Differences in Risk Factors for Decreased Cervical Lordosis after Multiple-Segment Laminoplasty for Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament: A Pilot Study
Asian spine journal(2023)
Abstract
Study Design: Retrospective study. Purpose: To compare the radiographic risk factors for decreased cervical lordosis (CL) after laminoplasty, focusing on the difference between cervical spondylotic myelopathy (CSM) and cervical ossification of the posterior longitudinal ligament (C-OPLL). Overview of Literature: A few reports compared the risk factors for decreased CL between CSM and C-OPLL although these two pathologies have their characteristics. Methods: This study included 50 patients with CSM and 39 with C-OPLL who underwent multi-segment laminoplasty. Decreased CL was defined as the difference between preoperative and 2-year postoperative neutral C2-7 Cobb angles. Radiographic parameters included preoperative neutral C2-7 Cobb angles, C2-7 sagittal vertical axis (SVA), T1 slope (T1S), dynamic extension reserve (DER), and range of motion. The radiographic risk factors were investigated for decreased CL in CSM and C-OPLL. Additionally, the Japanese Orthopedic Association (JOA) score was assessed preoperatively and 2 years postoperatively. Results: C2-7 SVA (p=0.018) and DER (p=0.002) were significantly correlated with decreased CL in CSM, while C2-7 Cobb angle (p=0.012) and C2-7 SVA (p=0.028) were correlated with decreased CL in C-OPLL. Multiple linear regression analysis revealed that greater C2-7 SVA (B=0.22, p=0.026) and small DER (B=-0.53, p=0.002) were significantly associated with decreased CL in CSM. By contrast, greater C2-7 SVA (B=0.36, p=0.031) was significantly associated with decreased CL in C-OPLL. The JOA score significantly improved in both CSM and C-OPLL (p<0.001). Conclusions: C2-7 SVA was associated with a postoperative decreased CL in both CSM and C-OPLL, but DER was only associated with decreased CL in CSM. Risk factors for decreased CL slightly differed depending on the etiology of the condition.
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Key words
Laminoplasty,Cervical spondylosis,Ossification of posterior longitudinal ligament,Decrease cervical lordosis,Risk factors
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