UCSF

Background

Assess correlation between preoperative cervical sagittal alignment (T1 slope [T1S] and C2-C7 cervical sagittal vertical axis [cSVA]) and postoperative cervical sagittal balance after posterior cervical laminoplasty.

Methods

Consecutive patients who underwent laminoplasty at a single institution with >6 weeks postoperative follow-up were divided into 4 groups based on preoperative cSVA and T1S (Group 1: cSVA <4 cm/T1S <20°; Group 2: cSVA ≥4 cm/T1S ≥20°; Group 3: cSVA <4 cm/T1S ≥20°; Group 4: cSVA <4 cm/T1S <20°). Radiographic analyses were conducted at 3 timepoints, and changes in cSVA, C2-C7 cervical lordosis (CL), and T1S -CL were compared.

Results

A total of 214 patients met inclusion criteria (28 patients had cSVA <4 cm/T1S <20° [Group 1]; 47 patients had cSVA ≥4 cm/T1S ≥20° [Group 2]; 139 patients had cSVA <4 cm/T1S ≥20° [Group 3]). No patients had cSVA ≥4 cm/T1S <20° (Group 4). Patients either had a C4-C6 (60.7%) or C3-C6 (39.3%) laminoplasty. Mean follow-up was 1.6 ± 1.32 years. For all patients, mean cSVA increased 6 mm postoperatively. cSVA significantly increased postoperatively for both groups with a preoperative cSVA <4 cm (ie, Groups 1 and 3 [P < 0.01]). For all patients, mean CL decreased 2° postoperatively. Groups 1 and 2 had significant differences in preoperative CL but nonsignificant differences at 6 weeks (P = 0.41) and last follow-up (P = 0.06).

Conclusion

Cervical laminoplasty resulted in a mean decrease in CL. Patients with high preoperative T1S, irrespective of cSVA, were at risk of loss of CL postoperatively. While patients with low preoperative T1S and cSVA <4 cm experienced a decrease in global sagittal cervical alignment, CL was not jeopardized.

Clinical relevance

The results of this study may facilitate preoperative planning for patients undergoing posterior cervical laminoplasty.

Level of evidence: 3