September 2010, 58 patients were diagnosed with cervical myelopathy and treated with midline splitting double-door laminoplasty.

OUTCOME MEASURES

The clinical results were assessed with the modified Japanese Orthopedic Association (JOA) score, neck disability index (NDI), and visual analog scale (VAS) and were compared to analyze the rate of change between preoperative and postoperative values. Postoperative radiological results at the final follow-up examinations were compared between groups to obtain the change in range of motion and sagittal alignment.

METHOD

The effect of cervical alignment on JOA, NDI, and VAS scales and also on change of alignment and change of range of motion (ROM) at the final follow-up examinations was analyzed statistically between two groups according to two different definitions such as Toyama classification and Cobb angle.

RESULTS

No difference was found between the two groups according to Toyama classification in terms of the postoperative improvement rate of the modified JOA score (p=.086), decreasing rate of the VAS (p=.940) or NDI (p=.211), postoperatively. Additionally, no difference was found for the decreasing rate of ROM (p=.427) or sagittal alignment (p=.864) based on the radiological evaluation results. Also, there was no difference between two groups according to Cobb angle in terms of the modified JOA score (p=.743), VAS (p=.548), or NDI (p=.32), postoperatively. Additionally, no difference was found for the ROM (p=1.000) or sagittal alignment (p=.440) based on the radiological evaluation results.

CONCLUSIONS

Despite nonlordosis cervical sagittal alignment, double-door laminoplasty would be effective for patients with cervical myelopathy because of cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament. Furthermore, sagittal alignment is not the absolute and sole factor that surgeons should consider when determining the optimal treatment strategy.

Authors+Show Affiliations

Spine Center, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, South Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23541454

Citation

Kim, Seok Woo, et al. "Is Cervical Lordosis Relevant in Laminoplasty?" The Spine Journal : Official Journal of the North American Spine Society, vol. 13, no. 8, 2013, pp. 914-21.
Kim SW, Hai DM, Sundaram S, et al. Is cervical lordosis relevant in laminoplasty? Spine J. 2013;13(8):914-21.
Kim, S. W., Hai, D. M., Sundaram, S., Kim, Y. C., Park, M. S., Paik, S. H., Kwak, Y. H., & Kim, T. H. (2013). Is cervical lordosis relevant in laminoplasty? The Spine Journal : Official Journal of the North American Spine Society, 13(8), 914-21. https://doi.org/10.1016/j.spinee.2013.02.032
Kim SW, et al. Is Cervical Lordosis Relevant in Laminoplasty. Spine J. 2013;13(8):914-21. PubMed PMID: 23541454.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is cervical lordosis relevant in laminoplasty? AU - Kim,Seok Woo, AU - Hai,Dinh Manh, AU - Sundaram,Shanmuga, AU - Kim,Yong Chan, AU - Park,Moon Soo, AU - Paik,Sang-Hoon, AU - Kwak,Yoon-Hae, AU - Kim,Tae-Hwan, Y1 - 2013/03/27/ PY - 2012/03/21/received PY - 2012/11/07/revised PY - 2013/02/18/accepted PY - 2013/4/2/entrez PY - 2013/4/2/pubmed PY - 2014/3/22/medline KW - Cervical myelopathy KW - Laminoplasty KW - Midline splitting double-door laminoplasty KW - Sagittal alignment SP - 914 EP - 21 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 13 IS - 8 N2 - BACKGROUND CONTEXT: Laminoplasty aims to decompress the spinal cord and stabilize the cervical spine in patients with multilevel cervical lesions. Not every patient with cervical compressive myelopathy is a good candidate for laminoplasty. Most studies recommend that neutral or kyphotic alignments are contraindications for laminoplasty. However, cervical sagittal alignment does not have a strong and consistent effect on the clinical outcomes of laminoplasty. Moreover, many reports on the effect of cervical sagittal alignment did not designate the ideal definition of alignment and used different definitions of lordosis. PURPOSE: To identify the effect of preoperative cervical alignment according to two different definitions after midline splitting double-door laminoplasty. STUDY DESIGN: Retrospective cohort study. PATIENT SAMPLE: From August 2008 to September 2010, 58 patients were diagnosed with cervical myelopathy and treated with midline splitting double-door laminoplasty. OUTCOME MEASURES: The clinical results were assessed with the modified Japanese Orthopedic Association (JOA) score, neck disability index (NDI), and visual analog scale (VAS) and were compared to analyze the rate of change between preoperative and postoperative values. Postoperative radiological results at the final follow-up examinations were compared between groups to obtain the change in range of motion and sagittal alignment. METHOD: The effect of cervical alignment on JOA, NDI, and VAS scales and also on change of alignment and change of range of motion (ROM) at the final follow-up examinations was analyzed statistically between two groups according to two different definitions such as Toyama classification and Cobb angle. RESULTS: No difference was found between the two groups according to Toyama classification in terms of the postoperative improvement rate of the modified JOA score (p=.086), decreasing rate of the VAS (p=.940) or NDI (p=.211), postoperatively. Additionally, no difference was found for the decreasing rate of ROM (p=.427) or sagittal alignment (p=.864) based on the radiological evaluation results. Also, there was no difference between two groups according to Cobb angle in terms of the modified JOA score (p=.743), VAS (p=.548), or NDI (p=.32), postoperatively. Additionally, no difference was found for the ROM (p=1.000) or sagittal alignment (p=.440) based on the radiological evaluation results. CONCLUSIONS: Despite nonlordosis cervical sagittal alignment, double-door laminoplasty would be effective for patients with cervical myelopathy because of cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament. Furthermore, sagittal alignment is not the absolute and sole factor that surgeons should consider when determining the optimal treatment strategy. SN - 1878-1632 UR - https://www.unboundmedicine.com/medline/citation/23541454/Is_cervical_lordosis_relevant_in_laminoplasty L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(13)00232-5 DB - PRIME DP - Unbound Medicine ER -