Effect of preoperative dynamic cervical sagittal alignment on the loss of cervical lordosis after laminoplasty
Abstract Purpose Cervical laminoplasty (CLP) is a developed surgical procedure for the treatment of cervical spondylotic myelopathy (CSM), but only a few of those studies focus on preoperative dynamic cervical sagittal alignment and the study of different degrees of loss of cervical lordosis (LCL) i...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-023-06335-8 |
| _version_ | 1797854063038038016 |
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| author | Chengxin Liu Bin Shi Wei Wang Xiangyu Li Shibao Lu |
| author_facet | Chengxin Liu Bin Shi Wei Wang Xiangyu Li Shibao Lu |
| author_sort | Chengxin Liu |
| collection | DOAJ |
| description | Abstract Purpose Cervical laminoplasty (CLP) is a developed surgical procedure for the treatment of cervical spondylotic myelopathy (CSM), but only a few of those studies focus on preoperative dynamic cervical sagittal alignment and the study of different degrees of loss of cervical lordosis (LCL) is lacking. This study aimed to analyze patients who underwent CLP to investigate the effect of cervical extension and flexion function on different degrees of LCL. Methods In this retrospective case–control study, we analyzed 79 patients who underwent CLP for CSM between January 2019 and December 2020. We measured the cervical sagittal alignment parameters on lateral radiographs (neutral, flexion, and extension positions) and used Japanese Orthopedic Association (JOA) score to assess clinical outcomes. We defined the extension ratio (EXR) as 100 × Ext ROM (cervical range of extension)/ROM (cervical range of motion). We observed the relationships between collected variables (demographic and radiological variables) and LCL. Patients were classified into the following three groups according to the LCL: stability group: (LCL ≤ 5°); mild loss group (5° < LCL ≤ 10°); and severe loss group (LCL > 10°). We compared the differences of collected variables (demographic, surgical and radiological variables) among the three groups. Results Seventy-nine patients were enrolled (mean age 62.92 years; 51 men, 28 women) in the study. Among the three groups, cervical Ext ROM was the best in the stability group (p < 0.01). Compared with the stability group, range of flexion (Flex ROM) was significantly higher (p < 0.05) and EXR was significantly lower (p < 0.01) in the severe loss group. Compared with the severe loss group, JOA recovery rates were better (p < 0.01) in the stability group. Receiver-operating characteristic curve (ROC) analysis to predict LCL > 10° (area under the curve = 0.808, p < 0.001). The cutoff value for EXR was 16.80%, with sensitivity and specificity of 72.5% and 82.4%, respectively. Conclusion CLP should be carefully considered for patients with a preoperative low Ext ROM and high Flex ROM, as a significant kyphotic change is likely to develop after surgery. EXR is a useful and simple index to predict significant kyphotic changes. |
| first_indexed | 2024-04-09T20:00:59Z |
| format | Article |
| id | doaj.art-85e235273f1d4370b7529fe5b3341e67 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-04-09T20:00:59Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-85e235273f1d4370b7529fe5b3341e672023-04-03T05:13:20ZengBMCBMC Musculoskeletal Disorders1471-24742023-03-012411810.1186/s12891-023-06335-8Effect of preoperative dynamic cervical sagittal alignment on the loss of cervical lordosis after laminoplastyChengxin Liu0Bin Shi1Wei Wang2Xiangyu Li3Shibao Lu4Department of Orthopedics, Xuanwu Hospital, Capital Medical UniversityDepartment of Orthopedics, Xuanwu Hospital, Capital Medical UniversityDepartment of Orthopedics, Xuanwu Hospital, Capital Medical UniversityDepartment of Orthopedics, Xuanwu Hospital, Capital Medical UniversityDepartment of Orthopedics, Xuanwu Hospital, Capital Medical UniversityAbstract Purpose Cervical laminoplasty (CLP) is a developed surgical procedure for the treatment of cervical spondylotic myelopathy (CSM), but only a few of those studies focus on preoperative dynamic cervical sagittal alignment and the study of different degrees of loss of cervical lordosis (LCL) is lacking. This study aimed to analyze patients who underwent CLP to investigate the effect of cervical extension and flexion function on different degrees of LCL. Methods In this retrospective case–control study, we analyzed 79 patients who underwent CLP for CSM between January 2019 and December 2020. We measured the cervical sagittal alignment parameters on lateral radiographs (neutral, flexion, and extension positions) and used Japanese Orthopedic Association (JOA) score to assess clinical outcomes. We defined the extension ratio (EXR) as 100 × Ext ROM (cervical range of extension)/ROM (cervical range of motion). We observed the relationships between collected variables (demographic and radiological variables) and LCL. Patients were classified into the following three groups according to the LCL: stability group: (LCL ≤ 5°); mild loss group (5° < LCL ≤ 10°); and severe loss group (LCL > 10°). We compared the differences of collected variables (demographic, surgical and radiological variables) among the three groups. Results Seventy-nine patients were enrolled (mean age 62.92 years; 51 men, 28 women) in the study. Among the three groups, cervical Ext ROM was the best in the stability group (p < 0.01). Compared with the stability group, range of flexion (Flex ROM) was significantly higher (p < 0.05) and EXR was significantly lower (p < 0.01) in the severe loss group. Compared with the severe loss group, JOA recovery rates were better (p < 0.01) in the stability group. Receiver-operating characteristic curve (ROC) analysis to predict LCL > 10° (area under the curve = 0.808, p < 0.001). The cutoff value for EXR was 16.80%, with sensitivity and specificity of 72.5% and 82.4%, respectively. Conclusion CLP should be carefully considered for patients with a preoperative low Ext ROM and high Flex ROM, as a significant kyphotic change is likely to develop after surgery. EXR is a useful and simple index to predict significant kyphotic changes.https://doi.org/10.1186/s12891-023-06335-8Cervical sagittal alignmentLaminoplastyLoss of cervical lordosisFlexion and extension function |
| spellingShingle | Chengxin Liu Bin Shi Wei Wang Xiangyu Li Shibao Lu Effect of preoperative dynamic cervical sagittal alignment on the loss of cervical lordosis after laminoplasty BMC Musculoskeletal Disorders Cervical sagittal alignment Laminoplasty Loss of cervical lordosis Flexion and extension function |
| title | Effect of preoperative dynamic cervical sagittal alignment on the loss of cervical lordosis after laminoplasty |
| title_full | Effect of preoperative dynamic cervical sagittal alignment on the loss of cervical lordosis after laminoplasty |
| title_fullStr | Effect of preoperative dynamic cervical sagittal alignment on the loss of cervical lordosis after laminoplasty |
| title_full_unstemmed | Effect of preoperative dynamic cervical sagittal alignment on the loss of cervical lordosis after laminoplasty |
| title_short | Effect of preoperative dynamic cervical sagittal alignment on the loss of cervical lordosis after laminoplasty |
| title_sort | effect of preoperative dynamic cervical sagittal alignment on the loss of cervical lordosis after laminoplasty |
| topic | Cervical sagittal alignment Laminoplasty Loss of cervical lordosis Flexion and extension function |
| url | https://doi.org/10.1186/s12891-023-06335-8 |
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