Relationship of Change in Cervical Curvature after Laminectomy with Lateral Mass Screw Fixation to Spinal Cord Shift and Clinical Efficacy

Abstract

Background and Study Aims Although laminectomy with lateral mass screw fixation (LCSF) is an effective surgical treatment for cervical spondylotic myelopathy (CSM), loss of cervical curvature may result. This study aimed to investigate the effect of cervical curvature on spinal cord drift distance and clinical efficacy.

Patients and Methods We retrospectively analyzed 78 consecutive CSM patients with normal cervical curvature who underwent LCSF. Cervical curvature was measured according to Borden's method 6 months after surgery. Study patients were divided into two groups: group A, reduced cervical curvature (cervical lordosis depth 0–7mm; n = 42); and group B, normal cervical curvature (cervical lordosis depth 7–17mm; n = 36). Spinal cord drift distance, laminectomy width, neurologic functional recovery, axial symptom (AS) severity, and incidence of C5 palsy were measured and compared.

Results Cervical lordosis depth was 5.1 ± 1.2 mm in group A and 12.3 ± 2.4 mm in group B (p < 0.05). Laminectomy width was 21.5 ± 2.6 mm in group A and 21.9 ± 2.8 mm in group B (p > 0.05). Spinal cord drift distance was significantly shorter in group A (1.9 ± 0.4 vs. 2.6 ± 0.7 mm; p < 0.05). The Japanese Orthopaedic Association (JOA) score significantly increased after surgery in both groups (p < 0.05). Neurologic recovery rate did not differ between the two groups (61.5 vs. 62.7%; p > 0.05). AS severity was significantly higher in group A (p < 0.05). C5 palsy occurred in three group A patients (7.1%) and four group B patients (11.1%), but the difference was not significant (p > 0.05).

Conclusion After LCSF, 53.8% of the patients developed loss of cervical curvature. A smaller cervical curvature resulted in a shorter spinal cord drift distance. Loss of cervical curvature was related to AS severity but not improvement of neurologic function or incidence of C5 palsy.

Keywords

laminectomy - cervical spondylotic myelopathy - cervical curvature - axial symptoms - C5 palsy

Publikationsverlauf

Eingereicht: 11. April 2020

Angenommen: 28. Oktober 2020

Artikel online veröffentlicht:
11. Oktober 2021

• References

• 1 Iyer A, Azad TD, Tharin S. Cervical spondylotic myelopathy. Clin Spine Surg 2016; 29 (10) 408-414
• 2 Lawrence BD, Shamji MF, Traynelis VC. et al. Surgical management of degenerative cervical myelopathy: a consensus statement. Spine 2013; 38 (22, Suppl 1): S171-S172
• 3 Huang RC, Girardi FP, Poynton AR, Cammisa Jr FP. Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decompression and fusion with lateral mass plate fixation and local bone graft. J Spinal Disord Tech 2003; 16 (02) 123-129
• 4 Du W, Wang L, Shen Y, Zhang Y, Ding W, Ren L. Long-term impacts of different posterior operations on curvature, neurological recovery and axial symptoms for multilevel cervical degenerative myelopathy. Eur Spine J 2013; 22 (07) 1594-1602
• 5 Zhao YJ, Cheng C, Chen HW, Li M, Wang L, Guo ZY. Limited laminectomy and foraminal decompression combined with internal fixation for treating multi-segment cervical spondylotic myelopathy: does it effectively improve neurological function and prevent C5 palsy?. Medicine (Baltimore) 2018; 97 (47) e13327
• 6 Lau D, Winkler EA, Than KD, Chou D, Mummaneni PV. Laminoplasty versus laminectomy with posterior spinal fusion for multilevel cervical spondylotic myelopathy: influence of cervical alignment on outcomes. J Neurosurg Spine 2017; 27 (05) 508-517
• 7 Jain A, Rustagi T, Prasad G, Deore T, Bhojraj SY. Does segmental kyphosis affect surgical outcome after a posterior decompressive laminectomy in multisegmental cervical spondylotic myelopathy?. Asian Spine J 2017; 11 (01) 24-30
• 8 Borden AG, Rechtman AM, Gershon-Cohen J. The normal cervical lordosis. Radiology 1960; 74: 806-809
• 9 Pal D, Bayley E, Magaji SA, Boszczyk BM. Freehand determination of the trajectory angle for cervical lateral mass screws: how accurate is it?. Eur Spine J 2011; 20 (06) 972-976
• 10 Stephens BF, Rhee JM, Neustein TM, Arceo R. Laminoplasty does not lead to worsening axial neck pain in the properly selected patient with cervical myelopathy: a comparison with laminectomy and fusion. Spine 2017; 42 (24) 1844-1850
• 11 Hosono N, Sakaura H, Mukai Y, Fujii R, Yoshikawa H. C3-6 laminoplasty takes over C3-7 laminoplasty with significantly lower incidence of axial neck pain. Eur Spine J 2006; 15 (09) 1375-1379
• 12 Kaptain GJ, Simmons NE, Replogle RE, Pobereskin L. Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg 2000; 93 (2, Suppl): 199-204
• 13 Liu Y, Liu L, Zhang Z. et al. Preoperative factors affecting postoperative axial symptoms after single-door cervical laminoplasty for cervical spondylotic myelopathy: a prospective comparative study. Med Sci Monit 2016; 22: 3746-3754
• 14 Du W, Zhang P, Shen Y, Zhang YZ, Ding WY, Ren LX. Enlarged laminectomy and lateral mass screw fixation for multilevel cervical degenerative myelopathy associated with kyphosis. Spine J 2014; 14 (01) 57-64
• 15 Lin S, Zhou F, Sun Y, Chen Z, Zhang F, Pan S. The severity of operative invasion to the posterior muscular-ligament complex influences cervical sagittal balance after open-door laminoplasty. Eur Spine J 2015; 24 (01) 127-135
• 16 Liu J, Ebraheim NA, Sanford Jr CG. et al. Preservation of the spinous process-ligament-muscle complex to prevent kyphotic deformity following laminoplasty. Spine J 2007; 7 (02) 159-164
• 17 Wei LF, Wang SS, Zheng ZC, Tian J, Xue L. Analysis of the diffusion tensor imaging parameters of a normal cervical spinal cord in a healthy population. J Spinal Cord Med 2017; 40 (03) 338-345
• 18 Baba H, Uchida K, Maezawa Y, Furusawa N, Azuchi M, Imura S. Lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy: a magnetic resonance imaging study. J Neurol 1996; 243 (09) 626-632
• 19 Klement MR, Kleeman LT, Blizzard DJ, Gallizzi MA, Eure M, Brown CR. C5 palsy after cervical laminectomy and fusion: does width of laminectomy matter?. Spine J 2016; 16 (04) 462-467
• 20 Khuyagbaatar B, Kim K, Park WM, Kim YH. Biomechanical investigation of post-operative C5 palsy due to ossification of the posterior longitudinal ligament in different types of cervical spinal alignment. J Biomech 2017; 57: 54-61
• 21 Blizzard DJ, Gallizzi MA, Sheets C. et al. The role of iatrogenic foraminal stenosis from lordotic correction in the development of C5 palsy after posterior laminectomy and fusion. J Orthop Surg Res 2015; 10: 160