Abstract:Objective To explore the changes of cervical sagittal balance after posterior cervical expansive open-door laminoplasty procedure.Methods The radiological and clinical data were analyzed retrospectively for 108 patients undergoing posterior cervical expansive open-door laminoplasty (C3~C7) in Department of Orthopaedic Surgery,ShanXi Bethune Hospital,from January 2014 to December 2017.The C0~2 Cobb angle,C2~7 SVA,C2~7 Cobb angle,and T1-Slope were recorded before operation and at the 24thmonth follow-up.The preoperative and the 24thmonth follow-up Japanese Orthopaedic Association (JOA) score,neck disabilityindex (NDI),the MOS item short from health survey(SF-36),visual analog scale (VAS) were recorded respectively,the severity of axial symptoms was also recorded at the 24th month follow-up.Results The JOA score and SF-36 score increased to (14.08±2.17),(51.25±5.82) from pre-operative (11.16±2.28),(42.76±5.63).The NDI score and VAS score decreased from pre-operative (15.61±5.43),(4.64±1.87) to (11.36±7.93),(3.31±1.62) at the 24th month follow-up,respectively,the value changes were all statistically significant (P=0.001,P=0.001,P=0.001,P=0.022).The C0~2 Cobb angle,C2~7 SVA increase to(15.36±4.51)°,(25.49±11.52)mm formpre-operative (11.37±5.54)°,(21.09±5.86)mm,C2~7 Cobb angle decrease to(10.65±8.72)°frompre-operative (13.93±8.68)°,the value changes were all respectively statisticallysignificant (P=0.001,P=0.001,P=0.016).T1-slope changed from (26.84±5.10)° before operation to (26.31±4.8) °,the difference was not statistically significant (P=0.186).The change in C0~2 Cobb angle was positively related to the change in C2~7 SVA(Pearson=0.420,P=0.015).At the 24th month follow-up,the average VAS score of high T1 group was (3.13±1.60) and low T1 group was (2.45±1.31),the differences were statisticallysignificant between the 2 groups (P=0.015).The incidence of severe axial symptoms was 64.8% in the high T1-Slope group and 33.3% in the low T1-Slope group.Conclusion There was significant impact of posterior cervical expansive open-door laminoplasty procedure on cervical sagittal balance.The cervical vertebrae show a tendency of tilting forward,suggesting that overextension of the upper cervical vertebra might be used to maintain the center of gravity of the skull and horizontal vision.And more severe axial symptoms often occurs in patients with high T1-Slope.
[1]Nagoshi N,Tsuji O,Okada E,et al.Clinical indicators of surgical outcomes after cervical single open-door laminoplasty assessed by the Japanese Orthopaedic association cervical myelopathy evaluation questionnaire[J].Spinal Cord,2019,57(8):644-651.
[2]Lin X,Chen K,Tang H,et al.Comparison of anchor screw fixation versus mini-plate fixation in unilateral expansive open-door laminoplasty for the treatment of multi-level cervical spondylotic myelopathy[J].Medicine(Baltimore),2018,97(49):E1-E11.
[3]Machino M,Yukawa Y,Imagama S,et al.Age-related and degenerative changes in the osseous anatomy,alignment,and range of motion of the cervical spine:a comparative study of radiographic data from 1016 patients with cervical spondylotic myelopathy and 1230 asymptomatic subjects[J].Spine(Phila Pa 1976),2016,41(6):476-482.
[4]Hyun SJ,Kim KJ,Jahng TA,et al.Relationship between T1 slope and cervical alignment following multilevel posterior cervical fusion surgery:impact of T1-Slope minus cervical lordosis[J].Spine(Phila Pa 1976),2016,41(7):E396-E402.
[5]Ames CP,Blondel B,Scheer JK,et al.Cervical radiographical alignment:comprehensive assessment techniques and potential importance in cervical myelopathy[J].Spine(Phila Pa 1976),2013,15(38):149-160.
[6]Fujimori T,Iwasaki M,Okuda S,et al.Long-term results of cervical myelopathy due to ossification of the posterior longitudinal ligament with an occupying ratio of 60% or more[J].Spine,2014,39(10):58-67.
[7]Tang JA,Scheer JK,Smith JS,et al.The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery[J].Neurosurgery,2012,71(76):662-669.
[8]Smith JS,Virginie Lafage,Devon JR,et al.Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume:analysis of 56 preoperative cases from the AOS pine North America myelopathy study[J].Spine,2013,38(22):161-170.
[9]Sodeyama T,Goto S,Mochizuki M,et al.Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord.[J].Spine(Phila Pa 1976),1999,24(15):27-31.
[10]Knott PT,Mardjetko SM,Techy F,et al.The use of the T1 sagittal angle in predicting overall sagittal balance of the spine[J].Spine J,2010,10(11):994-998.
[11]Cho JH,Ha JK,Kim DG,et al.Does preoperative T1 slope affect radiological and functional outcomes after cervical laminoplasty?[J].Spine(Phila Pa 1976),2014,39(26):1575-1581.
[12]Rao H,Huang Y,Lan Z,et al.Does preoperative T1 slope and cervical lordosis mismatching affect surgical outcomes after laminoplasty in patients with cervical spondylotic myelopathy?[J].World Neurosurg,2019,10(130):E687-E693.
[13]KimuraA,EndoT,InoueH,et al.Impact of axial neck pain on quality of life after laminoplasty[J].Spine,2015,40(24):1292-1298.
[14]Healy AT,Lubelski D,WestJL,et al.Biomechanics of open-door laminoplasty with and without preservation of posterior structures[J].J Neurosurg Spine,2016,24(5):746-751.
[15]Miao W,Xiao JL,Qian XD,et al.Prevalence of axial syptoms after posterior cervical decompression:a meta-analysis.[J].Eur Spine J,2016,25(7):2302-2310.
[16]Takeshi M,Takeshi A,Taiehi S,et a1.Cervical alignment,range of motion,and instability after cervical laminoplasty[J].Clin Orthop Relat Res,2002,401(3):132-138.
[17]Peolsson A,Peterson G,Hermansen A,et al.Physiotherapy after anterior cervical spine surgery for cervical disc disease:study protocol of a prospective randomised study to compare internet-based neck-specific exercise with prescribed physical activity[J].BMJ Open,2019,9(2):E1-E8.
[18]Coronado RA,Devin CJ,Pennings JS,et al.Early self-directed home exercise program after anterior cervical discectomy and fusion:A pilotstudy[J].Spine(Phila Pa 1976),2020,45(4):E1-27.