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The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine after the Laminoplasty.
J Korean Neurosurg Soc. 2017 Sep; 60(5):577-583.JK

Abstract

OBJECTIVE

Laminoplasty is an effective surgical method for treating cervical degenerative disease. However, postoperative complications such as kyphosis, restriction of neck motion, and instability are often reported. Despite sufficient preoperative lordosis, this procedure often aggravates the lordotic curve of the cervical spine and straightens cervical alignment. Hence, it is important to examine preoperative risk factors associated with postoperative kyphotic alignment changes. Our study aimed to investigate preoperative radiologic parameters associated with kyphotic deformity post laminoplasty.

METHODS

We retrospectively reviewed the medical records of 49 patients who underwent open door laminoplasty for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL) at Pusan National University Yangsan Hospital between January 2011 and December 2015. Inclusion criteria were as follows: 1) preoperative diagnosis of OPLL or CSM, 2) no previous history of cervical spinal surgery, cervical trauma, tumor, or infection, 3) minimum of one-year follow-up post laminoplasty with proper radiologic examinations performed in outpatient clinics, and 4) cases showing C7 and T1 vertebral body in the preoperative cervical sagittal plane. The radiologic parameters examined included C2-C7 Cobb angles, T1 slope, C2-C7 sagittal vertical axis (SVA), range of motion (ROM) from C2-C7, segmental instability, and T2 signal change observed on magnetic resonance imaging (MRI). Clinical factors examined included preoperative modified Japanese Orthopedic Association scores, disease classification, duration of symptoms, and the range of operation levels.

RESULTS

Mean preoperative sagittal alignment was 13.01° lordotic; 6.94° lordotic postoperatively. Percentage of postoperative kyphosis was 80%. Patients were subdivided into two groups according to postoperative Cobb angle change; a control group (n=22) and kyphotic group (n=27). The kyphotic group consisted of patients with more than 5° kyphotic angle change postoperatively. There were no differences in age, sex, C2-C7 Cobb angle, T1 slope, C2-C7 SVA, ROM from C2-C7, segmental instability, or T2 signal change. Multiple regression analysis revealed T1 slope had a strong relationship with postoperative cervical kyphosis. Likewise, correlation analysis revealed there was a statistical significance between T1 slope and postoperative Cobb angle change (p=0.035), and that there was a statistically significant relationship between T1 slope and C2-C7 SVA (p=0.001). Patients with higher preoperative T1 slope demonstrated loss of lordotic curvature postoperatively.

CONCLUSION

Laminoplasty has a high probability of aggravating sagittal balance of the cervical spine. T1 slope is a good predictor of postoperative kyphotic changes of the cervical spine. Similarly, T1 slope is strongly correlated with C2-C7 SVA.

Authors+Show Affiliations

Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea. Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea. Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea.Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea. Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea. Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea.Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea. Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea. Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea.Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea. Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea. Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea.Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea. Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea. Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea.Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea. Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea. Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28881121

Citation

Lee, Jun Seok, et al. "The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine After the Laminoplasty." Journal of Korean Neurosurgical Society, vol. 60, no. 5, 2017, pp. 577-583.
Lee JS, Son DW, Lee SH, et al. The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine after the Laminoplasty. Journal of Korean Neurosurgical Society. 2017;60(5):577-583.
Lee, J. S., Son, D. W., Lee, S. H., Kim, D. H., Lee, S. W., & Song, G. S. (2017). The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine after the Laminoplasty. Journal of Korean Neurosurgical Society, 60(5), 577-583. https://doi.org/10.3340/jkns.2017.0505.007
Lee JS, et al. The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine After the Laminoplasty. Journal of Korean Neurosurgical Society. 2017;60(5):577-583. PubMed PMID: 28881121.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine after the Laminoplasty. AU - Lee,Jun Seok, AU - Son,Dong Wuk, AU - Lee,Su Hun, AU - Kim,Dong Ha, AU - Lee,Sang Weon, AU - Song,Geun Sung, Y1 - 2017/08/30/ PY - 2017/05/17/received PY - 2017/06/30/revised PY - 2017/07/03/accepted PY - 2017/9/8/entrez PY - 2017/9/8/pubmed PY - 2017/9/8/medline KW - Cervical vertebrae KW - Kyphosis KW - Laminoplasty KW - Myelopathy KW - Spinal cord diseases/surgery KW - Spondylosis SP - 577 EP - 583 JF - Journal of Korean Neurosurgical Society VL - 60 IS - 5 N2 - OBJECTIVE: Laminoplasty is an effective surgical method for treating cervical degenerative disease. However, postoperative complications such as kyphosis, restriction of neck motion, and instability are often reported. Despite sufficient preoperative lordosis, this procedure often aggravates the lordotic curve of the cervical spine and straightens cervical alignment. Hence, it is important to examine preoperative risk factors associated with postoperative kyphotic alignment changes. Our study aimed to investigate preoperative radiologic parameters associated with kyphotic deformity post laminoplasty. METHODS: We retrospectively reviewed the medical records of 49 patients who underwent open door laminoplasty for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL) at Pusan National University Yangsan Hospital between January 2011 and December 2015. Inclusion criteria were as follows: 1) preoperative diagnosis of OPLL or CSM, 2) no previous history of cervical spinal surgery, cervical trauma, tumor, or infection, 3) minimum of one-year follow-up post laminoplasty with proper radiologic examinations performed in outpatient clinics, and 4) cases showing C7 and T1 vertebral body in the preoperative cervical sagittal plane. The radiologic parameters examined included C2-C7 Cobb angles, T1 slope, C2-C7 sagittal vertical axis (SVA), range of motion (ROM) from C2-C7, segmental instability, and T2 signal change observed on magnetic resonance imaging (MRI). Clinical factors examined included preoperative modified Japanese Orthopedic Association scores, disease classification, duration of symptoms, and the range of operation levels. RESULTS: Mean preoperative sagittal alignment was 13.01° lordotic; 6.94° lordotic postoperatively. Percentage of postoperative kyphosis was 80%. Patients were subdivided into two groups according to postoperative Cobb angle change; a control group (n=22) and kyphotic group (n=27). The kyphotic group consisted of patients with more than 5° kyphotic angle change postoperatively. There were no differences in age, sex, C2-C7 Cobb angle, T1 slope, C2-C7 SVA, ROM from C2-C7, segmental instability, or T2 signal change. Multiple regression analysis revealed T1 slope had a strong relationship with postoperative cervical kyphosis. Likewise, correlation analysis revealed there was a statistical significance between T1 slope and postoperative Cobb angle change (p=0.035), and that there was a statistically significant relationship between T1 slope and C2-C7 SVA (p=0.001). Patients with higher preoperative T1 slope demonstrated loss of lordotic curvature postoperatively. CONCLUSION: Laminoplasty has a high probability of aggravating sagittal balance of the cervical spine. T1 slope is a good predictor of postoperative kyphotic changes of the cervical spine. Similarly, T1 slope is strongly correlated with C2-C7 SVA. SN - 2005-3711 UR - https://www.unboundmedicine.com/medline/citation/28881121/The_Predictable_Factors_of_the_Postoperative_Kyphotic_Change_of_Sagittal_Alignment_of_the_Cervical_Spine_after_the_Laminoplasty_ L2 - http://jkns.or.kr/journal/view.php?doi=10.3340/jkns.2017.0505.007 DB - PRIME DP - Unbound Medicine ER -
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