Muscle-preserving selective laminectomy maintained the compensatory mechanism of cervical lordosis after surgery

Satoshi Nori, Tateru Shiraishi, Ryoma Aoyama, Ken Ninomiya, Junichi Yamane, Kazuya Kitamura, Seiji Ueda

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Study Design. A retrospective single-center study. Objective. The aim of this study was to evaluate the compensatory mechanism of cervical lordosis (CL), the changes in cervical sagittal alignment, and range of motion (ROM) after muscle-preserving selective laminectomy (SL). Summary of Background Data. CL increases as a compensatory mechanism for the adjustment of cervical sagittal balance or horizontal gaze. However, laminoplasty invades this mechanism and causes kyphosis in higher T1 (C7) slope patients. Methods. SL is a posterior surgery selecting the decompression laminae without disturbing the extensor musculature and facet joints. The clinical features and radiological findings of 125 cervical compressive myelopathy patients who underwent C6 single-level SL, C5-C6 two consecutive levels SL, C4-C6 three consecutive levels SL, and C3-C6 four consecutive levels SL were enrolled. Cervical spine lateral radiography was performed before surgery and at the final follow-up. The patients were divided into two groups according to the preoperative C7 slope. Postoperative cervical alignment change was compared between the higher and lower C7 slope groups. Subsequently, pre- and postoperative cervical alignment and cervical ROM were analyzed according to the number of consecutive laminae surgically treated. Results. Patients with higher C7 slope had greater lordotic cervical alignment and larger C2-C7 sagittal vertical axis (SVA) pre- and postoperatively. No kyphotic alignment change was observed, even in the higher C7 slope group. C6 SL and C5-C6 SL did not affect C2-C7 angle, and did not increase C2-C7 SVA after surgery. Although C4-C6 SL and C3-C6 SL demonstrated postoperative slight increase in C2-C7 SVA, C2-C7 angle never decreased after surgery. Cervical ROM slightly reduced in the C4-C6 SL and C3-C6 SL groups; however, no reduction of ROM was observed in the C6 SL and C5-C6 SL groups. Conclusion. SL preserved the inherent compensatory CL that had been observed preoperatively and maintained cervical sagittal balance after surgery.

Original languageEnglish
Pages (from-to)542-549
Number of pages8
JournalSpine
Volume43
Issue number8
DOIs
Publication statusPublished - 2018 Apr 15
Externally publishedYes

Keywords

  • C7 slope
  • Cervical alignment
  • Cervical compressive myelopathy
  • Cervical lordosis
  • Cervical sagittal balance
  • Cervical spondylotic myelopathy
  • Compensatory mechanism
  • Laminectomy
  • Laminoplasty
  • Minimally invasive surgery
  • Muscle preservation
  • Ossification of posterior longitudinal ligament
  • Sagittal vertical axis
  • Selective laminectomy

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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