Introduction: Laminoplasty is an acceptable surgical option for cervical degenerative disease. However, it often reported postoperative problem, such as kyphosis, restriction of neck motion, instability. The aim of our study was to evaluate changes in sagittal alignment and range of motion (ROM), instability after cervical laminoplasty for cervical spondylotic myelopathy(CSM) or ossification of posterior longitudinal ligament(OPLL).
Methods: We retrospectively reviewed the medical records of 44 patients (25 men and 19 female; mean age, 61.4yr) who underwent one door laminoplasty for CSM or OPLL from January 2009 to December 2014. The mean follow up period was 10.5 months. Cervical alignment in the neutral and flexion-extension view were measured by the Cobb method at C2-C7. The ROM was obtained by measuring the difference in alignment between maximum flexion and extension. On lateral radiographs, more than 3.5mm horizontal displacement or more than 11° rotational difference in relation to an adjacent vertebra was regarded to segmental instability.
Results: The mean sagittal alignment was 10.28 lordotic preoperatively and 7.58 lordotic postoperatively. Preoperatively, six patients has segmental instability. Among six patients, four patients has revealed unchanged instability at postoperative examination. The remaining 2 patients had resolved on neutral lateral radiographs. However, de novo segmental instability was detected at 2 cases in the postoperative examination. Due to the low dynamic radiograph follow-up rate, only 13 cases could estimate ROM differentiation. The mean total ROM was reduced from a preoperative value of 34.94° (flexion 11.30°; extension 23.63°) to 24.4° (flexion 7.99°; extension 16.41°) at final follow-up. Total ROM preservation rate was 70%.
Conclusions: Compared with preoperative data, sagittal alignment become slightly kyphosis. And the loss of ROM of cervical spine was identified. However, considering postoperative neurologic and clinical improvement, this changes would be acceptable.
Patient Care: We confirmed that a laminoplasty is a effective and less complicated operation technique.
Learning Objectives: By the conclusion of the this session, participants should able to identify the long term result of cervical laminoplasty operation.