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The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine after the Laminoplasty

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 lor...

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Autores principales: Lee, Jun Seok, Son, Dong Wuk, Lee, Su Hun, Kim, Dong Ha, Lee, Sang Weon, Song, Geun Sung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Neurosurgical Society 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594621/
https://www.ncbi.nlm.nih.gov/pubmed/28881121
http://dx.doi.org/10.3340/jkns.2017.0505.007
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author Lee, Jun Seok
Son, Dong Wuk
Lee, Su Hun
Kim, Dong Ha
Lee, Sang Weon
Song, Geun Sung
author_facet Lee, Jun Seok
Son, Dong Wuk
Lee, Su Hun
Kim, Dong Ha
Lee, Sang Weon
Song, Geun Sung
author_sort Lee, Jun Seok
collection PubMed
description 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.
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spelling pubmed-55946212017-09-13 The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine after the Laminoplasty Lee, Jun Seok Son, Dong Wuk Lee, Su Hun Kim, Dong Ha Lee, Sang Weon Song, Geun Sung J Korean Neurosurg Soc Clinical Article 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. Korean Neurosurgical Society 2017-09 2017-09-30 /pmc/articles/PMC5594621/ /pubmed/28881121 http://dx.doi.org/10.3340/jkns.2017.0505.007 Text en Copyright © 2017 The Korean Neurosurgical Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Article
Lee, Jun Seok
Son, Dong Wuk
Lee, Su Hun
Kim, Dong Ha
Lee, Sang Weon
Song, Geun Sung
The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine after the Laminoplasty
title The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine after the Laminoplasty
title_full The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine after the Laminoplasty
title_fullStr The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine after the Laminoplasty
title_full_unstemmed The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine after the Laminoplasty
title_short The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine after the Laminoplasty
title_sort predictable factors of the postoperative kyphotic change of sagittal alignment of the cervical spine after the laminoplasty
topic Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594621/
https://www.ncbi.nlm.nih.gov/pubmed/28881121
http://dx.doi.org/10.3340/jkns.2017.0505.007
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