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Does Preoperative T1 Slope and Cervical Lordosis Mismatching Affect Surgical Outcomes After Laminoplasty in Patients with Cervical Spondylotic Myelopathy?

Research paper by Hongming H Rao, Yuming Y Huang, Zhibin Z Lan, Zhengquan Z Xu, Guishuang G Li, Weihong W Xu

Indexed on: 16 May '20Published on: 08 Jul '19Published in: World Neurosurgery



Abstract

To assess whether preoperative T1 slope and cervical lordosis mismatching affect the surgical outcomes of patients with cervical spondylotic myelopathy (CSM) after laminoplasty. In total, 85 patients with CSM who underwent unilateral open-door laminoplasty from January 2013 to May 2017 were retrospectively reviewed. According to the preoperative T1 slope and C2-C7 lordosis matching or not, the patients were divided into two groups (the Match Group and the Mismatch Group). The T1 slope minus C2-C7 lordosis (T1S-CL) less than 20° was defined as matching. Radiographic parameters included T1 slope, C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), and T1S-CL. Clinical outcomes were based on the Neck Disability Index (NDI) and Japanese Orthopaedic Association (JOA) scores. The preoperative T1S-CL had significant correlation with T1 slope (r = 0.283), C2-C7 lordosis (r = -0.611), and C2-C7 SVA (r = 0.331). At the final follow-up, patients in the Mismatch Group had higher incidence of postoperative cervical kyphosis (P = 0.007) and C2-C7 SVA greater than 40 mm (P = 0.043). The Mismatch Group patients also had greater △C2-C7 lordosis (P = 0.028), △C2-C7 SVA (P = 0.042) and △T1S-CL (P = 0.044). Comparison of clinical outcomes revealed that patients in the Match Group had better NDI and JOA recovery (P < 0.05). T1S-CL is a clinically relevant parameter for surgical decision-making because patients with T1S-CL mismatching are more likely to have postoperative kyphotic alignment changes and cervical sagittal imbalance. Laminoplasty might not be a suitable option for patients with T1S-CL mismatching. Copyright © 2019 Elsevier Inc. All rights reserved.