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Influence of extending expansive open-door laminoplasty to C1 and C2 on cervical sagittal parameters.
BMC Musculoskelet Disord. 2020 Feb 05; 21(1):75.BM

Abstract

BACKGROUND

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. 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.

METHODS

A 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.

RESULTS

The 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.

CONCLUSIONS

The 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.

Authors+Show Affiliations

Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China.Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China.Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China.Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China.Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China.Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China.Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China.Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China.Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China.Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China. zzbb3737@126.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32024507

Citation

Wang, Wen-Xuan, et al. "Influence of Extending Expansive Open-door Laminoplasty to C1 and C2 On Cervical Sagittal Parameters." BMC Musculoskeletal Disorders, vol. 21, no. 1, 2020, p. 75.
Wang WX, Zhao YB, Lu XD, et al. Influence of extending expansive open-door laminoplasty to C1 and C2 on cervical sagittal parameters. BMC Musculoskelet Disord. 2020;21(1):75.
Wang, W. X., Zhao, Y. B., Lu, X. D., Zhao, X. F., Jin, Y. Z., Chen, X. W., Fan, Y. X., Wang, X. N., Zhou, R. T., & Zhao, B. (2020). Influence of extending expansive open-door laminoplasty to C1 and C2 on cervical sagittal parameters. BMC Musculoskeletal Disorders, 21(1), 75. https://doi.org/10.1186/s12891-020-3083-1
Wang WX, et al. Influence of Extending Expansive Open-door Laminoplasty to C1 and C2 On Cervical Sagittal Parameters. BMC Musculoskelet Disord. 2020 Feb 5;21(1):75. PubMed PMID: 32024507.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of extending expansive open-door laminoplasty to C1 and C2 on cervical sagittal parameters. AU - Wang,Wen-Xuan, AU - Zhao,Yi-Bo, AU - Lu,Xiang-Dong, AU - Zhao,Xiao-Feng, AU - Jin,Yuan-Zhang, AU - Chen,Xian-Wei, AU - Fan,Yan-Xin, AU - Wang,Xiao-Nan, AU - Zhou,Run-Tian, AU - Zhao,Bin, Y1 - 2020/02/05/ PY - 2019/11/14/received PY - 2020/01/20/accepted PY - 2020/2/7/entrez PY - 2020/2/7/pubmed PY - 2020/11/24/medline KW - Cervical sagittal parameters KW - Expansive open-door laminoplasty KW - Muscular-ligament complex KW - Upper cervical spine SP - 75 EP - 75 JF - BMC musculoskeletal disorders JO - BMC Musculoskelet Disord VL - 21 IS - 1 N2 - BACKGROUND: 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. 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. METHODS: A 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. RESULTS: The 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. CONCLUSIONS: The 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. SN - 1471-2474 UR - https://www.unboundmedicine.com/medline/citation/32024507/Influence_of_extending_expansive_open_door_laminoplasty_to_C1_and_C2_on_cervical_sagittal_parameters_ L2 - https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-020-3083-1 DB - PRIME DP - Unbound Medicine ER -