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Cervical alignment and clinical outcome of open-door laminoplasty vs. laminectomy and instrumentation in kyphotic multilevel cervical degenerative myelopathy

  • Orthopaedic Surgery
  • Published:
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Abstract

Introduction

The aim of this study was to determine whether the sagittal lordotic alignment, clinical outcomes and axial symptoms (AS) could be improved by kyphotic correction through the posterior approach for the treatment of multilevel cervical degenerative myelopathy (CDM) and to further analyze the changes of cervical spinal alignment parameters after correction of kyphosis. The hypothesis was that correction of kyphosis can improve the severity of AS and neurological recovery.

Materials and methods

We retrospectively reviewed 109 patients who suffered from multilevel CDM combined with kyphosis. The patients had undergone open-door laminoplasty (Group LP, 53 patients) and laminectomy with instrumentation (Group LI, 56 patients) between January 2014 and December 2018. Cervical spinal alignment parameters, including curvature index (CI), T1 slope, C2–7 Cobb angle, C2–7 SVA, were measured on the pre- and postoperative lateral radiographs. The recovery rate was calculated based on the Japanese Orthopedic Association (JOA) score. AS severity was quantified using Neck Disability Index (NDI). A P value less than 0.05 was considered to be significant.

Results

Analyses of postoperative follow-up data showed significant differences (P < 0.001) in CI, correction of CI, C2–7 Cobb angle, T1 slope, C2–7 SVA and NDI between Group LP and LI, but no significant differences in JOA score (P = 0.23) and recovery rate (P = 0.13). There were significant differences (P < 0.001) in CI, T1 slope, C2–7 Cobb angle, C2–7 SVA, JOA score, and NDI between pre- and postoperative follow-up in both groups. Correction of CI showed negative correlation with AS severity (r = -0.51, P < 0.001), and no association with recovery rate (r = 0.14, P = 0.15).

Conclusions

Satisfied neurological improvement was achieved by LP and LI for multilevel CDM combined with kyphosis. Cervical kyphotic correction produced significant improvement of AS and increase of T1 slope and C2–7 SVA. However, the kyphotic correction may not be associated with better neurological recovery in the short-term postoperative period.

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Abbreviations

CDM:

Cervical degenerative myelopathy

LP:

Open-door laminoplasty

LI:

Laminectomy and instrumentation

EL:

Expansive laminoplasty

LF:

Laminectomy and fusion

C2–7 SVA:

C2–7 sagittal vertical axis

CI:

Curvature index

JOA:

Japanese Orthopedic Association

AS:

Axial symptoms

NDI:

Neck Disability Index

OPLL:

Ossification of the posterior longitudinal ligament

MRI:

Magnetic resonance imaging

LOCL:

Loss of cervical lordosis

CGH-C7 SVA:

Center of gravity of the head–C7 SVA

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Acknowledgements

This study was funded by the Natural Science Foundation of Hebei Province (no. H2017206371) and Health Commission of Hebei Province (no. 20180407). No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Funding

This study was funded by the Natural Science Foundation of Hebei Province (no. H2017206371) and Health Commission of Hebei Province (no. 20180407).

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Authors and Affiliations

  1. Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China

    Wei Du, Shuai Wang, Haixu Wang, Jingtao Zhang, Feng Wang & Yong Shen

  2. Department of Hand Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China

    Xu Zhang

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  1. Wei Du
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Correspondence to Yong Shen.

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This study was approved by the Investigational Review Board at our institution.

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Informed consent was obtained from all patients included in the study.

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Du, W., Wang, S., Wang, H. et al. Cervical alignment and clinical outcome of open-door laminoplasty vs. laminectomy and instrumentation in kyphotic multilevel cervical degenerative myelopathy. Arch Orthop Trauma Surg 143, 1429–1440 (2023). https://doi.org/10.1007/s00402-021-04316-x

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